NCM 118A-MS3 LEC Principles of Critical Care
Continuous monitoring and
Introduction to Critical Care treatment
Prepared By: Jojo A. Sarmeinto RN, High-intensity therapies
Expert surveillance and efficiency
SCFHS-RN, NHRA-RN, USRN
Alert to early manifestations and
recognition of parameters denoting
progress and deterioration
Introduction To MS3
Roles of CCN
.
.
.
.
Critical Care Nursing
Specializes in caring for the most Goals of Critical Care
serious ill patients
Restoring Quality of LIFE
Care of seriously ill/injury until
discharge Helping families of critically-ill pt
Deals with human responses to life- in coping with stress
threatening problems.
Comprehensive, specialized, and Principles of Ethics
individualized nursing services to Beneficence:
patients with life threatening Non Maleficence:
conditions Autonomy:
Critical Care Unit Justice:
A room filled with clients attached Confidentiality
to interventional technology, Privacy
equipped facility, staffed by Fidelity
skilled personnel to provide Veracity
effective and safe care for patients
with a life-threatening problem that CONSENT
is potentially reversible. .
C r i ti c al Care Nursing Concepts
. Informed Consent includes:
. .
. .
. .
Critically-ill patient .
Require more intensive and careful .
nursing care Consent is Obtained By: __________
At risk for actual or potential life- Secured by:_____________________
threatening health problems. Given to:________________________.
Informed Consent Requisites for Validity
. .
.
. 1. GCS
. Interpretation:
. Mild:
. Moderate
Who are exempted in consents? Severe:
.
. 2. CPOT
. Interpretation:
Mild:
Contemporary Issues In Critical Care Moderate:
Nutrition and Hydration Severe:
Given thru NGT, IV, or duodenal feedings, 3. RASS
or gastrostomy
Interpretation:
CONTINUE Score 1 and above 0 to -2 below
Nutrition and hydration status expedites -2
the patient’s return to an acceptable level
of functioning Patient agitated sedated sedated too much
state properly
DISCONTINUE
not enough Cont. sedation dose
Non-beneficial
sedation monitor the should be
Intervention needs to ⇡ patient decreased
PAIN MANAGEMENT Education and Professional Activities,
One of the main components of palliative Competencies and Organizations
care
The CCNAPI Standards of Practice of 1982
have been revisited and revised to be
“should provide interventions to relieve pain
and other symptoms in the dying patient even when those interventions entail
risks of
hastening death” aligned with the 2005 BON statements of
the 11 Core Competencies for Entry
Level for Safe and Quality Nursing Care.
DNR The CCNAPI Core Competencies of a
. Critical Care Nurse are stated according
. to the levels of expected behavior
. defining the actual knowledge, skills, and
. abilities in the practice of critical care by a
nursing professional.
Common Assessment tool in Critical
Care unit: The International Council of
. Nurses (ICN) views health care as
. the rights of every individual
“regardless” of financial, political, • medical and surgical
geographical, racial, and patients;
religious considerations. • capable of providing
mechanical ventilation and
THE RIGHT’s OF THE CRITICALLY ILL simple invasive
PATIENT cardiovascular monitoring;
. Has a formal organization of
. medical staff and at least
. one registered nurse.
.
• A certain number of nurses
.
including the nurse in
American Association of Critical Care
charge of the unit should
Nursing (AACN) established in 1969 – this
possess post-registration
association promotes the health and
qualifications in critical
welfare of critically ill patients by
care or the related
advancing the art and science of critical
clinical specialties; and
care nursing and supporting work
environments that promote professional • Has a nurse-patient ratio of
nursing practice. 1:1 for all critically ill
patients.
