IN1LNSIVL CAkL UNI1 Argu|||a Chr|st|ne Ioy L Maca||nta| 8yron Lou|e C Mora|es kyan 1 edro kando|f Iay A 1agu|nod 8ongbong A 8ackground Abstract Introduct|on 1ypes of |ntens|ve care un|t About cr|t|ca| care nurs|ng ICU equ|pments Scenar|o Conc|us|on As advances have been made ln medlclne and Lechnology paLlenL care has become much more complex 1o provlde approprlaLe care nurses needed speclallzed knowledge and skllls whlle care dellvery mechanlsms also needed Lo evolve Lo supporL paLlenLs' needs for conLlnuous monlLorlng and LreaLmenL 1he flrsL lnLenslve care unlLs emerged ln Lhe 1930s as a means Lo provlde care Lo very slck paLlenLs who needed oneLoone care from a nurse lL was from Lhls envlronmenL LhaL Lhe speclalLy of crlLlcalcare nurslng emerged rlLlcal Lhlnklng helps Lhe nurse Lo navlgaLe Lhe complex and sLressful envlronmenL of Lhe lD rlLlcal Lhlnklng lncludes more Lhan [usL nurslng knowledge lL lncludes Lhe ablllLy Lo Lhlnk Lhrough complex mulLlfaceLed problems Lo anLlclpaLe needs recognlze poLenLlal and acLual compllcaLlons and Lo experLly communlcaLe wlLh Lhe Leam A nurse who ls able Lo Lhlnk crlLlcally wlll glve beLLer paLlenL care varlous sLraLegles can be used Lo develop crlLlcal Lhlnklng ln lD nurses nurse leaders are encouraged Lo supporL Lhe developmenL of crlLlcal Lhlnklng skllls ln less experlenced sLaff wlLh Lhe goal of lmprovlng Lhe nurses ablllLy Lo work ln Lhe lD and lmprovlng paLlenL ouLcomes rlLlcal care nurslng provldes care for paLlenLs LhaL are serlously lll and rellanL on llfe supporL equlpmenL for Lhelr recovery rlLlcal care nurslng can cover a varleLy of seLLlngs lncludlng coronary care emergency and hlgh dependency nurslng areas 1he crlLlcal care nurse worklng ln Lhe lnLenslve care unlL essenLlally cares for one paLlenL and Lhelr famlly 1hese characLerlsLlcs requlre nurslng sLaff Lo dlsplay unlque quallLles and hlgh levels of crlLlcal Lhlnklng boLh as lndlvlduals and as parL of a Leam 1he lD ls a place of hlgh paLlenL aculLy complex paLhologles and mulLlple unknowns" % WhaL klnd of admlsslons wlll arrlve Loday? % When wlll Lhey arrlve? % Pow acuLely lll wlll Lhey be? % WhaL slgns/sympLoms of paLhologles wlll paLlenLs presenL wlLh? % Pow many wlll requlre lmmedlaLe llfesavlng measures? % WhaL Lype and how many monlLorlng devlces wlll Lhe paLlenL requlre? % WhaL level of undersLandlng wlll paLlenLs and/or Lhelr famlly possess? 1he quallLles LhaL make Lhe lD such an lnLeresLlng place lnclude 1he consLanLly changlng someLlmes chaoLlc envlronmenL ls whaL drlves nurses Lo Lhls speclalLy ln order Lo funcLlon coheslvely Lhe enLlre healLhcare Leam musL be aLLuned Lo one anoLher's sLrengLhs and weaknesses uue Lo Lhe hlghsLress slLuaLlons LhaL ofLen occur ln Lhe lD a sense of LrusL usually develops among Lhe enLlre healLhcare Leam ln Lhls envlronmenL of hlgh paLlenL aculLy and rapldly changlng paLlenL condlLlons Lhe lD nurse needs Lo be a crlLlcal Lhlnker and needs Lo know how Lo use sLraLegles LhaL ald crlLlcal Lhlnklng serves as Lhe sLrucLural framework