NCM 118/L

Care of clients with life-threatening conditions, acutely

ill/multi-organ problems, high acuity and emergency
situation.

Regina Katherine Joyce Q. Mandigma, RN

 Unit Learning 1
Expectation:

Explain and introduce the concepts of Critical Care

Nursing, Emergency Nursing, Trauma Nursing, and care
of clients with Respiratory Emergencies.

 Activity #1

Type your answer on the padlet link

provided at the chat messaging
Critical Care Nursing

is the field of nursing with a focus on

the utmost care of the critically ill or
unstable patients following extensive
injury, surgery or life-threatening
diseases.
Critical care nurses can be found working in a
wide variety of environments and specialties,
such as general intensive care units, medical
intensive care units, surgical intensive care units,
trauma intensive care units, coronary care units,
cardiothoracic intensive care units, burns unit,
paediatrics and some trauma centre emergency
departments.
These specialists generally take care of critically
ill patients who require mechanical ventilation by
way of endotracheal intubation and/or titratable
vasoactive intravenous medication.

Critical Care Nurses can work in variety of

areas:
1. General ICU
2. Medical ICU
3. Surgical ICU
4. Cardiovascular ICU
5. Neuro-Trauma ICU
6. Burn ICU
7. Coronary Care Unit
8. Emergency Department
9. Neonatal ICU
10. Pediatric ICU
11.High Dependency Unit

Critical Care Nurses Roles and

Responsibilities

- provide direct, hands-on care for critically

ill or injured patients in pre-and
postoperative medical settings
- tasked with assessing the risks and benefits
of proposed medical interventions, rendering
life-saving treatment in emergency situations,
and nursing patients back to health.

- responsible for highly technical patient

assessments, implementing complex patient
care plans, and the administration of
extensive medication protocols. Duties such as
tracking life support equipment, providing
supplemental oxygen, administering IV
medications, monitoring cardiac and renal
status, catheter care, and dressing changes are
a common part of a critical care nurse’s job
description.
 Responsibilities of a Critical
Care Nurse:
1. Coordinate with health care team members to evaluate, plan,
and implement patient care plans

2.Prepare and administer (orally, subcutaneously, through an IV)

prescribed medications

3. Provide basic bedside care including dressing changes, catheter

care, assisting the patient with moving, and taking vital signs

4. Monitor patients for subtle or sudden changes in ventilation,

renal, and cardiac status

5. Report adverse reactions to treatments or medication

6. Order, interpret and evaluate diagnostic tests to

assess a patient’s condition

7.Quickly identify when a patient decompensates and

alert the rest of the critical care team

8. Initiate corrective action when a patient displays

adverse symptoms

9. Monitor and adjust specialized electronic

equipment such as cardiac monitors, respirators,
ventilators, and oxygen pumpsAct as a patient
advocate, by respecting the basic rights, beliefs, and
values of the patient

10. Communicate essential and appropriate

information about a patients’ condition to family

 Emergency Nursing
is a specialty within the field of professional nursing focusing
on the care of patients who require prompt medical attention
to avoid long-term disability or death. In addition to
addressing "true emergencies," emergency nurses increasingly
care for people who are unwilling or unable to get primary
medical care elsewhere and come to emergency departments
for help. In fact, only a small percentage of emergency
department (ED) patients have emergency conditions such as a
stroke, heart attack or major trauma. Emergency nurses also
tend to patients with acute alcohol and/or drug intoxication,
psychiatric and behavioral problems and those who have been
raped.
 Character of an emergency nurse:
- must be able to sit, stand, walk, reach, squat and lift throughout
their eight- or twelve-hour shift.
- must have good manual dexterity, hearing and vision.
- must understand principles of human development, anatomy,
physiology, and pharmacology.
- must also have a working knowledge of the many legal issues
impacting health care such as consent, handling of evidence,
mandatory reporting of child and elder abuse, and involuntary
psychiatric holds.
- must be adept and comfortable working with patients of many
different backgrounds, cultures, religions, ages and types of
disabilities.
- must be calm and professional at all times, especially when
dealing with situations which are difficult, emotional or
disgusting.

Emergency nurses must also know how to care for themselves

physically and emotionally.

Role of the emergency nurse:

- to evaluate and monitor patients and to manage their
care in the emergency department.
- to supervise licensed practical nurses and unlicensed
assistive personnel ("nurse aides" or "care partners")

Some ED nurse functions are common to other nursing

specialties, while others are specific to emergency
nursing. These can be divided into
1.) assessment,
2.) planning and managing care,
3.) tasks,
4.) communication, and
5.) teaching.

 Role of the ED Charge Nurse or

the Team leader

responsible for the overall "flow" of the

department. He or she assigns nurses to
patients, assures patients are being transported
to and from tests outside the ED, addresses
patient complaints and concerns,
communicates with the house supervisor, takes
phone calls, and assures nurses get their
breaks.
Trauma Nursing

- the content and process of all the various

roles nurses assume when caring for a trauma
patient.
 Trauma Nurse

-a nurse who specializes in the care of patients who

suffer an acute injury or illness, whether it is
accidental or intentional.
- a nurse skilled in caring for patients of all ages—
from newborn to the elderly. Examples of cases that
trauma nurses may be involved in are:
a. Motor vehicle accidents
b. Assault
c. Gunshot wounds
d. Stab wounds
e. Environmental injuries such as a crush or
penetrating injury
f.Head injuries
g. Physical or emotional abuse/neglect

- need to be able to function in a high-stress,

chaotic environment while maintaining an outwardly
calm demeanor.
- must also be able to think and intervene quickly
as trauma patients often arrive without easily
identifiable diagnoses.
- trauma patients can be critically unstable, so
nurses in this specialty need to be able to intervene
as rapidly as possible.
- Effective communication is also essential in
trauma nursing. Nurses must be able to multitask,
often performing life-saving care while reporting to
physicians and other members of the medical team.
- Communication is crucial in preventing errors
during emergencies.

