NMHS42770 The Complex Critically Ill Patient

Academic Year 2022/2023

This module focuses on the nursing and collaborative care of the acutely ill patient following major surgery, cardiothoracic surgery and cardiac transplantation; patients who have sustained multiple trauma including spinal injury, patients with liver dysfunction and who require liver surgery/transplantation and patients who develop ARDS,(COVID-19) MODS and sepsis.
Students will develop a proficient understanding of the pathophysiology of critical illness; its implications on advanced physical assessment findings, interpretation of clinical observations and learn to integrate best practice guidelines in caring for the critically ill patient.
In this module, students will develop their clinical reasoning and judgement skills utilising case studies, drawn from their area of practice. Students will develop a deep and systematic understanding of the complexities of critical illness in-order to inform planned nursing and collaborative care and facilitate the evaluation of delivered care.

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Curricular information is subject to change

Learning Outcomes:

On completion of this module, students will be able to:

1. Critically evaluate knowledge of rapidly changing critical illness pathophysiology in planning and managing the complex critically ill.
2. Critically discuss the necessity of including advanced respiratory and cardiovascular assessment, haemodynamic monitoring, and validated assessment tools for a complex critically ill patient.
3. Critically apply diagnostic reasoning skills following a comprehensive assessment of a complex critically ill patient.
4. Critically analyse & synthesise the best available current evidence that informs the nursing and collaborative management of the complex critically ill patient and formulate a plan of care based on scientific rationale, evidence-based standards of care, and practice guidelines.
5. Critically evaluate the patient’s response to the nursing and collaborative management of the complex critically ill patient.

Indicative Module Content:

Advanced cardiovascular and respiratory assessment
Validated assessment tools.
Current evidence that informs the nursing and collaborative management of the complex critically ill patient
Cardiothoracic Surgery/transplant
Sepsis
Renal Failure
ARDS/COVID 19
Liver Failure
Trauma
Brain Injury
Transporting critically ill patients
Review from Autumn Trimester
• Person centred care through the Careful Nursing Philosophy & Professional Practice Model
• Review of NANDA -I, NOC and NIC language.
• Review Modes of ventilation
• Chest drains
• Inotropes & Vasopressors
• Fluids and Electrolytes
• ABG's
• ABCDEF Care bundle (A: Assess & manage pain. B: SATs & SBTs. C: choice of analgesia & sedation. D: Delirium assessment & prevention. E: Early mobility. F: Family engagement )

Student Effort Hours: 
Student Effort Type Hours
Specified Learning Activities

80

Autonomous Student Learning

138

Online Learning

32

Total

250

Approaches to Teaching and Learning:
Lectures by clinical experts
Case-based learning
Active/task-based learning
 
Requirements, Exclusions and Recommendations
Learning Requirements:

Registered General Nurse. 12 months post registration experience, employed in Intensive Care Nursing and working a minimum of 75 hours per month


Module Requisites and Incompatibles
Equivalents:
Major Surgery &Multiple Trauma (NMHS40890), Person with Special Needs (NURS40890)


 
Assessment Strategy  
Description Timing Open Book Exam Component Scale Must Pass Component % of Final Grade
Continuous Assessment: Students will demonstrate their clinical reasoning and judgement skills and a deep and systematic evidence based understanding of the complexities of critical illness. Varies over the Trimester n/a Alternative non-linear conversion grade scale 50% No

65

Examination: Critical Care Knowledge Review Varies over the Trimester No Alternative non-linear conversion grade scale 50% No

35


Carry forward of passed components
Yes
 
Remediation Type Remediation Timing
In-Module Resit Prior to relevant Programme Exam Board
Please see Student Jargon Buster for more information about remediation types and timing. 
Feedback Strategy/Strategies

• Feedback individually to students, post-assessment

How will my Feedback be Delivered?

Students will receive feedback within 20 working days (Mon-Fri) of assessment submission.

Reading list resource NMHS 42770 Nursing Care of the Complex Critically Ill Patient
Aitken, L., Marshall, A. and Chaboyer, W., (2016). ACCCN's Critical Care Nursing. Elsevier Health Sciences .
Albarran, J.W., Mallett, J., RGN & Richardson, A. 2013, Critical care manual of clinical procedures and competencies, John Wiley & Sons, Ames, Iowa; Chichester, West Sussex;
Bademan, E.G. & Sigma Theta Tau International 2010;2009; A daybook for critical care nurses, 1st;1; edn, Sigma Theta Tau International, Indianapolis, IN.
Baid, H., Creed, F., Hargreaves, J. & Adam, S.K. 2016, Oxford handbook of critical care nursing, Second edn, Oxford University Press, Oxford, United Kingdom
Benner, P.E., Hooper-Kyriakidis, P.L. & Stannard, D. 2011, Clinical wisdom and interventions in acute and critical care: a thinking-in-action approach, 2nd edn, Springer Pub, New York.
Booker, K.J.;2015; Critical care nursing: monitoring and treatment for advanced nursing practice, Wiley Blackwell, Ames, Iowa
Boxwell, G. 2010, Neonatal intensive care nursing, 2nd edn, Routledge, New York; Abingdon, Oxon;
Chaney, A.;2016; Fast facts about G.I. and liver diseases for nurses: what APRNs need to know in a nutshell, 1st edn, Springer, New York.
Coviello, J.S. 2017, ECG interpretation made incredibly easy! pocket guide, Third edn, Wolters Kluwer, Philadelphia (eBook through UCD Library)
Finch, J. & Dutton, H.;2018; Acute and critical care nursing at a glance, Wiley, Hoboken, NJ.
Foreman, M.D., Milisen, K. & Fulmer, T.T. 2010, Critical care nursing of older adults: best practices, 3rd edn, Springer Pub. Co, New York, NY.
Goldsworthy, S. & Graham, L.2013; Compact clinical guide to mechanical ventilation: foundations of practice for critical care nurses, 1st edn, Springer Publishing Company, LLC, New York, NY.
Hardin, S.R., Kaplow, R., Teton Data Systems (Firm) & STAT!Ref (Online service) 2020;2019; Cardiac surgery essentials for critical care nursing, Third;3; edn, Jones & Bartlett Learning, Burlington, MA
Hazinski, M.F. 2013; Nursing care of the critically ill child, 3rd edn, Elsevier/Mosby, St. Louis, Mo.
Jevon, P. & Ewens, B. 2012, Monitoring the critically ill patient, 3rd edn, Wiley-Blackwell, Chichester, West Sussex.
Jones, J. & Fix, B. 2019, Critical care notes: clinical pocket guide, 3rd edn, F.A. Davis Company, Philadelphia, PA.
Knapp, R.; 2015; Hemodynamic monitoring made incredibly visual, Third;3; edn, Wolters Kluwer, Philadelphia.
Krau, S.D. and Overstreet, M. (2017). Pain Management, An Issue of Critical Nursing Clinics, E-Book (Vol. 29, No. 4). Elsevier Health Sciences.
Kucia, A.M. & Quinn, T. 2013; Acute cardiac care: a practical guide for nurses, 1. Aufl. edn, Wiley-Blackwell, Ames, Iowa;Chichester, West Sussex, U.K;
Marino, P.L., Teton Data Systems (Firm) & STAT!Ref (Online service) 2014;2013; Marino's the ICU Book, Fourth;4;4e.; edn, Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia
Mendoza, J.D. 2011, Acute kidney injury: causes, diagnosis, and treatments, Nova Biomedical/Nova Science Publishers, New York.
Miller, C.M. & Torbey, M.T. 2015; Neurocritical care monitoring, 1st edn, DEMOS Medical, New York
Morton, P.G. & Fontaine, D.K. (2017), Critical care nursing: a holistic approach, Eleventh edn, Wolters Kluwer, London; Philadelphia
Perrin, K.O. & MacLeod, C.E. (2017), Understanding the essentials of critical care nursing, Third edn, Pearson, Boston
Rabinovici, R., Frankel, H.L. & Kirton, O.C. 2016; Trauma, critical care, and surgical emergencies: a case and evidence-based textbook, Informa Healthcare, London.
Saxon, A. & Lillyman, S. 2011, Developing advanced assessment skills: patients with long-term conditions, M&K Pub, Keswick, Cumbria.
Ronco, C., Bellomo, R., Kellum, J.A. and Ricci, Z., (2017). SPEC–Critical Care Nephrology, 12-Month Access, eBook. Elsevier Health Sciences
Scarth, E. & Smith, S.P. 2016;, Drugs in anaesthesia and intensive care, Fifth edn, Oxford University Press, Oxford, United Kingdom.
Stevens, R.D., Hart, N.(. & Herridge, M.S. 2014, Textbook of post-ICU medicine: the legacy of critical care, First edn, Oxford University Press, New York, NY, United States of America;Oxford, United Kingdom;.
Tartavoulle, T. & Manning, J. 2017, Infection in the Intensive Care Unit, an Issue of Critical Care Nursing Clinics of North America, Elsevier [Imprint], Philadelphia
Vincent, J.L., Abraham, E., Kochanek, P., Moore, F.A. and Fink, M.P., (2016.) Textbook of Critical Care E-Book. Elsevier Health Sciences.
Urden, L.D., Stacy, K.M. & Lough, M.E. (2017), Critical care nursing: diagnosis and management, 8th edn, Elsevier, Maryland Heights, Missouri.
Willis, L.M. ;2016;, Health assessment made incredibly visual, Third edn, Wolters Kluwer, Philadelphia.
Woodruff, D.W. 2016;, Critical care nursing made incredibly easy, Fourth;4; edn, Wolters Kluwer, Piladelphia.
Ziemer, G. & Haverich, A. (2017), Cardiac surgery: operations on the heart and great vessels in adults and children, Springer, Berlin, Germany

