SHARDA SCHOOL OF NURSING SCIENCE AND RESEARCH

SHARDA UNIVERSITY

Observation Report of Intensive Care Unit

Submitted To Submitted By
Ms . Anam Mohammed Saleem Shreya Pandey
Assistant Professor. Msc (N)1st year.
Medical Surgical Nursing 2023538791
SSNSR

Submitted on
 INTENSIVE CARE UNIT
INTRODUCTION
Intensive care units (ICUs) is an integral part of the health care system. Icu is highly specified
and sophisticated area of a hospital which is specifically designed , staff , located furnished
and equipped, dedicated to management of critically sick patient, injuries or complications.
ICUs are also distinguished from general hospital wards by a higher staff-to-patient ratio and
access to advanced medical resources and equipment that is not routinely available
elsewhere. Common conditions that are treated within ICUs include acute respiratory distress
syndrome, septic shock, and other life-threatening conditions. Intensive care units (ICUs) are
specialist hospital wards that provide treatment and monitoring for people who are very ill.
The design of ICU requires not only a knowledge of regulatory standards but also the
expertise of critical care practionaiers who are families with special needs of this patient
population.
In 1988 the society of critrical care medicine developed guidelines for the design of ICUs.
ICU teams are multi-disciplinary, made up of highly skilled intensive care nurses, doctors
and specialists trained in providing critical care for patients with a variety of medical,
surgical and trauma conditions.All hospital ICUs specialise in providing care for particular
health conditions or injuries including:

• major trauma
• severe burns
• respiratory failure
• organ transplants
• complex spinal surgery
• cardiothoracic surgery.
• Neuro surgery
• Orthopaedics surgery.

FUNCTIONS OF ICU
• Close observation and treatment of critically ill patients
• To provide specialized treatment with specialized manpower and equipment
• To utilize staff more effectively and efficiently
• Care for post-surgical operations
• Provide care for medical emergency
• Provide care for cardiac emergency
• To provide support to critically ill patients

OBJECTIVES:
• Learn physical setup, routine and policy of the ward.
• Collect the relevant data through history taking and physical assessment.
• Monitor the patient on the ventilator.
• Learn about Endotracheal intubation and perform endotracheal suctioning.
• Administer fluid with infusion pump.
• Administer medication through IM, IV routes and inhalation safely.
• Demonstrate skills in calculating drug doses, flow rates and fluid requirements.
• Perform nasogastric tube and orogastric tube intubation for feeding.
• Participate in team work
 • PHYSICAL SETUP / LAYOUT

\ CENTRALIZED OXYGEN VENTILATOR AND SUCTION NURSING

STATION

VEN
TILA
TOR VEN
VEN TILA
VEN
BED TILA
TOR BED BED TILA
TOR BED
TOR

BED
STORE ROOM

SICU

CRASH CART

TROLLEY

MICU
STORE
RECORDS
AND
REGESTERS

DOCTOR’S
ROOM

ICU OBSERVATION

COLOR
CODED
DUSTBIN
ENTRANCE

Doctor’s room

WASH ROOM
STAFFING PATTERN
Head of the department:

UNIT-I:
Head of the unit:2
Professor:3
Assistant professor:2
Junior Resident:1
UNIT-II:
Head of the unit:2
Professor:3
Assistant professor:2
Senior resident:2
Junior Resident:1
NURSING STAFF:
DNS: 1
ICU In-
charge:2
Staffs:45
CHANNEL OF COMMUNICATION

HEAD OF THE DEPARTMENT

PROFESSOR

ASSOCIATE PROFESSOR

ASSISTANT PROFESSOR

SENIOR RESIDENT

POST GRADUATES

STAFF NURSES

Fig: CHANNEL OF COMMUNICATIONS

1. SIZE OF ICU: The ideal ICU size cannot be stated but six to ten beds is
desirable. ICU with less than 4 beds risk inefficiency and ICU with greater
than 16 beds may be difficult to manage, if not properly divided. For the ward,
beds up to 25 and a ICU of six to eight beds is ideal. Additional beds may be
required if divided into MICU, PICU, NICU,SICU, and isolation ICU.

2. SPACE: Each patient should be provided with minimum area of 100 sq. feet
with four feet minimum between two patients.

3. Design of ICU:
➢ It is recommended that the minimum floor area for a one bedroom
should be 100 square feet and for two beds rom 160nsquare feet.
➢ It has been found in practice that these areas are minimal and donot
provide sufficient space for working around the patient and moving
beds and stretchers.
➢ Recommended areas are 125 and 190 square feet.

4. FLOOR PLAN: The unit facility should be in square space so that abundant
open unencumbered space is available. The walls should be made of washable
glazed tiles and windows should have 2 layers of glass panes to ensure some
measure of heat and sound.

5. VENTILATION: Effective air ventilation is essential to reduce nosocomial

infection. Most satisfactory ventilation is maintained with laminar air flow
system which is rather expensive. A constant airway pressure should be
maintained in ICU so that contaminated air from corridor does not enter into
ICU.

