CLINICAL SPECIALITY – II

MEDICAL SURGICAL NURSING - CRITICAL CARE NURSING

Placement : Theory :- III Semester

Practical :-IV Semester Hours of instruction
Theory: 150 hours
Practical: 950 hours
Total : 1100 hours

Course Description

This course is designed to assist students in developing expertise and in-to develop advanced
skills for nursing intervention in caring for critically ill patients. It will enable the student to
function as critical care nurses practitioner/ specialist. It will further enable the student to
function as educator, manager and researcher in the field of Critical Care Nursing.Objectives

At the end of the course the students will be able to

1. Appreciate trends and issues related to Critical Care Nursing

2. Describe the epidemiology, etiology, pathophysiology and diagnostic assessment of
critically ill patient.
3. Describe the various drugs used in critical care and nurses responsibility
4. Perform physical, psychosocial & spiritual assessment
5. Demonstrate advance skills/competence in managing critically ili patients including
Advance Cardiac Life Support
6. Demonstrate skill in handling various equipments/gadgets used critical care
7. Provide comprehensive care to critically ill patients
8. Appreciate team work & coordinate activities related to patient care
9. Practice infection control measures
10. Assess and manage pain
11. Identify complications & take appropriate measures
12. Discuss the legal and ethical issues in critical care nursing
13. Assist patients and their family to cope with emotional distress spiritual, grief and
anxiety.
14. Assist in various diagnostic, therapeutic and surgical procedures.
15. Incorporate evidence based nursing practice and identify the areas of research in the field
of critical care nursing
16. Identify the sources of stress and manage burnout syndrome among health care providers
17. Teach and supervise nurses and allied health workers
18. Design a layout of ICU and develop standards for critical care nursing practice.
Unit Hours Content Distribution of
HRS
I 5 Introduction to Critical Care Nursing 1
Historical review- Progressive patient care(PPC)
Review of anatomy and physiology of vital organs, fluid 1
and electrolyte balance
Concepts of critical care nursing Principles of critical 1
care nursing, Scope of critical care nursing
Critical care unit set up including equipments supplies, 2
use and care of various type of monitors & ventilators
Flow sheets
II 10 Concept of Holistic care applied to critical care nursing 1
practice
Impact of critical care environment on patients:- 1
• Risk factors, Assessment of patients, Critical care 3
psychosis, prevention & nursing care for patients
affected with psycho physiological & psychosocial
problems of critical care unit,
Caring for the patient’s family, family teaching The 3
dynamics of healing in critical care unit:-therapeutic touch,
Relaxation, Music therapy, Guided Imagery, acupressure
Stress and burnout syndrome among health team members 2

III 14 1
Review Pharmacokinetics
Analgesics/Anti inflammatory agents 1
Antibiotics, antiseptics 1
Drug reaction & toxicity 1
Drugs used in critical care unit (inclusive of ionotropic, life 2
saving drugs)
Drugs used in various body systems 4
IV fluids and electrolytes 1
Blood and blood components 2
Principles of drug administration role of nurses and care of 1
drugs
IV 5 Pain Management 1
Pain & Sedation in Critically ill patients
Theories of pain, Types of pain, Pain assessment, 1
Systemic responses to pain 1
pain management-pharmacological and non- 2
pharmacological measures Placebo effect
V 5 Infection control in intensive care unit 1
Nosocomial infection in intensive care unit; methyl 2
resistant staphylococcus aureus (MRSA),
Disinfection, Sterilization, Standard safety measures, 2
Prophylaxis for staff
VI 10 Gastrointestinal System 3
Causes, Pathophysiology, Clinical types,Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and
Nursing management of:
-Acute Gastrointestinal Bleeding, Abdominal injury,
Hepatic Disorders:-Fulminent hepatic failure, 2
Hepatic encephalopathy, 1
Acute Pancreatitis, 1
Acute intestinal obstruction, 2
perforative peritonitis 1
VII 10 Renal System Causes, pathophysiology, Clinicaltypes, 2
Clinicalfeatures, diagnosis, Prognosis, Management:
Medical, Surgical and Nursing management of
Acute Renal Failure, Chronic Renal Failure,
Acute tubular necrosis, Bladder trauma 2
Management Modalities: Hemodialysis, Peritoneal 2
Dialysis, Continuous Ambulatory Peritoneal Dialysis, 2
Continuous arterio venus hemodialysis,
Renal Transplant 2
VIII 10 Nervous System 2
Causes,pathophysiology,Clinicaltypes,Clinicalfeatures,
diagnosis, Prognosis, Management: Medical, Surgical and
Nursing management of:-Common Neurological
Disorders:-
Cerebrovascular disease,
Cerebrovascular accident, Seizure disorders,
GuilleinBarre-Syndrome, Myasthenia Gravis, 2
Coma, Persistent vegetative state, Encephalopathy, 1
Head injury, Spinal Cord injury 1
Management Modalities: Assessment of Intracranial 2
pressure, Management of intracranial hypertension,
Craniotomy
Problems associated with neurological disorders: Thermo 2
regulation, Unconsciousness, Herniation syndrome
IX 5 Endocrine System 30min
Causes, Pathophysiology, Clinical types, Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and
Nursing Management of :-
Hypoglycemia, Diabetic Ketoacidosis,
Thyroid crisis, Myxoedema, Adrenal crisis, Syndrome of 30min
Inappropriate/ hypersecretion of Antidiuretic Hormone 30min
(SIADH)
Management of other Emergency Conditions 30min
Mechanism of injury, Thoracic injuries, Abdominal injuries, 30min
pelvic fractures, complications of trauma, Head injuries
Shock: Shock syndrome, Hypovolemic, Cardiogenic, 1
Anaphylactic, Neurogenic and Septic shock
Systemic inflammatory Response: The inflammatory 30min
response, Multiple organ dysfunction syndrome
Disseminated Intravascular Coagulation 30min
Drug Overdose and Poisoning, 30min
Acquired Immunodeficiency Syndrome (AIDS) 1