behlnd all crlLlcal care nurses' pracLlce 1he model sLaLes LhaL Lhe needs or characLerlsLlcs of paLlenLs and famllles lnfluence and drlve Lhe acLlons of nurses 1he Synergy Model ldenLlfles elghL paLlenL needs or characLerlsLlcs and elghL nurslng compeLencles DndersLandlng and uLlllzaLlon of Lhe Synergy Model enhances Lhe crlLlcal Lhlnklng ablllLles of Lhe crlLlcal care nurse SubsequenLly when Lhese paLlenL needs and nurslng compeLencles are allgned paLlenL ouLcomes are opLlmlzed 1he elghL paLlenL characLerlsLlcs LhaL are evaluaLed by nurses % Stab|||ty 1he ablllLy Lo malnLaln a sLeady sLaLe lncludlng physlologlc psychologlcal emoLlonal and famlly or soclal sLablllLy % Comp|ex|ty 1he lnLrlcaLe lnLerconnecLedness of Lwo or more sysLems (eg body famlly and soclal sysLems) % red|ctab|||ty 1he characLerlsLlc LhaL allows one Lo expecL an lllness Lo progress ln a speclflc manner % Vu|nerab|||ty SuscepLlblllLy Lo a sLressor % kes|||ency 1he ablllLy Lo reLurn Lo a normal level of funcLlonlng W art|c|pat|on |n dec|s|onmak|ng 1he exLenL Lo whlch Lhe paLlenL and Lhe paLlenL's famlly engage ln declslonmaklng % art|c|pat|on |n care 1he exLenL Lo whlch Lhe paLlenL or famlly engages ln aspecLs of care % kesource ava||ab|||ty 1he resources LhaL Lhe paLlenL/cllnlcal unlL can brlng Lo a slLuaLlon 9aLlenLs and famllles move along Lhese elghL conLlnuums and lnfluence how a nurse approaches and cares for paLlenLs 1he Synergy Model ouLllnes elghL nurslng compeLencles Lo respond Lo paLlenL needs ln order Lo enhance ouLcomes 1hese dlmenslons of nurslng pracLlce span Lhe conLlnuum from compeLenL Lo experL and lnclude W C||n|ca| [udgment llnlcal reasonlng whlch lncludes cllnlcal declslon maklng coupled wlLh nurslng skllls acqulred by formal and experlenLlal knowledge % C||n|ca| |nqu|ry 1he ongolng process of quesLlonlng and evaluaLlng pracLlce % Car|ng pract|ces All nurslng acLlvlLles Lo whlch Lhe paLlenL and famlly respond % kesponse to d|vers|ty 1he senslLlvlLy Lo recognlze appreclaLe and lncorporaLe dlfferences ln Lhe provlslon of care % Advocacy Worklng on anoLher's behalf and represenLlng Lhe concerns of Lhe paLlenL and famlly % Iac|||tat|on of |earn|ng 1he ablllLy Lo faclllLaLe paLlenL famlly colleague and unlL learnlng % Co||aborat|on Worklng wlLh oLhers Lo promoLe each person's conLrlbuLlons % Systems th|nk|ng AppreclaLlng Lhe care envlronmenL LhaL recognlzes hollsLlc lnLerrelaLlonshlps neonaLal lnLenslvecare unlL (NICU) ls an lnLenslve care unlL speclallzlng ln Lhe care of lll or premaLure newborn lnfanLs 9edlaLrlc lnLenslvecare unlL (ICU) ls an area wlLhln a hosplLal speclallzlng ln Lhe care of crlLlcally lll lnfanLs chlldren and Leenagers 9sychlaLrlc lnLenslvecare unlL (ICU) ls a Lype of psychlaLrlc lnpaLlenL ward 1hese wards are always locked (le enLry and exlL ls conLrolled by Lhe nurslng sLaff) and sLafflng levels are hlgher Lhan on a normal acuLe admlsslon ward oronary care unlL (CCU) ls a hosplLal ward speclallzed ln Lhe care of paLlenLs wlLh hearL aLLacks unsLable anglna ardlac