Lets Explore the ICU

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• Lets Explore the ICU

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What is the Purpose of the ICU?

• To provide around-the-clock intensive monitoring
  and treatment of patients seven days a week.

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The ICU Health Care Team

• Pharmacists
• Unit clerks
• Nurses
• Physicians (IM, Pulmonary, etc.)
• PAs

• Respiratory therapists
• Other medical consultants from a broad range of
  specialties including surgery, pediatrics,
  anesthesiology, and social services

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Intensive Care Unit

• Where do the patients come from?
• The general hospital floors
• The ER
• Transfers from other hospitals nursing homes
• OR
• Direct Admits, bypassing the ER

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Intensive Care Unit

• What types of patients would you see?
• Post heart surgery MIs
• Renal and Liver failure CVAs
• Pulmonary embolism Sepsis
• Shock Drug overdose
• Arrhythmias Suicidal
• Hypoglycemic coma ARDS

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A Common ICU Room? Or NOT!
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A REAL ICU Room
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A day in the life of an ICU nurse

• YouTube - Critical Care Nurse Day in The Life
• http//www.youtube.com/watch?vP3x-ASSwLv0

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EQUIPMENT

• The monitors are your second major bedside
  assessment tool the first is your eyes.

• What is on the monitor screen?
• EKG
• Heart rate
• Blood pressure
• Arterial pressure
• O2 Saturation
• Respirations

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

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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.

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Intubated Patient
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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

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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).

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What EQUIPMENT do you SEE?
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• LABS
• Nurses mostly draw the labs
• Similar labs to those drawn in the ER
• Common Labs Include
• ABGs (drawn by the RT usually)
• Evaluates the respiratory effort
• Glucose levels
• Chemistry
• Coagulation--Fibrinogen, Prothrombin
• Cardiac enzymesproteins released into the
  bloodstream when heart muscle damage occurs

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Intensive Care Unit

• 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

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Intensive Care Unit

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

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Intensive Care Unit

• The INs and OUTs of and ICU Patient
• SEE HANDOUT

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Intensive Care Unit

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

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• Whats next?
• Transfer to floor
• Take to surgery
• Discharge (rare)

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

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Intensive Care Unit

• There is more than one type of ICU? WHAT?
• NICU PICU
• SICU
• MICU
• CICU

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Lets look inside a NICU

• NICU at Cook Childrens Fort Worth
• http//www.youtube.com/watch?vNZT-mnCzTvc

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Whats a NICU?

• Neonatal Intensive Care Unit/Special Care Nursery
• For premature and critically ill term infants
• Different levels of care for newbornsLevels
  I-III
• Level I Lowest level of care (Newborn Nursery)
• Level II Intermediate careIV 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

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A Real NICU
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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!

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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?

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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

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Bronchopulmonary Dysplasia (BPD)
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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

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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

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What stress cues are this baby displaying?
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What is RIGHT with this picture?
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The Goal