Critical care environments

Critical care environment

Unit that is designed, equipped, and staffed to meet the anticipated needs of patient in life-threatening situations

• Supplies and equipment are highly sophisticated and must be readily accessible

1. Ever-changing database

2. The COMPLETE history and physical examination

• Assessment

• Planning

• Implementation

• Evaluation

3. High vigilance pharmacology

4. High tech interventions

5. Stressors for patients and families

How does managing a critically ill patient differ from other patients?

• A larger number of complex and interrelated problems

• Frequent priority reorganization

• Time limitations imposed by patient’s rapidly changing condition

What does it mean when critical care has an ever changing database?

• Cardiac monitoring

• Hemodynamic monitoring

What are the technology adjuncts to critical care assessments?

• Arterial line; MAP

• CO/CI

• Preload; CVP

• Swan Ganz

  • PA pressure

  • PCWP

What technology is used with hemodynamic monitoring?

((SBP + DBP) x 2)/3

How do you calculate mean arterial pressure (MAP)?

65-110

What is the normal range for MAP?

Cardiac output

Preload

Volume

Afterload (SVR)

How much resistance the heart is beating against

Contractility

How strong each beat is

Control of peripheral circulation

Dilation/constriction

2-6 MMHG

What is the normal central venous pressure (CVP)?

• Estimate of LV end diastolic pressure

• Normal: 15-26 MMHG/ 5-15 MMGH

What is pulmonary artery pressure (PA pressure)?

• Estimate of LA pressure

• Normal: 6-12 MMHG

What is pulmonary capillary wedge pressure (PCWP)?

10-15 MMHG

What are the normal levels of ICP?

• Vasoactive drugs

• Paralytics

• Anesthetics

• Dual drug sedation

What meds are high vigilance in critical care environments?

• CRRT

• Ventilators

• Arctic sun

What are examples of high tech interventions in critical care environments?

• Sleep cycle interruption and deprivation

• Mentation-altering drugs

• Fear

• Sensory deprivation/overload

• Lack of information or understanding of:

  • Prognosis and care plan

  • Policies and procedures

• Anticipation of painful interventions

• Impaired communication related to intubation

• Observation of crisis interventions in other patients

• Conflict between patient or family goals and staff goals

What can cause stressors to patients and their families in a critical care setting?

• Unfamiliar environment, new faces

• Noise, light levels

• Interruption of sleep-wake cycles

• Inaccessibility of family, friends

• Lack of privacy

What are things that can cause sensory deprivation/overload?