Placement: II Year
Hours of instruction
Theory: 150 hours
Practical: 950 hours
Total : 1100 hours
Course Description
This course is designed to assist students in developing expertise and indepth
knowledge in the field of Critical care Nursing. It will help students
to develop advanced skills for nursing intervention in caring for critically ill
patients. It will enable the student to function as critical care nurse
practitioner/ specialist. It will further enable the student to function as
Objectives
At the end of the course the students will be able to
1. Appreciate trends and issues related to Critical Care Nursing.
2. Describe the epidemiology, etiology, pathophysiology and diagnostic
assessment of critically ill patients
3. Describe the various drugs used in critical care and nurses
responsibility
4. Perform physical, psychosocial & spiritual assessment
5. Demonstrate advance skills/competence in managing critically ill
patients including Advance Cardiac Life Support.
6. Demonstrate skill in handling various equipments/gadgets used for
critical care
7. Provide comprehensive care to critically ill patients.
8. Appreciate team work & coordinate activities related to patient care.
9. Practice infection control measures.
10. Assess and manage pain .
11. Identify complications & take appropriate measures.
12. Discuss the legal and ethical issues in critical care nursing
13. Assist patients and their family to cope with emotional distress,
spiritual, grief and anxiety
14. Assist in various diagnostic, therapeutic and surgical procedures
15. Incorporate evidence based nursing practice and identify the areas of
research in the field of critical care nursing
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16. Identify the sources of stress and manage burnout syndrome among
health care providers.
17. Teach and supervise nurses and allied health workers.
18. Design a layout of ICU and develop standards for critical care nursing
practice.
Course Content
Unit
Hours Content
I 5 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 of critical care nursing
�� Scope of critical care nursing
�� Critical care unit set up including equipments supplies, use and
care of various type of monitors & ventilators
�� Flow sheets
II 10 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,
prevention & nursing care for patients affected with
psychophysiological & psychosocial problems of critical care
unit, Caring for the patient’s family, family teaching
�� The dynamics of healing in critical care unit:-therapeutic touch,
Relaxation, Music therapy, Guided Imagery, acupressure
�� Stress and burnout syndrome among health team members
III 14 Review
�� Pharmacokinetics
�� Analgesics/Anti inflammatory agents
�� Antibiotics, antiseptics
�� Drug reaction & toxicity
�� Drugs used in critical care unit (inclusive of ionotropic, 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
IV 5 Pain Management
�� Pain & Sedation in Critically ill patients
�� Theories of pain, Types of pain, Pain assessment, Systemic
responses to pain
�� pain management-pharmacological and non-pharmacological
measures
�� Placebo effect
Unit
Hours Content
V 5 Infection control in intensive care unit
�� Nosocomial infection in intensive care unit; methyl resistant
staphylococcus aureus (MRSA), Disinfection, Sterilization,
Standard safety measures, Prophylaxis for staff
VI 10 Gastrointestinal System
�� Causes, Pathophysiology, Clinical types, Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and Nursing
management of:-Acute Gastrointestinal Bleeding, Abdominal
injury, Hepatic Disorders:-Fulminent hepatic failure, Hepatic
encephalopathy, Acute Pancreatitis, Acute intestinal obstruction,
perforative peritonitis
VII 10 Renal System
�� Causes, pathophysiology, Clinical types,Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and Nursing
management of:-Acute Renal Failure, Chronic Renal Failure, Acute
tubular necrosis, Bladder trauma
�� Management Modalities: Hemodialysis, Peritoneal Dialysis,
Continuous Ambulatory Peritoneal Dialysis, Continuous arterio
venus hemodialysis, Renal Transplant,
VIII 10 Nervous System
�� Causes, pathophysiology, Clinical types,Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and Nursing
management of:-Common Neurological Disorders:-Cerebrovascular
disease, Cerebrovascular accident, Seizure disorders,
GuilleinBarre-Syndrome, Myasthenia Gravis, Coma, Persistent
vegetative state, Encephalopathy, Head injury, Spinal Cord injury
�� Management Modalities: Assessment of Intracranial pressure,
Management of intracranial hypertension, Craniotomy
�� Problems associated with neurological disorders: Thermo
regulation, Unconsciousness, Herniation syndrome
IX 5 Endocrine System
�� Causes, Pathophysiology, Clinical types, Clinical features,
diagnosis, Prognosis, Management: Medical, Surgical and Nursing
Management of :-Hypoglycemia, Diabetic Ketoacidosis, Thyroid
crisis, Myxoedema, Adrenal crisis, Syndrome of Inappropriate/
hypersecretion of Antidiuretic Hormone (SIADH)
X 15 Management of other Emergency Conditions
�� Mechanism of injury, Thoracic injuries, Abdominal injuries, pelvic
fractures, complications of trauma, Head injuries
�� Shock: Shock syndrome, Hypovolemic, Cardiogenic, Anaphylactic,
Neurogenic and Septic shock
�� Systemic inflammatory Response:The inflammatory response,
Multiple organ dysfunction syndrome
�� Disseminated Intravascular Coagulation
�� Drug Overdose and Poisoning,
�� Acquired Immunodeficiency Syndrome (AIDS)
�� Ophthalmic: Eye injuries, Glaucoma, retinal detachment
�� Ear Nose Throat: Foreign bodies, stridor, bleeding, quincy, acute
allergic conditions
�� Psychiatric emergencies;, suicide,
�� crisis intervention
XI 20 Cardiovascular emergencies
�� Principles of Nursing in caring for patient’s with Cardiovascular
disorders
�� Assessment: Cardiovascular system: Heart sounds, Diagnostic
studies:- Cardiac enzymes studies, Electrocardiographic
monitoring, Holter monitoring, Stress test. Echo cardiography,
Coronary angiography, Nuclear medicine studies
�� Causes, Pathophysiology, Clinical types, Clinical features,
Diagnostic Prognosis, Management : Medical, Surgical & Nurisng
management of:-Hypertensive crisis, Coronary artery disease,
Acute Myocardial infarction, Cardiomyopathy, Deep vein
thrombosis, Valvular diseases, Heart block, Cardiac arrhythmias &
conduction disturbances, Aneurysms, Endocarditis, Heart failure
Cardio pulmonary resuscitation BCLS/ ACLS
�� Management Modalities: Thrombolytic therapy, Pacemaker –
temporary & permanent, Percutaneous transluminal coronary
angioplasty, Cardioversion, Intra Aortic Balloon pump monitoring,
Defibrillations, Cardiac surgeries, Coronary Artery Bypass Grafts
(CABG/MICAS), Valvular surgeries, Heart Transplantation,
Autologous blood transfusion, Radiofrequency Catheter Ablation
XII 15 Respiratory System
�� Acid-base balance & imbalance
�� Assesment : History & Physical Examination
�� Diagnostic Tests:Pulse Oximetry, End –Tidal Carbon Dioxide
Monitoring, Arterial blood gas studies, chest radiography,
pulmonary Angiography, Bronchoscopy, Pulmonary function Test,
Ventilation perfusion scan, Lung ventilation scan
�� Causes Pathophysiology, Clinical types, Clinical features,
Prognosis, Management: 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, Atelectasis, Pulmonary embolism, Acute
respiratory failure, 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, Thoracic
surgeries
Unit
Hours Content
XIII 7 Burns
�� Clinical types, classification, pathophysiology, clinical features,
assessment, diagnosis, prognosis, Management: Medical, Surgical
& Nursing management of burns
�� Fluid and electrolyte therapy – calculation of fluids and its
administration
�� Pain management
�� Wound care
�� Infection control
�� Prevention and management of burn complications
�� Grafts and flaps
�� Reconstructive surgery
�� Rehabilitation
XIV 5 Obstetrical Emergencies