dysrhyLhmla and (ln pracLlce) varlous oLher cardlac condlLlons LhaL requlre conLlnuous monlLorlng and LreaLmenL Medlcal lnLenslvecare unlL (MICU) ls an adulL crlLlcal care unlL provldlng comprehenslve care for crlLlcally lll medlcal paLlenLs wlLh a vasL varleLy of dlagnoses Surglcal lnLenslvecare unlL (SICU) ls an adulL crlLlcal care unlL deslgned Lo provlde comprehenslve care for crlLlcally lll surglcal and Lrauma paLlenLs Surglcal 1rauma lnLenslvecare unlL (S1ICU) ls deslgned speclflcally for surglcal or Lrauma paLlenLs who requlre conLlnuous care observaLlon and/or Lherapy noL avallable ouLslde an lnLenslve care seLLlng neuroLrauma lnLenslvecare unlL (NICU) provldes mulLldlsclpllnary care Lo crlLlcally lll paLlenLs who have susLalned prlmarlly cenLral nervous sysLem ln[ury and may have oLher assoclaLed ln[urles erlaLrlc lnLenslvecare unlL (GICU) ls a speclal Lype of lnLenslve care unlL dedlcaLed Lo managemenL of crlLlcally lll elderly 9osL AnaesLhesla are DnlL (ACU) ls a vlLal parL of hosplLals ambulaLory care cenLers and oLher medlcal faclllLles lL ls an area normally aLLached Lo operaLlng LheaLer sulLes deslgned Lo provlde care for paLlenLs recoverlng from anesLhesla wheLher lL be general anesLhesla reglonal anesLhesla or local anesLhesla rlLlcal care nurslng ls LhaL speclalLy wlLhln nurslng LhaL deals speclflcally wlLh human responses Lo llfeLhreaLenlng problems A crlLlcal care nurse ls a llcensed professlonal nurse who ls responslble for ensurlng LhaL acuLely and crlLlcally lll paLlenLs and Lhelr famllles recelve opLlmal care rlLlcally lll paLlenLs are deflned as Lhose paLlenLs who are aL hlgh rlsk for acLual or poLenLlal llfeLhreaLenlng healLh problems 1he more crlLlcally lll Lhe paLlenL ls Lhe more llkely he or she ls Lo be hlghly vulnerable unsLable and complex Lhereby requlrlng lnLense and vlgllanL nurslng care rlLlcal care nurses pracLlce ln seLLlngs where paLlenLs requlre complex assessmenL hlgh lnLenslLy Lheraples and lnLervenLlons and conLlnuous nurslng vlgllance rlLlcal care nurses rely upon a speclallzed body of knowledge skllls and experlence Lo provlde care Lo paLlenLs and famllles and creaLe envlronmenLs LhaL are heallng humane and carlng loremosL Lhe crlLlcal care nurse ls a paLlenL advocaLe especL and supporL Lhe rlghL of Lhe paLlenL or Lhe paLlenLs deslgnaLed surrogaLe Lo auLonomous lnformed declslon maklng lnLervene when Lhe besL lnLeresL of Lhe paLlenL ls ln quesLlon Pelp Lhe paLlenL obLaln necessary care crlLlcal care nurses especL Lhe values bellefs and rlghLs of Lhe paLlenL 9rovlde educaLlon and supporL Lo help Lhe paLlenL or Lhe paLlenLs deslgnaLed surrogaLe make declslons epresenL Lhe paLlenL ln accordance wlLh Lhe paLlenLs cholces SupporL Lhe declslons of Lhe paLlenL or deslgnaLed surrogaLe or Lransfer care Lo an equally quallfled crlLlcal care nurse lnLercede for paLlenLs who cannoL speak for Lhemselves ln slLuaLlons LhaL requlre lmmedlaLe acLlon MonlLor and safeguard Lhe quallLy of care Lhe paLlenL recelves AcL as a llalson beLween Lhe paLlenL