1. Introduction to Critical Care Nursing
- Historical review- Progressive patient care (PPC)
- Review of anatomy and physiology of vital organs, fluid and electrolyte balance
- Concepts of critical care nursing
- Principles and Scope of critical care nursing
- Critical care unit set up including equipments supplies, use and care of various type of monitors & ventilators Flow sheets
2. Concept of Holistic care applied to critical care nursing practice
- Impact of critical care environment on patients:-Risk factors, Assessment of patients, Critical care psychosis
- The dynamics of healing in critical care unit:-therapeutic touch,Relaxation, Music therapy, Guided Imagery, acupressure Stress and burnout syndrome among health team members
3. Review of Drugs/Fluids Pharmacokinetics
- Analgesics/Anti inflammatory agents
- Antibiotics, antiseptics
- Drug reaction & toxicity
- Drugs used in critical care unit (inclusive of inotropes, vasopressors and life saving drugs)
- Drugs used in various body systems
- IV fluids and electrolytes
- Blood and blood components
- Principles of drug administration, role of nurses and care of drugs
4. Pain Management
- Pain & Sedation in Critically ill patients
- pain management-pharmacological and non-pharmacological
5. Infection control in intensive care unit
- Nosocomial infection in intensive care unit; Disinfection, Sterilization, Standard safety measures, Needle Stick Injury, Prophylaxis for staff Bio Medical Waste Management
6. Gastrointestinal System
- Medical, Surgical and Nursing management of: Acute Gastrointestinal Bleeding, Abdominal injury
- Hepatic Disorders:- Fulminant hepatic failure, Hepatic Encephalopathy, Acute Pancreatitis, Acute intestinal obstruction, perforation Peritonitis
7. Renal System
- Medical, Surgical and Nursing management of:- Acute Renal Failure, Chronic Renal Failure
- Management Modalities: Renal Replacement Therapy
8. Nervous System
- Medical, Surgical and Nursing management of:-Common Neurological Disorders:- Cerebrovascular disease, Cerebrovascular accident, Seizure disorders, GuilleinBarre-Syndrome, Myasthenia Gravis, Coma, Persistent vegetative state, Head injury, Spinal Cord injury
9. Endocrine System
- Medical, Surgical and Nursing Management of :- Hypoglycemia, Diabetic Ketoacidosis, Insulin therapy
10. Management of other Emergency Conditions/ Trauma
- Mechanism of injury, Cervical Spine/Thoracic injuries, Abdominal injuries, pelvic fractures, complications of trauma
- Shock: Shock syndrome, Hypovolemic, Cardiogenic, Anaphylactic, Neurogenic and
- Septic shock Systemic inflammatory Response: The inflammatory response, Multiple organ dysfunction syndrome Drug Overdose and Poisoning,
11. Cardiovascular emergencies
- Principles of Nursing in caring for patient’s with Cardiovascular disorders Assessment: Cardiovascular system: Diagnostic studies:- Cardiac enzymes studies, ECG monitoring, Holter monitoring, Stress test. Echo cardiography, Coronary angiography Medical, Surgical & Nurisng management of:- Hypertensive crisis, Coronary artery disease, Acute Myocardial infarction, Deep vein thrombosis, Cardiac arrhythmias, Heart failure Management Modalities: Thrombolytic therapy, Pacemaker – temporary & permanent, PCI/Thrombolysis, Cardioversion, Intra Aortic Balloon pump monitoring, Defibrillations, Cardiac surgeries, Coronary Artery Bypass Grafts (CABG/MICAS), Valvular surgeries Autologous blood transfusion, Radiofrequency Catheter Ablation Cardio pulmonary resuscitation BCLS/ ACLS
12. Respiratory System
- Acid-base balance Assesment : History & Physical Examination Pulse Oximetry, End –Tidal Carbon Dioxide, Arterial blood gas studies, chest radiography, pulmonary Angiography, Bronchoscopy Medical, Surgical and Nursing management of Common pulmonary disorders:- Pneumonia, Status asthmaticus, Interstitial drug disease, Pleural effusion, Chronic obstructive pulmonary disease, Pulmonary tuberculosis, Pulmonary edema, Pulmonary embolism, Acute respiratory distress syndrome (ARDS), Chest Trauma - Haemothorax, Pneumothorax Management Modalities:-Airway Management Ventilatory Management:-Invasive, non- invasive, long term mechanical ventilations Bronchial Hygiene:-Nebulization, deep breathing exercise, chest physiotherapy, postural drainage, Inter Costal Drainage
