Copy of 1-ICN Lab_ Introduction to ICN.pdf

Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR ICUs are also distinguished from general INTRODUCTION TO INTENSIVE CARE NURSING...

Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR ICUs are also distinguished from general INTRODUCTION TO INTENSIVE CARE NURSING hospital wards by a staff-to-patient ratio and I. Introduction to Intensive Care Nursing access to advanced medical resources and II. Common Equipments in ICU equipment that is not routinely available III. Basic Life Support elsewhere. Common conditions treated within IV. Equipments Gallery ICUs are ARDS, shock, and other life-threatening conditions INTRODUCTION TO INTENSIVE CARE NURSING Types of Intensive Care Unit Critical Care Nursing or Intensive Care Nursing CCU Critical Care Unit / Regular ICU - ex: Speciality within nursing which deals Medical ICU, Surgical ICY specifically to human responses with PACU - Post anesthesia care unit life-threatening illness PICU - Pediatric Intensive Care Unit ○ Ex. hemodynamics during critical NICU - Neonatal Intensive Care Unit times tapos manipis ugat ng px CCU - Cardiac Care Unit / Coronary Care Unit - ○ Ex. Inserting IV and other post angioplasty, catheter based procedures, interventions during brownout etc Requires an ability to deal with crucial CT ICU - Cardiothoracic ICU - underwent situations rapidly with precision. Before it was invasive or open heart surgery such as bypass, limited to traditional ICU within hospitals. CABG, heart transplant, valve reconstruction, However, CCN is no longer geographically VSD repair, etc. defined. Neuro ICU - px with increased ICP, stroke, CV ○ The creation of the mechanical accidents ventilator prompted the creation of Isolation Intensive Care Unit - infectious an intensive care unit. Psychiatric Intensive Care Unit - mentally ill The primary reason is to provide care to Mobile Intensive Care Unit - to be transported critically ill patients and their families and but with ICU setup promoting a patient-driven system of health care ○ Critical care nursing should be holistic approach; hence it includes providing updates to the patients’ relatives Intensive Care Unit An ICU, aka Intensive Therapy Unit or Intensive Treatment Unit or Critical Care Unit, Sample ICU Setup is a special department of a hospital or health care facility that provides intensive care medicine Intensive Care Unit Nurses Intensive care unit caters to patients with severe or life-threatening illnesses and Also known as critical care nurses are highly specialized injuries, which require constant care, close and trained healthcare personnel who provide nursing supervision from life support equipment and care to patients with life-threatening illnesses or medication in order to ensure normal bodily conditions. They provide specialized experience, functions knowledge, and skills that patients need to survive or Staffed by highly trained doctors, nurses, and de-escalate care. ICU nurses are trained to make respiratory therapists, perfusionists, and split-second decisions and act quickly when a patient’s others who specialize in caring for critically ill status changes. patients Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR ICU nurses work in challenging complex fields Cardiac monitor - continuously monitors a patient's in their nursing profession. They have the heart rate, rhythm, and electrical activity. It is essential primary duty to provide lifesaving care to for detecting and treating cardiac arrhythmias and patients fighting for their lives other heart problems. They are highly trained to provide exceptional care for patients who depend on 24/7 nursing Manual Defibrillator - maximum of 200 joules and has care. A patient in ICU is often ventilated, three functions. Nursing responsibilities include: intubated, and can be on several life-saving No need for doctor’s order machines and medications. Put the defib to apex and sternum ICU nurses are at the top of their game and Put 22-25 lbs of weight in total to actually well versed with all aspects of specialized care transmit properly the electricity from the to restore their patients’ health and wellness. machine to the heart of the patient No one touch the patient, that’s why you shout “clear” COMMON EQUIPMENTS IN INTENSIVE CARE UNIT Automated External Defibrillator - analyzes a patient's heart rhythm and delivers an electric shock if Mechanical Ventilator - assists or replaces a patient's necessary to restore a normal heart rhythm. AEDs are breathing by delivering oxygen and removing carbon used in emergency situations to treat sudden cardiac dioxide from the lungs. arrest. Emergency cart - integral storage for emergency Basic ET Set - this includes laryngoscope, ET tube of situations. different sizes, oral airway, guide wire, stylet. First drawer / Emergency medications - high 2.0 for premature babies alert drugs used during emergency situations 7.0 - 8.0 - average ET tube size for adult such as in cardiac situations. Includes: Filipino ○ Epinephrine is given 1 mg every 3-5 Nasopharyngeal - contraindicated for neck minutes for cardiac arrest injuries, only used when oral is not accessible ○ Atropine 1 mg for symptomatic Two types of tongue blades: McIntosh (curve) bradycardia and Miller (straight) ○ Amiodarone is an antiarrhythmic ○ 00 Miller - used for neonates to drug. expose larynx quickly ○ Inotropes such as epinephrine dopamine and norepinephrine Bag Valve Mask (Ambubag) - manual resuscitator used ○ Verapamil to provide artificial ventilation by delivering oxygen to ○ Dexamethasone the lungs. It is often used during emergencies or as a ○ Isosorbide dinitrate temporary measure before intubation. ○ Aminophylline ○ Hydrocortisone Suction Machine ○ Nicardipine - 5cc to 10cc per hour ○ Suction the endotracheostomy first ○ All of which are given via drip and before the mouth to prevent not given through push or bolus. infection. Second drawer / Cannulas and Syringes - ○ Clean the tracheostomy first for the syringes and iv cannulas for electrolytes patient to have a good supply of Third drawer / Tubes and Catheters- et tubes oxygen. and ngt, micro and macro sets, ○ Use different gloves and suction ○ Neck should be extended for catheters for oral, nasal, and trach. intubation to visualize the larynx? ○ Cross contamination will happen as Fourth drawer / Oxygenation and IV sets the patient has an open wound so it Last drawer / IV Fluids comes down to the maintenance of cleanliness.. Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR ECG Machine - machine used to record the electrical Infusion Pump - device used to deliver larger volumes activity of the heart. It is used to diagnose various heart of fluids or medications at a controlled rate. It is conditions, such as arrhythmias and heart attacks. commonly used for administering intravenous fluids, antibiotics, and other medications. ICP Monitoring Device - used to measure the pressure within the skull. Syringe Pump - used to deliver medications or fluids at The catheter should at least reach the dura a precise rate. It is often used for administering small mater of the brain to measure the ICP. volumes of medication or for critical care situations. 7mmHg to 15mmHg is the normal ICP. 15mmHg to 20mmHg is the borderline. Intra-aortic Balloon Pump Machine - device that is inserted into the aorta to improve blood flow to the heart and reduce the workload on the heart. It is often used in patients with heart failure or after a heart attack. ABG machine - aka blood gas analyzer, is a medical device used to measure the levels of various gasses in a blood sample. Radial, ulnar, and brachial arteries are the most common sites. From distal to proximal to Basic cardiac monitor reading not compromise the blood flow. Allen’s test Peripheral Arterial Line - catheter inserted into a BASIC LIFE SUPPORT peripheral artery, such as the radial or brachial artery. It Basic Life Support is used to monitor blood pressure continuously and to Activation of emergency response obtain blood samples for laboratory testing. High quality CPR The physician will be the one to insert the Defibrillation catheter and the nurse will be responsible for Advances resuscitation the catheter monitoring and care. Post-cardiac arrest care Recovery Intraosseous Kit - Used when IV line is not possible during emergency situations. This is the second Sudden Cardiac Arrest - It is the sudden unexpected preferred route before the ET tube. death caused by loss of heart function, the most common cause is a heart attack. Hemoperfusion Machine - Same as hemodialysis. Assessment: For instance, this is usually used for those ○ No palpable pulse patients with highly infectious COVID. This is ○ No breathing used to remove cytokines. ○ The victim is unconscious Cytokine storm - results in autoimmune response leading to organ failure. CCPRR / CPR Hydrocortisone is the medication. Cerebro-Cardio-Pulmonary and Renal Resuscitation Extracorporeal Membrane Oxygenation Machine (CCPRR / CPR) (ECMO) - Machine that temporarily acts as heart and A technique of basic life support for the lungs. It oxygenates the blood and circulates it purpose of promoting circulation and throughout the systemic system. oxygenating the brain, heart, lungs, kidneys, Best option for heart failure. until a more advanced definitive medical treatment can restore normal heart and ventilatory function Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR Primary indication: Px has signs of irreversible death ○ Cardiac arrest ○ Brain matter Secondary indication: ○ Decapitation ○ Pulseless electrical activity (PEA) ○ Rigor mortis ○ Ventricular fibrillation (VF) ○ Dependent lividity ○ Pulseless ventricular tachycardia When to stop: (pulseless V Tach) ○ Scene is not safe QUALITY MATTERS: Improves chance of ○ Turn over to medical services survival ○ Operator or nurse is already 2 key elements: exhausted and can’t continue CPR ○ High quality CPS skills (Chest ○ Physician assumes responsibility Compression and Rescue Breaths) ○ More efficient team approach Advanced Cardiac Life Support (ACLS) High Quality CPR Skills Begin CPR compressions within 10s of determining cardiac arrest Is to achieve the best possible outcome for individuals Compress fast at a rate of 100-120 bpm who are experiencing a life-threatening event. ACLS is a Compress hard at least 2 inches or more for series of evidence-based responses simple enough to be adult, at least ⅓ if an inch for infants/children committed to memory and recalled under moments of Allow for complete chest recoil at top of each stress. These ACLS protocols have been developed compression through research, patient case studies, clinical studies, Minimize interruptions to compressions and the opinions of experts in the field. Give effect rescue breaths that create a visible chest rise (10-12 breaths per minute via bag Code Management valve mask in hospital setting, head tilt chin lift maneuver or jaw thrust or if advance airway is Code Management - It is the organization and direction available) of resuscitation, following ACLS & PALS Protocol around Avoid excessive air on rescue breaths the world External chest Compressions “CODE” - a commonly used term in the medical Increases pressure inside chest and directly community for a cardiopulmonary arrest. compresses heart, forcing blood to move from For resuscitation to be effective, there must be chest to lungs, heart brain,kidney and the rest a systematic approach to the delivery of care of the body. Code Team - usually a 5 man team 1. Team leader - directs and organizes the code 2. One member manages airway 3. One member provides chest compressions 4. One members tarts an IV line, gives medication 5. One member handles the monitor and records events Be Ready Call 9-1-1 or 1-1-7 Hands Only CPR - the shoulders should be perpendicular to the patient’s sternum Defibrillation When to stop CPR Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR Cardiac Monitor Sample Hospital Code Basic Ethico-Legal Considerations Endotracheal Intubation Set Ethico-Legal considerations In a hospital setup, once a patient is for resuscitation, you must know if he has advance directive. If the patient or the relative (next of kin) already signed a DNI and DNR waiver, we must respect that. Manual If a patient does not have an advance directive, Defibrillator and the relatives are still in the process of deciding whether to sign the DNR, you are still to perform resuscitative efforts as long as there is no signed form/waiver. Automated External Defibrillator EQUIPMENTS GALLERY Equipment Example Infusion Pump Mechanical ventilator Syringe Pump Emergency Cart Intra-Aortic Balloon Pump Machine Intensive Care Nursing | Laboratory Pamantasan ng Lungsod ng Maynila | BSN 4-9 College of Nursing | 4th year | 1st semester | Date: MM-DD-YR ABG Machine ECG Machine Peripheral Arterial Line ICP Monitoring Machine Intraosseous Kit Hemoperfusion Machine Extracorporeal Membrane Oxygenation Machine (ECMO) Bag Valve Mask Suction Machine