lec # 1 basic concepts ccn

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  • OBJECTIVES By the end of this presentation, students will be able to:Define what is critical care nursing.Describe the roles of CCN.Explain what is Evidence Based Practice.Discuss the patients experience with critical illness.Review familys experience with critical illness.List down end of life issues in critical care.Discuss about transportation of critically ill patients.

  • CRITICAL CARE NURSINGCritical care nursing is the field of nursing with a focus on the care of the critically ill or unstable patients. The aims of Critical Care Nursing are to promote excellence through caring, competency and commitment in critically ill patients.CCN deals with human responses to life threatening problems.

  • CONT.Goal is to restore physiologic, psychologic stability of severely ill patient.A critical care nurse must have knowledge and skill beyond those of nurse generalist.CCN should use the nursing process as a framework for practice.CCN encompass independent, dependent and interdependent nursing interventions.

  • ROLES OF CCNCARE PROVIDER: provides comprehensive, highly technical direct care to patient and family, also in response to life threatening health conditions.EDUCATOR: provides education to patient and family based on identified learning needs.ADVOCATE: protects and fights for patients rights.MANAGER: coordinates the care provided by multidisciplinary team.

  • FUNCTIONS OF CCNAssesses and implements treatment for patient responses to life threatening health problems.Uses independent, dependent and interdependent interventions to restore stability, prevent complications and to achieve and maintain optimal patient response.

  • CONT.Provides health education to patient and family.Supervise patient care and ancillary personnel.Support patients adaptation, restore health and preserves patients rights.Provide direct measures to resuscitate if necessary.

  • CRITICAL CARE ENVIRONMENTLIGHTS ACTION CAMERAICU can seem like a movie setNoise levelsLight 24 hours/dayMovement of people and equipmentLack of privacy

  • ESSENTIAL PHYSIOLOGIC CONCEPTSVentilationGas exchangeTissue perfusionFluid and electrolyte balanceAcid base balance

  • PATIENT EXPERIENCING CRITICAL ILLNESSAdmitting in ICU may signal a threat to the life and well-being of the patient.ICU patients are subject to multiple physical, psychological, and environmental stressors. Prolong stress lead to immunosuppression, hypoperfusion, tissue hypoxia, and eventual death.

  • CONT.Environmental stressors also contribute to patients stress.Blinking monitors, ventilators, intravenous (IV) pumps, noise from equipment and the health practitioners talking at the bedside, bright lights and code management.Anxiety may be defined as an emotional state of apprehension in response to a real or perceived threat.

  • NURSING INTERVENTIONSCreate a healing environment which allow critically ill patients to have their psychological needs as well as physical needs met.Promote rest and sleep as deprivation can lead to altered cognition, confusion, impaired wound healing, and the inability to wean from the ventilator due to muscle fatigue and carbon dioxide retention.

  • CONT.Have the patient use earplugs.Assess sleep time and quality of sleep by asking the patient when possible.Provide a 5-minute backrub before sleep. Eliminate pain.Position patient for comfort with pillows. Evaluate the need for nursing care interruptions.

  • CONT.Titrate environmental stimuli: turn down lights, turn down alarms, and decrease noise from television and talking.Stop the practice of bathing patients in the middle of the night for the convenience of the nursing staff.Allow family to be with the patient. Practice culturally sensitive care.

  • CONT.Build trust relationship with patient by displaying confident, caring attitude, demonstrate technical competence, and develop effective communication techniques.Patients need to know all aspects of the their care.Involving the patient in decision making.

  • CONT.Presence and reassurance is a meaningful strategy for alleviating distress or anxiety in the patient.Recognize and promote patients' spiritual sources of strength.

  • TRANSPORTING CRITICALLY ILL PATIENTSTransporting critically ill patients within hospital or outside hospital is a great challenge.Within hospital transfer could be because of diagnostic and therapeutic purposes.Safe patient transport requires thoughtful planning, organization and interdisciplinary communication and cooperation.

  • CONT.The goal during transport is to maintain the same level of care regardless of location.Transfer of critically ill patient always involves some degree of risk to the patient (risk vs benefit ratio).Proper assessment for risk of complications should be performed before transport.

  • COMPLICATIONSPulmonary: hyperventilation, hypoventilation, airway obstruction, aspiration, changes in ABGs.Cardiovascular: hypotension, hypertension, arrhythmias, decrease tissue perfusion, cardiac ischemia.Gastrointestinal: nausea, vomiting.Neurological: increased ICP, cerebral hypoxia, cerebral hypercarbia, paralysis.Pain.

  • PREPERATION What is current level of care?What will be needed during the transfer to maintain level of care?What additional resources may be required during transport?Do you have all necessary equipment needed in the emergency during transport?

  • CONT.Minimum 3 people should accompany the patient.One should be assigned critical care nurse, other should be a doctor and third one should be a nursing assistant.Transport equipments should include a cardiac monitor, airway management equipment, source of oxygen, standard resuscitation drugs, ample supply of IV fluids, resuscitation cart within range.Documentation.

  • MODE OF TRANSPORTPhysician must order type of transport The level of transport should be the same as the level of care the patient is already receiving.Ambulances BLS ACLSAir transport All ACLS Helicopter Fixed wing