13. Burns
- Clinical types, classification, assessment, diagnosis, prognosis Management: Medical, Surgical & Nursing management of burns Fluid and electrolyte therapy – calculation of fluids and its administration Pain management
14. Obstetrical Emergencies
- Medical, Surgical and Nursing management of : Antepartum haemorrhage, Preeclampsia, eclampsia, Post partum haemorrhage, Peurperal sepsis, Obstetrical shock
15. Neonatal Paediatric emergencies
- Medical, surgical and Nursing management of Neonatal emergencies
16. Legal and ethical issues in critical care-Nurse’s role
- Brain death & Organ donation & Counselling Do Not Resuscitate (DNR)
17. Quality assurance
- Standards, Protocols, Policies, Procedures Infection control; Standard safety measures Nursing audit Staffing, Design of ICU/CCU
| Proposed Rotation |
| Deptt/Unit |
No. of Months |
| Medical ICU |
4 Mo |
| Surgical ICU |
4 Mo |
| CCU/CTVS |
1 Mo |
| Emergency Department |
1 Mo |
| Dialysis Unit/ Transplant |
1 Mo |
| Paediatric/ OT |
1 Mo |
ESSENTIAL CRITICAL CARE NURSING SKILLS
I. Procedures Observed
- CT Scan
- MRI
- EEG
- Hemodialysis
- Endoscopic Retrograde cholangio Pancreaticogram(ERCP)
- Heart/ Neuro/GI./ Renal Surgeries
II. Procedures Assisted
- Advanced life support system
- Basic cardiac life support
- Arterial line/arterial pressure monitoring/blood taking
- Arterial blood gas
- ECG recording
- Blood transfusion
- IV cannulation therapy
- Arterial Catheterization
- Chest tube insertion
- Endotracheal intubations
- Ventilation
- Insertion of central line/cvp line
- Connecting lines for dialysis
III. Procedure Performed
- Airway management: airway adjuncts, Oxygen therapy, Non Invasive Ventilation/CPAP ET Suction, Care of tracheostomy Endotracheal extubation
- Cardiopulmonary resuscitation, Basic cardiac life support,
- Monitoring of critically ill patients – clinically with monitors, capillary refill time (CRT) assessment of jaundice, ECG.
- Gastric lavage
- Assessment of critically ill patients Identification & assessment of risk factors for Pressure Sores, Glasgow coma scale, Arterial pressure monitoring, cardiac output/pulmonary artery pressure monitoring, detection of life threatening arrhythmias.
- Admission & discharge of critically ill patients
- Nutritional needs – Enteral & Parenteral formula preparation & patient education.
- Assessment of blood sugar levels periodically & administering insulin.
- Administration of drugs: IM, IV injection, IV cannulation calculation of dosages, blood administration.
- Procedures for prevention of infections: Hand washing, disinfection & sterilization surveillance, and fumigation Universal Precautions
- Collection of specimen.
- Setting, use & maintenance of basic equipment, ventilator, O2 analyzer, monitoring equipment, transducers, defibrillator, infusion & syringe pumps.
COMPETENCIES
A Record of competencies will be issued by the recognised teacher/guide at the end of training. The following are the competencies that shall be assessed and signed after the end of each posting.
- Recognition, assessment and stabilisation of a critically ill patient – structured and timely approach
- Manages cardiopulmonary resuscitation
- Manages the patient post-resuscitation
- Triages and prioritises patients appropriately, including timely admission to ICU
- Obtain a history and performs an accurate clinical examination
- Undertakes timely and appropriate investigations
- Describes indications for Endotracheal Intubation
- Performs ECG and interprets the results
- Recognises and manages electrolyte, glucose and acid-base disturbances
- Chest x-rays - Liaises with radiologists to organise and interpret clinical imaging
- Monitors and responds to trends in physiological variables
- Co-ordinates and provides nutritional assessment and support
Certificate of Succesful Completion to be given by Indian College of Critical Care Medicine after an Exit Evaluation which would include Theory (MCQ ) and Viva.