Intensive Care Unit Intensive Care Unit is a hospital facility for care of critically ill patients at a more intensive

e level than is needed by other patients. Staffed by specialized personnel. ICU care requires a multidisciplinary team that consists of but is not limited to intensivists (clinicians who specialize in critical illness care. They will provide treatment management, diagnosis, interventions, and individualized care for each patient recovering from severe illness. Purpose of ICU The purpose of the intensive care unit (ICU) is simple even though the practice is complex. Healthcare professionals who work in the ICU or rotate through it during their training provide around-the-clock intensive monitoring and treatment of patients seven days a week. When patients are transferred to the ICU from another hospital department, treatment orders and planning must be reviewed and new treatment plans written for the patient's current status. For example, a chronically ill inpatient may grow markedly worse within a few hours and may be transferred to the ICU, where the staff must reevaluate orders for his or her care. Description of ICU ICUs are highly regulated departments, typically limiting the number of visitors to the patient's immediate family even during visiting hours. In addition to the intensivist's role in direct patient care, he or she is usually the lead physician when multiple consultants are involved in an intensive care program. The intensivist coordinates the care provided by the consultants, which allows for an integrated treatment approach to the patient. The nurse's role usually includes clinical assessment, diagnosis, and an individualized plan of expected treatment outcomes for each patient History of ICU In 1854, Florence Nightingale left for the Crimean War, where the necessity to separate seriously wounded soldiers from less-seriously wounded was observed. Nightingale reduced mortality from 40% to 2% on the battlefield, creating the concept of intensive care.

 In 1950, anesthesiologist Peter Safar established the concept of "Advanced Support of Life," keeping patients sedated and ventilated in an intensive care environment. Safar is considered the first intensivist. In response to a polio epidemic (where many patients required constant ventilation and surveillance), Bjrn Ibsen established the first intensive care unit in Copenhagen in 1953.The first application of this idea in the United States was pioneered by Dr. William Mosenthal, a surgeon at the DartmouthHitchcock Medical Center. In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions (heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially in the post-MI setting. PATIENTS IN THE ICU TYPES OF PATIENTS Patients come into the MICU from a variety of places: the floors, the ER, as transfers from other hospitals, as postops, as boarders from other services, and sometimes as direct admits, bypassing the ER. The interesting thing about the MICU is that we literally see a bit of absolutely everything, unlike the specialty ICUs. If you work here long enough, youll see patients that would normally be in every other ICU environment (except maybe fresh postop cardiothoracic patients that ICU will bump more stable patients out to make room). We see cardiac patients, sometimes with intra-aortic balloon pumps; we see neuro patients, occasionally with monitored bolts in place, weve done adult ECMO a few times, and we even sometimes get generalsurg postop cases.. MICU Equipments 1.) Mechanical Ventilator Definition is a method to mechanically assist or replace spontaneous breathing. circumstances for which ventilation is required then additional measures are often required to "secure" the airway during positive pressure ventilation to allow unimpeded passage of air into the trachea and avoid air passing into the esophagus and stomach. Commonly this is by insertion of a tube into the trachea which provides a clear route for the air.

 This can be either an endotracheal tube, inserted through the natural openings of mouth or nose or a tracheostomy inserted through an artificial opening in the neck. Mechanical ventilation is often a life-saving intervention, but carries many potential complications including pneumothorax, airway injury, alveolar damage, and ventilator-associated pneumonia. Indications: Mechanical ventilation is indicated when the patient's spontaneous ventilation is inadequate to maintain life. also indicated as prophylaxis for imminent collapse of other physiologic functions, or ineffective gas exchange in the lungs Common medical indications for use include: Acute lung injury (including ARDS, trauma) Apnea with respiratory arrest, including cases from intoxication Chronic obstructive pulmonary disease (COPD) Acute respiratory acidosis with partial pressure of carbon dioxide (pCO2) > 50 mmHg and pH < 7.25, which may be due to paralysis of the diaphragm due to Guillain-Barr syndrome, Myasthenia Gravis, spinal cord injury, or the effect of anaesthetic and muscle relaxant drugs Increased work of breathing as evidenced by significant tachypnea, retractions, and other physical signs of respiratory distress Hypoxemia with arterial partial pressure of oxygen (PaO2) with supplemental fraction of inspired oxygen (FiO2) < 55 mm Hg Hypotension including sepsis, shock, congestive heart failure Neurological diseases such as Muscular Dystrophy Amyotrophic Lateral Sclerosis Because mechanical ventilation only serves to provide assistance for breathing and does not cure a disease, the patient's underlying condition should be correctable and should resolve over time. 2.) ECG

 Electrocardiography (ECG or EKG) is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes. It is a noninvasive recording produced by an electrocardiographic device. The etymology of the word is derived from electro, because it is related to electrical activity, cardio, Greek for heart, and graph, a Greek root meaning "to write". is the most commonly performed cardiac test This is because the ECG is a useful screening tool for a variety of cardiac abnormalities. ECG machines are readily available in most medical facilities; and the test is simple to perform, risk-free and inexpensive. What information can be gained from the ECG? the heart rate the heart rhythm whether there are conduction abnormalities (abnormalities in how the electrical impulse spreads across the heart) whether there has been a prior heart attack whether there may be coronary artery disease whether the heart muscle has become abnormally thickened How is the ECG performed? You will lie on an examination table, and 10 electrodes (or leads) are attached to your arms, legs, and chest. The electrodes detect the electrical impulses generated by your heart, and transmit them to the ECG machine. The ECG machine produces a graph (the ECG tracing) of those cardiac electrical impulses. The electrodes are then removed. The test takes less than 5 minutes to perform. RA on the right arm, avoiding bony prominences. LA in the same location that RA was placed, but on the left arm this time.

 RL on the right leg, avoiding bony prominences. LL in the same location that RL was placed, but on the left leg this time. V1 in the fourth intercostal space (between ribs 4 & 5) just to the right of the sternum (breastbone). V2 in the fourth intercostal space (between ribs 4 & 5) just to the left of the sternum. V3 between leads V2 and V4. V4 in the fifth intercostal space (between ribs 5 & 6) in the mid-clavicular line (the imaginary line that extends down from the midpoint of the clavicle (collarbone). V5 horizontally even with V4, but in the anterior axillary line. (The anterior axillary line is the imaginary line that runs down from the point midway between the middle of the clavicle and the lateral end of the clavicle; the lateral end of the collarbone is the end closer to the arm.) V6 horizontally even with V4 and V5 in the midaxillary line. (The midaxillary line is the imaginary line that extends down from the middle of the patient's armpit.) 3.) Nebulizer device used to administer medication to people in the form of a mist inhaled into the lungs. It is commonly used in treating cystic fibrosis, asthma, and other respiratory diseases. Nebulizers accept their medicine in the form of a liquid solution, which is often loaded into the device upon use The reason they are inhaled instead of ingested is usually to target their effect to the respiratory tract, which speeds onset of action of the medicine and reduces side effects compared to other means of delivering these medicines. medicine is inhaled through a tube-like mouthpiece, similar to that of an inhaler. however, is sometimes replaced with a face mask, similar to that used for inhaled anaesthesia, for ease of use with young children or the elderly 4.) Defibrillator

 treatment for the life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart This depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus rhythm to be reestablished by the body's natural pacemaker, in the sinoatrial node of the heart. Manual external defibrillator used in conjunction with (or more often have inbuilt) electrocardiogram readers, which the healthcare provider uses to diagnose a cardiac condition The healthcare provider will then decide what charge (in joules) to use, based on proven guidelines and experience, and will deliver the shock through paddles or pads on the patient's chest. 5.) Pulse Oximeter 6.) Suction 7.) Cardiac Monitor DRUG STUDY COMMONLY USED ABBREVIATIONS Medication Schedules ac = before meals QD = every day Q AM = every morning QOD = every other day Medication Schedules PRN

= as needed/whenever necessary HS = hour of sleep/at bedtime MR x 1 = may repeat x 1 Stat = at once Medication Schedules qh,q1 = every hour q2h,q2 = every two hours q4h,q4 = every four hours BID =twice a day Medication Schedules TID = three times a day QID = four times a day ASAP = as soon as possible q hs = every night at bedtime Patient Activity Terms

ad lib = as tolerated Up ad lib = up as tolerated BRP = bathroom privileges BR = bedrest Patient Activity Terms CBR = complete bedrest Adm =admitted/admission DC or d/c = discontinue/discharge I&D =Incision & drainage Patient Activity Terms OOB = out of bed CC =chief complaint TCDB = turn, cough, deep breath BR c BRP = bedrest c bathroom privilege

 Patient Activity Terms ADL = activities of daily living Amb = ambulatory S/S = signs & symptoms n/v = nausea & vomiting Routes of Medication Administration IV = intravenous IM = intramuscular SQ = subcutaneous IVPB = intravenous piggyback Routes of Medication Administration p.o. =by mouth Supp =suppository SL = sublingual SD

= side drip Common Diagnostic Tests EKG,ECG = Electrocardiogram EEG = Electroencephalogram CXR = Chest X-ray UGI = Upper Gastrointestinal X-rayLGI = Lower Gastrointestinal X-ray Common Diagnostic Tests MRI = Magnetic Resonance Imaging IVP = Intravenous Pyelogram Hct = Hematocrit BUN = Blood Urea Nitrogen Common Diagnostic Tests CT = Clotting Time GTT = Glucose Tolerance Test

EMG = Electromyography LP = Lumbar Puncture GB = Gallbladder Common Diagnostic Tests CAT Scan = Computerized Axial Tomography Scan USD = Ultrasound KUB = Kidney, Ureter, Bladder HBT = Hepato Biliary Tract Common Diagnostic Tests CBC = Complete Blood Count Hgb = Hemoglobin FBS = Fasting Blood Sugar Bt = Bleeding Time PPD = Purified Protein Derivative

