Intensive Care Nursing - II .pptx

CRITICAL CARE NURSING – II
INTENSIVE CARE RECORDS, COMMUNICATION IN ICU,
LEGAL ASPECTS, INFECTION CONTROL, TRANSITIONAL
CARE, A.C.L.S.
Presented By:
Mr. NANDISH.S
Associate Professor
Mandya Institute of Nursing Sciences

INTENSIVE CARE RECORDS :
- Patient Information Records
- Medical History records
- Admission Register / Record
- Vital signs record
- Daily Progress Record
- Medication chart / record
- Fluid balance / Intake output chart
- Laboratory reports
- Procedure & Intervention records
Continued……

- Nurses Notes / Nursing care records
- Consultation report
- Discharge summary
- Infection control records
- Stock inventory records
- Equipment record
- LAMA records.

COMMUNICATION WITH PATIENT &
FAMILY :

COMMUNICATION WITH PATIENT & FAMILY :
Breaking bad news to patients & their families is undoubtedly one of the most
challenging aspects of health care.
1. PREPARATION :
Before delivering the news, ensure you have all the necessary
information about the condition, prognosis and treatment options. Be prepared
to answer questions the patient or family may have.
2. CHOOSE RIGHT TIME & SETTING :
Find a quiet, private space where the patient and family can have
some privacy and won’t be interrupted. Comfort is crucial during such
discussions.

3. START WITH EMPATHY :
Begin the conversation with empathy & compassion. Acknowledge
the seriousness of situation & express your concern for the patient & family.
4. USE PLAIN, CLEAR & SIMPLE LANGUAGE:
Avoid medical jargon & use simple, clear language that the patient
and their family can understand. Its essential that they fully grasp the
information you are conveying.
5. BE HONEST & TRANSPARENT :
Deliver the information honestly, but gently. Avoid giving false hope, refrain
from being overly pessimistic. Provide information about the condition,
prognosis and treatment options as clearly as possible.

6. GIVE TIME FOR REACTIONS:
Allow the patient & their family time to process the information and
express their emotions. Listen actively, without interrupting and validate their
feelings.
7. ENCOURAGE QUESTIONS:
Encourage the patient and their family to ask questions. Be patient &
provide honest answers to the best of your ability. If you don’t know the
answer to a question, its ok to say so and promise to find out.
8. OFFER SUPPORT :
Provide information about support services available such as counselling,
support groups or palliative care services. Offer to connect them with
resources that can help them cope with such situation.

9. PROVIDE INFORMATION IN INCREMENTS :
Break the information into smaller, manageable chunks to avoid
overwhelming the patients & their family. Allow them time to process each
piece of information before moving on.
10. RESPECT CULTURAL & SPIRITUAL BELIEF :
Be sensitive to the patient & their family’s cultural, spiritual and
religious beliefs. Respect their preferences & incorporate their beliefs into the
conversation as appropriate.
11.FOLLOW UP :
Arrange for follow up discussions to address any further questions or
concerns the patient and their family may have. Reiterate your availability &
willingness to support them through out their journey.

LEGALASPECTS IN CRITICAL CARE UNIT :
They are crucial to ensure the well being of patients, protect health care
providers & maintain overall integrity of health care system. Some of the key
legal considerations in critical care unit as follows.
1. INFORMED CONSENT :
 Ensure that patients or their legal representatives provide informed consent
before any medical treatment or procedure.
 Clearly communicate the risks, benefits and alternatives to the proposed
treatment.

2. ADVANCED DIRECTIVES & END OF LIFE CARE :
 Respect and follow advanced directives, living wills and durable power of
attorney for health care decisions.
 Adhere to legal guidelines for end of life care & decisions, including do –
not – resuscitate (DNR) orders.
3. PATIENT PRIVACY & CONFIDENTIALITY :
 Comply with health information privacy laws (Health Insurance portability
& accountability act).
 Safeguard the patient information & only disclose it as allowed by law.

