PROF. DR. M.J.
DINO
COURSE MAP
Critical Care Nursing is an elective course that allows nursing students to manage common healthcare problems involved
in critical care, trauma or emergency situations. The course focuses on the introduction to critical care nursing, foundation
2.0 of circulation, airway and breathing management, and management of client with critical conditions. The nursing students
are expected to develop an effective nursing care plan for critically-ill clients.
Unit Learning Outcome
Describe the assessment priorities in a critically-ill patient based on the client’s clinical status.
Critical Care Nursing (CCrN) is the delivery of specialised care
to critically ill clients (with life-threathening illness or injuries).
Such patients may be unstable, have complex needs, and
require intensive and vigilant nursing care. Critical care nurses
are responsible for making sure that critically ill patients and
members of their families receive close attention and the best
care possible.
CHARACTERISTICS OF A CRITICAL CARE NURSE
• Advocate - a person who works on another person’s behalf
(protect his/her rights, assist with family decisions, negotiate
with other members of the healthcare team, keeping patient
and family informed)
• Critical Thinker - a person with a complex mixture of
knowledge, intuition, logic, common sense, and experience.
• Team Player - collaborates with other members of the
healthcare team to optimise patient outcomes.
• Educator - facilitator of patient, family and staff education.
RESPONSIBILITIES OF A CRITICAL CARE NURSE
• Assessment - constant assessment of patient for subtle
changes ad monitoring of equipment
• Planning - nurses consider the patient’s psychological and
physiological needs and set realistic patient goals
• Implementation - carrying-out specific interventions to
address existing and potential patient problems
• Evaluation - nurse continually evaluate a patient’s response
to interventions to change the care plan as needed to make
sure that your patient continues to work toward achieving his
outcome goals
MULTIDISCIPLINARY TEAMS IN CRITICAL CARE
Nurses working with critically ill patients commonly collaborate
with a multidisciplinary team of health care professionals. The
team approach enables caregivers to better meet the diverse
needs of individual patients. Members commonly include: (a)
registered nurses, (b) doctors, (c) physician assistants, (d)
advanced practice nurses such as clinical nurse specialists and
nurse practitioners, (e) patient care technicians, (f) respiratory
therapists and others.
ACUTE AND CRITICAL CARE NURSIN
RAPID RESPONSE TEAMS (RRTs) - The use of RRTs was
identified as an evidence-based, lifesaving strategy that would
improve patient outcomes by preventing avoidable patient deaths
outside the critical care areas. Most RRTs consist of a structured
group and usually include a critical care nurse, a respiratory
therapist and, possibly, a doctor who collaborate with the
patient’s nurse and intervene appropriately. The RRT may be
called upon at any time (24/7) that a staff member becomes
concerned about a patient’s condition.
COMMUNICATION IN HEALTHCARE
Because communication failures in health care can lead to errors
and serious adverse events, health care professionals must pay
close attention to communicating effectively. Consistent use of a
structured communication tool, such as SBAR, improves the
effectiveness of communications, provides a safer environment
for patients, and pro- motes collegial relationships among health
care team members. SBAR is a communication tool for ensuring
that the right information gets to the right person in the most
clear, concise, and effective way.
S Situation What is going on at the present
time?
B Background What has happened in the past and
is relevant to this situation?
A Assessment What do you think is happening?
R Recommendation What do you think needs to be
done?
SBAR Example: Nurse Calling a Physician:
"Dr. Garci, this is Nurse Gloria, I am calling from Fatima University
Medical Center about your patient Renato. (S) Here’s the situation:
Renato is having increasing dyspnea and is complaining of chest pain.
(B) The supporting background information is that he had a total knee
replacement two days ago. About two hours ago he began complaining
of chest pain. His pulse is 120 and his blood pressure is 128 over 54.
He is restless and short of breath. (A) My assessment of the situation is
that he may be having a cardiac event or a pulmonary embolism. (R) I
recommend that you see him immediately and that we start his on O2
stat. Do you agree?”

 PROF. DR. M.J. DINO

CRITICAL ASSESSMENT PROCESS Past Medical Hx Medical conditions, Laboratory

procedures, Hospitalisations, Medications,
A. Pre-arrival Assessment - begins at the moment the Allergies, Review of Body Systems
information is received about the upcoming admission of the
patient. It provides baseline perspectives of the patient and Social Hx Age, Gender, Ethnic origin, Height,
helps nurses to predict the patient’s health needs and the Weight, Education, Occupation, Marital
possible resources and setup that will be needed. Status, Religion, Significant others,
Substance abuse, Domestic abuse