 Miscellaneous Patient/Hospital Related Terms E.R. = Emergency Room O.R. = Operating Room PACU = Post Anesthesia Care Unit R.R. = Recovery Room Ca = Cancer Miscellaneous Patient/Hospital Related Terms CHF = Congestive heart failure FUO = fever of unknown origin MI = Myocardial infarction OBS = Organic Brain Syndrome URI = Upper Respiratory Infection Miscellaneous Patient/Hospital Related Terms UTI = Urinary Tract Infection HEENT

= head,ears, eyes, nose, throat GI = Gastrointestinal GU = Genito-urinary GYN = Gynecology Miscellaneous Patient/Hospital Related Terms OB = Obstetrics COC =,continuity of care ABO = The main blood group Meds = medication LMP = last menstrual period Miscellaneous Patient/Hospital Related Terms ARDS = Adult Respiratory Distress Syndrome AKA = above knee amputation A/SGA = Average/Small Gestational Age ASHD

= Arteriosclerotic Heart Dis. Miscellaneous Patient/Hospital Related Terms IVF = Intravenous fluid C/S = Cesarean Section CAPD = Continuous Ambulatory Peritoneal Dialysis CPR = Cardio Pulmonary Resuscitation Miscellaneous Patient/Hospital Related Terms CVA = Cerebro Vascular Accident FHR = fetal heart rate ICP = intracranial pressure NSVD = Normal Spontaneous Vagina Delivery Miscellaneous Patient/Hospital Related Terms PROM = premature rupture of membrane PID = Pelvic Inflammatory Disease PMI = point of maximum impulse

VBAC = Vaginal birth after cesarean section Miscellaneous Patient/Hospital Related Terms T&A = Tonsillectomy & Adenoidectomy TIA = Transient Ischemic Attack C.N.M. = Clinical Nurse Manager P.C.C. = Patient Care Coordinator ICU = Intensive Care Unit Miscellaneous Patient/Hospital Related Terms SOB = shortness of breath N.P. = Nurse Practitioner AMNP = Advanced Medical Nurse Practitioner HOH = hard of hearing Ectomy = removal Miscellaneous Patient/Hospital Related Terms itis

= inflammation Otomy = incision into PE = pulmonary embolism PMH = past medical history PTA = prior to admission Miscellaneous Patient/Hospital Related Terms Lap = laparotomy ABGs = Arterial blood gases C&S = culture & sensitivity U/A, UA = urinalysis CVMS = clean voided urine midstream Miscellaneous Patient/Hospital Related Terms BM = bowel movement ACLS = Advanced Cardiac Life Support AIDS

= Acquired Immune Deficiency Syndrome anes. = anesthesia Miscellaneous Patient/Hospital Related Terms A/CRF = Acute/Chronic Renal Failure BPH = Benign Prostatic Hypertrophy CPD = Cephalo Pelvic Disproportion CAD = Coronary Artery Disease Miscellaneous Patient/Hospital Related Terms CNS = Central Nervous System TPN = total parenteral nutrition CVP = Central Venous Pressure GCS = Glasgow Coma Scale IOP = intraocular pressure Miscellaneous Patient/Hospital Related Terms ORIF = Open Reduction Internal Fixation

PEEP = Positive End Expiratory Pressure PUD = Peptic Ulcer Disease SVC = superior vena cava Miscellaneous Patient/Hospital Related Terms TOF = Tetralogy of Fallot TAHBSO = Total Abdominal Hysterectomy w/ Bilateral Salpingo-oophorectomy TURP = transurethral resection of the prostate General Terms c = with s = without a = before p = after General Terms ac = before meals R

= right OD = right eye (oculus dexter) F = Fahrenheit General Terms C = Celsius, centigrade Dx = Diagnosis Rx = Treatment Sx = Service General Terms Tx = traction, therapy Bx = biopsy Fx = fracture c/c = complaint of General Terms w/c = wheelchair

DAT = diet as tolerated amt. = amount drsg. = dressing General Terms Os = mouth or opening post-op = post operatively prep = preparation VO = verbal order General Terms KVO = keep vein open Tbsp = tablespoon Ss = half Cc = cubic centimeter General Terms VS

= Vital signs BP = Blood Pressure TPR = Temperature, Pulse, Respiration NPO = nothing by mouth (non per os) General Terms pc = after meals L = left, liter OS = left eye (oculus sinester) OU = both eyes General Terms H20 = water R/O = Rule Out O2 = oxygen Pt = patient General Terms

PT = Physical Therapy AP&L = anterior posterior & lateral noc = night gen = general General Terms Approx = approximately Mod = moderate Gtt = drop Neg = negative General Terms per = by or through preop = preoperatively WNL = within normal limits TO = telephone order

 General Terms Wt = weight Tsp = teaspoon Cath. = catheter Ml = millimeter end of presentation THANK YOU!