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    Critical Care Nursing: Debbie L. Dempel

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    Grace Nazareno
    The document provides an overview of the history and development of critical care nursing and intensive care units. It discusses key events and advances in critical care from the 1930s to present day. These include the emergence of recovery rooms in the 1930s, development of critical care units in the late 1950s, and establishment of the American Association of Critical-Care Nurses in 1969. The document also reviews common critical care technologies, patient problems, and the roles of critical care nurses including critical care nurse specialists.

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    Critical Care Nursing: Debbie L. Dempel

    Uploaded by

    Grace Nazareno
    96 views37 pages
    The document provides an overview of the history and development of critical care nursing and intensive care units. It discusses key events and advances in critical care from the 1930s to present day. These include the emergence of recovery rooms in the 1930s, development of critical care units in the late 1950s, and establishment of the American Association of Critical-Care Nurses in 1969. The document also reviews common critical care technologies, patient problems, and the roles of critical care nurses including critical care nurse specialists.

    Original Description:

    how to manage critical situations

    Original Title

    Critical Care

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    The document provides an overview of the history and development of critical care nursing and intensive care units. It discusses key events and advances in critical care from the 1930s to present day. These include the emergence of recovery rooms in the 1930s, development of critical care units in the late 1950s, and establishment of the American Association of Critical-Care Nurses in 1969. The document also reviews common critical care technologies, patient problems, and the roles of critical care nurses including critical care nurse specialists.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    96 views37 pages

    Critical Care Nursing: Debbie L. Dempel

    Uploaded by

    Grace Nazareno
    The document provides an overview of the history and development of critical care nursing and intensive care units. It discusses key events and advances in critical care from the 1930s to present day. These include the emergence of recovery rooms in the 1930s, development of critical care units in the late 1950s, and establishment of the American Association of Critical-Care Nurses in 1969. The document also reviews common critical care technologies, patient problems, and the roles of critical care nurses including critical care nurse specialists.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 37

    Critical Care Nursing

    Debbie L. Dempel

    History of Critical Care & ICUs


    1930s Introduction of Recovery
    Rooms
    WWII & Korean War Concepts of
    triage and specialty nursing
    Late 1950s beginning of Critical
    Care Units
    Early Technology
    2

    History Continued
    Collaboration between nurses and
    physicians
    1950s & 1960s CV Disease most
    common diagnosis
    1960s 30-40% mortality rate for MI
    1965 1st specialized ICU The
    Coronary Care Unit
    Emergence of Specialized ICUs
    3

    American Association of CriticalCare Nurses - AACN


    1969
    Educational
    support
    Certification
    Largest
    professional
    specialty nursing
    organization
    Scholarships

    Research
    Publishes 2
    journals
    Local chapters
    Political awareness
    Provides standards
    of practice

    Critical Care Now

    Critical Care Now


    Nursing shortage
    Half of patients in
    ICUs >65
    In US critical
    care beds account
    for 8% of all
    hospital beds

    20% of patients
    spends time in a
    critical care unit
    Downsizing
    Goal: provide high
    quality, holistic
    care

    Critical Care Technology


    ECG monitoring
    Arterial Lines
    Oxygen
    Saturation
    Ventilation
    Intracranial
    Pressure
    Monitoring

    Temperature
    Pulmonary Artery
    Catheter
    IABP
    VAD
    Extensive use of
    pharmaceuticals

    The Critical Care Nurse


    Specialty dealing with human
    responses to life-threatening
    problems
    Requires Extensive Knowledge and
    a Continual Desire to Learn

    CCRN
    Critical Care Certification by AACN
    Requires:
    Clinical hours working in an ICU
    Successful completion of an exam
    Requires continuing education and
    clinical hours for recertification

    Critical Care Clinical Nurse


    Specialist (CCNS)
    Advanced practice nurse
    Licensed by the State
    Five Roles of a CNS:

    Patient & staff educator


    Consultant
    Administrator
    Researcher
    Expert practitioner
    10

    Acute Care Nurse Practitioner


    (ACNP)
    Advanced practice nurse
    Licensed by the State
    Provides comprehensive care to
    select critically ill patients

    11

    The Critical Care Patient


    Physiologically Unstable
    At Risk for Serious Complications
    Require Intensive and Complicated
    Nursing Support and/or Advanced
    Technology

    12

    Common Problems of Critical


    Care Patients - Nutrition
    Address it early
    Goal: prevent or correct nutritional
    deficiencies
    Parenteral
    Enteral