4. MEDICAL MALPRACTICE:
 Practice within the scope of professional standards & guidelines to avoid
medical malpractice claims.
 Maintain accurate & detailed medical records to document the care
provided.
5. STAFFING RATIOS & ADEQUATE TRAINING :
 Adhere to legal staffing ratios to ensure there are enough qualified health
care professionals to provide appropriate care.
 Provide on-going training & education to staff to maintain competence &
compliance with legal standards.

6. DOCUMENTATION :
 Maintain thorough & accurate of patient assessment, intervention &
outcomes.
 Document any communication with patients or their families regarding
treatment plans & decisions.
7. QUALITY OF CARE AND STANDARDS :
 Follow established clinical practice guidelines & standards of care.
 Regularly evaluate and improve the quality of care provided to patients.
8. CULTURAL COMPETENCE & PATIENT RIGHTS:
 Be aware of & respect the cultural and religious beliefs of patients.
 Uphold patients rights & address any concerns or complaints in accordance
with legal requirements.

9. HEALTHCARE REGULATIONS & ACCREDITATION :
 Stay informed about & comply with federal, state and local healthcare
regulations.
 Meet accreditation standards set by relevant healthcare organizations.
10. EMERGENCY MEDICAL TREATMENT AND LABOR ACT
(EMTALA) :
 Understand and comply with EMTALA, which ensures that emergency
medical services are provided to all individuals, regardless of their ability
to pay.

INFECTION CONTROL IN ICU :
 It refers to the policies, procedures and practices implemented to prevent or
minimize the spread of infection in healthcare settings or other
environment where the transmission of pathogens can occur.
 It is a crucial step of patient care aimed at preventing & managing
Healthcare Associated Infections (HAI).

SOURCES OF INFECTIONS :
 Indwelling Medical devices – urinary catheters, ET Tubes, Central Venous
catheters.
 Ventilator Associated Pneumonia
 Surgical sites
 Contaminated hands
 Environment (contaminated surfaces)
 Cross – contamination (from other patients / attenders)
 Blood stream infections (IV Lines).

INFECTION CONTROL PROTOCOLS IN ICU :
1. Hand Hygiene
2. Personal Protective Equipment
3. Isolation precautions
4. Environmental cleaning
5. Patient placement
6. Respiratory Hygiene & cough etiquette
7. Antibiotic stewardship
8. Vaccination
9. Education and Training
10.Surveillance & monitoring
11.Waste management

ROLE OF NURSE IN INFECTION CONTROL :
1. Patient Assessment and Monitoring :
- Nurses assess the patients for signs and symptoms of infections.
- They also monitor vital signs, laboratory results and other clinical
indicators.
2. Isolation Precautions :
- Nurses implement & manage isolation precautions based on type of
infection.
- They educate patients, families & other healthcare staff about isolation
protocols.

3. Infection Prevention :
- Nurses follow & enforce infection prevention protocol (PPE).
- They ensure that PPE is used correctly & consistently.
4. Wound Care and Infection Control :
- Staffs are responsible for proper wound care to prevent infection in patients
with injuries or surgical wounds.
- They monitor for signs of wound infections & intervene promptly.
5. Adhere to policies & Guidelines :
- Follow established infection control policies & guidelines within healthcare
facility.
- Participate in development & updating of these policies.

TRANSITIONAL CARE :
 It refers to the coordination & the continuity of healthcare during
movement between different healthcare settings such as from hospital to
home or from one healthcare provider to another.
 It ensures smooth & safe transition for patients.
AIM :
It aims to prevent complications, reduce readmission & enhance the
overall quality of care.

INDICATIONS FOR TRANSITIONAL CARE :
 Hospital Discharge
 Post Surgery care
 Chronic Disease Management : Heart failure, Respiratory distress, Diabetes
Mellitus
 Elderly Care : older adults with multiple chronic conditions.
 Psychiatric Transitions

ACTIVITIES :
1. Coordination of Care :
it involves coordinating various care among health care providers,
discipline and setting.
2. Communication :
it includes sharing relevant information about patient’s health status,
treatment plan, medications & other important details with health care
providers.
3. Medication Management :
it includes reconciling medications, providing education on new
medications, ensuring clear understanding of medication.

