"AACN Advanced Critical Care Nursing" Editor: K. Carlson
Marino, ICU Book Masson
Karen K. Carlson, American Association of Critical-Care Nurses.
AACN Advanced Critical Care Nursing. Saunders / Elsevier, 2009
Marino PL. The ICU book. Intensive Therapy: Fundamental Principles.
Publisher Elsevier -Masson, 2007
Learning Objectives
"Describe the organization of the Emergency System both intra and extra hospital;
Describe the elements that make up a patient at risk of impaired vital functions;
Recognize and identify the priorities of the careers of key critical and vitality frameworks
organ;
Describe and implement basic and advanced monitoring of vital functions;
Describe the quality support indicators in the critical focus setting.
Teaching Methods
"Frontal Lessons- Discussion of Clinical Cases
Type of Assessment
Oral exam
Course program
Emergency System Overview (Organization):
• 118: Organization, Purpose, Means and Features of
service.
DEA: organization, purpose and endowment, quality indicators.
UTI: organization, admission criteria, characteristics of the
setting, outreach service, organ dysfunction signs,
clinical scores.
Triage
The purpose, characteristics, role of nurse and normative.
The experience of the See & Treat
General approach to the patient in DEA
DEA Setting Description
General Scheme according to the ABCDE of the DEA course
Critical Communication Area (DEA)
General Approach to Patient Intensive Therapy, Sec
scheme ABCDE
Securing the context
Patient safety
Clinical priorities
Primary evaluation
Secondary assessment
Intensive Therapy Open and Closed
Basic monitoring
ECG: recognition and rhythm characteristics
Invasive and non-invasive arterial pressure
Peripheral oxygen saturation (SpO2)
Exhalation Carbon Dioxide (ETCO2)
Nursing patient in mechanical ventilation
Indications and definition of non-invasive mechanical ventilation
Indications and definition of invasive mechanical ventilation
Short and long term ventilation
Main controlled ventilation modes
Volume, Pressure, Flow Control
Main assisted or support ventilation modes
Assisted Mechanical Ventilation (AMV)
Intermittent mandatory ventilation (IMV)
Synchronized intermittent mandatory ventilation (SIMV)
Assisted spontaneous breaths (ASB)
Continuous Positive Airway Pressure (CPAP)
Positive End Exhaustive Pressure (PEEP)
Mechanical ventilation parameters: monitoring
Protective ventilation in the ADS: parameters
Automatic alarm fan management
Notes on patient placement in ventilation
mechanics
Arterial Emogasanalysis: Normal Values
ABCDE bundle
Nursing the patient with artificial airways
Tracheal Intubation: Indications and Benefits
Tracheostomy: Indications and Benefits
Assistance to tracheal intubation
Technique
Checking for correct positioning
Support for percutaneous bedside tracheotomy
Types of endotracheal tubes
Types of tracheal cannulas
Prevention of complications
Fixing the tracheal / tracheostomy tube
Headphone management
Oral cavity hygiene
Management of the fenestrate and non fenestrata of the
tracheostomy tube
Treatment of dysphagia in the patient with tracheostomy
Handling phonation in a patient with cannula
tracheostomic fenestrate
Tracheal suction technique with open system and system
closed
Pain and sedation in UTI
Assessment of pain and sedation in therapy
Intensive
The scales of ethereal evaluation of pain in the patient
intensive
Sedation assessment scales
Instrumental monitoring of sedation
Approach to the management of pain and sedation
Prevention of critical area infections
General aspects and control measures
Vascular catheter-related infections
Pneumons associated with mechanical ventilation
Bladder-related catheter-related infections
Artificial Nutrition
Indications for parenteral, enteral, and nutrition
percutaneous gastrostomy
evaluation of the critical patient's nutritional needs
Basic monitoring
ECG: recognition and rhythm characteristics
Invasive and non-invasive arterial pressure
Peripheral oxygen saturation (SpO2)
Exhalation Carbon Dioxide (ETCO2)
Advanced Monitoring
Central venous pressure
o Measurement mode
o Clinical meaning, normal values, influence of
intrathoracic pressures
Hemodynamic monitoring with pulmonary artery catheter
Purposes
or Indication
o Description of catheter
o Nursing and nursing technician
during insertion
o Direct and indirect parameters of the catheter, measurement
and clinical significance
Measurement of cardiac output with
intermittent and continuous thermodilution
Management of transducer circuit and positioning of the
patient to read the pressures
Potential complications of the Swan Ganz catheter
Infectious risk management
Mixed venous saturation (SVO2)
or measurement method
or normal values
or clinical significance in relation to consumption and transport
of O2
Mixed central venous saturation (ScVO2)
or measurement method
or normal values
or clinical significance in relation to consumption and transport
of O2
or difference compared to mixed vein saturation
Neuromonitoring
o Evaluation of the pupillary state
o Assessment state of conscience
or intracranial hypertension
or pathogenesis / pathophysiology
o Monro-Kelly's Doctrine
o Brain ernactions
o Intracranial pressure monitoring:
Indications, Locations, and Normal Values
o Target for cerebral perfusion pressure and flow
cerebral hematoma
o Ventricular drainage system
o Venous saturation to the jugular bulb (SJO2):
hints, normal values, clinical significance
o Partial tissue pressure of cerebral oxygen
(pbtO2): notes, normal values, clinical significance
Therapeutic and assistive diagnostic pathways in the patient
life critical conditions
Burning / Politrauma
IMA (Respiratory Cardiac Arrest)
Stroke
The cardiac surgeon
The neurosurgical patient
Sepsi
Respiratory failure