Patient Age, Gender, Chief Complaint, Diagnosis, Psychological Communication, Coping Styles, Anxiety,
Pertinent history, Physiologic status, Stress, Family needs
Invasive devices, Equipment, Laboratory/
Spirituality Faith/preference, Spiritual practices
diagnostic tests.
Environment Setup, Equipment Functioning: PA Nervous, Cardiovascular, Respiratory,
ECG and electrodes Renal, Gastrointestinal, Endocrine,
Sphygmomanometer Hematologic, Immune, Integumentary
Pulse oxymeter D. Ongoing Assessment - An abbreviated version of the
Suction machine ad catheters comprehensive admission assessment performed by the
Bag valve mask device
Oxygenation equipment
nurse at varying intervals.
IV poles and infusion pumps
Bedside supply cart AMERICAN HEART ASSOCIATION STANDARDS
Admission kit
Forms and care documentations The BLS Survey (Arrest)

The BLS Survey is a systematic approach to basic life support

B. Admission Quick Check - starts immediately upon arrival that any trained healthcare provider can perform. This approach
of the patient. It is a quick overview of ventilation stresses early CPR and early defibrillation. It does not include
(respiratory), circulation (cardiac), and chief complaint advanced interventions such as advanced airway technique or
(diagnostic tests and equipment). Common diagnostic tests drug administration. By using the BLS Survey, healthcare
include: (a) serum electrolytes, (b) glucose, (c) CBC with providers may achieve their goal of supporting or restoring
platelets, (d) coagulation studies, (e) arterial blood gases, (f) effective oxygenation, ventilation and circulation until the Return
chest x-ray, and (g) ECG. of Spontaneous Circulation (ROSC) or initiation of ACLS
interventions.
Airway Patency
Position of artificial airway
Check Verbalization: Tap and shout “Are you
Breathing Quantity and quality of respirations Responsiveness alright?”;
Breath sounds Check for absent or abnormal breathing
Spontaneous breathing (presence) (or only gasping) by looking or scanning
the chest movement (5-10 seconds)
Circulation ECG
Cerebral Perfusion Blood pressure Activate Activate emergency response system and
Chief Complaint Peripheral pulses, capillary refill Emergency get an AED; send someone to get an AED
Skin color, temperature, moisture Response
Bleeding (presence)
Level of consciousness, responsiveness
Circulation Check carotid pulse for 5-10 seconds;
Drugs Drugs prior to admission If no pulse, start HQCPR (30:2) beginning
Diagnostic Tests Current medication with chest compressions
Diagnostic test results If there is pulse, start rescue breathing at
1 breath every 5-6 seconds (10-12
Equipment Patency of vascular and drainage system breaths per minute);
Equipment functioning and labeling check pulse every 2 minutes
Defribrillation If no pulse, check for shockable rhythm
C. Comprehensive Admission Assessment - an in-depth with AED as soon as it arrives;
assessment of the past medical and social history and a Follow each shock immediately with CPR,
complete physical examination of each body system. beginning with compressions

 PROF. DR. M.J. DINO

The ACLS Survey (Pre-Arrest) ROSC Assessment/ Interventions

In the ACLS survey, the healthcare provider continue to assess C Circulation Fluids (PNSS/ PLRS) 1-2 L
and perform an action appropriate until transfer to the next level Perform 4 point auscultation
of care. Many times, team members perform assessment and
actions in ACLS simultaneously. An important component of this
survey is the differential diagnosis, where identification and AB Airway Advanced airway
treatment of the underlying causes may be critical to patient Breathing Perform 5 point auscultation
outcome.
D Disability Therapeutic hypothermia:
REMEMBER! For unconscious patients, healthcare providers PNSS/PLRS, 30cc/kg, 4
should conduct the BLS Survey followed by ACLS Survey. For degrees Celsius
conscious patients, providers should conduct ACLS Survey first. 12-24 hours
Core body temperature should
be 32-34 degrees Celsius
SURVEY CODE ACTION
V Visualize; Verbalize
Vital Signs (HR, BP, RR, O2, T) -end of Course Map 2.0-
Airway O Supplementary oxygen (below 94%):
Nasal cannula (2-4 L/min)
Face Mask (2-10 L/min)
Breathing
Circulation M Monitor (Pads on Chest)
“White on the right, Smoke over Fire”
Provide HRQCPR as needed
Rhythm intervention (slow, fast)
I Establish IV/IO
Differential T Treat reversible causes (5 Hs and 5 Ts):
Diagnosis 5Hs: Hypovolemia, Hypoxia, Hydrogen
Ion, Hyper/pokalemia, Hypothermia
5Ts: Tension pneumothorax, Tamponade
(cardiac), Toxins, Thrombosis
(pulmonary/ coronary)

Return of Spontaneous Circulation (ROSC: Post Arrest)

Return of spontaneous circulation (ROSC) is resumption of

sustained perfusing cardiac activity associated with significant
respiratory effort after cardiac arrest. Signs of ROSC include
breathing, coughing, or movement and a palpable pulse or a
measurable blood pressure [PETCO 35-45]. Attachments: