Nurse Practitioner in Critical Care Post Graduate Residency ...

Indian Nursing C

ouncil8

th Floor, NBC

C C

entre, Plot No.2

Com

munity C

entre,Okhla Phase - I

New

Delhi-110020

Syllabus & R

egulations N

urse Practitioner in Critical C

are Post G

raduate Residency Program

ii

Copyright ©

2016 by Indian Nursing C

ouncilFirst A

ddition

All rights reserved. N

o part of this publication may be reproduced,

reviewed, abstracted, stored in a retrieval system

or transmitted in

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eans including photocopying without the prior

written perm

ission of the Indian Nursing C

ouncil, New

Delhi.

iii

PRE

FAC

E

Healthcare system

landscape in India is changing rapidly to meet the grow

ing health needs and demands of

the population. Nurses in India are expected to extend and expand their scope of practice beyond general practice.

the government. Specialist nurses w

ith advanced educational preparation are required to support specialized and superspecialized healthcare services. R

ecognizing this need, INC

has prepared Nurse Practitioner in C

ritical

NH

P 2015 draft document in order to provide quality care to critically ill patients of all age groups and fam

ilies.

This program has a strong clinical com

ponent and utilize a competence based training approach. The

curriculum com

prises three major areas nam

ely core courses, advanced practice courses and critical care speciality courses. Through developm

ent of competencies and accreditation, this program

aims to enhance service delivery

and improve health outcom

es. It is hoped to provide new opportunities for N

urses practitioners in terms of

career pathway and professional developm

ent. Established institutional protocols/standing orders will guide

their independent and advanced critical care nursing practice. The critical care nursing practice standard of INC

w

ill regulate their practice.

It is my earnest desire and hope that this program

will prepare registered nurses as specialists/ N

Ps to work

in all critical care units of tertiary care hospitals, who can provide high quality critical care and im

pact health

I take this opportunity to acknowledge the contribution of nursing experts especially D

r. Punitha Ezhilarasu in preparing this syllabus.

I sincerely acknowledge the support of Secretary (H

ealth), Additional Secretary, M

ission Director N

RH

M,

and Joint Secretary (HR

) of Ministry of H

ealth & FW

for their co-operation and approving the programm

e of N


are.

I also take this opportunity to acknowledge the contribution of V

ice-President, Secretary and Joint Secretary of IN

C in preparation of the syllabus of N


are.

(T. D

ileep Kum

ar)

President,Indian N

ursing Council

and Ex-Nursing A

dvisor to Govt. of India

v

IND

EX

S. No.

ParticularsPage N

o.

1Introduction

1

2A

n Educational Curricular Fram

ework

2

3A

im &

Objectives, M

inimum

requirements to start N

urse Practitioner in C

ritical Care program

3

4Exam

ination Regulation

5

(i) Schem

e of Final Examination

6

5C

urriculum8

6Im

plementation of curriculum

11

7C

ore Courses

(i) Theoretical B

asis for advanced practice nursing13

(ii) R

esearch application and Evidence based practice in critical care15

(iii) A

dvanced skills in leadership, managem

ent and teaching17

(iv) A

dvanced pathophysiology applied to critical care nursing-A&

B19

(v) A

dvanced pharmacology relevant to critical care nursing

23

(vi) A

dvanced health/physical assessment in critical care nursing

28

8C

ritical care specialty courses

(vii) Foundations of critical care nursing practice

32

(viii) C

ritical care nursing I38

(ix) C

ritical care nursing II42

9Equipm

ent list – Appendix 1

47

10C

linical log book-Appendix 2 a &

b49

11C

linical requirements – A

ppendix 356

12Standing orders – A

ppendix 458

1

INT

RO

DU

CT

ION

AN

D B

AC

KG

RO

UN

D

In India, reshaping health systems in all dim

ensions of health has been recognized as an important need in

the National H

ealth Policy, 2015 (NH

P, 2015 draft document). It em

phasizes human resource developm

ent in

expansion in tertiary care services both in public and private health sectors. In building their capacity, it is highly

specialty services. To support specialized and super-specialized healthcare services, specialist nurses with advanced

preparation are essential. Developing training program

s and curriculum in the area of tertiary care is recognized

as the need of the hour. Nurse practitioners (N

Ps) will be able to m

eet this demand provided they are w

ell trained and em

powered to practice. W

ith establishment of new

cadres in the center and state level, master level prepared

NPs w

ill be able to provide cost effective, competent, safe and quality driven specialized nursing care to patients

in a variety of critical care settings in tertiary care centres. Nurse practitioners have been prepared and functioning

in USA

since 1960s, UK

since 1980s, Australia since 1990s and N

etherlands since 2010.