 Perioperative Nurse

- registered nurses who work directly with patients who

are undergoing operations or other invasive procedures.
- These nurses work closely alongside surgeons, nurse
anesthetists, anesthesiologists, surgical technologists,
and nurse practitioners to provide pre- and post-op
education as well as preoperative, intraoperative, and
postoperative care in the operating room, recovery room,
and other locations within medical surgical units.
- Within the broad field of perioperative nursing, nurses
can choose to focus on surgical sub-specialties like
cardiac surgery, neurosurgery, oncology, urology,
plastic or reconstructive, transplant, general and more.

Circulating nurse - supervises nursing care and ensures

surgical rooms are safe, secure, and sterile

RN First Assistant - perform suture cuts, manage and monitor

bleeding, and carry out other complex tasks.

Scrub Nurse - sterilizing tools and providing tools to surgeons

as they require them throughout a procedure, assisting
surgeon to perform simple tasks throughout surgery

Post-Surgery Recovery Nurse - provides immediate patient care

post-surgery

Stroke Specialist Nurse

- work closely with the medical team to work

out what tests, treatments and care you need.
- Their role also includes offering support
and education to you and your family.
- works closely with the rest of the team in
coordinating the stay and help the patient to
prepare to leave hospital.

Cardiac Catheterization Lab Nurse

a nursing professional and patient-care

s p e c i al i s t w h o w o r k s i n t h e car d i a c
catheterization lab - the examination area of
the hospital that specializes in procedures
which allow physicians to visualize certain
aspects of the heart.

Respiratory Therapist

- a specialized healthcare practitioner trained

in critical care and card io -pulmonar y
medicine in order to work therapeutically
with people suffering from acute critical
conditions, cardiac and pulmonary disease

- graduate from a college or university with

a degree in respiratory therapy and have
passed a n at i o n a l b o ar d ce r t if y i ng
examination.

Phlebotomist

- people trained to draw blood mostly from veins for clinical

or medical testing, transfusions, donations, or research
- duties of a phlebotomist may include:
a. interpreting the tests requested,
b. drawing blood into the correct tubes with the proper
additives, accurately explaining the procedure to the person
and preparing them accordingly,
c. practicing the required forms of asepsis,
d. practicing standard and universal precautions,
e. res toring haemos tasis of the puncture site, g iving
instructions on postpuncture care,
f. affixing tubes with electronically printed labels, and
delivering specimens to a laboratory

Emergency Physician

also known as an emergency room (ER) doctor

or emergency medicine physician, works in a
hospital's emergency care center to provide
immediate treatment to people with injuries,
illnesses, or ailments that require attention
beyond what an emergency medical technician
can give. Patients are often faced with life-
threatening situations and the ER doctor is
responsible for stabilizing patients

Flow of care of a client with life-threatening

conditions.
TRIAGE SYSTEM

Tr i ag e i s p ro ce s s o f co lle ct i ng h e alt h
infor matio n f ro m the client and quick
decision making. The Triage Nurse will use
his/her assessment skills and critical care
thinking skill in sorting-out injured clients.
Hospitals around the world use different
Triage Acuity Systems. Triage Nurses will have
education and training in using these acuity
systems.

The following are Triage Acuity

Systems:

1. ESI- Emergency Severity Index

2. CTAS- Canadian Triage and
Acuity Scale
3. ATS- Australasian Triage Scale
4. MTS- Manchester Triage System

 Activity 2

Say something about each of the

triage Acuity system

Please answer by clicking the “raise

hand” icon

Emergency Severity Index (ESI)

fundamental goal is to connect every patient to the

right resources at the right place and in the right
amount of time.

LEVELS OF ESI TRIAGE SYSTEM:

level 1 criteria
- include patients who are intubated, apneic, pulseless,
or unresponsive, as well as patients in imminent risk
of death if lifesaving interventions aren't started.

Level 2 criteria
- patient would be someone who arrives at the
ED saying she's hearing voices, is thinking of
committing suicide, and describes a detailed
suicide plan. This patient is at high risk.

Level 3-5
-are focused on resource allocation

 Canadian Triage and Acuity Scale

(CTAS)

- more accurately define patients’ needs for timely

care.
- helps emergency departments to evaluate the
patients’ acuity levels, resource needs and
departments’ performance against certain operating
objectives.
- Improves communication and public relations.

Australasian Triage Scale (ATS)

-a clinical tool used to establish the maximum waiting

time for medical assessment and treatment of a patient.

- aims to ensure that patients presenting to emergency

departments (EDs) are treated in the order of their
clinical urgency and allocated to the most appropriate
assessment and treatment area.

 Categories:
1. ATS 1 (Immediate)
2. ATS 2 (10 minutes)
3. ATS 3 (30 minutes)
4. ATS 4 (60 minutes)
5. ATS 5 (120 minutes)

The ATS utilizes five categories from Category 1 – an

immediately life-threatening condition that requires
immediate simultaneous assessment and treatment –
to Category 5 - a chronic or minor condition which
can be assessed and treated within two hours.

 Manchester Triage System

is a clinical risk management tool used by clinicians worldwide to

enable them to safely manage patient flow when clinical need far
exceeds capacity.

The Manchester Triage System (MTS) :

1. Red (Immediate)
2. Orange (Very Urgent 10 minutes)
3. Yellow (Urgent 60 minutes)
4. Green (Standard 120 minutes)
5. Blue (Non-Urgent 240 minutes)