Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill – that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

Level 0 is normal acute ward care.
Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient’s condition or therapy/equipment used in their care means increased intervention is needed.
Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.
Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

traumatic injuries from such events as road traffic accidents, falls and assaults
cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])
elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy
emergency surgeries, such as bowel perforation and neurosurgery
neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage
respiratory disorders, such as acute respiratory failure and pulmonary embolism
GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure
renal disorders, such as acute and chronic renal failure
cancers, such as lung, oesophageal and gastric cancer
shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients
coronary care units
cardiothoracic/neurosurgical/burns/liver units
accident and emergency departments
postanaesthesia/postoperative care units
general wards as part of an ‘outreach’ team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).

What Critical Care Specialists Do?

Managing fatal injuries or illnesses is the main objective of critical care medicine. There may be various types of organ support systems needed by patients who are critically injured or ill to survive. In the intensive care unit or the ICU various equipments are fastened to the patient’s body.

People who have specialized in Critical care take care of them. There is 24 hour vigilance over the condition of the patient so as to ensure instantaneous intervention if there is any problem in the patient’s condition. There is a monitor attached to almost all patients which measures the breathing and heart rate of the patient. The staffs get alerted if they hear the beep of the monitor.

It does so only when there is a decrease in the normal range in the patient’s body functions. There may be tubes fastened to the patient’s body in the ICU. These may be inserted into their veins to administer the needed medicines into their body. These are required for the patient to recover. There may be tubes inserted into the nose and stomach of the patient too, which in order to prevent throwing out and gets rid of the gases from the stomach.

If the patient finds it hard to breath, mechanical ventilators are used to facilitate breathing by supplying oxygen to the patient’s lungs. Several problems and disorders like acute respiratory distress syndrome are treated by Critical care professionals. Here the lungs stop functioning abruptly. Infection of the lungs or illness may cause this condition.

Placing the patient in Mechanical ventilator would help the patient retrieve breathing. Trauma is also specialization of these doctors and the staff under them. Motor vehicle accidents and other types of incidents cause serious injuries to thousands of people. Intensive care for life support and further surgery are needed to make these patients survive.

People whose condition are critical and near death are treated by critical care specialists. If these doctors are not there to help they might die. Emergency care units in hospitals employ critical care to bring these patients to normal from the fatal conditions they are pushed into by accidents and illnesses. Intensive vigilance, life support, care of people with lethal diseases are done in the critical care area of the medical field.