View
218
Download
0
Category
Tags:
Preview:
Citation preview
Lets Explore the ICULets Explore the ICU
What is the Purpose of the ICU?
To provide around-the-clock intensive monitoring and
treatment of patients seven days a week.
• Pharmacists
• Unit clerks
• Nurses
• Physicians (IM, Pulmonary, etc.)
• PA’s
The ICU Health Care Team•Respiratory therapists
•Other medical consultants from a broad range of specialties including surgery, pediatrics, anesthesiology, and social services
Where do the patients come from?
• The general hospital floors
• The ER
• Transfers from other hospitals & nursing homes
• OR
• “Direct Admits”, bypassing the ER
Intensive Care Unit
What types of patients would you see?Post heart surgery MI’s
Renal and Liver failure CVA’s
Pulmonary embolism Sepsis
Shock Drug overdose
Arrhythmias Suicidal
Hypoglycemic coma ARDS
Intensive Care Unit
A Common ICU Room? Or NOT!
A REAL ICU Room
A day in the life of an ICU nurse…
• YouTube - Critical Care Nurse: Day in The Life
http://www.youtube.com/watch?v=P3x-ASSwLv0
The monitors are your second major bedside assessment tool – the first is your eyes.
EQUIPMENT
What is on the monitor screen?
•EKG•Heart rate•Blood pressure•Arterial pressure•O2 Saturation•Respirations
EQUIPMENT cont….
Ventilators: a machine designed to mechanically move breathable air into and out of the lungs
NEW VENT OLD VENT
CHEST TUBES:a flexible plastic tube that is inserted through the side of the chest into the pleural space to drain blood, body fluid or air.
LARYNGOSCOPE & ETT
•Laryngoscope: An instrument that helps in intubation for mechanical ventilation.
•Endotracheal Tube: inserted into a patient's trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. Regarded as the most reliable available method for protecting a patient's airway.
Intubated Patient
CRASH CARTA set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency meds/equipment at the site of the emergency for life support.
Includes:•Defibrillator with pads•AMBU bag•Medications•IV equipment•Normal Saline•Procedure kits•Oxygen tank•And much more
Central IV LinesA catheter placed into a large vein in the neck (internal jugular vein),chest (subclavian vein) or groin (femoral vein).
It is used to administer medication or fluids, obtain blood tests and directly obtain cardiovascular measurements (central venous pressure).
What EQUIPMENT do you SEE?
LABS
•Nurses mostly draw the labs
•Similar labs to those drawn in the ER
Common Labs Include:
•ABG’s (drawn by the RT usually)
•Evaluates the respiratory effort
•Glucose levels
•Chemistry
•Coagulation--Fibrinogen, Prothrombin
•Cardiac enzymes—proteins released into the bloodstream when heart muscle damage occurs
What are the routines of the ICU?
• Report, assessment, time management
• Record info: flow sheets, med sheets, intake and output totals, lab results, nurses notes
• Monitoring
• KARDEX
• Carrying out orders
• Documentation q2h
• Administering medication
Intensive Care Unit
How does the ICU affect the family members?
• Feelings of uncertainty
• Scared and afraid
• Angry
• Inquisitive
• Guilt
Intensive Care Unit
The IN’s and OUT’s of and ICU Patient
SEE HANDOUT
Intensive Care Unit
How to care for the family members?Practice HOLISTIC Care!!!
• Be empathetic
• EDUCATE, EDUCATE, EDUCATE
• Anticipate needs
• Keep them updated
Intensive Care Unit
What’s next?
•Transfer to floor
•Take to surgery
•Discharge (rare)
What are some important facts to consider before going into an ICU as a student?
There is more than one type of ICU? WHAT?
NICU PICU
SICU
MICU
CICU
Intensive Care Unit
Lets look inside a NICU…
NICU at Cook Children’s Fort Worth
http://www.youtube.com/watch?v=NZT-mnCzTvc
What’s a NICU?
• Neonatal Intensive Care Unit/Special Care Nursery
• For premature and critically ill term infants
• Different levels of care for newborns…Levels I-III– Level I: Lowest level of care (Newborn Nursery)
– Level II: Intermediate care—IV fluids, oxygen, “feeder growers”, CPAP, 32 wks gestation or greater
– Level III: Highest level of care• 23 weeks gestation or greater (generally)• Ventilators• Surgeries (sometimes in the unit!)—post operative
care• Nitrous oxide therapy, Extra Corporeal Membrane
Oxygenation (ECMO)– heart/lung bypass
A Real NICU
Who works there?
• Pediatricians• Neonatologists• NNPs, PNPs• Nurses• OT (feeding)• PT (positioning,
massage)• Child life specialist• Respiratory Therapy
• Pharmacist• Pharmacy Technicians• Lactation Consultants• Chaplains• And more!
Why do we need a special ICU for infants?
• In premature infants, every body system is underdeveloped
• What problems do you think that a baby would have with each body system?– Nervous?– Cardiovascular?– GI?– Immune?– Endocrine?– Respiratory?– Musculoskeletal?– Reproductive?– Urinary?
What problems would you see?
• Chronic lung disease of prematurity (BPD)
• Necrotizing enterocolitis• Jaundice• Meconium aspiration• Congenital heart defects• Apnea• Anemia• Intraventricular
Hemorrhage• Bradycardia
• Retinopathy of prematurity
• Sepsis• Hypothermia
Bronchopulmonary Dysplasia (BPD)
Developmental care
• Simulate a womb-like environment– Warm, humid, dark, quiet
• Developmental positioning to aid with neurologic and musculoskeletal development– Make the environment
less stressful
• Poor weight gain
and growth• Abnormal VS
Stress signals
• May be different than in term babies, children and adults
• Crying– Less common in the very ill
or very premature babies
• Frowning• Wrinkled forehead• Averted gaze
• Extended arms and legs• “Stop” hands• “Shut down”• Changes in vital signs
What stress cues are this baby displaying?
What is RIGHT with this picture?
The Goal…
Recommended