Course Description

This course is designed to assist students in developing expertise and knowledge in the field of Critical care Nursing. It will help students to develop advanced skills for nursing intervention in caring for critically ill patients.

Objectives : At the end of the course the students will be able to

• Appreciate trends and issues related to Critical Care Nursing
• Describe the epidemiology, etiology, pathophysiology and diagnostic assessment of critically ill patients.
• Describe the various drugs used in critical care by nurses - Responsibility in their administration.
• Demonstrate advance skills/competence in managing critically ill patients including Advance Cardiac Life Support.
• Demonstrate skill in handling various equipments used in ICU.
• Provide comprehensive care to critically ill patients.
• Appreciate team work & coordinate activities related to patient care.
• Practice infection control measures.
• Assess and manage pain.
• Identify complications & take appropriate measures.
• Assist patients and their family to cope with emotional distress, grief and anxiety
• Assist in various diagnostic, therapeutic and surgical procedures.
• Identify the sources of stress and manage burnout syndrome among health care providers.
• Teach and supervise nurses and allied health workers.
• Design a layout of ICU and develop standards for critical care nursing practice

Course Content

1. Introduction to Critical Care Nursing

• Historical review- Progressive patient care (PPC)
• Review of anatomy and physiology of vital organs, fluid and electrolyte balance
• Concepts of critical care nursing
• Principles and Scope of critical care nursing
• Critical care unit set up including equipments supplies, use and care of various type of monitors & ventilators Flow sheets

2. Concept of Holistic care applied to critical care nursing practice

• Impact of critical care environment on patients:-Risk factors, Assessment of patients, Critical care psychosis
• The dynamics of healing in critical care unit:-therapeutic touch,Relaxation, Music therapy, Guided Imagery, acupressure Stress and burnout syndrome among health team members

3. Review of Drugs/Fluids Pharmacokinetics

• Analgesics/Anti inflammatory agents
• Antibiotics, antiseptics
• Drug reaction & toxicity
• Drugs used in critical care unit (inclusive of inotropes, vasopressors and life saving drugs)
• Drugs used in various body systems
• IV fluids and electrolytes
• Blood and blood components
• Principles of drug administration, role of nurses and care of drugs

4. Pain Management

• Pain & Sedation in Critically ill patients
• pain management-pharmacological and non-pharmacological

5. Infection control in intensive care unit

• Nosocomial infection in intensive care unit; Disinfection, Sterilization, Standard safety measures, Needle Stick Injury, Prophylaxis for staff Bio Medical Waste Management

6. Gastrointestinal System

• Medical, Surgical and Nursing management of: Acute Gastrointestinal Bleeding, Abdominal injury
• Hepatic Disorders:- Fulminant hepatic failure, Hepatic Encephalopathy, Acute Pancreatitis, Acute intestinal obstruction, perforation Peritonitis

7. Renal System

• Medical, Surgical and Nursing management of:- Acute Renal Failure, Chronic Renal Failure
• Management Modalities: Renal Replacement Therapy

8. Nervous System

• Medical, Surgical and Nursing management of:-Common Neurological Disorders:- Cerebrovascular disease, Cerebrovascular accident, Seizure disorders, GuilleinBarre-Syndrome, Myasthenia Gravis, Coma, Persistent vegetative state, Head injury, Spinal Cord injury

9. Endocrine System

• Medical, Surgical and Nursing Management of :- Hypoglycemia, Diabetic Ketoacidosis, Insulin therapy

10. Management of other Emergency Conditions/ Trauma

• Mechanism of injury, Cervical Spine/Thoracic injuries, Abdominal injuries, pelvic fractures, complications of trauma
• Shock: Shock syndrome, Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic and
• Septic shock Systemic inflammatory Response: The inflammatory response, Multiple organ dysfunction syndrome Drug Overdose and Poisoning,

11. Cardiovascular emergencies

• Principles of Nursing in caring for patient’s with Cardiovascular disorders Assessment: Cardiovascular system: Diagnostic studies:- Cardiac enzymes studies, ECG monitoring, Holter monitoring, Stress test. Echo cardiography, Coronary angiography Medical, Surgical & Nurisng management of:- Hypertensive crisis, Coronary artery disease, Acute Myocardial infarction, Deep vein thrombosis, Cardiac arrhythmias, Heart failure Management Modalities: Thrombolytic therapy, Pacemaker – temporary & permanent, PCI/Thrombolysis, Cardioversion, Intra Aortic Balloon pump monitoring, Defibrillations, Cardiac surgeries, Coronary Artery Bypass Grafts (CABG/MICAS), Valvular surgeries Autologous blood transfusion, Radiofrequency Catheter Ablation Cardio pulmonary resuscitation BCLS/ ACLS