Nurse practitioners in critical care / acute care, oncology, em

ergency care, neurology, cardiovascular care, anesthesia and other specialties can be prepared to function in tertiary care settings. R

igorous educational preparation w

ill enable them to collaboratively diagnose and treat patients w

ith critical illnesses both for prevention and prom

otion of health. A curricular structure / fram

ework is proposed by IN

C tow

ards preparation of Nurse

Practitioner in Critical C

are (NPC

C) at M

asters Level. The special feature of this program is that it is a clinical

residency program em

phasizing a strong clinical component w

ith 15% of theoretical instruction and 85%

of practicum

. Com

petency based training is the major approach and N

P education is based on competencies adapted

from International C

ouncil of Nurses (IC

N, 2005), and N

ON

PF competencies (2012). Every course is based on

achievement of com

petencies.

Critical C

are Nurse Practitioner Program

is intended to prepare registered BSc N

urses to provide advanced nursing care to patients w

ho are critically ill. The nursing care is focused on stabilizing patients’ condition, m

inimizing acute com

plications and maxim

izing restoration of health. These NPs are required to practice in

critical care units of tertiary care centers. The program consists of various courses of study that are based on

These are built upon the theoretical and practice competencies of B

Sc trained nurses. On com

pletion of the program

and registration with respective state council they are perm

itted to independently administer drugs and

order diagnostic tests, procedures, medical equipm

ent and therapies as per institutional protocols. The NPs in

CC

when exercising this authority, they are accountable for the com

petencies in

a) Patient selection/adm

ission into ICU

and discharge

c) Selection/adm

inistration of medication or devices or therapies

d) Patients’ education for use of therapeutics

e) K

nowledge of interactions of therapeutics, if any

f) Evaluation of outcom

es and

g) R

ecognition and managem

ent of complications and untow

ard reactions.

2

critically ill patients under his/ her care.

Philosophy

Indian Nursing C

ouncil believes that there is a great need to establish a postgraduate program titled N

urse Practitioner in C

ritical Care to m

eet the challenges and demands of tertiary health care services in India w

hich is

ill patients and families.

INC

believes that postgraduates from a residency program

focused on strong clinical component and

competency based training m

ust be able to demonstrate clinical com

petence based on sound theoretical and evidence based know

ledge. The teaching learning approach should focus on adult learning principles, competency

based education, collaborative learning, clinical experience with m

edical and nursing preceptors, experiential learning and self-directed learning. Education providers/preceptors/m

entors must update their current know

ledge and practices. M

edical faculty are invited to participate as preceptors in the training.

INC

also believes that a variety of educational strategies can be used in the clinical settings to address the

licensure and create cadre positions for appropriate placement of these postgraduate critical care N

Ps to function in critical care units of tertiary care centers.

An educational fram

ework for the N

P curriculum is proposed (See Figure 1).

3

II. Program D

escription

The NP program

is a Nursing residency program

with a m

ain focus on Com

petency based training. The duration is of tw

o years with the curriculum

consisting of theory that includes core courses, advanced practice courses and clinical courses besides clinical practicum

which is a m

ajor component (R

efer Curricular fram

ework).

II. PRO

GR

AM

DE

SCR

IPTIO

N

III. AIM

IV. OB

JEC

TIV

ES

V. MIN

IMU

M R

EQ

UIR

EM

EN

TS TO

STAR

T TH

E N

P C

RIT

ICA

L CA

RE

PRO

GR

AM

The critical care NP program

prepares registered BSc nurses for advanced practice roles as clinical experts,

managers, educators and consultants leading to M

.Sc degree in critical care NP

On com

pletion of the program, the N

P will be able to

1. assum

e responsibility and accountability to provide competent care to critically ill patients and appropriate

