Lets Explore the ICU

What is the Purpose of the ICU? To provide around-the-clock intensive monitoring and treatment of patients seven days a week.

Pharmacists Unit clerks Nurses Physicians (IM, Pulmonary, etc.) PA’s The ICU Health Care Team Respiratory therapists Other medical consultants from a broad range of specialties including surgery, pediatrics, anesthesiology, and social servicespediatrics

Where do the patients come from? The general hospital floors The ER Transfers from other hospitals & nursing homes OR “Direct Admits”, bypassing the ER Intensive Care Unit

What types of patients would you see? Post heart surgeryMI’s Renal and Liver failureCVA’s Pulmonary embolismSepsis ShockDrug overdose ArrhythmiasSuicidal Hypoglycemic comaARDS Intensive Care Unit

A Common ICU Room? Or NOT!

A REAL ICU Room

A day in the life of an ICU nurse… YouTube - Critical Care Nurse: Day in The Life

The monitors are your second major bedside assessment tool – the first is your eyes. EQUIPMENT What is on the monitor screen? EKG Heart rate Blood pressure Arterial pressure O2 Saturation Respirations

EQUIPMENT cont…. Ventilators: a machine designed to mechanically move breathable air into and out of the lungs NEW VENT OLD VENT

CHEST TUBES: a flexible plastic tube that is inserted through the side of the chest into the pleural space to drain blood, body fluid or air.

LARYNGOSCOPE & ETT Laryngoscope: An instrument that helps in intubation for mechanical ventilation. Endotracheal Tube: inserted into a patient's trachea in order to ensure that the airway is not closed off and that air is able to reach the lungs. Regarded as the most reliable available method for protecting a patient's airway.

Intubated Patient

CRASH CART A set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency meds/equipment at the site of the emergency for life support. Includes: Defibrillator with pads AMBU bag Medications IV equipment Normal Saline Procedure kits Oxygen tank And much more

Central IV Lines A catheter placed into a large vein in the neck (internal jugular vein),chest (subclavian vein) or groin (femoral vein). It is used to administer medication or fluids, obtain blood tests and directly obtain cardiovascular measurements (central venous pressure).

What EQUIPMENT do you SEE?

LABS Nurses mostly draw the labs Similar labs to those drawn in the ER Common Labs Include: ABG’s (drawn by the RT usually) Evaluates the respiratory effort Glucose levels Chemistry Coagulation--Fibrinogen, Prothrombin Cardiac enzymes—proteins released into the bloodstream when heart muscle damage occurs

What are the routines of the ICU? Report, assessment, time management Record info: flow sheets, med sheets, intake and output totals, lab results, nurses notes Monitoring KARDEX Carrying out orders Documentation q2h Administering medication Intensive Care Unit

How does the ICU affect the family members? Feelings of uncertainty Scared and afraid Angry Inquisitive Guilt Intensive Care Unit

The IN’s and OUT’s of and ICU Patient SEE HANDOUT Intensive Care Unit

How to care for the family members? Practice HOLISTIC Care!!! Be empathetic EDUCATE, EDUCATE, EDUCATE Anticipate needs Keep them updated Intensive Care Unit

What’s next? Transfer to floor Take to surgery Discharge (rare)

What are some important facts to consider before going into an ICU as a student?

There is more than one type of ICU? WHAT? NICU PICU SICU MICU CICU Intensive Care Unit

Lets look inside a NICU… NICU at Cook Children’s Fort Worth

What’s a NICU? Neonatal Intensive Care Unit/Special Care Nursery For premature and critically ill term infants Different levels of care for newborns…Levels I-III –Level I: Lowest level of care (Newborn Nursery) –Level II: Intermediate care—IV fluids, oxygen, “feeder growers”, CPAP, 32 wks gestation or greater –Level III: Highest level of care 23 weeks gestation or greater (generally) Ventilators Surgeries (sometimes in the unit!)—post operative care Nitrous oxide therapy, Extra Corporeal Membrane Oxygenation (ECMO)– heart/lung bypass

A Real NICU

Who works there? Pediatricians Neonatologists NNPs, PNPs Nurses OT (feeding) PT (positioning, massage) Child life specialist Respiratory Therapy Pharmacist Pharmacy Technicians Lactation Consultants Chaplains And more!

Why do we need a special ICU for infants? In premature infants, every body system is underdeveloped What problems do you think that a baby would have with each body system? –Nervous? –Cardiovascular? –GI? –Immune? –Endocrine? –Respiratory? –Musculoskeletal? –Reproductive? –Urinary?

What problems would you see? Chronic lung disease of prematurity (BPD) Necrotizing enterocolitis Jaundice Meconium aspiration Congenital heart defects Apnea Anemia Intraventricular Hemorrhage Bradycardia Retinopathy of prematurity Sepsis Hypothermia

Bronchopulmonary Dysplasia (BPD)

Developmental care Simulate a womb-like environment –Warm, humid, dark, quiet Developmental positioning to aid with neurologic and musculoskeletal development –Make the environment less stressful Poor weight gain and growth Abnormal VS

Stress signals May be different than in term babies, children and adults Crying –Less common in the very ill or very premature babies Frowning Wrinkled forehead Averted gaze Extended arms and legs “Stop” hands “Shut down” Changes in vital signs

What stress cues are this baby displaying?

What is RIGHT with this picture?

The Goal…