03/25/22

SUCHISMITA SETHI
M.SC NURSING IIND YR
COLLEGE OF NURSING
BERHAMPUR
03/25/22
SUCHISMITA SETHI
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SUCHISMITA SETHI
 INTRODUCTION

Critical care nursing is that speciality within

nursing that deals specifically with human
responses to life threatening problems.
A critical care nurse is a licensed personnel who
is responsible for ensuring that all critically ill
patients & there families receives optimal care.

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 CONT...

She applies her specialised knowledge base to

care for & maintain the life support of
critically ill patients who are often on the
verge of death.
They have advance knowledge on
variety of technology & its use in critical
care setting.

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 FUNCTIONS OF SKILLED CCU
NURSE:-
Some of the basic functions of the CCU
nurse are :-
Assessing patient condition &
implementing appropriate care
Treat wounds.
Administering IV fluids & medications.
Manage ventilator, monitors & other
equipments.
Performing defibrillation.
providing advance life support.
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 CONT...
Maintaining arterial lines and pressure
interpretations.
Control infection in CCU.
Providing patient/family teaching.
Interpret and order diagnostic laboratory tests.
Make nursing diagnoses, using standards and
protocols for treatment.
Keep emergency equipments ready.
Assisting physicians in performing procedures.
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 IMMIDIATE CARE OF PATIENT

1. Initial assessment
2. Immediate management
3. Initial investigations
4. Monitoring

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 1. PATIENT ASSESSMENT
• A comprehensive H/PA of critically ill patients
health status is important to find out risk
factors.
• Adequate knowledge on assessment can make
sure about pt.’s vitals, neurological status & also
pain score.
• The nurse should assess the ABCDE of patient
immediately after receive the patient.

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 “A”- AIRWAY
SNORING – UPPER AIRWAY CLEAR
OBSTRUCTION BY TONGUE AIRWAY

GURGLING- UPPER AIRWAY SUCTIONING

OBSTRUCTION BY LIQUID
STRIDOR- OBSTRUCTION BY REMOVE FB
FOREIGN BODY OR STENOSIS / INTUBATE
OF UPPER AIRWAY
WHEEZE- BRONCHO
SPASM OF SMALL AIRWAYS DILATORS

SILENT- COMPLETE AIRWAY INTUBATE

OBSTRUCTION SUCHISMITA SETHI
 “B”- BREATHING

C/F of Respiratory C/F of Inadequate

Distress: oxygenation:
Breathlessness Restlessness
Tachypnea- Delirium
Inability to talk Drowsiness
Open mouth breathing Cool extremities
Flaring of nose Cyanosis
Paradoxical breathing Tachycardia
Use of accessory muscles Arrhythmia
for respiration. Hypotension
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 “C”- CIRCULATION
 Look at the colour of the hands and digits.
 Assess the limb temperature.
 Measure the capillary refill time (CRT).
 Assess the state of the veins: they may be under filled
or collapsed when hypovolaemia is present.
 Palpate peripheral and central pulse.
 Measure the patient’s blood pressure.
 Auscultate the heart.
 Look for other signs of a poor cardiac output, such as
reduced conscious level.
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MANAGEMENT OF CIRCULATION
JUDICIOUS USE OF VOLUME,IONOTROPES AND VASOPRESSORS

PERICARDIAL IMMEDIATE
TAMPONADE- PERICARDIOCENTESIS
URGENT
PULMONARY EMBOLISM- ANTI-COAGULATION
THEN INVESTIGATION
URGENT CONTROL
AORTIC DISSECTION- OF HYPERTENSION AND
HEART RATE
BROAD SPECTRUM
SEPSIS AND SEPTIC SHOCK ANTI-BIOTICS AND
RESUSCITATION
SHOCK- HYPOVOLEMIC, TREAT ACCORDING
CARDIOGENIC, SPINAL
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TO CAUSE
 DISABILITY
Measure level of consciousness by using
AVPU method:-
 A:-Alert.
V:- Verbal method.
P:- Pain.
U:- Unresponsiveness.
Check pupil size and functioning response.
Assess motor and sensory responses to all
four limbs.
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 EXPOSURE

Head to toe examination.

Look for any signs of haemorrhage, bruising,
infection, injury, etc.
Examine for gross neurological deficit.

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 3. BASIC INVESTIGATIONS

Investigations during
initial resuscitation:-
 CBC  Coagulation profile.
 Blood sugar  ABG.
 Electrolytes  Chest x-ray,12 lead
 Urea ECG.
 Creatinin.  Appropriate
 LFT. Microbiology cultures.

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 4. CONTINIOUS MONITORING

Regularly reviewing the patients enhancing

elements of safety & comfort of patient care in
CCU
While monitoring patient condition the nurse
should follow mnemonic FASTHUG.
The FASTHUG mnemonic - checklist which
should be employed everyday by nurse during
care of critically ill patient.

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 CONT….

F:- FEEDING
A:- ANALGESIA
S:- SEDATION
T:- THROMBO EMBOLIC PROPHYLAXIS
H:- HEAD-OF-BED ELEVATION
U:- ULCER PREVENTION
G:- GLUCOSE CONTROL
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EXTENDED ROLE OF CRITICAL CARE
NURSE

1. CLINICIAN
2. PRACTITIONER
3. EDUCATOR
4. MANAGER
5. MENTOR
6. ADVOCACY
7. COUNSELLOR
8. RESEARCHER
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 CLINICIAN

As a nurse clinician she is responsible for

identification & intervention of clinical problems
& manage those problems to improve care for
patients & families.
They provide direct comprehensive patient care
& prescribing pharmacologic & non
pharmacologic treatment of health problems.

