What is an intensive care unit in a hospital
Intensive care unit and outpatient intensive care
On the Intensive care unit In a hospital, seriously ill patients are monitored and treated. Some of the patients are in acute danger of death, for example after an accident. Other patients are carefully monitored in the intensive care unit, for example after extensive operations. This is to ensure that it is possible to react quickly if the condition worsens.
The medical and nursing effort is particularly high in the intensive care unit. This effort is made up of intensive monitoring, intensive therapy and intensive care. The Definition of intensive care is therefore the special care of seriously ill patients.
Some patients can continue to be cared for at home after treatment in the intensive care unit. This is then called out-of-hospital intensive care, outpatient intensive care or home intensive care designated.
Intensive care unit: typical illnesses of patients
What are typical illnesses of patients in an intensive care unit? The following often occur: disorders of the cardiovascular functions, breathing, the central nervous system, the water and electrolyte balance, the acid-base balance or kidney function. The threat to life is usually either acute or foreseeable.
Interdisciplinary intensive care unit or specialist intensive care unit
Intensive care units are organized either subject-specific or interdisciplinary. Patients with uniform diseases are treated in specialist areas. Examples of this are pediatric intensive care units (especially for the care of serious illnesses in the newborn), neurosurgical intensive care units (for example for patients with acute traumatic brain injury) and cardiac surgery intensive care units (for example for the postoperative care of cardiac surgery patients).
In mixed intensive care units, on the other hand, patients with different diseases are treated. The focus can be anesthesiological-surgical (e.g. patients after surgical interventions), internal (e.g. drug treatment of cardiovascular diseases) or interdisciplinary.
Personnel key: How many specialists are planned for the intensive care unit?
Specialists, nurses and assistants work together in intensive care units. Auxiliary staff should relieve the nursing staff by taking on tasks that are not directly used for patient care. The number of intensive care beds in a hospital depends on the total bed size of the house. Experts recommend that at least five percent of all beds should be in the intensive care unit - more on this in the "Introduction to Intensive Care Medicine" chapter of the textbook "Anesthesia and Intensive Care Medicine for Specialized Care". An exception applies to the care of premature babies. In neonatology, one-to-one care by nursing staff must be ensured at all times. At least 40 percent must have completed specialist training.
The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) recommends as a guideline that one nurse should be present per shift for two patients. In special cases, a higher presence makes sense. Seven ward physicians are recommended for eight to twelve intensive care beds. Management positions are not taken into account in this information.
Intensive care: observation, monitoring, care
The intensive care doctor Reinhard Larsen writes that "no hospital group (...) is exposed to higher demands" than "the nursing staff in intensive care units". The most important tasks of nurses in the intensive care unit are:
- the general and special care of intensive care patients (e.g. with regard to personal hygiene, nutrition, mobility) and
- the Observation and surveillance of patients.
A closely networked work between doctor and nurse is particularly important in the intensive care unit. Many former medical tasks are now regularly taken over by nurses. According to a survey of senior nursing staff, only a few therapy decisions are made by doctors alone.
Intensive care unit of the Heidelberg University Hospital (archive image)
Vital signs at a glance: monitor cardiac function, check the oxygen level in the blood
For example, it is the responsibility of the nursing staff to monitor the vital signs of patients. Nurses monitor at least the heart function with the help of EKG values (electrocardiogram) and the oxygen content in the blood with the help of pulse oximetry. Body temperature and blood pressure are also checked.
If the situation worsens, the nursing staff takes measures independently to stabilize the patient. Often the dosage of circulatory drugs (catecholamines) is in the hands of the caregiver. This applies within previously agreed limits.
Further tasks: determining ventilation values, venous pressure, taking blood
Depending on the clinical picture and the current condition of the patient, other vital parameters and data such as ventilation values, central venous pressure or the bispectral index (to estimate the depth of anesthesia) are often collected. In addition, there are sometimes hourly blood gas analyzes and blood samples for laboratory tests. Nursing staff independently take blood from their patients and react to the results of blood analyzes.
In order to be able to carry out and accompany the intensive monitoring and therapy of the patient, it is essential to work with a large number of medical devices. The reprocessing, functional testing and monitoring of devices such as ventilators (respiratory care), perfusors, defibrillators, monitors and extracorporeal membranous oxygenators, or ECMO for short, are largely the responsibility of nursing.
12/19/2017 | Nursing College | course
At the ITS
The topics: Risk of foreign blood: The patient blood management concept; Organ Failure: The New Sepsis 3 Definition; Away from the machine: weaning - relearn how to breathe
Glasgow Coma Scale and Other Scores: How is the Patient?
Despite the extensive possibilities of monitoring, the view of the patient must not be lost. In order to guarantee this as uniformly as possible, scores are used. Scores record various parameters of the disease process and assign these to fixed point values. The "Glasgow Coma Scale", for example, is a specific score for assessing the neurological condition of the patient.
The TISS (Therapeutic Intervention Scoring System), on the other hand, provides information about the general condition of patients. But scores can also be used to assess the therapeutic or nursing effort. When using scores, however, it should not be forgotten that they only consider a partial aspect and not the patient in its entirety. In the intensive care unit, too, it is of great importance to write a care report and to hand it over to the following service in a structured manner.
Further training in intensive care: a requirement for work in the intensive care unit?
The advanced training in anesthesia and intensive care lasts two years. Completed vocational training is a prerequisite. Depending on the federal state and the provider, one to two years of experience in intensive care is expected. However: In order to work as a nurse in an intensive care unit, further training in anesthesia and intensive care is usually not a requirement.
Outpatient intensive care: When is outpatient intensive care possible?
Intensive care is also possible in the home setting. In this way, patients are cared for who also need to continue intensive therapy outside the hospital. This applies, for example, to patients who are permanently dependent on ventilators. They are cared for 24 hours a day at home (ventilation care 24), in ventilation homes or shared apartments. Care is provided by outpatient intensive care services.
German Interdisciplinary Association for Intensive Care and Emergency Medicine (2014): Nursing skills for intensive care workers, www.divi.de/empfänger/publikationen/intensiv-und-notfallpflege
Larsen R: Anesthesia and Intensive Care Medicine for Specialized Nursing. Springer-Verlag Berlin Heidelberg. DOI 10.1007 / 978-3-662-50444-4
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