X 15 Ophthalmic: Eye injuries, 2

Glaucoma, 1
retinal detachment 1
Ear Nose Throat: Foreign bodies, 1
stridor, 1
bleeding, 1
quinsy, 1
acute allergic conditions 1
Psychiatric emergencies 2
suicide, 2
crisis intervention 2
XI 20 Cardiovascular emergencies 1
Principles of Nursing in caring for patient’s with
Cardiovascular disorders
Assessment: Cardiovascular system: Heart sounds, 1
Diagnostic studies:- Cardiac enzymes studies, 1
Electrocardiographic
monitoring, Holter monitoring, Stress test. Echo
cardiography, Coronary angiography, Nuclear medicine
studies
Causes, Pathophysiology, Clinical types, Clinical features,
Diagnostic Prognosis, Management : Medical, Surgical &
Nurisng
 management of:- 2
Hypertensive crisis, Coronary artery disease,
Acute Myocardial infarction,
Cardiomyopathy, Deep vein thrombosis, Valvular diseases, 2
Heart block, Cardiac arrhythmias & conduction
disturbances,
Aneurysms, Endocarditis, Heart failure 2
Cardio pulmonary resuscitation BCLS/ ACLS 1
Management Modalities: Thrombolytic therapy, 2
Pacemaker – temporary & permanent,
Percutaneous transluminal coronary angioplasty, 2
Cardioversion, Intra Aortic Balloon pump monitoring, 2
Defibrillations,
Cardiac surgeries, Coronary Artery Bypass Grafts 2
(CABG/MICAS), Valvular surgeries,
HeartTransplantation, Autologous blood transfusion, 2
Radiofrequency Catheter Ablation

XII 15 Respiratory System 1

Acid-base balance & imbalance Assesment : History &
Physical Examination
Diagnostic Tests:Pulse Oximetry, End –Tidal Carbon 1
Dioxide
Monitoring, Arterial blood gas studies, chest radiography, 2
pulmonary Angiography, Bronchoscopy, Pulmonary
function Test, Ventilation perfusion scan, Lung ventilation
scan
Causes Pathophysiology, Clinical types, Clinical features, 2
Prognosis, Management: Medical,SurgicalandNursing
management of Common pulmonary disorders:-
Pneumonia, Status asthmaticus, interstitial drug disease,

