1. Core practice skills for adult critical care dedicated Prepared By Randa Mamdouh Under Supervision of Assist. Prof. Dr/ Salwa Samir Medical Surgical Nursing Department Faculty of Nursing Ain-Shams University 2010

2. Outlines Part One  Overview of critical care unite  Definitions of …..critical care unite, critical ill patient, chronic ill patient  Levels of critical care  Common critical conditions need critical care.

3. Part TPN. Chest tube. Artificial airways. Mechanical Ventilation. Suctioning. Definition of core practical skills Common practical skills related to body system Pulmonary Artery Pressure Arterial Line.

4. 0bjectives Clarify overview of critical care unite  Define critical care unite  Define critical ill patient  List Regulatory issues in ICU  Enumerate Ethical consideration in ICU  Explain Infection control in critical care unite  List Levels of critical care  Enumerate Criteria for admission to an ICU  Apply Nursing role in ICU  Define core practical skills  Explain Stages of skill performance

5. 0bjectives cont. : Explain Core practical skills in critical care unite. Arterial Line. Swan Ganz. Chest Tube. TPN. Artificial airway Ventilator

6. Definition of chronic ill patient Chronic diseases as prolonged illnesses that do not resolve spontaneously and are rarely cured completely. According to the CDC, chronic illnesses such as cardiovascular disease, cancer, respiratory disease, cerebrovascular disease, and diabetes The Centers for Disease Control and Prevention (CDC), (2009)

7. Definition of critical ill patient People requiring intensive care after major surgery, with severe head trauma, life-threatening acute illness, respiratory insufficiency, coma, homodynamic insufficiency, severe fluid imbalance or with the failure of one or more of the major organ systems (dictionary, 2004)

8. Critical care unit Any unit that attends to critically ill patients, including intensive care units, coronary care units, the emergency room, or the post-anesthesia care unit (dictionary, 2004)

9. Levels of critical care Level 1 Patients at risk of their condition deteriorating Level 2 Patients requiring more detailed observation or intervention including support for a single failing organ system or postoperative care Level 3 Patients requiring advanced respiratory support alone or basic respiratory support

10. Role of critical care nurse American Association of Critical Care Nurse AACN (2009) Act as a liaison between the patient, the patient’s family and other healthcare professionals Respect and support the patient rights and autonomous informed decision making Help the patient obtain necessary care Respect the values, beliefs and rights of the patient Monitor and safeguard the quality of care that patient receives Provide highest quality of care following evidence based Promoting high standards of professional practice and safety by mark excellence and certification

11. Critical disorders need critical care

12. Common critical cardiac disorders Heart failure Unstable angina MI. Hypertensive crisis Arrhythmias (AF- SVT- VT). Valve disorders. Congenital heart diseases. Heart block.

13. Common Respiratory critical disorders  Acute Respiratory failure.  ARDS.  COPD.  Sever Asthma.  Pulmonary embolism.  Acute Pneumonia.  Tension pneumothorax.

14. Common critical Neurological disorders Stroke. Myasthenia gravis crises Brain tumor Brain Haematoma.

15. Common critical Endocrine disorder Diabetic coma Hypoglycemic coma Hyperglycemic coma & ketoacidosis Thyroid storm Myxedema coma.

16. Part Core practical skills in critical care unite

17. Definition of core practical skills (Lesley, 2001) defines practical nursing skills as hands-on actions that promote the patient's physical comfort, hygiene, and safe medical treatment which are commonly referred to as procedures or psychomotor skills.

18. Cardiovascular system practical skills Arterial Line. Central venous line. Pulmonary Artery Pressure IAPB.

19. Respiratory system Endotracheal intubations. Tracheotomy. Oxygen therapy. Suctioning. Chest tube.

20. Other practical skills TPN. Blood Transfusion. Haemodialysis. Peritoneal dialysis.