ICU/HDU care – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.

Table of Contents

ICU/HDU care

1. Neonatal intensive care unit (NICU)	This specialty unit cares for neonatal patients who have not left the hospital after birth
2. Pediatric intensive care unit (PICU)	Pediatric patients are treated in this intensive care unit for life- threatening medical problems such as asthma, influenza, diabetic ketoacidosis, or traumatic brain injury.
3. Psychiatric intensive care unit (PICU).	Patients who may voluntarily harm themselves are delivered here so they can be monitored more vigorously. Patient rooms are locked, preventing escaping.
4. Coronary care unit (CCU):	Also known as Cardiac Intensive Care Unit (CICU) or Cardiovascular Intensive Care Unit (CVICU), this ICU caters to patients specifically with congenital heart defects or life-threatening acute conditions such as cardiac arrest.
5. Neurological intensive care unit (Neuro ICU)	Patients here are treated for aneurysms, brain tumors, stroke, rattlesnake bites and post-surgical patients who have undergone various neurological surgeries and require hourly neurological exams
6. Trauma intensive care unit	(Trauma ICU). These are found only in hospitals certified in Trauma and have a dedicated Trauma Emergency Department equipped with a team of surgeons, nurses, respiratory therapists, and radiological staff.
7. Post-anesthesia care unit (PACU)	Also known as the post-operative recovery unit, or recovery room, the PACU provides immediate post-op observation and stabilization of patients following surgical operations and anesthesia.
8. High dependency unit (HDU)	These units are also called step-down, progressive and intensive recovery units and are utilised until a patient’s condition stabilizes enough to qualify them for discharge to a general ward
9. Surgical Intensive Care Unit (SICU):	A specialized service in larger hospitals that provides inpatient care for critically ill patients on surgical services. As opposed to other ICUs, the care is managed by surgeons trained in critical-care.

Roles of Critical Care Nurse:

A. Knowledge and Skills:	The critical care nurse must be an expert clinician, who can recognize signs and symptoms of complications at the earliest stages. She must have an extensive knowledge of human physiology and the ways in which it changes as patients deteriorate or recover. Critical care nurses are expected to intervene to prevent complications and to manage patients’ well-being by adjusting medications, fluid and therapeutic devices to keep the patient stabilized during the recovery process. In addition, the nurse is the person who provides emotional support in a high-technology environment.
B. Technology and Equipment	Intensive care units are heavy in technology, and the critical care nurse must be able to manage the various pieces of equipment while still maintaining human contact with severely ill patients who may not be able to communicate ICU equipment includes patient monitoring equipment such as electrocardiograph and blood pressure monitors, pulse oximeters to measure oxygen in the patient’s bloodstream and other monitors that measure pressure inside the brain or the patient’s breathing
C. Coordinating Care	ICU patients often have multiple doctors as well as other health care professionals involved in their care. The critical care nurse is expected to coordinate care and to intervene if there is confusion or conflict between other staff members. Family members are often very stressed by the patient’s illness and need emotional support; in some cases, the nurse may need to facilitate discussion between family members and physicians about the best choice of care. When disputes arise, the nurse might act as mediator, obtain assistance from social workers or chaplains, or access the hospital’s ethics committee.
D. End of Life Care	Not all patients in an ICU survive. When a patient refuses care or a family has decided to remove life-support equipment, the nurse is often the person who facilitates the discussions and supports the family members during the patient’s last moments. If a family decides on organ donation, the nurse helps ensure that the patient is maintained in the best possible state to allow for high-quality organ recovery. Critical care nurses also support family members through this difficult time.

IN SHORT

Respect and support the right of the patient or the patient’s designated surrogate to autonomous informed decision making.
Intervene when the best interest of the patient is in question.
Help the patient obtain necessary care.
Respect the values, beliefs and rights of the patient.
Provide education and support to help the patient or the patient’s designated surrogate make decisions.
Represent the patient in accordance with the patient’s choices.
Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse.
Intercede for patients who cannot speak for themselves in situations that require immediate action.
Monitor and safeguard the quality of care the patient receives
Act as a liaison between the patient, the patient’s family and other healthcare professionals.
Maintain balance diet and drugs chart.
Maintain intake and output chart.
Monitor strictly patient conditions.
Maintain good personal hygiene and strict aseptic techniques when performing any procedures.

