Glomerular Filtration rate and its determinants.pptx
Â
NEURO ICU SET UP
1. NEURO INTENSIVE CARE
UNIT
Presented To Presented By
Ms. Tarika Sharma Ms. Amandeep Kaur
Nursing Tutor Msc Nsg. 2nd
Yr
Nsg. Foundation Deptt. 1915703
2. INTENSIVE CARE UNIT
īˇ Intensive care unit is a hospital unit specially
designed to care for people who have sustained or
are at risk of sustaining acutely life threatening
single or multiple organ system failure due to
disease or injury, and who are hemodynamically
unstable and require prolonged minute therapy.
3. NEURO INTENSIVE CARE
UNIT
īˇ âNeuro-critical care or neuro-intensive care
is a branch of medicine that emerged in the
1980s and deals with life-threatening
diseases of the nervous system, which are
those that involve the brain, spinal cord and
nerves.â
4. NEURO HDU
īˇ âHigh Dependency Unit (HDUs) Some hospitals
have High Dependency Units (HDUs), also called
step-down, progressive and intermediate care units.
HDUs are wards for people who need more
intensive observation, treatment and nursing care
than is possible in a general ward but slightly less
than that given in intensive care.â
5. NEURO STROKE ICU
īˇ âAn intensive care unit (ICU) is a specially
trained area of the hospital providing patients with
personalized care from a team of experts. The
patients in the Neuro ICU suffer from severe brain
injuries, stroke or brain tumors and many are post-
op from a neurosurgical procedureâ.
6. Policy Guideline
īˇ A policy guideline to be developed for planning an
ICU by the hospital by framing a committee.
It includes:-
īˇ Medical superintendent
īˇ Surgeon/ neuro surgeon
īˇ HODs Anaesthesia.
īˇ Architect/designer
īˇ Nursing superintendent
īˇ Physician Paediatrician
7. DECISION MAKING
The planning committee will take the following
decisions:-
īˇ Critical care need of the hospital
īˇ Type and size of ICU
īˇ Appointment of ICU in charge
īˇ Appointment of ICU matron
īˇ Planning, designing and physical facilities
īˇ Guidelines, policies and procedures in ICU.
9. PRE-REQUISITE
īˇ Training of nursing and medical staff
īˇ Procurement of beds and equipments
īˇ Developing protocols for monitoring and life
support techniques
īˇ Training of supporting staff
īˇ Commissioning and opening
10. LOCATION
īˇ Should be centrally located with easy access
to emergency and other wards, OT and OPD.
īˇ Easily approachable.
īˇ Away from general hospital traffic.
īˇ Restricted entry.
11. SIZE
īˇ Size of ICU depends on the type of services
provided.
īˇ In super specialty hospital 10% of total beds
īˇ In general hospital 2% of hospital beds.
īˇ Optimum size is 14 beds and minimum 4
beds.
īˇ If no. of beds required is more than 14 beds,
two ICUs be opened. Ideal ICU is 10 beded.
12. DESIGNING OF ICU
There are some principles of designing:-
īˇ All patients can be closely observed
īˇ Ample space around bed for free movements
īˇ Piped gas supply
īˇ Adequate light and electric fixtures.
13. LAY OUT DESIGNING
īˇ Circular placement of beds with central
nursing station
īˇ Rectangular with central monitor system
īˇ Semi circular with monitoring station at the
front.
īˇ The lay out design depends on the
availability of space.
15. ENTRANCE TO ICU
īˇ Broad corridor
īˇ Entrance double door swinging â5â to â6â width
īˇ Toilet
īˇ Reception counter
īˇ Telephone
īˇ Visitors lounge 2sq feet
īˇ Snack bar
16. PATIENT CARE AREA
īˇ Bed space
īˇ Nursing monitoring station
īˇ Call bell system
īˇ Equipments
īˇ Hand washing
īˇ Wall fixers
17. BED SPACE
īˇ Sufficient space is required for each bed for free
movement and keeping ventilator, monitoring
system and other equipments.
īˇ They are required for each bed 100-120 sq ft in
open ICU 140-180 sq ft in cubicle.
īˇ Minimum 15 sq ft clear area.
