Lesson 2

Critical Care
Nursing
Concepts
TEST YOUR NURSING KNOWLEDGE

Fill in the blanks:

1. The term ________________ is used to describe the electrical stimulation of
the heart.
2. The ability of the cardiac muscle to initiate an electrical impulse is called
___________________.
3. The ability of the cardiac muscle to transmit electrical impulses is called
___________________.
4. The term ____________________________ is used to describe an irregular
or erratic heart rhythm
5. A dysrhythmia common in normal hearts and described by patients as “my
heart skipped a beat” is ___________________________
6. Two factors that determine preload are _____________________ and
________________________.
7. Two factors that determine afterload are _______________________ and
________________________.
8. Gas exchange between the lungs and the blood and between the blood and
tissues is called _________________________________.
9. Hypoxemia usually leads to ________________________, a decrease in
oxygen supply to the tissues.
10. With the progression of shock, damage at the ___________________ and
__________________ level occurs when the blood pressure drops.
11. The earliest sign of increased ICP is _______________________.
12. An altered level of consciousness (LOC) is
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________________________________________________.

Critical Care Nursing is the delivery of specialized care to critically ill patients, ones
who have life-threatening illnesses or injuries. Such patients may be unstable, have
complex needs, and require intensive and vigilant nursing care (i.e., cardiovascular
disorders, traumatic injuries, gunshot wounds, cancers, shock, sepsis, respiratory
failure).

Critical Care Nurses are also known as ICU nurses. They treat patients who are
acutely ill and unstable requiring more frequent nursing assessments and the
utilization of life sustaining technology and drugs. They fill many roles in the critical
care setting, such as staff nurses, nurse-educators, nurse-managers, case-managers,
clinical care specialists, nurse practitioners, and nurse researchers.

Where: wherever critically ill patients are found, including adult, pediatric and
neonatal CCUs; coronary care and progressive coronary care units; emergency
departments, post-anesthesia care units.

What: responsibilities include, being an advocate, using sound clinical judgment,

demonstrating caring practices, collaborating with a multidisciplinary team,
demonstrating an understanding of cultural diversity, providing patient and family
teaching.
 Acute Critical Care Continuum - The patient’s continuum after ICU discharge
must also be taken into account during their ICU stay. Minimal sedation, good
communication, and early mobilization are three factors that can help patients survive
their ICU stay with minimal sequelae. Critical illness therefore needs to be seen as a
continuum, a continuous sequence of interlinked events from the very early moments
of illness, through the ICU stay, and into recovery and rehabilitation.

Cultural considerations – the best way to respond to concerned family

members is to acknowledge their feelings and ambivalences and to lend reality to
their statements. The critical nurse needs to reinforce and acknowledge the family’s
decision and accept their feelings and decisions. You must honor the patient’s cultural
beliefs and values.

Assessing cultural considerations:

 Cultural health beliefs – the patient’s illness is believed to be a punishment
of past transgression, or the result of divine wrath.
 Communication differences – how does the patient want to be addressed?
What are the styles of nonverbal communication? Does the patient need an
interpreter?
 Cultural restrictions – how does the patient’s cultural group express
emotion? How is modesty expressed? How are feelings about death, dying,
and grief expressed?
 Social networks – who makes the decision? What are the roles of each
family member during health and illness?
  Religion – are there healing rituals or practices that must be followed? Does
the patient believe that special rites or blessings need to be performed?

Holistic health care revolves around a notion of totality. The goal of holistic
care is to meet not just the patient’s physical needs but also his social and emotional
needs. Only by considering all dimensions of a person can the health care team
provide high-quality holistic care, even though his/her physical needs may seem to be
more pressing than his/her other needs.

Various problems or concerns would include:

 Patient and family issues (i.e.,monetary, worry about possible death)
 Cognitive issues (i.e, overwhelmed over technology, effect of disease to
cognition, adverse effect of medication to CNS, sensory perception)
 Pain control issues ( acute or chronic; include in your pain assessment:
location, intensity, quality, onset, duration & frequency, alleviating and
aggravating factors, associated factors, effects on lifestyle)
 Ethics issues (dilemma in the following circumstances: more than one
solution exists, each solution carries equal weight, each solution is equally
defensible. These dilemmas revolve around quality-of-life issues, especially
as they relate to end-of-life decisions.)

THINK!
CLINICAL APPLICATION

Mrs. Reyes is a 65-year old hospitalized client with a history of cerebral vascular
accident (CVA). Upon entering the room, the nurse on duty asks the client how she is
doing today. The client replies, but the wording is unrecognizable. What term is used
for this condition? How will you apply holistic care to meet her physical, social
and emotional needs?

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________

Mrs. Santos is readmitted to the clinical area after being in the intensive care unit
(ICU). She is recovering from a right pneumonectomy and has a central venous
pressure catheter inserted by the physician. What can the catheter readings help the
nurse to detect? What symptoms will the nurse recognize that would indicate for signs
of impending respiratory insufficiency from the patient? Identify the level, based
from the classification of critical care patients, when impending respiratory
insufficiency is present.

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________

Use additional sheet of paper when needed.