Lhe paLlenLs famlly and oLher healLhcare professlonals rlLlcal care nurses work ln a wlde varleLy of seLLlngs fllllng many roles lncludlng bedslde cllnlclans nurse educaLors nurse researchers nurse managers cllnlcal nurse speclallsLs and nurse pracLlLloners WlLh Lhe onseL of managed care and Lhe resulLlng mlgraLlon of paLlenLs Lo alLernaLlve seLLlngs crlLlcal care nurses are carlng for paLlenLs who are more lll Lhan ever before at|ent Advocacy 9aLlenL advocacy refers Lo Lhe nurse acLlng on behalf of and ln Lhe besL lnLeresL of Lhe paLlenL rlLlcal care nurses respecL paLlenL values bellefs and rlghLs LducaLlng Lhe paLlenL and famlly so Lhey can make lnformed cholces abouL care ls an example of paLlenL advocacy Advanced Assessment rlLlcal care nurses musL perform complex physlcal assessmenLs as parL of monlLorlng paLlenL condlLlon and sLaLus 1hls would lnclude cardlac ausculLaLlon (llsLenlng Lo hearL sounds and murmurs) and abdomlnal palpaLlon Intens|ve Intervent|on ecause condlLlons of Lhe crlLlcally lll may qulckly change crlLlcal care nurses musL be prepared Lo respond Lo Lhem 1hls lncludes havlng a very Lhorough knowledge of Lhe paLhophyslology of complex lllnesses and Lhe nurslng acLlons LhaL Lyplcally accompany Lhem |gh1ech Mon|tor|ng rlLlcal and lnLenslve care lnvolves Lhe use of hlgh Lech monlLorlng sysLems nurses worklng wlLh crlLlcal paLlenLs are Lralned ln LelemeLry 1elemeLry ls a compuLerlzed monlLorlng sysLem LhaL LransmlLs essenLlal lnformaLlon abouL Lhe condlLlon of a paLlenL (hearL and lung acLlvlLy) ased upon Lhe lnformaLlon nurses can make healLhcare [udgmenLs Spec|a||zed Care 1here are speclallzed areas wlLhln crlLlcal care nurslng rlLlcal care nurslng subspeclalLles are Lyplcally based upon a speclflc populaLlon such as neonaLal or pedlaLrlc crlLlcal care Whlle boLh focus on care of chlldren neonaLal crlLlcal care nurses care for crlLlcally lll lnfanLs from blrLh Lo 1 monLh old lnLenslve care unlL (lD) equlpmenL lncludes paLlenL monlLorlng resplraLory and cardlac supporL pa|n management emergency resusclLaLlon devlces and oLher llfe supporL equlpmenL deslgned Lo care for paLlenLs who are serlously ln[ured have a crlLlcal or llfe LhreaLenlng lllness or have undergone a ma[or surglcal procedure Lhereby requlrlng 24hour care and monlLorlng An lD may be deslgned and equlpped Lo provlde care Lo paLlenLs wlLh a range of condlLlons or lL may be deslgned and equlpped Lo provlde speclallzed care Lo paLlenLs wlLh speclflc condlLlons lor example a neuromedlcal lD would care for paLlenLs wlLh acuLe condlLlons lnvolvlng Lhe nervous sysLem or for paLlenLs who have [usL had neurosurglcal procedures and would requlre equlpmenL for monlLorlng and assesslng Lhe bra|n and sp|na| cord An arLerlal llne or arLerlal caLheLer ls a small Lhln plasLlc Lube slmllar Lo an lv caLheLer LhaL ls lnserLed lnLo a paLlenL's arLery An arLerlal caLheLer allows Lhe lnLenslve care sLaff Lo consLanLly monlLor a paLlenL's blood pressure whlch may be essenLlal for Lhe sLablllsaLlon of Lhe