īˇ Head wall space 1-2 ft.
18. ConâĻ
īˇ Space between two beds 5-8ft.
īˇ The cubicles must have glass partitions or
transparent curtains for clear observation
from monitoring station.
19. BED HEAD FIXTURE AND
CALL BELL SYSTEM
īˇ High intensity spot light connected to generator.
īˇ Wall panel and call bell buttons near the bed
īˇ Sufficient electric sockets for plugging.
īˇ Wall suction tubes and piped oxygen supply.
īˇ Small wash basin.
īˇ No extension wire to be used.
īˇ Equipments with CV stabilizer / USP
20. EQUIPMENTS
īˇ Ventilators, fluids stands
īˇ Defibrillator, pulse
oxymeter
īˇ Monitor and monitor
procedure trolley
īˇ Infusion pump, crush cart
trolley with emergency
equipments and
medicines.
21. NURSING STATION
īˇ Central monitoring
system
īˇ Counter, case records
and essential drugs.
īˇ Complete visibility of
all patients.
īˇ Two way
communication paging
as well as intercom.
22. AUXILLARY AREA
īˇ Medication and nursing area
īˇ Nursing changing room
īˇ Doctors duty room
īˇ Dressing room
īˇ Store
īˇ Equipment maintenance
īˇ Isolation room
īˇ Clean and dirty utility room
īˇ Pantry
23. ISOLATION AREA
The working area is equal to total bed area and separated by
clean corridor from patient area. This area has 14sq. yards
area comprises of:-
īˇ Washing, utility area
īˇ Securable cabinets for staff rooms
īˇ Clean supply room
īˇ Work room with separate sink
īˇ Toilet, dirty utility
īˇ X-ray viewing, Special examination, procedure
īˇ 24hours laboratory, pharmacy, radiology
24. ANCILLARY AREA
īˇ Office space and record room
īˇ Staff lounge, toilet
īˇ Telephone facility
īˇ Staff rest room
īˇ Janitorâs room/cleaner
īˇ ICU matronâs office
25. MEDICAL ENVIRONMENT
Air condition:-
īˇ ICU must be air conditioned
īˇ Temperature maintained at 25o
to 27o
c and 40-50%
humidity.
īˇ Plenty of sunlight, large windows.
Ventilation:-
īˇ 6/8 air changes
īˇ Filter less than 10micron
īˇ Positive pressure flow from patient area to outside
26. ConâĻ
īˇ Lighting:-
īˇ Varying degree of illuminations for patient area,
working area
īˇ Soothing and glare free
īˇ Provision of dimmer lights
īˇ Noise:-
īˇ To be noise free
īˇ Soft and light music
īˇ Noise absorbable material
īˇ Walls reflection free, light color
27. STAFFING REQUIREMENT AS
PER SHIFT
Nursing:-
īˇ Ideally 1:1ratio during day and 1:2ratio during
night
īˇ Broadly 4-5 nurses per bed including reliever
īˇ One ANS for administration.
Medical staff:-
īˇ One physician for per 5beds
īˇ Consultant ICU-1/shift
īˇ Senior resident -2/shift
īˇ Junior resident-2/shift
29. ADMISSION AND
TREATMENT POLICY
īˇ ICU is a place for critically ill patients in need of
constant monitoring , life support and requiring
specialized treatment and trained nursing care.
īˇ The ICU care is based on its three levels:-
īˇ Level-1:- monitoring, observation and short time
ventilation.
īˇ Level-2:- monitoring, observation and long time
ventilation.
īˇ Level-3:- intensive care, invasive procedures,
continuous consultant support.
30. Admission criteria:-
īˇ There should be fixed admission criteria for
admission.
īˇ Priority to be given to the patients, who have
fair chances of reversible condition or
chances of improvement.
31. Treatment policy:-
īˇ Responsibility lies with the incharge of unit admitting the
case.
īˇ No direct admission to ICU but transferred from units.
īˇ A vacant bed is allocated in original ward for patient
return.
īˇ Admission only on recommendations of ICU direct
subjected to available of beds.
īˇ 20% of beds to be kept vacant for emergency admission.