12. Respiratory System

• Acid-base balance Assesment : History & Physical Examination Pulse Oximetry, End –Tidal Carbon Dioxide, Arterial blood gas studies, chest radiography, pulmonary Angiography, Bronchoscopy Medical, Surgical and Nursing management of Common pulmonary disorders:- Pneumonia, Status asthmaticus, Interstitial drug disease, Pleural effusion, Chronic obstructive pulmonary disease, Pulmonary tuberculosis, Pulmonary edema, Pulmonary embolism, Acute respiratory distress syndrome (ARDS), Chest Trauma - Haemothorax, Pneumothorax Management Modalities:-Airway Management Ventilatory Management:-Invasive, non- invasive, long term mechanical ventilations Bronchial Hygiene:-Nebulization, deep breathing exercise, chest physiotherapy, postural drainage, Inter Costal Drainage

13. Burns

• Clinical types, classification, assessment, diagnosis, prognosis Management: Medical, Surgical & Nursing management of burns Fluid and electrolyte therapy – calculation of fluids and its administration Pain management

14. Obstetrical Emergencies

• Medical, Surgical and Nursing management of : Antepartum haemorrhage, Preeclampsia, eclampsia, Post partum haemorrhage, Peurperal sepsis, Obstetrical shock

15. Neonatal Paediatric emergencies

• Medical, surgical and Nursing management of Neonatal emergencies

16. Legal and ethical issues in critical care-Nurse’s role

• Brain death & Organ donation & Counselling Do Not Resuscitate (DNR)

17. Quality assurance

• Standards, Protocols, Policies, Procedures Infection control; Standard safety measures Nursing audit Staffing, Design of ICU/CCU

Proposed Rotation
Deptt/Unit	No. of Months
Medical ICU	4 Mo
Surgical ICU	4 Mo
CCU/CTVS	1 Mo
Emergency Department	1 Mo
Dialysis Unit/ Transplant	1 Mo
Paediatric/ OT	1 Mo

ESSENTIAL CRITICAL CARE NURSING SKILLS

I. Procedures Observed

• CT Scan
• MRI
• EEG
• Hemodialysis
• Endoscopic Retrograde cholangio Pancreaticogram(ERCP)
• Heart/ Neuro/GI./ Renal Surgeries

II. Procedures Assisted

• Advanced life support system
• Basic cardiac life support
• Arterial line/arterial pressure monitoring/blood taking
• Arterial blood gas
• ECG recording
• Blood transfusion
• IV cannulation therapy
• Arterial Catheterization
• Chest tube insertion
• Endotracheal intubations
• Ventilation
• Insertion of central line/cvp line
• Connecting lines for dialysis

III. Procedure Performed

• Airway management: airway adjuncts, Oxygen therapy, Non Invasive Ventilation/CPAP ET Suction, Care of tracheostomy Endotracheal extubation
• Cardiopulmonary resuscitation, Basic cardiac life support,
• Monitoring of critically ill patients – clinically with monitors, capillary refill time (CRT) assessment of jaundice, ECG.
• Gastric lavage
• Assessment of critically ill patients Identification & assessment of risk factors for Pressure Sores, Glasgow coma scale, Arterial pressure monitoring, cardiac output/pulmonary artery pressure monitoring, detection of life threatening arrhythmias.
• Admission & discharge of critically ill patients
• Nutritional needs – Enteral & Parenteral formula preparation & patient education.
• Assessment of blood sugar levels periodically & administering insulin.
• Administration of drugs: IM, IV injection, IV cannulation calculation of dosages, blood administration.
• Procedures for prevention of infections: Hand washing, disinfection & sterilization surveillance, and fumigation Universal Precautions
• Collection of specimen.
• Setting, use & maintenance of basic equipment, ventilator, O2 analyzer, monitoring equipment, transducers, defibrillator, infusion & syringe pumps.

COMPETENCIES

A Record of competencies will be issued by the recognised teacher/guide at the end of training. The following are the competencies that shall be assessed and signed after the end of each posting.

• Recognition, assessment and stabilisation of a critically ill patient – structured and timely approach
• Manages cardiopulmonary resuscitation
• Manages the patient post-resuscitation
• Triages and prioritises patients appropriately, including timely admission to ICU
• Obtain a history and performs an accurate clinical examination
• Undertakes timely and appropriate investigations
• Describes indications for Endotracheal Intubation
• Performs ECG and interprets the results
• Recognises and manages electrolyte, glucose and acid-base disturbances
• Chest x-rays - Liaises with radiologists to organise and interpret clinical imaging
• Monitors and responds to trends in physiological variables
• Co-ordinates and provides nutritional assessment and support

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Certificate of Succesful Completion to be given by Indian College of Critical Care Medicine after an Exit Evaluation which would include Theory (MCQ ) and Viva.