Suggested Reading Resources
Alhazzani, W., Belley-Cote, E., Møller, M.H., Angus, D.C., Papazian, L., Arabi, Y.M., Citerio, G., Connolly, B., Denehy, L., Fox-Robichaud, A., Hough, C.L., Laake, J.H., Machado, F.R., Ostermann, M., Piraino, T., Sharif, S., Szczeklik, W., Young, P.J., Gouskos, A., Kiedrowski, K. & Burns, K.E.A. (2020), "Neuromuscular blockade in patients with ARDS: a rapid practice guideline", Intensive care medicine, vol. 46, no. 11, pp. 1977-1986
Baue, A.E., Fry, D.E. and Faist, E. (2012) Multi-Organ Failure, Pathophysiology, prevention and therapy, Saunders, Science & Business Media.
Bickley L.S., Szilagyi P.G., (2016) Bates' Pocket Guide to Physical Examination and History Taking. Lippincott Williams & Wilkins
Burns, S. and Delgado, S., (2015). Acute & Critical Care Nurse Practitioner: Cases in Diagnostic Reasoning. McGraw Hill Professional, USA
Chaney, A. (2017) Fast facts about GI and liver diseases for nurses: what APRNs need to know in a nutshell, 1st edn, Springer, New York.
Demoule, A., Brochard, L., s, M., Heunks, L., Jubran, A., Laghi, F., Mekontso-Dessap, A., Nava, S., Ouanes-Besbes, L., Peñuelas, O., Piquilloud, L., Vassilakopoulos, T. & Mancebo, J. (2020), "How to ventilate obstructive and asthmatic patients", Intensive care medicine, vol. 46, no. 12, pp. 2436-2449.
Hardin, S.R. and Kaplow, R. eds., (2019). Cardiac surgery essentials for critical care nursing. Jones & Bartlett Publishers.
King, D.R., (2011). Trauma, Critical Care, and Surgical Emergencies: A Case and Evidence-based Textbook. Annals of Surgery, 254(5),
Krau, S.D. and Overstreet, M., (2017). Pain Management, An Issue of Critical Nursing Clinics, E-Book (Vol. 29, No. 4). Elsevier Health Sciences.
Kumar, M., Levine, J., Schuster, J. and Kofke, W.A. eds., (2017). Neurocritical Care Management of the Neurosurgical Patient E-Book. Elsevier Health Sciences.
Leisman, D.E., Deutschman, C.S. and Legrand, M., 2020. Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive care medicine, 46(6), pp.1105-1108
Lough, M.E. (2016), Hemodynamic monitoring: evolving technologies and clinical practice, Mosby, St. Louis.
McGrath, B.A., Brenner, M.J., Warrillow, S.J., Pandian, V., Arora, A., Cameron, T.S., Añon, J.M., Martínez, G.H., Truog, R.D., Block, S.D., Grace C Y Lui, McDonald, C., Rassekh, C.H., Atkins, J., Qiang, L., Vergez, S., Dulguerov, P., Zenk, J., Antonelli, M., Pelosi, P., Walsh, B.K., Ward, E., Shang, Y., Gasparini, S., Donati, A., Singer, M., Peter J M Openshaw, Tolley, N., Markel, H. & Feller-Kopman, D.J. (2020), "Tracheostomy in the COVID-19 era: global and multidisciplinary guidance", The Lancet Respiratory Medicine