īˇ Continuity of treatment is the per view of ICU in charge in
consultation with unit in charge.
32. POLICIES & PROCEDURES
īˇ Standard treatment protocol should be followed.
īˇ Silence to be observed.
īˇ All new admission/ discharge to be informed to the
ICU in charge.
īˇ All new admission/ discharge to be registered.
33. STAFF STANDING
ORDERS
īˇ Joint round at the time of shift change and proper
handing/taking.
īˇ Instructions and maintenance of intake/output chart.
īˇ Cleaning and maintenance of equipments.
īˇ Checking and replacement of essential drugs.
īˇ Proper maintenance of records.
īˇ Daily round of physician and incharge ICU
combine to take decision for change in treatment.
34. DISCHARGE POLICY
īˇ Decision to discharge is taken in consultation with unit
in charge.
īˇ Patient who have recovered, stable and does not
required artificial ventilation can be shifted to
intermediate care unit or high dependency unit area.
īˇ Patients who are not progressing and chances of
recovery is remote to be discharged for allotting bed to
patient having fair chance of recovery when demand is
acute.
īˇ When there is no demand patient kept in ICU till death.
35. QUALITY ASSURANCE IN
ICU
īˇ To maintain high standard by hygiene and
cleanliness.
īˇ To prevent hospital acquired infection.
īˇ Proper treatment and disposal of bio-medical waste.
īˇ Daily maintenance and checking of vital
equipments.
īˇ Priority on patient comfort and home feeling.
īˇ Exit interview of patient and relatives to improve
standard and quality of care.
36. In Service Education
īˇ A program of instruction or training provided by an
agency or institution for its employees.
īˇ The program is held in the institution or agency and
is intended to increase the skills and competence of
the employees in a specific area.
īˇ Inservice education may be a part of any program
of staff development.
37. TYPE OF TRAINING AND EDUCATION
PROGRAMS FOR ICU NURSES
īˇ In-House training Programs
īˇ College-Based training Programs
īˇ Distance Education
īˇ Simulation training
īˇ Training through E-Learning
44. ICU Psychosis
īˇ ICU psychosis is a disorder in which
patients in an intensive care unit (ICU) or a
similar setting experience a cluster of serious
psychiatric symptoms.
īˇ ICU psychosis is also known as- ICU
syndrome.
45. ICU Psychosis
īˇ Acc. to Hackett et al (1968) 30 % to 70 % of
patients in intensive care units develop this
syndrome.
īˇ The patientâs personality and psychological make-
up are predisposing factors in developing an ICU
psychosis.
īˇ A person suffering from depression pre-operatively,
for example, still be depressed post-operatively and
similarly, an anxious person who has a myocardial
infarct will retain his anxiety.
46. ICU Psychosis
Other predisposing factors are:-
īˇ the length of time under anaesthesia (8 to 10 hours)
īˇ on the cardiopulmonary bypass machine.
īˇ The type of illness can also play a role â it is
easier to cope with a cholecystectomy or an asthma
attack than with a colostomy.
47. ICU Psychosis
īˇ The signs and symptoms of the syndrome are mild
at first, presenting with sleeplessness and
restlessness.
īˇ The patient then becomes disorientated, frightened
and often starts interfering with his treatment.
īˇ This may be followed by perceptual distortions and
illusions â seeing and hearing things that are not
there
48. CAUSES OF PSYCHOLOGICAL
PROBLEMS IN PATIENTS
īˇ Various factors in the intensive care unit itself can
contribute to the psychological breakdown of
patients and staff.
īˇ 1. Fear and anxiety,
īˇ 2.The unit,
īˇ 3. Communication,
īˇ 4. Security,
īˇ 5. Visitors.
49. 1. Fear and anxiety
īˇ The first factor which may cause the ICU
syndrome is the patientâs fear and anxiety.
These two are related and are the most
frequently occurring manifestations of stress.
Most patients are afraid â afraid of the new
environment, new people, his illness and its
prognosis, in short, afraid of the unknown.
50. 2.The unit
īˇ The unit environment, is unpleasant. The
lights are usually on 24 hours a day, there is
constant noise and the patients lie fairly close
together. This results in the patient getting
very little rest and sleep and becoming
exhausted.