Pleural effusion, Chronic obstructive pulmonary disease, 2

Pulmonary tuberculosis, 2

Pulmonary edema, Atelectasis, Pulmonary embolism,

Acute respiratory failure, Acute respiratory distress 1
syndrome (ARDS),
Chest Trauma Haemothorax, Pneumothorax 1
Management Modalities:-Airway Management 1
Ventilatory Management:-Invasive, non- invasive, long
term mechanical ventilations
 Bronchial Hygiene:-Nebulization, deep breathing exercise, 1

chest physiotherapy, postural drainage, Inter Costal 1

Drainage, Thoracic surgeries

XIII 7 Burns 1
Clinical types, classification, pathophysiology, clinical
features, assessment, diagnosis, prognosis, Management:
Medical, Surgical & Nursing management of burns
Fluid and electrolyte therapy – calculation of fluids and its
administration
Pain management 1
Wound care 1
Infection control 1
Prevention and management of burn complications 1
Grafts and flaps 1
Reconstructive surgery
Rehabilitation 1

XIV 5 Obstetrical Emergencies 2

Causes, Pathophysiology, Clinical types, clinical features,
diagnostic Prognosis, Management: Medical, Surgical and
Nursing management of :Antepartum haemorrhage, Post
partum haemorrhage,
Preeclampsia, eclampsia, 1
Obstructed labour and ruptured uterus, Peurperal sepsis, 2
Obstetrical shock

XV 10 Neonatal Paediatric emergencies 2

Causes, pathophysiology, Clinical types, Clinical features,
diagnostic, Prognosis , Management: medical, surgical and
Nursing management of
• Neonatal emergencies
Asphyxia Neonatarum, Pathological Jaundice in Neonates,
Neonatal seizures, Metabolic disorders, Intra cranial 2
Hemorrhage,
NeonatalSepsis,RDS/HMD(RespiratoryDistress 2
Syndrome/Hyaline Membrane Disease),
Congenital disorders:- 2
• Cyanotic heart disease, tracheo oesophageal fistula,
congenital hypertropic pyloric stenosis, imperforate anus
 • Pediatric emergencies 2
Dehydration, Acute broncho pneumonia, Acute respiratory
distress syndrome, Poisoning, Foreign bodies, seizures,
traumas, Status asthmaticus

XVI 2 Legal and ethical issues in critical care-Nurse’s role 1

Brain death
Organ donation & Counselling
Do Not Resuscitate(DNR) 1
Euthanasia
Living will

XVII 2 Quality assurance 1

Standards, Protocols, Policies, Procedures
Infection control; Standard safety measures
Nursing audit 1
Staffing
Design of ICU/CCU

Practical Total = 960 Hours

1 Week = 30 Hours

SR.NO. Dept.Unit No.of Weeks Total Hours

1 Burns ICU 2 60 Hours

2 Medical ICU 8 240 Hours

3 Surgical ICU 12 360 Hours

4 CCU 2 60 Hours

5 Emergency Department 3 90 Hours

6 Dialysis Unit 1 30 Hours

7 Transplant Room 2 60 Hours

 8 Paediatric/ NICU 2 60 Hours

Total 32 Weeks 960 Hours

Biblography
1. P.G.Mortan “Critical care NSG” 8th edition, 2005 Lippincott Williams and nel kins.
2. Sheree Comer Delumer’s “Critical care NSG care plan” 2nd edition, 2005 Thomson.
R.J. Vakil “ Gastrontorolgy Dennis Kason”.
3. Marvynsinger “OxFord Haudbook of Critical Care” 2nd edition, 2005 Oxford
University press. “M.S. Baird Manual of Critical Care” NSG 5th edition 2005 Elsevier.
4. Janeb HGicks Keen “ Critical Care Nursey Consultant Mosby” 1997
Jaya Kurvella “Essentials of oritical NSGJaypee Brothers Number 2007
5. Thresyamma, C.P “Operating Room Technique and Anesthesia for General Nursing
Course “2nd edition,Jaypee Brothers Medical Publisher.

