1 - Scope of Critical Care Nursing
1 - Scope of Critical Care Nursing
1 - Scope of Critical Care Nursing
- Critical care practice areas began to develop in the late 1960’s in response
to:-
Definition:
- The basis of the definition rests with the words human responses.
- This suggests that the critical care nurse is involved with prevention as
well
as cure.
a- a physiological phenomenon.
b - a psychological phenomenon.
- Ex: a critical care nurse can teach patient methods to lower blood
cholesterol levels, which may prevent a life-threatening problem.
- The needs of the critically ill are considerable. These needs may be
categorized as physical or non-physical
1- Physical needs:-
- are equated with basic physiological or biological needs for ex, for air,
nutrition, and elimination.
2- Non-physical needs:-
- The nature of critical care is such that physical needs are considered a
priority and are almost always met. However, the critical care environment
can actually obstruct the fulfillment of non-physical needs contributing to
the stressful nature of critical illness.
- The obstructed need for identity and social integrity may lead to the
development of a range of negative emotional or psychological status for
ex. Loss of self-esteem & confidence.
- Obviously the needs of the patient’s family and significant others must also
be considered and met as far as possible.
- If all the needs of the critically ill are to be met, both physical and non-
physical needs should be considered in planning holistic nursing care.
1- Assessment.
2- Clinical judgment.
- Since the clinical requirements of the critically ill are such that the team
caring for any single patient may consist of :-
- A social worker.
a- Research activity
b-Technological innovation.
- The safety of both patients and staff in the CCU is a primary consideration
in designing the milieu in which critical care nursing is carried out.
2-The setting within which critically ill patient receive care. Here critical
care management and administrative structure ensure effective care
delivery through provision of:-
- Legal,
- Regulatory,
- Social,
- Economic,
- Political factors.
- Critical care nurses are required to be competent in the use of a wide range
of technological devices, many of which are necessary for life support.
Stress
Stressor:
- Initial reaction, the defenses of the whole body mobilized and prepared to
action.
2- Stage of resistance:-
3- Stage of exhaustion:-
Coping:
or
Physiologic adaptation:
- Drop in eosinophils.
- Immunoglobulin assays.
- Blood pressure and heart rate and other indices of stress that may be
observed by others or by the person himself. (both physical and behavioral
changes)
1- Irregular pulse,
2- Hypotension,
3- Weakness,
4- ECG chances.
- This can pose special problems for the persons who has pulmonary and
cardiovascular problems because he will be unable to meet the O2 needs,
or to handle the circulatory demands.
- Also the selective vasoconstriction of the vessels that serve vital body
parts. E.g. Kidney cause ®
- Peripheral vasoconstriction.
- Gluconeogenesis, from Protein and fat will cause Blood sugar, this is
very dangerous for diabetics.
- Fluids must be given with great care to the severely stressed person.
(because of the increased intravascular volume) that cause ® (Fluid
overload, and ¯ urinary output).
A- Delirium.
B- Catastrophic reaction.
C- Euphoric response.
A- Delirium.
B- Catastrophic reaction.
C- Euphoric response.
- Pain.
- Fear of death.
- Presence of tubes.
- Monitors.
- Ventilators.
- Lack of sleep.
- Immobility.
- Isolation.
- Admission to the I. C. U.
- Too much light (sensory overload).
- Extreme of temp.
- Noise.
Coping patterns:
1- Pray.
2- Work off tension with physical activity.
3- Go to sleep.
4- Seek comfort or help from family or friends.
2- Fostering optimism:
3- Reassurance:
4- Listening:
5- Manipulating environment:
7- Drug therapy:
Delirium
Definition:-
Clinical manifestation:-
1- Disorientation,
2- Impaired short-term memory,
3- Altered sensory perceptions (hallucinations),
4- Abnormal thought processes,
5- Inappropriate behavior.
Incidence of delirium:-
Causes of delirium:-
1- Metabolic
2- Intracranial
3- Endocrine
4- Organ failure
5- Respiratory
6- Alcohol withdrawal
7- Heavy metal poisoning.
8- Drug related
9- Additional causes
1- Metabolic
- Acid-base disturbance,
- Electrolyte imbalance,
- Hypoglycemia.
2- Intracranial
- Epidural hematoma,
- Subdural hematoma,
- Intracranial hemorrhage,
- Meningitis,
- Encephalitis,
- Cerebral abscess,
- Tumor.
3- Endocrine
- Hyperthyroidism
- Hypothyroidism,
- Addison's disease,
- Hyperparathyroidism,
- Cushing's syndrome
4- Organ failure
- Liver encephalopathy,
- Uremic encephalopathy,
- Septic shock.
5- Respiratory
- Hypoxemia
- Hypercarbia.
6- Alcohol withdrawal,
8- Drug
- Digitalis,
- Antibiotics,
- Steroids,
- Beta adrenergic blockers,
- Respiratory stimulant.
9- Additional causes
- Sleep deprivation,
- Sensory deprivation
- Sensory overload,
- Immobilization,
- Age over 60 years old.
Forms of delirium:-
A- Hyperactive delirium
B- Hypoactive delirium
C- Mixed delirium
A- Hyperactive delirium
- Become violent;
- Be extremely restless .
- Remove invasive devices (intravenous lines, catheters, machines, and
dressings
- Try to get out of bed;
- Pick at things in the air;
- Call out of persons who are not there.
- Tachycardia,
- Dilatation of pupils,
- Diaphoresis,
- Facial flushing
B- Hypoactive delirium
Management:
A- Prevention
1- Backmassage,
2- Music therapy,
3- Noise reduction in the environment,
4- Decreasing lights at night to promote sleep,
5- Clustering nursing care to provide some uninterrupted rest periods,
6- Speaking in calm, quit, and gentle voice.
C- Pharmacologic strategies:-
1- Sedatives for short-term use are prescribed for patients with hyperactive
delirium.
- Less sedation
- Fewer anticholinergic effects
(e.g., dry mouth, constipation, urinary retention).