Introduction:

Delivery of Care in the ICU can be very task oriented and labor intensive. Assessment skills must be systematic to be able to effectively progress to the business of patient care. As an ICU nurse hones skills and develops knowledge base, the assessment moves from function to art. The assessment will become second nature, and the nurse will be able to rapidly prioritize assessment as well as care.

Admission Protocol

- Patients with Respiratory failure. - Post successful CPR. - Post neurosurgery (Brain surgery). - Fluids and electrolytes imbalance. - D.I.C. (Disseminated intravascular co-agulopathy. - Pneumothorax and hemothorax affecting respiration. - Shock. - Chest trauma (Flail chest). - Poisoning. - Post major surgery. - Coma with unknown cause. - Acute renal failure

Assessment tools:
Index of independence in activities of daily living. Barthel index Crighton royal behaviour rating scale Clifton assessment procedures General Health Questionnaire Geriatric mental health state schedule

Assessment of Critically Ill Patient-FANCAP

- F: Fluid: movement of fluid and electrolytes among body compartment. Electrolyte imbalance, Dehydration, hypervolemia, hemodynamic stability (V/S) - A: Aeration: assess the patient clinically and laboratory.

 Type of respiration, normal and extrabreathing sounds, color of skin & mucous membrane, rate of respiration, ABGs determination is the best indicator for the patient condition. - N: Nutrition: assess the patient through physical examination and lab. Investigation and ask the following question: Can we use the normal GI tract, what about the GI system condition, does the patient need biologic nutrition (TPN), what about vitamins and minerals supplementation.

C: Communication: Assess neurological function (GCS), look at the patient eyes, does he cooperative, does he oriented. - Activity: bed rest with mild activity (ADL), complete bed rest, - Up with help----need assistant. - Up in chair ------ cannot walk. - P: Pain: Physiological pain from the disease process, psychological pain from loneless, hopelessnessfear,

P.Q.R.S.T. criteria for assessment of pain

- P: (Precipitating & palliating factors). - Q: (Quality of pain) how would describe the pain burning, stabbing, squeezingdescription may indicate the cause. - R: (Region & radiation) where is the pain, as; the patient to point the area of pain,does it travel any where. - S: (Severity) does it make you stop what you are doing, double over. - T: (Time factor) how often does the pain occur, how long does it lasts, when did you first experience the pain.

CLASSIFICATION

Level I - District Hospital

A Level I ICU can be referred as high dependency are where close monitoring, resuscitation, and short term ventilation <24hrs has to be performed.

Level II - General Hospital

A Level II ICU Can be located in general hospital, undertake more prolonged ventilation. Must have resident doctors, nurses, access to pathology, radiology, etc.

Level III - Tertiary Hospital

A Level III ICU is located in a major tertiary referral hospital. It should provide all aspects of intensive care required. All complex procedures should be undertaken. Specialist intensivist, critical care fellows, nurses, therapists, support of complex investigations and specialists of from other disciplines to be available at all times.

Principles of Critical Care Nursing

1.Anticipation Early detection & prompt action Collaborative practice Communication Prevention of Infection Crisis Intervention & Stress Reduction

Organization of ICU
Design of ICU Storage areas/services areas Equipments Staffing 1.Medical staff 2.Nursing staff 3.Allied staff Special Equipments

DESIGN OF ICU
There should be a single entry and exit. There should not be any through traffic of goods or hospital staff. ICU must have areas and rooms for public reception, patient management and support services. Full commitment must be given from administration and a designated team to work on various tasks..

1. Patient Areas

Each patient requires a floor space 18.5m2 (200 sq.ft) with single room being larger about 2630m2 to accommodate patient, staff, equipment without overcrowding. There should be at least 3 to 3.67 metres between the bed centers.

Single rooms are essential for isolation and privacy. The ratio of single room beds to open ward beds depends on the role and type of ICU.

Bedside service outlets should conform to local standards and requirements (including electrical safety and emergency supply).

Three oxygen, 2 air, 4 suction, and 16 power outlets with a bedside lamp are optimal for a Level III ICU.