Critical care nursing is a field of nursing that focuses on the provision of care to critically patients, unstable patients, or pediatric patients. Critical care nursing is usually implemented at the Emergency Room (ER) and at the Intensive Care Unit (ICU). Because of the unstable nature of the client’s illnesses, on nurses who specialize in critical care nursing are allowed to handle them. Nursing assistants, Licensed Practical Nurse, or Licensed Vocational Nurses are utilized on rare occasions.

The critical care environment has high noise levels, with natural and artificial light 24 hours a day, movement of people and environment is constant, and there is a lack of privacy. This can bring about stress, anxiety, and poor adaptation or coping. Clients may feel that they are losing control, helpless, and isolated. This may lead them to feel dependent, angry, and depressed.

The Critically Ill Pediatric Patient

Vital Signs

  • Vital signs differ with age
  • Blood pressure is the last vital sign to change in a child with shock
  • Bradycardia is not well tolerated in young children and can be precipitated by hypoxia
  • Tachycardia can be a non-specific response to many conditions
  • Tachypnea might indicate respiratory distress
  • Bradypnea may indicate respiratory arrest

Neurological

  • Needs to be age appropriate
  • Check reflexes
  • Check the fontanels
  • Assess mental status
    • Interaction with the environment
    • For children should know parents
    • Is awake and is looking around

Cardiovascular

  • Skin Color
    • Peripheral cyanosis is normal for newborn only
    • Central cyanosis is always abnormal
    • Mottling should be taken into consideration if in room temperature
  • Capillary refill time is less than 2 seconds

Respiratory

  • Infants under 6 months are obligatory nose breathers
  • Smaller airway diameter and length is easier to occlude
  • Watch for retractions (Abdominal breathing, Seesaw breathing)
  • Listen for sounds (Grunting, Stridor, Wheezing)

Renal

  • Normal urine output for infants is 2 mL/kg/hour. Take note that infants has a decreased ability to concentrate urine.
  • Normal urine output for children is 1 mL/kg/hour
  • Children have increased risk for dehydration. Observe for dry mucous membranes, poor skin turgor, and sunken fontanels.

The Critically Ill Pregnant Woman

Be observant for the following:
  • Severe pre eclampsia
  • Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP)
  • Disseminated Intravascular Coagulation (DIC)
  • Amniotic Fluid Embolus
  • Acute Respiratory Distress Syndrome (ARDS)

The Critically Ill Older Patient

Physiologic changes of the older adult:
  • Many changes occur in every system
  • Most troublesome changes are: loss of sight, loss of hearing, decrease in quality of sleep, and cognitive changes

Medications in the Older Adult

Be guided with “Start low and go slow” which means that you should start administering medications in a low dose and observe for any reactions.

Bear in mind that geriatric clients also have altered drug absorption, distribution, metabolism and excretion.

The Post Anesthesia Patient

Problems in the Post Anesthesia Patient:
  • Airway
  • Hypoxemia
  • Hypertension
  • Cardiac dysrhytmias
  • Hypothermia