Critical Care/Emergency Nursing NCMP119 1st Semester

CRITICAL CARE / EMERGENCY NURSING NCMP119 1ST SEMESTER (PRELIMS) –DR. EMMA INTIA – TUES 3:30-5:30PM ○ Critical care nurse association of...

CRITICAL CARE / EMERGENCY NURSING NCMP119 1ST SEMESTER (PRELIMS) –DR. EMMA INTIA – TUES 3:30-5:30PM ○ Critical care nurse association of the philippines, inc. CRITICAL NURSING C CRITICAL CARE NURSING A CRITICAL NURSING ROLES Delivery of specialized care to critically ill patients – that is who have life-threatening illness or injuries A1 PROFESSIONAL REGISTERED NURSE (RN) C1 CANDIDATES FOR ADMISSION AT THE Direct care provider to the critically-ill ICU patients Need for intubation and/or mechanical ventilation A2 ADVANCED PRACTICE NURSES (APN) Seizures Unresponsiveness to verbal stimuli Met educational and critical requirements Respiratory depression beyond the basic nursing educational Cardiac conduction or rhythm disturbances requirements of all nurses Close monitoring of vital signs during The APNs are predominantly the clinical antidote administration or elimination nurse specialists; and Nurse Practitioner Persistent hypotension, hypoxemia, (NP) or Acute Care Nurse Practitioner hypothermia, or hyperferia (?) (ACNP) Increasing metabolic acidosis Pulmonary edema, induced by toxins or A3 CLINICAL NURSE SPECIALIST (CNS) drugs Needs for emergency dialysis or Serves in the specialty roles that require hemoperfusion their clinical teaching, research, leadership Progressive deterioration or significant and other consultative abilities; be underlying medical disorders designated as case managers for specific patient population Antidotes: acetaminophen antidote - acetylcysteine A4 NURSE PRACTITIONER (NP) AND ACUTE lanoxin - digibind CARE NURSE PRACTITIONER (ACNP) vitamin k - protamine sulfate magnesium sulfate - calcium gluconate Manages a clinical care of a group of opioid - narcan patients and have various levels of prescriptive authority, depending on the state and practice area in which they work C2 ILLNESSES AND INJURIES COMMONLY SEEN IN ICU OR CCU B CRITICAL CARE NURSING STANDARDS Gunshot wounds AACN (American Association of Critical Care Traumatic injuries such as motor vehicle Nurses) established nursing standards to collisions and falls provide a framework for Critical Care Nurses Cardiovascular disorders, such as heart Standard failure and acute coronary syndrome ○ Authoritative statements that describe the level of care and performance by which the quality of D WHERE DO YOU WORK nursing care can be judges Critical care nurse work wherever critically ill ○ serve as descriptions of expected patients are found including: nursing roles and responsibilities ○ Adult, pedia, and neonatal ICU CCNAPI CRITICAL CARE / EMERGENCY NURSING NCMP119 1ST SEMESTER (PRELIMS) –DR. EMMA INTIA – TUES 3:30-5:30PM ○ Coronary care units and other specialized ICU G2 PLANNING E WHAT MAKES YOU SPECIAL? pain being an advocate cardiac arrhythmias using sound clinical judgment altered hemodynamics states demonstrating caring practices impaired physical mobility collaborating with a multidisciplinary team impaired skin integrity demonstrating an understanding of cultural deficient fluid volume diversity providing patient and family teaching G3 IMPLEMENTATION monitoring and treating cardiac arrhythmias Culturally Competent Nurse assessing hemodynamic parameters, such A - Awareness as pulmonary artery pressure central venous S - Skill K - Knowledge pressure, and cardiac output E - Encounter D - Desire G4 EVALUATION F BECOMING A CCN learn by doing one way or another H MULTIDISCIPLINARY TEAMWORK the goal is holism F1 GAINING CREDENTIALS The goal of collaboration is to provide effective and comprehensive (holistic) care. American Association of Critical Care Nurses Holistic care addresses the biologic, is one of the world's target specialty nursing psychological, social, and spiritual organization with more than 100,000 members H1 TEAM G RN, Doctors, PA, APRNs, patient care technicians, respiratory therapist, and