6. LIGHTING: ICU must be well illuminated and painted white or slightly off
white to permit prompt or early detection of jaundice and cyanosis.

7. ENVIRONMENTAL TEMPERATURE AND HUMIDITY: The

temperature should be maintained around 26 to minimize the effect of thermal
stress or effect on patients.

8. HANDLING AND SOCIAL CONTACT: Gentle handling, soothing words,

and meeting with the family and relatives should be provided.

9. COMMUNICATION SYSTEM: ICU complex should be provided with

intercom system so that additional practitioner can be called for help in case of
emergency.

10. CRASH CART: A crash cart with emergency drugs and portable monitor/
defibrillator should be readily accessible. Zones should be provided for
 medication preparation and cabinets should be available for the storage of
medications and supplies.

11. NURSES STATION: Every ICU nursing unit has its own nursing station,
preferably situated centrally within the unit. As a general rule, rooms designed
for the sickest patients should be nearest to the nursing station. It is also
determined by the hospital’s general plan for controlling visitors.

12. ELECTRICAL OUTLET: There should be adequate number of electric

points. Use of adaptor and extensions boards should be discouraged. Electrical
equipment should be checked at least once a month for leakage of current and
adequacy of grooming special fitting with safety devices should be installed.

13. ISOLATION ROOM: It is essential to provide with one or more isolation

rooms for patients with known or suspected infection. The room should have
only one bed and should have an enter room with gowning and masking
facilities, sink with hand washing facilities without the use of hands, foot
operated waste receptable and smaller cabinets for clean gowns, masks, etc.
The isolation rooms is remoted for other rooms.

14. ACOUSTIC CHARACTERISTICS: It is desirable to have effective sound,

proofing of ceiling, door and floor instead of air compressor, centralized
sources of compressed air, oxygen suction should be provided.

15. WASTE DISPOSAL: Mechanism of disposal of contaminated waste

(segregation of garbage and contaminated medical waste) and adequate
disposal of needles and sharp objects needs to be as per standard applicable
pollution control guidelines.

❖ EQUIPMENTS IN ICU
1. Ventilator
2. Pulse oximeter
3. Syringe pumps
4. Infusion pump
5. NIBP and spo2 monitor
6. FiO2 monitor
7. Central O2 air suction supply
8. CPAP
9. Multipara monitors
10. ADULT-PUFF T-piece resuscitation
11. Peripheral IV set
12. Feeding tubes
13. Suction tubes
14. Laminar air flow
15. Boiler
16. Suction machine
 ❖ ORGANIZATION AND STAFFING IN ICU
Medical director/ intensive unit in charge should be a internist, trained and experienced in
critical care of patients with following responsibilities:
1. Establishing policies and protocols
2. Smooth functioning of ICU with implementation of policies and protocols including
admission and discharge criteria.
3. Quality assurance and improvement
4. Establishing teaching and training system of medical, nursing and auxiliary staff
5. Maintaining ICU statistics for mortality and morbidity
6. Being member of infection control committee.

❖ STAFFING REQUIREMENTS
• Intensivist/s
• Resident doctors
• Nurses
• Physiotherapists
• Technicians
• Biomedical engineer
• Clinical pharmacist
• Social worer
• Other supporting staffs like helper, sweeper, guards, etc.
S.NO REGISTER PURPOSES
1. Census register To maintain the record of total number of patients of the
ward including admissions, discharges and deaths.

2. Report register To maintain the record of progress or any change in the

patient’s treatment and condition.

3. Treatment To maintain the record of the treatment of patients. It

includes drug name, dose, frequency and route. It is
used by both nurse and doctors.

4. IPD register To maintain the record of IPD, OPD numbers allotted to

the patients as well as to record the complete address of
the admitted patients.

5. Round register To maintain the record of any special orders related to

change in the treatment of patients given by Seniors
doctors in rounds. This register is maintained by both
doctors and nurses.

6. Death register To record the total deaths of the patients with date, time,
cause of death mentioned.

7. Discharge register To record the data of discharged patients.

8. Call register To maintain the record of calls sent to other department

for consulting regarding the diseased conditions of the
patients.

IMPORTANT PROCEDURE RESUSCITATIONS IN ICU

➢ Lumbar puncture
➢ Cricothyrotomy
➢ Cardiopulmonary resuscitation
➢ Endotracheal intubation
➢ CPAP,NIV
➢ Nasogastric tube insertion
➢ Orogastric tube insertion
➢ Blood transfusion
➢ IV cannulation
➢ Sampling
CONCLUSION
I, Shreya Pandey a, student of M.sc (N), 1st year, was posted in 2nd floor ICU from 1/12/023
to 08/12/023. ICU is well equipped with ventilators, defibrillators, etc. All
the staff members well trained and corporative. I learned various important procedures like
observe throracotrachesotomy procedure, endotracheal intubation, collecting ABG sample
and processing ,CPAP, NIV, application of DVT cuff, etc.