51. 3. Communication
īˇ Patients in the intensive care unit are
submitted to both sensory overstimulation
and sensory deprivation â overstimulation
by noise, light and new things, but
deprivation through the lack of touch, spoken
word and reassurance.
52. 4. Security
īˇ The patient is quite defenceless â he is too
sick to defend himself physically and can
often not defend himself verbally either. He
realises that he is totally vulnerable and thus
regresses to childlike behaviour in order to
overcome his feelings of helplessness.
53. 5. Visitors
īˇ Patients are allowed to have visitors for short
periods. This is, however, a controversial
point â visitors are important for the
patientâs wellbeing, but at the same time they
may have a negative influence.
54. FACTORS AFFECTING THE
STAFF
īˇ Most nurses have at some stage of their career felt
stagnant, bitter, disillusioned and have seen no
future.
īˇ They have done their work, but have put no feeling
into it. This often happens when nurses eventually
realize that things are not as they had expected them
to be â their ideals are not congruent with the
reality.
īˇ This apathetic state of the staff is not only
detrimental to the patients but also to the person
herself and other staff.
55. īˇ To reach a situation where the work is more or less
in line with the beliefs of the staff, the co-operation
of the nursing service is necessary â including
adequate and functioning equipment, enough staff
and good pay.
īˇ The nurses want to be treated with respect and there
must be mechanisms of discussing problems of
medical incompetence with the doctors.
56. Factors including:-
īˇ Nature of the work,
īˇ Communication,
īˇ Group pressure,
īˇ Aspects of patient care,
īˇ Visitors.
57. Team Approach
īˇ âTeam-based health care is the provision of health
services to individuals, families, and/or their
communities by at least two health providers who
work collaboratively with patients and their
caregivers-to the extent preferred by each patient-to
accomplish shared goals within and across settings
to achieve coordinated, high-quality care.â
58. Functions
īˇ Ensuring that the patient and family are at the center of the
team requires careful planning and execution.
īˇ Targeting of team-based care-matching resources to patient
and family needs-is essential to maximize value.
īˇ Building bridges to ongoing activities related to team-based
care is critical to ensure efficiency.
īˇ Defining a coordinated research agenda for team-based care
is necessary to achieve continuously improving, high-value
team-based health care.
67. Care of the Patient
With a Neurological
Disorder
68. Anatomy and Physiology
īˇ Central nervous system
(CNS)
īŽ Brain
īŽ Spinal cord
īˇ Peripheral nervous
system
īŽ Somatic (voluntary)
īŽ Autonomic
(involuntary)
69. Anatomy and Physiology
īˇ Neurons
īŽ Transmitter cells
īŽ Carry messages to and
from brain and spinal
cord
īˇ Glial cells
īŽ Support and protect
neurons
īŽ Produce cerebral spinal
fluid
76. Cranial Nerves
īˇ I. Olfactory
īˇ II. Optic
īˇ III. Oculomotor
īˇ IV. Trochlear
īˇ V. Trigeminal
īˇ VI. Abducens
īˇ VII. Facial
īˇ VIII. Acoustic
īˇ IX. Glossopharyngeal
īˇ X. Vagus
īˇ XI. Spinal Accessory
īˇ XII. Hypoglossal
79. Nursing Care of the Patient
With IIP
īˇ Elevate HOB
īˇ Neck in neutral
position
īˇ Avoid flexion of hips,
waist and neck
īˇ Hypothermia blanket
īˇ Restrict fluids
īˇ Foley
īˇ Suctioning
īˇ O2
80. Seizures
īŽ Disorderly neuron discharges in brain
īŽ Different types affect body differently
īŽ Involuntary movement usually
81. Seizures
īˇ Generalized:
īŽ Tonic-clonic â
grand mal
īŽ Absence - Petit mal
īŽ Myoclonic
īŽ Atonic or akinetic
īˇ Localized: (Focal)
īŽ Partial (Jacksonian)
īŽ Psychomotor
82. Seizures: Nursing Care
īŽ Continue medicines
īŽ Medical alert ID
īŽ Avoid alcohol, avoid driving, get adequate rest
īˇ If on Dilantin, instruct on oral hygiene.