Where Critical Care Nurses Work

Intensive Care Units,
Pediatric ICUs,
Neonatal ICUs,
Cardiac Care Units,
Cardiac Catheter Labs,
Telemetry Units,
Progressive Care Units,
Emergency Departments and Recovery Rooms.

Conditions for admitting in critical care unit are given bellow:

1. Sepsis:	Sepsis is a condition that starts with a widespread infection throughout the body and grows into a life threatening condition. In sepsis, the body’s response to the infection creates a new problem: widespread inflammation that can lead to organ failure.
2. Traumatic Brain Injury:	Traumatic brain injury involves temporary or permanent damage to brain tissue. It is usually the result of a hard impact to the head or face and is often associated with bleeding into the brain and/or swelling of the brain.
3. Shock:	Shock is the slowing of blood flow to the vital organs (brain, lungs, heart, kidneys and others). Shock occurs when blood pressure and flow are not strong enough to supply blood to to the vital organs.
4. Ruptured Brain Aneurysm or stroke:	An aneurysm is a dilation (ballooning) and weakening of the walls of a blood vessel When an aneurysm in the brain bursts, it causes bleeding into the brain, known as a subarachnoid hemorrhage (SAH).
5. Trauma:	Trauma can take many forms: most trauma is cause by road accident or motor vehicle accidents or falls. Less commonly people may be the victim of an assault which may involve blunt objects, stabbing, or shooting
6. Post-operative Intensive Care	Some patients may require monitoring in the ICU after surgery. Causes ✔ There are several problems which may occur during surgery which may lead a patient to the ICU. ✔ Common examples include – unexpected bleeding, low blood pressure, problems with heart rhythm, or difficulty with breathing
7. Cancer-related Intensive Care	Patients with cancer sometimes require admission to the ICU. While this can happen for a number of reasons, frequently it occurs after chemotherapy or a bone marrow transplant because of bleeding or infection
8. Heart Failure:	The most common heart problem leading to ICU admission is heart failure. Heart failure is a situation where the pumping muscles of the heart become too weak to circulate enough blood around the body. Shock and organ failure may occur.
9. Respiratory (Lung) Failure:	There are many causes of respiratory failure, but the most common cause leading to ICU admission is lung infection (pneumonia). Pneumonia can be caused by infection with bacteria, viruses, or a fungus

Responsibilities of a ICU/HDU Nurse:

Consults and coordinates with health care team members to assess, plan, implement and evaluate patient care plans
Prepares and administers (orally, subcutaneously, through an IV) and records prescribed medications.
Reports adverse reactions to medications or treatments in accordance with the policy regarding the administration of medications by a licensed registered nurse
Provides basic, bedside care.
Initiates patient education plan, as prescribed by physician.
Teaches patients and significant others how to manage their illness/injury, by explaining: post- treatment home care needs, diet/nutrition/exercise programs, self-administration of medication and rehabilitation
Records patients’ medical information and vital signs
Orders, interprets and evaluates diagnostic tests to identify and assess patient’s condition
Takes samples for lab work, orders prescribed lab work and evaluates/interprets lab reports
Prepares equipment and aids physician during examination and treatment of patient
Responds to life-saving situations based upon nursing standards and protocol
Records all care information concisely, accurately and completely, in a timely manner, in the appropriate format and on the appropriate forms.
Applies Hemodynamic, Phlebotomy and IV protocols.
Monitors and adjusts specialized equipment used on patients, and interprets and records electronic displays, such as intracranial pressures, central venous pressures, pulmonary artery pressures, and cardiac rhythms from cardiac monitors, respirators, ventilators, manometers, oxygen pumps, etc.
Monitors catheters, leads and tubing for proper placement and functioning
Initiates corrective action whenever information from monitoring/life support equipment shows adverse symptomatology

Risk/Predisposing Factors of Critical Illness:

1. Background factors	Age, Sex, Level of education and Genetic composition
2. Behavioral factors	Tobacco use, Unhealthy diet and Physical inactivity
3. Intermediate factors	Elevated blood lipids, Diabetes, High blood pressure and Overweight/obesity.
4. Social and economic conditions	Poverty, Employment and Family composition;
5. Environment	climate or air pollution;
6. Culture	Practices, Norms and values
7. Urbanization	Housing. Access to products and services.

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Medical and Surgical Nursing | Diploma in Nursing Science and Midwifery

ICU/HDU care | CHAPTER-9 | Medical and Surgical Nursing