family care in tertiary care centres

2. dem

onstrate clinical competence / expertise in providing critical care w

hich includes diagnostic reasoning, com

plex monitoring and therapies

3. apply theoretical, patho-physiological and pharm

acological principles and evidence base in implem

enting therapies / interventions in critical care

4. identify the critical conditions using differential diagnosis and carry out treatm

ent/interventions to stabilize and restore patient’s health and m

inimize or m

anage complications independently or collaboratively as

a part of critical care team

5. collaborate w

ith other health care professionals in the critical care team, across the continuum

of critical care

The institution must accept the accountability for the N

P program and its students and offer the program

a. If any institution opting to start N

P program already has B

Sc (N) or M

Sc (N) program

recognized by

care post graduate residency program from

State Governm

ent

b. If the institution is having any U

niversity education program of training nurses and doctors or if they

have DN

B program

, NO

C w

ill not be required to start NP program

4

2. Hospital

The hospital should be a parent tertiary care centre, with a m

inimum

of 200 beds. It can have a medical

college or nursing college

3. ICU

Beds

The hospital should have a minim

um of 4 IC

Us nam

ely medical IC

U, surgical IC

U, cardio/cardiothoracic IC

U

and Emergency care unit w

ith a minim

um of 5 beds each and total of 20 beds.

b. The nurse patient ratio should be 1:1 for every shift for ventilated patients

c. For the rest of IC

U beds the nurse patient ratio should be 1:2 for every shift

d. Provision of additional 45%

staff towards leave reserve

e. D

octor patient ratio can be 1:5

years experience in critical care nursing or MSc(Specialty-M

edical Surgical Nursing/Pediatric N

ursing/O

bsetrics & G

ynaecology Nursing) w

ith one year critical care nursing experience (One faculty for every

10 students)

b. Teaching faculty: Professor/A

ssociate professor- 1(Teaching experience- 5 years post PG), A

ssistant professor- 1 (Teaching experience- 3 years post B

Sc)

hospital.

d. G

uest lecturers: for pharmacology

Preceptor student ratio -N

ursing 1:10, Medical 1:10

a. O

ne classroom/conference room

at the clinical area

b. Skill lab for sim

ulated learning (hospital/college)

c. Library and com

puter facilities with access to online journals

d. E-Learning facilities

a. A

pplicants must possess a registered B.Sc nurse w

ith a minim

um of one year clinical experience, preferably

in any critical care setting prior to enrollment.

5

b. M

ust have undergone the BSC

in an institution recognized by the Indian Nursing C

ouncil.

c. M

ust have scored not less than 55% aggregate m

arks in the BSc program

d. Selection m

ust be based on the merit of an entrance exam

ination and interview held by the com

petent authority

N

umber of candidates: 1 candidate for 4-5 IC

U beds,

Salary:

1. In-service candidates will get regular salary

2. Salary for the other candidates as per the salary structure of the hospital where the course is conducted

Eligibility for appearing for the exam

ination

A

ttendance: Theory, practical and Clinical – 100%

VI. E

XA

MIN

ATIO

N R

EG

UL

ATIO

N

Pass: 50% pass in theory and C

linical Practicum

Second Division: 50-59%

First Division: 60-74%

Distinction: 75%

and above

For declaring the rank, aggregate of two years m

arks will be considered

If a candidate fails in theory or practical, he/she has to reappear for the paper in w

hich he/she has failed.

M

aximum

number of attem

pts = 2, Maxim

um period to com

plete the program = 4 years

Practicum

: 6hours of examination per student

M

aximum

number of students per day = 5 students

Exam

ination should be held in clinical area only

Exam

ined by one internal and one external examiner

The exam

iner should be MSc faculty teaching the N

P program w

ith minim

um tw

o years of experience.

Dissertation

R

esearch guides: Main guide – N

ursing faculty (3years experience) teaching NP program

, Co guide: M

edical preceptor

G

uide student ratio- 1:5

There should be a separate research com

mittee in the college/hospital to guide and oversee the progress of

the research (minim

um of 5 m

embers w

ith principal or CN

O-M

ScN)