    13

    Common Problems of Critical


    Care Patients - Anxiety
    70-80% of patients
    Indicators agitation, increased
    BP, increased HR, verbalization,
    restlessness
    Treatment

    14

    Common Problems of Critical


    Care Patients - Pain
    70% reported moderate to severe
    pain
    5th vital sign
    Leads to anxiety, agitation,
    increased myocardial oxygen
    consumption, delays wound
    healing
    15

    Common Problems of Critical


    Care Patients Impaired

    Patient on the ventilator


    Communication
    Use of medications
    Nursing Interventions

    16

    Common Problems of Critical


    Care Patients Sensory
    ICU Psychosis
    Really Delirium
    Perceptual
    Problems
    15-40% of patients
    Alteration in mentation
    Psychomotor behavior
    Alterations in sleep
    Predisposing factors
    17

    Common Problems of Critical


    Care Patients Sleep

    Poor sleep/wake cycles


    Deprivation
    Lack of REM sleep
    Predisposes patients for delirium
    Treatment

    18

    Family Need of the Critical Care


    Patient
    Information major source of
    anxiety and litigation
    Reassurance can reassure care is
    being given
    Convenience access to the
    patient

    19

    Arterial Lines
    Catheter placed in an artery
    Pressure from the artery is transmitted
    to a transducer by a column of fluid and
    converted in a pressure tracing
    Transducer must be placed at the
    Phlebostatic Axis 4th intercostal space
    Radial artery is the most common site

    20

    Phlebostatic Axis

    21

    Arterial Lines - Waveform


    Systole aortic valve opens, blood
    ejected from LV, sharp rise in
    waveform
    Dicrotic Notch closure of the
    aortic valve, signifies the beginning
    of diastole
    Diastole lowest point recorded on
    the waveform
    22

    Arterial Lines - Waveform

    23

    Pulmonary Artery Catheter


    (Swan-Ganz Catheter)
    Evaluate heart disease, shock states,
    compromised CO, and fluid status
    Also used to evaluate a patients
    response to treatment
    Catheter placed through a central
    vein to the right atrium, right
    ventricle, and into the pulmonary
    artery
    24

    Pulmonary Artery Catheter


    (Swan-Ganz Catheter)
    Measures Intracardiac Pressures
    Measures Cardiac Output
    Able to Obtain Mixed Venous Blood
    Samples

    25

    Pulmonary Artery Catheter


    (Swan-Ganz Catheter)
    1.
    2.
    3.
    4.
    5.

    Pulmonary Artery Port


    Central Venous Port
    Injectate Port
    Thermister Connection
    Balloon Inflation Valve

    26

    PA Catheter

    27

    PA Catheter Insertion

    28

    Preload
    Volume within a cardiac chamber at
    the end of diastole
    Pulmonary Capillary Wedge Pressure
    estimates the left ventricular enddiastolic pressure, 6-12 mm Hg
    Central Venous Pressure right
    ventricular end-diastolic pressure, 28 mm Hg
    29

    Afterload
    Refers to the forces that oppose
    ventricular ejection
    Systemic arterial pressure,
    resistance of the aortic valve, and
    mass and density of the blood
    Systemic Vascular Resistance

    30

    Cardiac Output
    Volume of blood pumped by the
    heart in 1 minute
    Normal: 4-8 L/minute
    Doesnt take into account body size
    More specific is Cardiac Index size
    adjusted by Body Surface Index

    31

    Intraaortic Balloon Pump (IABP)


    Balloon Catheter placed in the
    descending thoracic aortic arch
    Balloon inflation timed to begin to
    inflate at the time the aortic valve
    closes time of early diastole
    dicrotic notch

    32

    IABP
    Augments aortic pressure and
    forward flow
    Increases coronary perfusion
    When balloon deflates at end of
    diastole and aortic valve opens
    negative pressure pulls blood
    forward
    33

    A: Systole-balloon
    Deflated, facilitates
    Ejection of blood to
    Periphery
    B: Early diastole
    Balloon begins to
    Inflate
    C: Late diastole
    Balloon is totally
    Inflated, augments
    Aortic pressure &
    Increases coronary
    perfusion
    34

    IABP - Goals
    Support patients with inadequate
    CO
    Support patients with inadequate
    BP

    35

    IABP Common Indications


    1.
    2.
    3.
    4.

    Cardiogenic shock
    Left ventricular failure
    Cardiomyopathy
    Bridge to transplant

    36

    IABP - Contraindications
    Aortic aneurysm
    Aortic dissection
    Severe PVD
    Aortic Valve Insufficiency

    37

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