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 PRACTITIONER
• Nurse practitioner is a registered nurse with additional
educational preparation & experience.
• She has the competencies to autonomously diagnosed
order, interpret diagnostic test, prescribe
pharmaceutical & perform specific procedures within
there legislative scope.
• She is trained to advanced skills like:-
Chest tube insertion.
Ventilator management.
Intubation.
Arterial puncture etc.
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 MANAGER
• The nurse manager is responsible for both the clinical &
administrative aspects.
• She is the in charge of daily operation of a nursing unit
within the hospital .
• The main function of manager are:-
Create shift schedules.
Create departmental budget & track monthly
expenses.
Perches equipment & supplies.
Ensure safety of equipments & work environment.
Solve patient care issues etc.
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 EDUCATOR
Clinical nurse educator is a registered professional
nurse with advance clinical & educational
experience.
She should complete post master degree in
nursing.
She educate health personnel's on new treatment
protocols which improve disease out com.
She educate patient & family on different
treatment option & teach them how to manage a
particular disease.
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 MENTOR

Mentorship is a relationship in which a more

experienced or more knowledgeable person
guide a less experience person.
Fresher nurses faces many challenges in there
day to day activities in CCU.
The nurse mentor can help, guide & support the
newer nurse, teaching clinical skill, time
management skill & help them find ways to deal
with stress within the profession.
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 ADVOCACY

 As a advocate the nurse protects the clients

human & legal rights.
The nurse explain what is likely to happen,
reason for tests or procedures which make client
confidence & promote healing.
 She provide a safe environment for the client,
takes steps to prevent injury & protect the client
from possible adverse effects of treatment
measures.
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 COUNSELLOR

As a counselor the nurse helps client:-

 To recognize & cope with stressful
psychologic problems.
 Give stress management & grief counseling.
 Focus on helping client to develop positive
attitude & provides emotional , intellectual
and psychological support.
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 RESEARCHER

Research is a vital aspect of the health service &

essential to the provision of effective & safe
health & social care.
The role of nurse is to conduct clinically relevant
research & integration of researcher finding in to
nursing practice, particularly within the patient
setting.
The main objective of clinical researcher to
improve patient quality of care.
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INFECTION CONTROL MEASURES

“It is the measures practiced

by health care personnel to
prevent spread of infection
between clients, from health
care providers to clients and
from clients to health care
providers”.

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 RISK FACTORS LEADING TO HAIs

IMPAIRED HOST
DEFENCE

CROSS SEVERITY OF
INFECTION ILLNESS

INVASIVE LENGTH OF
DEVICE STAY
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 MODE OF TRANSMISSION

CONTACT

VECTOR
BORNE

AIR BORNE

DROPLET

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 STANDERD PRECAUTION

“Standard precautions are a set of

infection control practices used to
prevent transmission of diseases that
can be acquired by contact with blood,
body fluids, non intact skin & mucous
membranes”.
-These measures are to be used when
providing care to all individuals.
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 STANDARD PRECAUTIONS

i. Hand Hygiene
v. Safe Handling Sharp
ii. Personal Protective
vi. Waste Management
Equipments
iii. Respiratory vii. Pre and Post
Hygiene Prophylaxis
iv. Safe Injection viii. Immunization
Practice

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 HAND HYGIENE

Hand washing is the

most important way to
reduce the spread of
infections in health care
setting.
It reduces the
number of infectious
microorganisms on hands
& also reduces client
sickness and death caused
by infections.
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 5 MOMENTS FOR HAND HYGIENE

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 SEVEN STEPS OF HAND WASHING

Rub palm together Rub back side of both hands Interlace fingers and rub hands

Interlock the finger and rub the Rub thumbs by rotating manner Rub fingertips on palm for both hands
back of fingers of both hands area in between index finger

Rub both wrists in a rotating

manner rinse and dry thoroughly SUCHISMITA SETHI
II. PERSONAL PROTECTIVE EQUIPMENT

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 III. RESPIRATORY HYGIENE

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CONT…
• Respiratory hygiene is directed to patients and
family members with signs of respiratory illness
such as cough, congestion, or increased
respiratory secretion.
• Use of mask for person who is coughing is
necessary.
• There should be spatial separation of the
person with a respiratory illness, At least 1
meter (3 feet) away from others in common
waiting areas.
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IV. SAFE INJECTION PRACTICE

Aseptic technique
Using a single syringe and
fluid infusion sets only once
Using single-dose vials
when possible
If multi-dose vials must be
used, then use & store them
according to manufacturer's
recommendation.
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 V. SAFE HANDLING OF SHARP
Technique:
Perform the procedure carefully.
Minimize handling of sharp instruments.
The needle should not be recapped, if necessary
use scoping method to recap the needle. 
Each health care worker who uses sharp
instruments is responsible for their
management and disposal.
         
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 CONT…

Dispose of all the sharp instrument used

during the procedure immediately, carefully
and appropriately.
 The sharps container never be overfilled
and dispose after ¾ filled up the container.
 The sharp container must be securely
sealed with a lid before disposal. Use utility
glove during disposing the sharps.

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VI.HOSPITAL WASTE MANAGEMENT

The nurse should aware about :-

Types of hospital waste.

Segregation of different type of waste.

How to treat infectious waste.

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 VII. POST EXPOSURE
PROPHYLAXIS
 Post exposure prophylaxis is a preventive
medical treatment started immediately
after exposure to pathogen in order to
prevent infection by the pathogen & the
development of disease.
 Rabies vaccine
 Tetanus toxoid.
 Hepatitis A & B vaccine
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 VIII. PRE EXPOSURE
PROPHYLAXIS
 Pre-exposure prophylaxis is the preemptive use
of drugs to prevent disease in the people who have
not been exposed to the disease causing agents.
Immunization against HBV must be provided to

health workers who perform task involving

contact with potentially infectious blood or other
bodily fluids.

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