�� Causes, Pathophysiology, Clinical types, clinical features,
diagnostic Prognosis, Management: Medical, Surgical and Nursing
management of :Antepartum haemorrhage, Preeclampsia,
eclampsia, Obstructed labour and ruptured uterus, Post partum
haemorrhage, Peurperal sepsis, Obstetrical shock
XV 10 Neonatal Paediatric emergencies
�� Causes, pathophysiology, Clinical types, Clinical features,
diagnostic, Prognosis , Management: medical, surgical and Nursing
management of
• Neonatal emergencies
�� Asphyxia Neonatarum, Pathological Jaundice in Neonates,
Neonatal seizures, Metabolic disorders, Intra cranial Hemorrhage,
Neonatal Sepsis, RDS/HMD (Respiratory Distress
Syndrome/Hyaline Membrane Disease), Congenital disorders:-
• Cyanotic heart disease, tracheo oesophageal fistula, congenital
hypertropic pyloric stenosis, imperforate anus
• Pediatric emergencies
�� Dehydration, Acute broncho pneumonia, Acute respiratory distress
syndrome, Poisoning, Foreign bodies, seizures, traumas, Status
asthmaticus
XVI 2 Legal and ethical issues in critical care-Nurse’s role
�� Brain death
�� Organ donation & Counselling
�� Do Not Resuscitate(DNR)
�� Euthanasia
�� Living will
XVII 2 Quality assurance
�� Standards, Protocols, Policies, Procedures
�� Infection control; Standard safety measures
�� Nursing audit
�� Staffing
�� Design of ICU/CCU
Practical
Total = 960 Hours
1 Week = 30 Hours
S.No. Deptt./Unit No. of Week Total Hours
3 Burns ICU 2 60 Hours
5 Medical ICU 8 240 Hours
6 Surgical ICU 12 360 Hours
9 CCU 2 60 Hours
10 Emergency Department 3 90 Hours
12 Dialysis Unit 1 30 Hours
13 Transplant Room 2 60 Hours
14 Paediatric/ NICU 2 60 Hours
Total 32 Weeks 960 Hours
ESSENTIAL CRITICAL CARE NURSING SKILLS
I. Procedures Observed
1. CT Scan
2. MRI
3. EEG
4. Hemodialysis
5. Endoscopic Retrograde cholangio Pancreaticogram(ERCP)
6. Heart/ Neuro/GI./ Renal Surgeries
II. Procedures Assisted
1. Advanced life support system
2. Basic cardiac life support
3. Arterial line/arterial pressure monitoring/blood taking
4. Arterial blood gas
5. ECG recording
6. Blood transfusion
7. IV cannulation therapy
8. Arterial Catheterization
9. Chest tube insertion
10. Endotracheal intubations
11. Ventilation
12. Insertion of central line/cvp line
13. Connecting lines for dialysis
III. Procedure Performed
1. Airway management
a. Application of oropharyngeal airway
b. Oxygen therapy
c. CPAP (Continuous Positive Airway pressure)
d. Care of tracheostomy
e. Endotracheal extubation
2. Cardiopulmonary resuscitation, Basic cardiac life support, ECG
3. Monitoring of critically ill patients – clinically with monitors, capillary
refill time (CRT) assessment of jaundice, ECG.
4. Gastric lavage
5. Assessment of critically ill patients
Identification & assessment of risk factors, Glasgow coma scale,
and dolls eye movement, arterial pressure monitoring, cardiac
output/pulmonary artery pressure monitoring, and detection of
life threatening abnormalities
6. Admission & discharge of critically ill patients
7. Nutritional needs – gastrostomy feeds, pharyngeal feeds, jejunostomy
feeds, TPN, formula preparation & patient education.
8. Assessment of patient for alteration in blood sugar levels monitoring
blood sugar levels periodically & administering insulin periodically.
9. Administration of drugs: IM, IV injection, IV cannulation & fixation
of infusion pump, calculation of dosages, use of insulin syringes/
tuberculin, monitoring fluid therapy, blood administration.
10. Setting up dialysis machine and starting, monitoring and closing
dialysis
11. Procedures for prevention of infections:
Hand washing, disinfection & sterilization surveillance, and
fumigation universal precautions.
12. Collection of specimen.
13. Setting, use & maintenance of basic equipment, ventilator, O2
analyzer, monitoring equipment, transducers, defibrillator, infusion
& syringe pumps, centrifuge machine.
IV Other Procedures:
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