1. Kuruvilla, Jaya “ Esentials of Critical Care Nursing”, 1st edition, Jaypee Brothers
Medical Publisher.
2. Davidson “ Davidson’s Principles and Practice of Medicine”,20th edition, Churchil
Lvingstone.
3. Dennis, L.K “ Harrison’s Principles of Internal Medicine. Vol.-2,16th edition,
McGraw- Hill Medical Publishing.
4. Marion, Paul “The I.C.U. Book” 3rd edition Lippincott Williams.
5. Taylor, Carol “Fundamentals of Nursing: The art and Science of Nursing Care”
5th edition With CD – ROM, Lippincott Williams.
6. Potter, P “Fundamentals of Nursing” 6th edition With CD –ROM, Mosby.
7. Potter, P “ Basic Nursing : Essentials fro Practice” 6th edition With CD-ROM, Mosby.
8. Joshi, Y.K.” Basic of Clinical Nutrition” 1st edition, Jaypee Brothers Med. Publiers.
9. Black, J” Medical Surgical Nursing : Clinical Management for Positive outcomes”,
Vol-1,7th edition. Saunders, Elsevier.
10. Black, J “ Medical Surgical Nursing : Clinical Management for Positive outcomes”,
Vol-2,7th edition With CD-ROM, Saunders, Elsevier.
11. Behram, R “Nelson Textbook of Pediatric” 17th edition, Saunders.
12. Rang, H.P” Pharamcology” 5th edtion, Churchil Livingstone.
13. Smelter’s “Brunner and Suddarths Textbook of Medical Surgical Nursing” 10th
 Edition ,With CD-ROM, Lippincott Williams.
14. White, L. Duncan “ Medical Surgical Nursing : An Integrated Approach, 2 nd edition,
Delmar.
15. M.S. Baird, Manual of Critical care Nursing 5th ed, Elsevier,2005.
16. P.G.Morton :Critical Care Nursing 8th ed. Lippincott Villiams and wilkins, 2005
17. Sheree Comer: Delmar’s Critical care Nursing care plans:2nd Ed.

Journals :- 1.Critical care nursing : AACN

2.Critical Care Nursing Clinic

ESSENTIAL CRITICAL CARE NURSING SKILLS

I. Procedures Observed

1.CT Scan
2. MRI
3. EEG
4. Hemodialysis
5. Endoscopic Retrograde cholangio Pancreaticogram(ERCP)
6. Heart/ Neuro/GI./ Renal Surgeries

II. Procedures Assisted

1.Advanced life support system

2.Basic cardiac life support
3.Arterial line/arterial pressure monitoring/blood taking
4.Arterial blood gas
5. ECG recording
6. Blood transfusion
7. IV cannulation therapy
8. Arterial Catheterization
9. Chest tube insertion
10. Endotracheal intubations
11. Ventilation
12.Insertion of central line/cvp line
13. Connecting lines for dialysis

III. Procedure Performed

1. Airway management
a. Application of oropharyngeal airway
 b. CPAP (Continuous Positive Airway pressure)
c. Care of tracheostomy
d. Endotracheal extubation
2. Cardiopulmonary resuscitation, Basic cardiac life support, ECG
3. Monitoring of critically ill patients – clinically with monitors, capillary refill time (CRT)
assessment of jaundice, ECG
4. Gastric lavage
5. Assessment of critically ill patients

Identification & assessment of risk factors, Glasgow coma scale and dolls eye movement, arterial
pressure monitoring, cardiac output/pulmonary artery pressure monitoring, and detection of
life threatening abnormalities

6. Admission & discharge of critically ill patients

7. Nutritional needs – gastrostomy feeds, pharyngeal feeds, jejunostomy feeds, TPN, formula
preparation & patient education
8. Assessment of patient for alteration in blood sugar levels monitoring blood sugar levels
periodically & administering insulin periodically
9. Administration of drugs: IM, IV injection, IV cannulation & fixation of infusion pump,
calculation of dosages, use of insulin syringes tuberculin, monitoring fluid therapy, blood
administration.
10. Setting up dialysis machine and starting, monitoring and closing
dialysis
11. Procedures for prevention of infections:
Hand washing, disinfection & sterilization surveillance and fumigation universal precautions.
12. Collection of specimen.
13. Setting, use & maintenance of basic equipment, ventilator,O2 analyzer, monitoring
equipment, transducers, defibrillator, infusion & syringe pumps, centrifuge machine.

IV Other Procedures:

Evaluation Criteria:

Theory:

Unit test I 25 marks

Prefinal 100 marks

Seminar (2) 100 marks each

Written assignment 25 marks

Project 100 marks

Total marks 450 marks (send university out of 100)

Practical:

Unit test I 25 marks

Prefinal 100 marks

Nursing procedure 50 marks

Clinical assignments

 Case study (2) 50 marks each

 Case presentation (2) 50 marks each
 Care plan (3) 50 marks each
 Clinical evaluation (2) 100 marks each
Total marks 725 marks (send university out of 100)

University Examination:

Theory: 100
Practical: 100

Dr D Y Patil College of Nursing

M Sc Nursing
Evaluation criteria for Case study

Name of the student:

Topic:
Date of submission:

Sr No Criteria Marks allotted Marks obtained

1 Assessment 05

2 Theoretical knowledge about 05

disease
3 Comparative study of patient’s 10
disease & book picture
4 Management: Medical/surgical 05

5 Nursing process 15

6 Drug study 03

7 Summary & conclusion 05

including research evidence
8 Bibliography 02

Total 50

Remark
Signature of student Signature of evaluator
Date Date

Dr D Y Patil College of Nursing

M Sc Nursing
Evaluation criteria for Care Plan

Name of the student:

Topic:
Date of submission: Field of placement:

Sr No Criteria Marks allotted Marks obtained

1 Assessment 12

2 Nursing diagnosis 3

3 Goal 2

4 Outcome criteria/Objective 2

5 Nursing intervention 15

6 rationale 03

7 Evaluation 03

8 Nurses notes 10

Total 50

Remark
Signature of student Signature of evaluator
Date Date

Dr D Y Patil College of Nursing

M Sc Nursing
Evaluation criteria for Case presentation

Name of the student:

Name of the patient:
Diagnosis:
Ward:
Date of presentation:

Sr No Criteria Marks allotted Marks obtained

1 Subjective & objective data 08

2 Problem & need identified & 15

nursing care plan
3 Effectiveness of presentation 05

4 Corelation with patient & book, 10

research evidence
5 Use of A. V. aids 05

6 Physical arrangement 02

7 Group participation 03

8 Bibliography 02
 Total 50

Remark

Signature of student Signature of evaluator

Date Date

DR.D.Y.PATI COLLEGE OF NURSING PIMPRI , PUNE-18.

EVALUATION CRITERIA FOR SEMINAR PRESENTATION

Subject:
Date:

Name of student: Time:

Group: Maximum Marks: 100

S.No. Criteria Rating Remarks

1 2 3 4 5

1. Content

Introduction

2. Organization of Content

3. Presentation of topic

4. Relevant examples
 5. Relevant statistical data

6. Group participation

7. Control of group

8. AV Aids:

Appropriate to subject

9. Proper use of A/V Aids

10. Self explanatory

11. Attractive

12. Planning and preparation

13. Use of Modern technology

14. Physical facilities:

Environment

15. Classroom preparation

16. Over lay out

17. Personal Appearance:

Voice & clarity

18. Mannerisms

19. Conclusion

20. References

Remarks & signature of supervisor:

Signature of student:

DR. D. Y. Patil College of Nursing, Pimpri, Pune-18

M. Sc. Nursing

Evaluation Criteria for Written Assignment

Total Marks = 25

S.N. Criteria Marks

1. Content 10
2. Organization 05
3. Resources used 03
4. Completeness 03
5. Neatness 02
6. Bibliography 02
Total 25

Remarks: - Total:-
 Date & Signature of the Evaluator: Date & Signature of the student

CLINICAL EVALUATION: - COMPREHENSIVE NURSING CARE

(maximum marks – 100 each area)

Name of the students

Year :- II semester M.Sc Nursing Duraration of Experience :

SR.No. Criteria 1 2 3 4 5

I Understanding of patient as person

A.Approach

1. Rapport with patient / family members.

2.Collects significant information

B.Understanding of patient’s health problems.

1.knowledge about disease condition.

2. knowledge about investigations.

3. knowledge about treatment.

 4.knowledge about progress of the patient.

II Nursing care plan

A.Assessment of the condition of the patient .

1. History taking –past & present health and illness

2.specific observation of the patient

3.Nursing diagnosis

B.Development of the short – term & long term nursing care plans.

1.Indentification of all problems in the patient family.

2. Priritization 7 implementation of the plans.

3. Evaluation of the care given & re-planning

III Technical skill

1.Economical & safe adaptation to the situation & available facilities.

2.Implements the procedure with skill speed & completeness.

IV Recording & Reporting

1.Prompt, Precise , accurate & relevant.

2.Maintanance of clinical experience file.

V Health Teaching

1.Incidental/ Planned teaching with principles of teaching & learning.

2.Uses visual aids appropriately

VI Personality
 1. Professional appearance (Uniform, dignity, tact fullness
interpersonal relationship , ,Punctuality etc.

2. Sincerely, honesty & sense of responsibility

Total Marks

Comments

Signature of student signature of clinical supervisor