others Assessment Planning Implementation H2 WORKING WITH RNs Evaluation G1 ASSESSMENT H3 WORKING WITH BUDDY SYSTEM Subtle changes in condition and monitor all equipments being used Involve the use of highly specialized equipment such as cardiac monitor, H4 COORDINATED EFFORTS hemodynamic monitoring devices, Accurately and succinctly convery important intra-aortic balloon pumps and ICP patient information monitoring devices Relay assessment findings, laboratory data, Physical and psychological statuses and and patient care issues in a concise report interpret laboratory date CRITICAL CARE / EMERGENCY NURSING NCMP119 1ST SEMESTER (PRELIMS) –DR. EMMA INTIA – TUES 3:30-5:30PM Often collaborate with doctors on patient ○ establish a standard approach to care decisions care for all provides in the facility Be sure to have important information at ○ establish roles for various members hand before you call of the team ○ provide a framework for collecting data on patient outcomes H5 COMMUNICATING EFFECTIVELY USING SBAR? I4 PRACTICE GUIDELINES (CLINICAL SBAR is a communication tool for ensuring GUIDELINES) that the right information gets to the right person in the most clear, concise and specify courses of action to be taken in effective way response to a diagnosis or condition they reflect value judgments about relative importance of various health economic outcome I CLINICAL TOOLS Aid decision making by providers. They’re multidisciplinary in nature and can be used to coordinate care by multiple providers I1 CLINICAL PATHWAY clinical pathways (critical pathways) are care management plans for patients with a given diagnosis or condition I2 PROTOCOLS Describe a sequence of actions a practitioner should take to establish a diagnosis or begin a treatment regimen. For example, a pain management protocol outlines a bedside strategy for managing acute pain Facilitate the delivery of consistent, cost-effective care. They are also educational resources for clinicians who strive to keep abreast of current best practices Protocols may be either highly directive or flexible, allowing practitioners to use cli facility established sets of procedures for a given circumstance. their purpose is to outline actions that are most likely to produce optimal patient outcomes I3 FOLLOW THE PATH overall goals are to Step 11: Steps after Tracheal Intubation CRITICAL CARE / EMERGENCY NURSING NCMP119 1ST SEMESTER (PRELIMS) –DR. EMMA INTIA – TUES 3:30-5:30PM ○ Initiate mechanical ventilation if treatment that seemed effective for other required patients ○ Give analgesia and sedation as In this example, you may believe that a required certain drug would be effective for pain relief ○ Obtain chest radiograph to confirm based on previous experience with that tube position, bilateral lung drug.. The trouble with such an approach is expansion and oro/nasogastric tube that other factors can contribute to pain relief position such as the route of administration, dosage ○ Do not start feeding the patient until and concurrent treatments the position of oro/nasogastric tube is confirmed on chest radiograph ○ Check the ETT cuff pressure using ER NURSES the cuff pressure machine and “Adrenaline Junkies” maintain it below 29 mmHg at all Maintain liability insurance on yourself times Document, document, document Step 13: Follow a protocol for Airway Maintenance ○ Proper maintenance of the airway will reduce the incidence of EMERGENCY NURSING accidental extubations, disconnections, tube blockage, and A EMERGENCY NURSING nosocomial pneumonia ○ Keep the head elevated at 30-45 specialty in which nurses care for patients in degrees _ or critical phase of their illness or injury and are adapt at discerning life-threatening ○ All ETT and tracheostomy tubes problems, prioritizing the urgency of care, (TT) should be checked for position rapidly and effectively carrying out at incisor teeth. Alae nasi, adequate resuscitation measures and other treatment, fixation, patency, tracheal cuff acting with a high degree of autonomy and pressure (