CARE OF A CRITICALLY ILL PATIENT

Definition

Critically ill patients - Critically ill patients are those who are at risk for actual potential life
threatening health problems.

Critical Care units- CCU & ICU are designed to meet the special needs of critically ill patients.
❖ What are the condition considered as critical
➢ Any person with life threatening condition
➢ Patient with
1. Acute respiratory failure
2. Acute myocardial infarction
3. Cardiac tamponade
4. Severe shock
5. Heart Block
6. Acute renal failure
7. Polytrauma
8. Multi organ failure
9. Organ dysfunction
10. Severe burns

Classification of Critically ill patients

Level 0 - Normal ward care
Level 1 - At risk of deterioration, support from critical Care team
Level 2 - More observation or intervention, single failure post operative care
Level 3 - advanced respiratory support or basic respiratory support multi organ failure

Guiding principles

● Delivery of optimal and appropriate care

● Relief of distress
● compassion and support
● Dignity
● information
● care and support of relatives and Care give us
● Assessment in critical Care unit
● Gcs
● airway
● breathing
● circulation and cerebral perfusion past medical history

Physical assessment in CCU and ICU

● Nervous system
 ● cerebrovascular system
● respiratory system
● renal system
● gastrointestinal system
● endocrine system hematological problem
● immune system
● integumentary system
●
Planning for patient care
Know- medical history, social history medical intervention
See- airway pattern, pallor, sweating mental state, posture, facial expression, general condition,
breathing pattern
Find- respiratory care, adequacy of oxygenation, pulse, blood pressure, urine output, conscious
level

monitor for changes any of the above

A- airway pattern
B- breathing respiratory rate
C- circulation pallor and hemorrhage D- disability altered conscious level
E- exposed to examine unseen hemorrhage und leakage

Nursing management
● Continuous monitoring
● Respiratory care
● Cardiovascular care
● GI nutritional care
● Neuromuscular care
● Comfort & reassurance
● Communication with patients and relatives
● Infection control, skin care, general hygiene & mouth care
● Fluid, electrolytes & glucose balance
● Bowel and bladder care
● Dressing and wound care

Continuous monitoring

Vital signs- continuous monitoring of heart rate, respiratory rate, pulse rate, blood pressure and
SpO2by using multi-channel monitors. Documentation of vital signs in every hour is necessary.
Continue to monitor if any changes occur.

Respiratory care
● Improving oxygenation- by using nasal cannula, oxygen mask, non rebreathing face
mask, non rebreathing mask, high flow nasal cannula ( HFNC), ventilator.
 ● Appropriate use of medication - bronchodilators are used to loosen the secretion in
lungs.
● Chest physiotherapy
● Monitoring of treatment efficiency
● Recognition of early warning signs of an exacerbation with rapid access to appropriate
service( ventilator, crash trolley, emergency drug etc)
● Position - in case of respiratory distress
● Suctioning is necessary
● Tracheostomy care- daily dressing in case of soaked, proper suctioning.
● ET tube care- suction in every 2 hr and , position change, check proper fixations and
measure cuff pressure.
● Mouth care- morning mouth care is important to prevent oral infection.
Cardiovascular care
● Look for arrhythmias
● Appropriate use of cardiac medicine- heart rate, blood pressure
● Monitoring of treatment efficiency
● Recognition of early signs of an emergency ( Defibrillator, ECG, emergency drug)
● Positioning
GI/ Nutritional care
● In supine position gastroesophageal reflux and aspiration pneumonia occurs. Patient
positioning with 30° head up prevents this.
● Early enteral feeding reduces infection, stress ulceration, GI bleeding.
● Immobility is associated with gastric stasis and constipation, so provide gastric
stimulants and laxatives.
● Nasogastric tube care- every day check for any redness around the nose. Properly clean
the tube after feeding.
● Parenteral nutrition - total parenteral nutrition through intravenous line is given to the
patient to provide adequate nutrition.
Neuromuscular care
● GCS- check for the Glasgow coma scale.
● Immobility, prolonged neuromuscular blockage and sedation promotes atrophy.
● Physiotherapy and splints.
Comfort and reassurance
● Anxiety, discomfort and pain must be recognised and relieved with reassurance, physical
measures, analgesics and sedatives.
● In particular ET tube, nasogastric tube, bladder or bowel distention, inflammation.
● Line sites, painful joints and urinary catheter often cause discomfort.
Infection control
● Hand washing is important to prevent transmission of organisms between patients.
● Clean the patient surrounding area with proper antiseptic.
● Bed making should be done everyday.
● Disposable aprons are recommended including gloves, mask, cap .
● Proper biomedical waste management.
Skin care, general hygiene and mouth care
 ● Check for bed sore in patients body (bony prominence) due to local pressure, friction,
malnutrition, edema, ischemic damage related to moist or soiled skin.
● Provide bed bath, mouth care, back care, general hygiene to the patient.
● Bladder care- urinary catheters causes painful urethral ulcers and must be stabilized by
urinary catheter. This catheter should be clean every morning.
● Early removal of catheters reduces urinary tract infection
Fluid electrolytes & glucose balance
● Regularly uses fluid and electrolytes balance by maintaining I/O chart.
● Insulin resistance and hyperglycemia are common but maintaining normoglycemia
improves outcome.