Journal Articles, Guidelines and Publications of Interest (this list is updated every year)
Adler, A.C., Sharma, R., Higgins, T. and McGee, W.T., (2014). Hemodynamic assessment and monitoring in the intensive care unit: An overview. Enliven: J Anesthesiol Critical Care Med, 1(4), p.010.
Barnes‐Daly, M.A., Pun, B.T., Harmon, L.A., Byrum, D.G., Kumar, V.K., Devlin, J.W., Stollings, J.L., Puntillo, K.A., Engel, H.J., Posa, P.J. and Barr, J., (2018). Improving Health Care for Critically Ill Patients Using an Evidence‐Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation. Worldviews on Evidence‐Based Nursing, 15(3), pp.206-216.
Berry, W. and McKenzie, C., (2010). Use of inotropes in critical care. Clinical Pharmacist, 2, p.395.
Bangash, M.N., Kong, M.L. and Pearse, R.M., (2012). Use of inotropes and vasopressor agents in critically ill patients. British journal of pharmacology, 165(7), pp.2015-2033
Bhandary, R., (2015). Chest imaging in the intensive care unit. Surgery (Oxford), 33(10), pp.480-484.
Devlin, J.W., Skrobik, Y., Gélinas, C., Needham, D.M., Slooter, A.J., Pandharipande, P.P., Watson, P.L., Weinhouse, G.L., Nunnally, M.E., Rochwerg, B. and Balas, M.C., (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical care medicine, 46(9), pp.e825-e873.
Dooley, N., Hew, S. and Nichol, A., (2015). Acute pancreatitis: An intensive care perspective. Anaesthesia & Intensive Care Medicine, 16(4), pp.191-196.
Durko, A.P., Budde, R.P., Geleijnse, M.L. and Kappetein, A.P., (2018). Recognition, assessment and management of the mechanical complications of acute myocardial infarction. Heart, 104(14), pp.1216-1223.
Goligher, E.C., Dres, M., Fan, E., Rubenfeld, G.D., Scales, D.C., Herridge, M.S., Vorona, S., Sklar, M.C., Rittayamai, N., Lanys, A. and Murray, A., (2018). Mechanical ventilation–induced diaphragm atrophy strongly impacts clinical outcomes. American journal of respiratory and critical care medicine, 197(2), pp.204-213.
Headley, J.M., (2016). The Goldilocks Principle: Using functional hemodynamics for fluid optimization. Nursing2017 Critical Care, 11(3), pp.23-27.
Lundy, J.B., Chung, K.K., Pamplin, J.C., Ainsworth, C.R., Jeng, J.C. and Friedman, B.C., (2016). Update on severe burn management for the intensivist. Journal of intensive care medicine, 31(8), pp.499-510.
Jibaja, M., Sufan, J.L. and Godoy, D.A., (2018). Controversies in weaning from mechanical ventilation a Pollard, S., Edwin, S.B. and Alaniz, C., (2015). Vasopressor and inotropic management of patients with septic shock. Pharmacy and Therapeutics, 40(7), p.438.nd extubation in the neurocritical patient. Medicina intensiva, 42(9), p.551.
McClave, S.A., Taylor, B.E., Martindale, R.G., Warren, M.M., Johnson, D.R., Braunschweig, C., McCarthy, M.S., Davanos, E., Rice, T.W., Cresci, G.A. and Gervasio, J.M., (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Journal of Parenteral and Enteral Nutrition, 40(2), pp.159-211.
Nielson, C.B., Duethman, N.C., Howard, J.M., Moncure, M. and Wood, J.G., (2017). Burns: pathophysiology of systemic complications and current management. Journal of Burn Care & Research, 38(1), pp.e469-e481.
Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J.E., Sprung, C.L., Nunnally, M.E. and Rochwerg, B., (2017). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive care medicine, 43(3), pp.304-377.
Thygesen, K., Alpert, J.S., Jaffe, A.S., Chaitman, B.R., Bax, J.J., Morrow, D.A. and White, H.D., (2018). Fourth universal definition of myocardial infarction (2018). Journal of the American College of Cardiology, 72(18), pp.2231-2264.
van Vught LA, Klein Klouwenberg PMC, Spitoni C, et al. (2016) Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis. JAMA. 2016;315(14):1469–1479
Varma, R. and Karim, M., (2016). Lesson of the month 1: Diabetic ketoacidosis in established renal failure. Clinical Medicine, 16(4), pp.392-393.

Name Role
Ms Orla Daly Lecturer / Co-Lecturer