Nursing and ICU Overview

Nursing History

• A nursing history is conducted before a physical examination.
• The purpose of a nursing history is to establish a rapport with the patient and family.
• Elements of a nursing history include health status, cause of present illness, current management of illness, past medical history, social history, and perception of illness.

Psychological and Social Examination

• Includes the client's perception of illness, emotional health, physical health, spiritual health, and intellectual health.

ICU

• ICUs are designated areas within a hospital for patients requiring sophisticated medical and nursing care.
• Types of ICUs include general, medical, surgical, medical surgical, neonatal, special care nursery, pediatric, coronary, and cardiac surgery.

Design of an ICU

• Should have controlled access with a single entry and exit.
• Emergency exit points are required.
• There should be no through traffic of goods or hospital staff.

Indications for Admission to the ICU

• Patients with metastatic malignancy complicated by infection, cardiac tamponade, or airway obstruction.
• Status epilepticus.
• Severe head injury.
• Hemodynamically unstable drug ingestion.
• Drug ingestion with significantly altered mental status with inadequate airway protection.
• Seizures following drug ingestion.
• Life-threatening gastrointestinal bleeding.
• Hepatic failure.
• Severe pancreatitis.
• Diabetic ketoacidosis complicated by hemodynamic instability, altered mental status, respiratory insufficiency, or severe acidosis.

Crisis Intervention and Stress Reduction

• Partnerships are formulated during crises.
• Bonds between nurses, patients, and families are stronger during hospitalization.
• Nurses assist patients to express fear and identify their grieving patterns and provide avenues for positive coping.

Organization of an ICU

• Nursing Staff: Highly trained critical care nurses are required in a tertiary care ICU. The ideal nurse-to-patient ratio is 1:1, but a 1:2 ratio is acceptable in some cases.
• Allied Services: Respiratory services, nutritionists, physiotherapists, biomedical engineers, technicians, computer programmers, clinical pharmacists, social workers/counsellors, support staff, guards, and grade IV workers are all essential roles.

Prime Responsibilities of a Critical Care Nurse

• Continuous monitoring.
• Maintaining an emergency trolley/crash cart.
• Providing efficient individualized care.

Team of Critical Care Unit

• Physicians: The Most Responsible Physician (MRP) is in charge of the patient's care during hospitalization.
• Nurses: Intensive care nurses are the minute-to-minute critical care providers, providing and coordinating most aspects of care delivery.
• Respiratory Therapists: Respiratory therapists provide care for patients with breathing problems.

Common Drugs Used in Critical Care

• Analgesics:

  • Fentanyl: 600 times more effective than morphine, used in moder-ate and severe pain.
  • Naloxone: Antidote for fentanyl.

• Dissociative Anesthesia:

  • Ketamine: Used for sedation.
  • Propofol: Rapid arousal, used in neuro cases and patients with increased intracranial pressure.

• Inotropes:

  • Dopamine, dobutamine, nor-adrenaline: Used to increase heart contractility.

• Thrombolysis:

  • Diazepam, LMWX, heparin flush: Used to dissolve blood clots.

Infection Control

• Hand washing before, during, and after procedures.
• Maintaining sterility during procedures.
• Use of disinfectants.
• Weekly high wash.
• Monthly culture tests for health personnel, equipment, and infrastructure.
• Regular inspections by the infection control team.
• Each shift CVP dressing.

Central Venous (CVC) or Central Line Catheter

• Insertion of a catheter into a large vein through the subclavian, intra-jugular, or femoral vein for various purposes, including chemotherapy, antibiotics, total parenteral nutrition, and hemodialysis.

Hemodynamic Monitoring

• Measures blood circulation and the heart's function.
• Indicates the movement of blood throughout the body and the amount of oxygen the body needs.
• Two types of hemodynamic monitoring:
  • Non-invasive monitoring: Supine, mid-axillary position.
  • Invasive monitoring: Direct measurement of pressures within the cardiovascular system using catheters.

This quiz covers essential topics in nursing history, psychological and social examinations, and the design and types of Intensive Care Units (ICUs). It addresses the processes involved in patient assessment and the specific requirements for caring for critically ill patients in a hospital setting.