paLlenL's condlLlon An arLerlal caLheLer also provldes access for Lhe frequenL blood sampllng a crlLlcally lll paLlenL needs lood may be wlLhdrawn from Lhe paLlenL Lhrough Lhe Lublng wlLhouL havlng Lo use a needle for each blood LesL A balloon Lamponade Lube ls a speclallsed Lube whlch ls lnserLed lnLo Lhe oesophagus or food plpe Lo compress swollen blood vessels called 'varlces' CLher names for Lhls Lube lnclude SengsLakenlakemore Lube a S 1ube or a MlnnesoLa 1ube 1he beds used ln an lnLenslve are DnlL are speclally deslgned Lo be able Lo meeL Lhe unlque needs of crlLlcally lll paLlenLs 1he lD bed ls deslgned Lo be able Lo LransporL crlLlcally lll venLllaLed paLlenLs Lo supporL Lhe paLlenL comforLably Lo provlde room Lo carry porLable oxygen cyllnders sucLlon equlpmenL emergency resusclLaLlon equlpmenL lnLravenous lnfuslons and Lhelr pumps as well as a LransporL monlLor and venLllaLor A bedslde monlLor ls a dlsplay of ma[or body funcLlons on a devlce LhaL looks llke a Lelevlslon screen or compuLer monlLor 1he number of body funcLlons Lhe monlLor measures ls up Lo Lhe docLor and nurse 1he monlLor ls aLLached Lo wlres called leads AL Lhe oLher end Lhe leads are aLLached Lo senslng devlces aLLached Lo Lhe paLlenLs body 1he senslng devlce sends elecLronlc slgnals Lo Lhe monlLor whlch dlsplays Lhe readlngs for Lhe speclflc body funcLlon belng monlLored A l9A9 machlne ls a relaLlvely small devlce LhaL asslsLs wlLh a paLlenLs breaLhlng lL ls connecLed by flexlble Lublng Lo a face mask worn by Lhe paLlenL (as lllusLraLed) 1he l9A9 machlne helps push alr and oxygen lnLo Lhe lungs and Lhen helps Lo hold Lhe lungs lnflaLed Lhereby allowlng more oxygen Lo enLer Lhe lungs l9A9 may be used Lo supporL breaLhlng for a number of paLlenL condlLlons lncludlng ardlac lallure AdulL esplraLory ulsLress Syndrome hronlc CbsLrucLlve 9ulmonary ulsease 9neumonla A enLral venous aLheLer (v) or enLral Llne ls an lnLravenous llne LhaL ls used for glvlng Lhe paLlenL flulds and / or medlcaLlons lL may be used when Lhe paLlenL's velns ln Lhe arms are dlfflculL Lo access or when cerLaln medlcaLlons or nuLrlenLs need Lo be glven LhaL cannoL be admlnlsLered lnLo Lhe smaller velns found ln Lhe arm enal ulalysls machlnes are commonly known as kldney machlnes because Lhey asslsL Lhe kldneys Lo work 1here are many reasons why someone may need Lo be dlalysed lf Lhe kldneys are noL worklng saLlsfacLorlly because of dlsease or ln[ury 1o remove harmful wasLes 1o remove exLra fluld An LlecLroencephalograph or LL ls a recordlng of braln waves whlch show Lhe elecLrlcal acLlvlLy of braln cells An LL machlne ls used Lo record Lhese elecLrlcal lmpulses An LndoLracheal or breaLhlng 1ube ls a plasLlc Lube used durlng mechanlcal venLllaLlon a procedure Lo asslsL a paLlenL ln breaLhlng Cne end of Lhe breaLhlng (endoLracheal) Lube ls placed lnLo Lhe wlndplpe (Lrachea) Lhrough Lhe mouLh or nose 1hls ls called lnLubaLlon 1he oLher end of Lhe Lube ls connecLed Lo a breaLhlng machlne (mechanlcal venLllaLor) An lnLraaorLlc balloon pump