Ethical clearance should be obtained by the hospital ethics com

mittee

6

Scheme of Final E

xamination

S. NO

TitleT

heory %Practical %

Hours

InternalE

xternalH

oursInternal

External

I Year

1I YearC

ore Courses

Theoretical Basis for A

dvanced Practice N

ursing

3 hrs50

2R

esearch Application and Evidence

Based Practice in C

ritical Care

3 hrs30

70

3A

dvanced skills in Leadership, M

anagement and Teaching Skills

3 hrs30

70

4A

dvanced Practice Courses

Advanced Pathophysiology &

Advanced Pharm

acology relevant to C

ritical Care

3 hrs30

70

5A

dvanced Health/physical

Assessm

ent3 hrs

3070

5050

7

1II YearSpecialty C

ourses Foundations of C

ritical Care

Nursing Practice

3 hrs30

70

100100

2C

ritical Care N

ursing I 3 hrs

3070

100100

3C

ritical Care N

ursing II 3 hrs

3070

100100

4D

issertation and viva3 hrs

5050

8

VIII. C

UR

RIC

UL

UM

Courses of Instruction

Theory(H

rs)L

ab/Skill L

ab(Hrs)

Clinical (H

rs)

I Year

IIIIII

IVVVI

Core C

oursesTheoretical B

asis for Advanced Practice N

ursingR

esearch Application and Evidence B

ased Practice in C

ritical Care

Advanced skills in Leadership, M

anagement and

Teaching Skills

Advanced Practice C

oursesA

dvanced Pathophysiology applied to Critical

Care

Advanced Pharm

acology applied to Critical C

areA

dvanced Health/physical A

ssessment

405656605470

242448

3367w

ks184

4wks

3367w

ks336

7wks

57612w

ks

TOTA

L= 2208hrs

336(7w

ks)96

(2wks)

1776(37wks)

II year

VII

VIII

IX

Specialty Courses

Foundations of Critical C

are Nursing Practice

Critical C

are Nursing I

Critical C

are Nursing II

969696

484848

55211w

ks552

13wks

64413w

ks

TOTA

L=2208hrs

288(6w

ks)144

(4wks)

1748(37w

ks)

No of w

eeks available in an year =52 -6 (Annual leave, C

asual leave, sick leave = 6 weeks) =46 w

eeks x 48 hrs = 2208 hrs

Two years = 4416 hrs

Instructional Hours: Theory = 624hrs, Skill lab= 240hrs, C

linical =3552hrs

TOTA

L= 4416 hrs

9

I year : 336-96-1776hrs (Theory-skill lab-clinical) [Theory + Lab=20%, C

linical=80%]

II year : 288-144-1776hrs ( ’’ ’’ ) [Theory + Lab=20%, C

linical=80%]

I YEA

R =46 w

eeks/ 2208 hrs(46x48hrs)( Theory +Lab :7.5 hrs/week for 44w

ks =336+96 hrs*)

*Theory + Lab= 96 hrs can be given for 2w

ks in the form of introductory block classes and w

orkshops

II Y

EAR

=46 weeks/ 2208 hrs(46x48hrs) ( Theory +Lab : 8.5hrs/w

eek for 45wks=384+48hrs)

(1 w

eek Block classes = 48 hrs)

CL

INIC

AL PR

AC

TIC

E

different shifts and OFF follow

ed by on call duty )

8 hours duty with one day O

ff in a week and on call duty one per w

eek

Clinical placem

ents:

I year: 44 wks (excludes 2 w

eeks of introductory block classes and workshop)

Medical IC

U – 12 w

eeks

Surgical ICU

– 12 weeks

Cardio/C

ardio thoracic (CT) IC

U – 8 w

eeks

Emergency D

epartment - 6 w

eeks

Other IC

Us (N

eurology, Burns, D

ialysis unit) - 6 weeks

II Year: 45wks (Excludes one w

eek of block classes)

Medical IC

U – 12 w

eeks

Surgical ICU

– 12 weeks

Cardio/C

ardio thoracic (CT) IC

U – 8 w

eeks

Emergency D

epartment - 8 w

eeks

Other IC

Us (N

eurology, Burns, D

ialysis unit) - 6 weeks

C.

Teaching methods:

Teaching-theoretical, lab &

Clinical can be done in the follow

ing methods and integrated during

clinical postingC

linical conferenceC

ase/clinical presentationIn depth drug study, presentation and reportN

ursing roundsC

linical seminars

10

Journal clubsC

ase study/Nursing process

Advanced health assessm

entFaculty lecture in the clinical areaD

irected readingA

ssignments

Case study analysis

Workshops

D.

Procedures/log book

E.