īˇ Prevent aspiration (airway)
īŽ Turn side; loosen clothing around neck
83. Seizures: Nursing Care
īˇ Protect
īŽ Lower to the floor; pad side rails; pillow under
head; donât restrain
īŽ No bite block or padded tongue blade
īŽ Allow for post-ictal rest
īˇ Document everything
91. Parkinsonâs â Nursing Care
īˇ Prevent injury (fall or aspiration)
īˇ Prevent urinary retention and constipation
īˇ Patient teaching about medication
īˇ Patient and family support
92. Alzheimerâs
īˇ Unknown cause, but genetic link
īˇ Very common; risk increases with age
īˇ Brain changes:
īŽ plaques
īŽ tangled neurons
īŽ blood vessel degeneration
īŽ chemical changes
93. Alzheimerâs - Symptoms
īˇ 1stâ memory lapses, difficult word finding,
decreased attention span
īˇ 2nd â increased memory problems,
disoriented to time, loses things,
confabulates
īˇ 3rd â total disorientation, apraxia, wanders
īˇ 4th â severe impairment
95. Alzheimerâs â Nursing Care
īˇ 2 key points for all care:
īŽ Prevent overstimulation
īŽ Provide structured, orderly environment
īˇ Other concerns
īŽ Communication
īŽ Family support and education
96. Cerebrovascular Accident
(CVA)
īˇ Ischemia of brain tissue
īŽ Hemorrhage
īŽ Thrombus
īŽ Embolus
īˇ 3rd
leading cause of death in the US
īˇ All ages, but usually elderly
97. CVA-Nursing Care
īˇ Assess LOC
īˇ IV, NG, Foley, Vent.
īˇ Nutrition
īˇ Encourage perform ADLs
īˇ Bladder and bowel training
īˇ ROM
īˇ Teaching and emotional support
98. Meningitis
īˇ Acute infection of the meninges
īˇ Viral or bacterial
īˇ Severe headache, irritable, fever, delirium,
N/V, neck stiffness
īŽ Kernigâs sign
īŽ Brudzinskiâs sign
102. RESEARCH INPUT
īˇ TITLE:-
TRAINING PROGRAMS CARRIED FOR NURSES
WORKING IN INTENSIVE CARE UNIT
īˇ OBJECTIVE :
īˇ To study training programs carried for nurses
working in intensive care unit.
103. RESULT
īˇ An ICU is a consolidated area of a hospital
where patients with acutely life-threatening
illnesses or injuries receive around the clock
specialized medical and nursing care.
īˇ Intensive care medicine/ Quality of patient
care in ICU is the result of close cooperation
among doctors, nurses, and allied health care
professionals.
104. CONCLUSION
īˇ The intensive care unit is equipped and staffed to
provide patients treatment.
īˇ In-house orientation is the most commonly used
method to prepare nurses for practice in critical care
area.
īˇ An efficient process of communication has to be
organized between the medical and nursing staff of
the ICU.
īˇ Tasks and responsibilities have to be clearly
defined.
105. SUMMARY
īˇ Neuro intensive care unit
īˇ Neuro hdu
īˇ Neuro stroke icu
īˇ Policy guidelines fo
neuro icu
īˇ Physical set-up
īˇ Staffing requirements
īˇ Policies
īˇ Procedures
īˇ In service education
programmes
īˇ Team approach
īˇ Nursing care of patients
with neuro disorders.
106. CONCLUSION
īˇ Patients are admitted to an intensive care unit after
experiencing a significant illness or injury.
īˇ ICU nurses need in-house hospital-based training
programs to provide quality of patient care and
treatment.
īˇ College-based training programs will help in
enhancing knowledge and new skills important in
ICU section.
107. References
BOOK:-
īˇ The clinical practice of NEUROLOGICAL AND
NEUROSURGICAL NURSING. Seventh edition.
By Joanne V. Hickey.P-312-332.
INTERNET:-
īˇ https://www.nursingtimes.net/...care/care...patients
...care.../199659.article
īˇ www.curationis.org.za/index.php/curationis/article/
download/425/365