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Essentials of Critical Care Nursing
© 2007, Jaya Kuruvilla
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2007
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, NoidaReviewers
- Kasturi Ramesh Adiga BSc (N) DNEA MA (Sociology)
- Acting Dean, Ibri Nursing Institute
- Ministry of health
- Sultanate of Oman
- (Former Principal, School of Nursing, Manipal, India)
- Nandini Korula MD (Anesthesia)
- Professor in Anesthesiology
- CMC hospital, Vellore, India.
- (Former consultant in Anesthesia, Royal Hospital, Muscat, Sultanate of Oman)
- John Idikula MS
- Senior Specialist (Surgery) and Medical
Dedicated (Professionally) to My former colleagues of Surgical Intensive Care Unit, CMC Hospital, Vellore and students of the past and present
(Personally) to My inspiring father, (Late) T B John and loving and supportive children, Sheba, Shubha and VinodPreface
Critical Care Nursing has reached an all time height in its advances in technology and in caring based on scientific basis during the last two decades. The focus of Critical Care Nursing is to provide care for patients who are experiencing acute physical, physiological and psychological alteration which occur as a result of the disease process, hospitalization and diagnostic and therapeutic interventions.
In this book CCU refers to critical care unit, which may be synonymous to Intensive Care Unit. Critical care unit is defined as a specially designed and equipped facility staffed by skilled personnel to provide effective and safe care for patients with life threatening or potentially life threatening problems.
Critical care nurses provide care to restore health, alleviate pain and suffering, preserve and uphold the rights and dignity of the individuals and assist those patients in whom the salvageability is impossible, to a humane and dignified death.
While working in critical care unit a nurse keeps the unit always ready, receives the patient to the unit, monitors the alterations, plans and carries out interventions that compensate for altered body functioning and participates in all diagnostic and therapeutic interventions.
Nursing is aimed at diagnosis and treatment of human responses to actual and potential health problems. Maslow's hierarchy of needs provides for a route to holistic care. It allows the client to be placed on health-illness continuum and to incorporate the health models in meeting the needs of the patient in critical care unit. Sister Callista Roy's Adaptation model is incorporated into the care of patients. According to her each person is a unified biopsychosocial system which is in constant interaction with the changing environment. The nurse in the critical care unit assists the client to reach a balance in the biopsychosocial system or to a peaceful death. This book focuses on total aspects of care of an adult patient with selected critical illnesses. Some of the common conditions are discussed in detail.
Advances in medical science and biomedical technology have brought about considerable impact on the practice of critical care nursing. A critical care nurse needs to understand the physiology and pathophysiology of organ system so that she can quickly and intelligently identify the responses in the client based on which she would plan and implement and evaluate care. So I believe that a nurse has to have knowledge in medicine and nursing to provide scientific nursing care. Therefore, this book is organized according to different body systems with necessary medical knowledge as the background, while emphasizing the human responses such as fear, pain, sensory deprivation and sensory overload and their management through application of Nursing process.
I also believe that success of any critical care unit depends on the cooperative and collaborative effort of the nurses, physicians, technicians and other health team members. The nurse has to communicate effectively with all team members and coordinate the activities of the critical care unit to achieve high quality of care. While working in the highly charged high tech environment, she also needs to incorporate the human touch into the care.
The family of critically ill needs support during the illness and assistance in grieving process when they become bereaved. It is a challenge for critical care nurses to extend their empathetic support and communication skills to the outside walls of the critical care unit and reach them, who are in need and being drained off their physical and mental energy, time and financial resources.
While giving attention to holistic care of individual with critical illness, other general aspects of management of a critical care unit also is touched upon which would help nurses who would be called upon to take up additional responsibilities of planning and managing the critical care unit. Chapter on Pharmacology has touched upon briefly the drugs used in CCU. As these drugs undergo rapid revolutions, reader is expected to check on the latest information by the Manufacturer or detailed and latest work on pharmacology. As for procedure carried out in CCU, the institution's policy, standing orders, protocol and the technical facility available are to be taken into consideration.
This book is intended for the students of basic and posts basic programs, nurse practitioners in CCU and educators to serve as a reference on essential aspects of critical care nursing. Nursing care plan is incorporated into most of the conditions. Different formats of care plan are used to give an opportunity for the reader to be familiar with them.
Finally, critical care nurses at all time must strive for updating their knowledge continuously through all the resources available to make themselves capable of meeting diversified challenges which they come across in their day-to-day practice.
Only when I ventured, I did realize that writing is highly demanding, taxing and time consuming, especially when it has to be done along with regular job commitment and family responsibilities. Writing of this book took unusually long time due to many unexpected problems and course of events in my personal and professional life. But many supportive and encouraging people sustained me throughout especially during the latter part of the completion of the work. If not for them this would not have become a reality. These people along with my clinical experience, patients and colleagues in Surgical Intensive Care Unit, CMC Hospital, Vellore, my students of the past and present have influenced my thinking on critical care nursing. Mrs Violet Jayachandran, MSc (N) (Wayne State University, Detroit) my professor and retired Head of Surgical Nursing Department, CMC Hospital, Vellore, was instrumental in creating an interest in critical care nursing in me, when I worked with her during the inception of Surgical Intensive Care Unit, CMC Hospital, along with Dr Nandini Korula, then head of the department of SICU who is also one of the reviewers of this book. I owe a lot to them and other colleagues of SICU, nurses, doctors and paramedical staff for influencing my learning in SICU.
I am indebted to many others to whom I would like to express my gratitude. First of all to thank Mr Abraham Thomas medical coordinator and Mr Juma Ali the typist for their clerical assistance, M/s Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi for taking up the publishing of this book.
All my reviewers whose names are listed elsewhere have taken pain and time to review the material and offer valuable guidance. Their knowledge, rich experience and expertise has helped to give shape to this maiden venture. Mrs Kasturi Ramesh Adiga in her busy schedule found time to go through each and every chapter of the book meticulously. There is no word to express my gratitude to her. Dr Nandini Korula and Dr John Idikula have reviewed the medical and surgical parts of the contents in spite of the tight schedule of their work. My thanks to them.
Dr John Idikula, MOIC and Dr Mercy John, Specialist (Microbiology) of Ibri Regional Referral Hospital, who in their personal capacity sustained me throughout with innumerable resources. My warmest gratitude to them.
There are many other friends and my former students who encouraged me throughout. I conclude with lots of appreciation for all those who have directly and indirectly helped me to make this book a reality.