4. Patient & Family Education :
This empowers family members to take an active role in managing
their health and improve outcome.
5. Assessment and planning :
It involves assessing patient’s functional status, social support & other
factors that can impact their well being.
6. Follow-up & Monitoring
7. Emphasis on Patient-Centered Care

PURPOSES :
 Accurate Delivery : Precise & controlled administration of fluids &
medication.
 Patient safety : Minimize risk of medication error & fluid overload.
 Convenience :It allows for continuous infusion.
 Customization : They can be programmed to meet individual patient
needs.
 Enhanced patient comfort : They provide steady & controlled flow of
medications.

STEPS OF USE :
1. Preparation
2. Priming
3. Programming
4. Connection
5. Start infusion
6. Monitoring
7. Discontinuation

ROLE OF NURSE :
 Preparation & Set up :
- Gather all necessary supplies including medications, IV Tubing, Infusion
pump.
- make sure that pump is working.
 Programming & Monitoring :
- Program the infusion pump according to health care provider’s orders.
- Monitor the infusion closely. Regularly check the pump settings to ensure
accurate delivery.

 Patient Assessment & Education
- Monitor patient’s condition before, during & after infusion.
- Educate family members about purposes, uses and any side effects to watch
out for.
 Troubleshooting & Intervention
- Recognize & Respond to any alarm or alert generated by pumps.
- In case of emergencies, initiate appropriate interventions. (stop infusion /
notify higher authorities)
 Documentation & Communication :
- Maintain accurate & detailed documentation of the procedure.
- Communicate effectively with other members of health care team like
physician, pharmacist, etc.

ADVANCED CARDIAC LIFE SUPPORT :
 It is a set of clinical interventions aimed at managing cardio vascular
emergencies particularly cardiac arrest or other life threatening cardiac
events.
 It is an advanced level of medical care provided by health care
professionals.

INDICATIONS :
1) Cardiac Arrest
2) Symptomatic Bradycardia
3) Pulseless Electrical Activity (PEA)
4) Tachycardia
5) Acute Coronary Syndromes
6) Post – Cardiac Arrest Care
7) Stroke & Post – Cardiac Arrest Neurological Support
8) Severe Respiratory Distress or Failure

EQUIPMENT USED FOR A.C.L.S :
1) Defibrillator
2) Cardiac Monitor
3) Intravenous (IV) Access Equipment
4) Airway Management Devices
5) Medications
6) Advanced Airways
7) Pulse Oxymeter
8) Capnography Equipment (monitors the level of CO2 in exhaled air)
9) Suction Equipment
10) Emergency Medication trays (pre packed tray containing commonly used
medicines)

STEPS OF A.C.L.S :
1. Assessment and Recognition :
 Quickly assess the situation & ensure your safety.
2. Airway Management & Breathing :
 Open the airway using head tilt – chin lift or Jaw – thrust maneuver.
 Provide 2 rescue breaths & check for chest rise.
 If trained, use advanced airway device like Endotracheal tube.

3. CPR
 Begin high quality chest compression at the rate of 100 – 120 compression
per minute.
 Allow for the full chest recoil between compressions.
 Give 2 rescue breaths after every 30 chest compressions.
 Continue CPR Until the arrival of the AED or Advanced life support team
or Code Blue team.

4. Defibrillation :
 If defibrillator is available, follow its protocol promptly.
 Deliver the shock as soon as possible for shockable rhythm.
 The recommended energy for initial shock is 200 joules, second shock 300
joules and third shock is 360 joules if defibrillation is unsuccessful.
 Resume CPR immediately after the shock.

5. Medications :
Administer medications as prescribed based on the patient’s rhythm and
condition.
Common medications used in ACLS include Epinephrine, Amiodarone,
Atropine.
Follow the AHA guidelines for medication administration.
6. Post Cardiac Care :
 Optimize oxygenation and ventilation.
 Maintain hemodynamic stability.
 Manage the underlying cause of Arrest.

7. Team Dynamics :
 Coordinate & communicate effectively within the resuscitation team.
 Assign roles and responsibilities to team members.
 Rotate team members to prevent fatigue.

Intensive Care Nursing - II .pptx

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Intensive Care Nursing - II .pptx