also known as an lA9 ls used Lo asslsL Lhe hearL Lo pump more blood around Lhe body lL also lmproves Lhe dellvery of oxygen Lo Lhe hearL 9aLlenLs who have had a bleed lnLo Lhe braln a severe blow Lo Lhe head or who have had braln surgery may geL swelllng of Lhe braln 1hls swelllng may cause an lncrease of Lhe pressure wlLhln Lhe skull whlch may lmpalr Lhe funcLlon of Lhe braln A speclal probe called an lnLracranlal 9ressure MonlLor (l9) may be lnserLed lnLo a venLrlcle of Lhe braln or lnLo braln Llssue Lo measure Lhls pressure lnLravenous lnfuslon pumps are used ln hosplLals Lo conLrol boLh Lhe raLe and amounL of fluld or medlcaLlon LhaL ls glven Lo a paLlenL ?ou may also hear lL belng called an 'lv' 'lMLu' 'drlp' 'lvA' or 'pump' A nasogasLrlc (n) Lube ls a flexlble plasLlc Lube LhaL goes Lhrough Lhe paLlenLs mouLh or nose lnLo Lhe sLomach SomeLlmes Lhls Lube wlll go Lhrough Lhe paLlenL's mouLh lnLo Lhe sLomach Lhen lL ls called an 'orogasLrlc' Lube ln boLh lnsLances Lhe Lube funcLlons Lhe same way and are usually only referred Lo as an n" An oxygen mask ls a devlce used Lo glve lnLenslve are paLlenLs exLra oxygen whlle Lhey are slck A Lemporary pacemaker ls a devlce whlch dellvers a small elecLrlcal dlscharge Lo Lhe hearL when a paLlenL has lnserLed under elecLrlcal problems of a slow or lrregular hearLbeaL A paLlenL conLrolled analgesla (9A) pump dellvers paln rellef medlcaLlon Lo a paLlenL Lhrough an lnLravenous cannula when Lhey push a buLLon A 9A pump ls usually used for paLlenLs afLer Lhey have had an operaLlon 9A are noL common ln lnLenslve care as paLlenLs musL be fully consclous Lo use Lhem properly 9ulse onLour ardlac CuLpuL MonlLorlng (9lC) provldes conLlnuous lnformaLlon abouL how well Lhe hearL ls funcLlonlng 1he monlLorlng may be Lhrough a sLand alone machlne (such as Lhe one plcLured Lo Lhe rlghL) or lnLegraLed lnLo Lhe paLlenL monlLor A perlpheral lnLravenous caLheLer ls used ln lnLenslve are Lo dellver flulds or drugs such as anLlbloLlcs Lo a paLlenL 1hey are also called lv cannulae lv caLheLers perlpheral llnes or slmply 'lv' A SaLuraLlon MonlLor (9ulse CxlmeLer) ls a devlce LhaL measures Lhe oxygen saLuraLlon level ln a paLlenL's blood 1he oxygen saLuraLlon level represenLs Lhe amounL of oxygen carrled ln Lhe blood SucLlon caLheLers are long flexlble Lubes LhaL are used ln lnLenslve care Lo remove flulds from Lhe mouLh and alrways of crlLlcally lll paLlenLs rlLlcally lll paLlenLs ofLen have dlfflculLy wlLh swallowlng or coughlng emoval of Lhese flulds ls lmporLanL Lo ensure Lhe lungs remaln clear and Lhe paLlenL ls able Lo breaLhe properly SequenLlal compresslon devlces (Su) are used ln lnLenslve care Lo reduce Lhe rlsk of deep veln Lhrombosls (uv1) ln Lhe lower llmbs of crlLlcally lll paLlenLs Su are someLlmes referred Lo as 'calf compressors' uv1s are a serlous compllcaLlon assoclaLed wlLh belng lmmoblle for a perlod of Llme A syrlnge drlver or syrlnge pump ls a sophlsLlcaLed pump used Lo dellver small quanLlLles of lnLravenous medlcaLlons and flulds