Certification for Critical Care Nurse in
the Philippines Level 2
1. Registered Nurse (RN) • capable of providing a
2. Intravenous Training (IVT high standard of general
Nurse) critical care for patients
3. BLS/ACLS Training who are stepping down
4. Critical Care Course from higher levels of care
Program (optional) – high or requiring single organ
advantage support/support post-
operatively;
LEVELS & CATEGORIES OF CRITICAL • Capable of providing
CARE PROVISIONS WITHIN sustainable support for
PHILIPPINES mechanical ventilation,
Level 1 renal replacement therapy,
invasive hemodynamic
• providing immediate
monitoring, and equipment
resuscitation
for critically ill patients of
• short-term cardio-
various specialties such as
respiratory support
medicine, surgery, trauma,
• major role in monitoring
neurosurgery, and vascular
and preventing
surgery;
complications in “at risk”
• Has a designated medical • A nurse-patient ratio is at
director with appropriate least 1:1 for all patients at all
intensive care times
qualifications and a duty
Training of Nurses for Critical
specialist available
Care Unit
exclusively to the unit at all
times; 1. Orientation Program/
Preceptorship and
• The nurse in charge and a
mentoring program
significant number of
nursing staff in the unit have 2. In-service training program
critical care certifications;
a. Unit/hospital-based training
and
courses/seminars
• A nurse-patient ratio is 1:1
b. On-the-job training and bedside
for all critically ill patients.
supervision
Level 3
1. Critical Care Nursing
• Is a tertiary referral unit, Program (Postgraduate
capable of managing all program)
aspects of critical care
a. Postgraduate course
medicine (This does not
in critical care
only include the
management of patients nursing
requiring advanced b. Cardiac special care
respiratory support but nursing
also patients with multi-
organ failure); c. Advanced Critical
Care Nursing
• Has a medical director (ACCN) provider
with specialist course
critical/intensive care
qualification and a duty
specialist available Communication
exclusively to the unit and
medical staff with an Effective communication is
appropriate level of essential for delivering safe patient
experience present in the care. Communication breakdowns
unit at all times; occur during handoff situations
when patient information is being
• A nurse in charge and the transferred or exchanged for care.
majority of nursing staff
have intensive care Common handoff situations include
certifications; and nursing shift reports, transcription
of verbal orders, and inter-facility Before providing treatments and
procedures.
patient transfers.
Policies and procedures support consistent
1. Closed Loop Communication practice in all situations.
IPSG 2 – Improve Effective Communications
Complete verbal and telephone orders
were written down by the receiver.
Read back by the receiver of the order.
Confirmed by the individual who gave the
order.
SBARR
Closed Loop Closed loop
Correct abbreviation
Communication
IPSG 3 – Improve the Safety of High Alert
Medications
Medications involved in a high
2. SBARR percentage of error and sentinel
S- events.
B-
A- Medications that carry a higher
R- risk for adverse outcomes.
Barriers to Effective Handoff Communication Look a like, sounds a like
medications.
a. Physical setting – background
noise, lack of privacy, Policies and procedures are
interruptions developed to address the
b. Social setting – organizational identification, location, labeling,
hierarchy and status issues and storage of high alert
c. Language – differences between medications.
people of varying racial and
IPSG-4. IPSG 4 – Ensure Correct Site,
ethnic backgrounds or
Correct Procedure, Correct Patient
geographical areas
Surgery
d. Communication medium –
limitations of communications via Uses an instantly recognized mark for
telephone, email, or computerized surgical site, identification and involves the
records versus face-to-face patient in the marking process.
International Patient Safety Goals Uses a checklist to verify preoperatively
the correct site, correct procedure, and
These goals were established by the JCI (Joiint
correct patient and that all documents and
Commission International) to promote specific
equipment needed are on hand, correct,
movements in safety by focusing on common
and functional.
problems areas in health care.
The full surgical team conducts and
documents a time-out procedure just
IPSG 1 – Identify Patients Correctly before starting a surgical procedure.
Using 2 identifiers (Name and ID band). Policies and procedures are developed
Before administering medications, blood, that support uniform process to ensure the
or blood products.
correct site, correct procedure, and
correct patient.
IPSG-5. Prevent Infection
6. IPSG 6 – Reduce the Risk of Patient Harm
Resulting from Falls
Implements a process for initial
assessment of patients for fall risk
and reassessment of patients when
indicated by a change in condition
or medication.
Measures are implemented to
reduce fall risk for those assessed
to be at risk.
Monitor for results, both
successful fall injury reduction and
any unintended related
consequences.
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