Critical Care Nursing Essentials: ICU Concepts for Students

Hemodynamic Monitoring

Key Parameters

• MAP (Mean Arterial Pressure): Normal 70-100 mmHg. MAP <65 = organ hypoperfusion
• CVP (Central Venous Pressure): Normal 2-6 mmHg. Reflects right heart preload
• Cardiac Output: Normal 4-8 L/min
• Cardiac Index: CO / BSA. Normal 2.5-4.0 L/min/m²
• SVR: Normal 800-1200 dynes/sec/cm⁵. Afterload indicator

Interpreting Values

• Low CO + High SVR = Cardiogenic shock (pump failure)
• Low CO + Low SVR = Distributive shock (sepsis)
• Low CO + High CVP = Right heart failure or cardiac tamponade
• Low CO + Low CVP = Hypovolemic shock

Mechanical Ventilation

Common Modes

• AC (Assist-Control): Every breath is a full machine breath
• SIMV: Set rate + patient can breathe spontaneously between
• PSV (Pressure Support): Patient-triggered, pressure-assisted
• CPAP/BiPAP: Non-invasive positive pressure

Key Settings

• FiO2: Fraction of inspired oxygen (21-100%)
• Tidal Volume: 6-8 mL/kg ideal body weight
• PEEP: Positive end-expiratory pressure (prevents alveolar collapse)
• Respiratory Rate: Set backup rate

Nursing Priorities

• Verify ventilator settings match orders
• Monitor SpO2 and ABGs
• Assess for complications: barotrauma, VAP, auto-PEEP
• HOB 30-45° to prevent VAP
• Oral care with chlorhexidine every 2-4 hours
• Assess readiness for weaning (daily spontaneous breathing trial)

ABG Interpretation

Normal Values

• pH: 7.35-7.45
• PaCO2: 35-45 mmHg
• HCO3: 22-26 mEq/L
• PaO2: 80-100 mmHg

Steps (Tic-Tac-Toe Method)

1. Look at pH: <7.35 = acidosis, >7.45 = alkalosis
2. Look at PaCO2: Does it match the pH direction? → Respiratory
3. Look at HCO3: Does it match? → Metabolic
4. Is there compensation? (Other value trying to normalize pH)

Common ICU Medications

• Vasopressors: Norepinephrine (first-line septic shock), vasopressin, dopamine
• Inotropes: Dobutamine, milrinone (increase contractility)
• Sedation: Propofol, dexmedetomidine, midazolam
• Analgesia: Fentanyl (first-line ICU), hydromorphone
• Paralytics: Cisatracurium, rocuronium (monitor with TOF)

Sepsis Bundle (Hour-1 Bundle)

1. Measure lactate level
2. Obtain blood cultures before antibiotics
3. Administer broad-spectrum antibiotics
4. Begin rapid 30 mL/kg crystalloid for hypotension or lactate ≥4
5. Apply vasopressors if hypotensive during or after fluid resuscitation

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