NP C

ritical Care C

ompetencies ( A

dapted from IC

N, 2005)

Uses advanced com

prehensive assessment, diagnostic, treatm

ent planning, implem

entation and evaluation skillsA

pplies and adapts advanced skills in complex and / or unstable environm

entsA

pplies sound advanced clinical reasoning and decision making to inform

, guide and teach in practiceD

ocuments assessm

ent, diagnosis, managem

ent and monitors treatm

ent and follow-up care in partnership

with the patient

Adm

inister drugs and treatments according to institutional protocols

Uses applicable com

munication, counseling, advocacy and interpersonal skills to initiate, develop and

discontinue therapeutic relationshipsR

efers to and accepts referrals from other health care professionals to m

aintain continuity of carePractices independently w

here authorizes and the regulatory framew

ork allows in the interest of the

patients, families and com

munities

Consults w

ith and is consulted by other health care professionals and othersW

orks in collaboration with health team

mem

bers in the interest of the patient

managem

ent of patients, families and com

munities

Introduces, tests, evaluates and manages evidence based practice

care through independent and inter-professional researchEngages in ethical practice in all aspects of the A

PN role responsibility

Accepts accountability and responsibility for ow

n advanced professional judgement, actions, and

continued competence

Creates and m

aintains a safe therapeutic environment through the use of risk m

anagement strategies and

quality improvem

ent

nursing services in a changing health care systemA

cts as an advocate for patients in the health care systems and the developm

ent of health policies that prom

ote and protect the individual patient, family and com

munity

Adapts practice to the contextual and cultural m

ilieu

11

F. Institutional Protocol/standing orders based adm

inistration of drugs & ordering of investigations and

therapies

The students will be trained to independently adm

inister drugs and order diagnostic tests, procedures, m

edical equipment and therapies as per institutional protocols/standing orders. (A

ppendix 4 Standing orders). A

dministration of em

ergency drugs is carried out in consultation with concerned physician and endorsed later

by written orders.

Implem

entation of curriculum-A

tentative planI yr. C

oursesIntroductory

classesW

orkshopT

heory integrated in clinical practicum

Methods of teaching

1. Theoretical basis for A

dvanced practice N

ursing (40)8hrs

1x32=32hrsapplication

2. R

esearch Application and

Evidence Based Practice in

Critical C

are (56+24)

840 (5days)

+6hrs1x26=26hrs

3. A

dvanced skills in leadership, M

anagement and Teaching

(56+24)

122hrs(B

lock classes )

1x26=26hrs2.5x16=40hrs

Exercises/Assignm

ent (lab)4.

Advanced Pathophysiology

(60)1.5x37=56hrs

5. A

dvanced Pharmacology (54)

1x44=44hrs

presentation6.

Advanced H

ealth Assessm

ent (70+40)

6hrs2x26=52hrs

1.5x18=27hrs1x12=12hrs2x7=14hrs2x2=4hrs

(faculty)

systems)

I Year – Introductory classes = 1 week,

Workshop = 1 w

eek ,44 weeks = 7.5 hrs/w

eek

12

II year courses 1w

k Block classes (48hrs)

Theory

integrated into clinical practicum

Methods of teaching

1. Foundations (96+48hrs) =144hrs9hrs

x11wks=99hrs

2. Critical C

are N

ursing 96+48hrs) =144hrs

9x16=144hrs --------

3. Critical C

are N

ursing II 96+48hrs) =144hrs

9x16=144hrs

II year 45 w

ks – 8.5/9hrs/wk

A

ttendance: 100% in theory, practical and clinical.

13

CO

RE

CO

UR

SE

I. Theoretical B

asis for Advanced Practice N

ursingC

OM

PET

EN

CIE

S

1. A

nalyses the global healthcare trends and challenges

2. A

nalyses the impact of H

ealthcare and Education policies in India on nursing consulting the documents

available.

3. D

evelops in depth understanding of the healthcare delivery system in India, and its challenges

4. A

pplies economic principles relevant to delivery of healthcare services in critical care

5. M

anages and transfzorms health inform

ation to effect health outcomes such as cost, quality and satisfaction

6. A

ccepts the accountability and responsibility in practicing the Nurse practitioner’s roles and com

petencies

7. A

ctively participates in collaborative practice involving all healthcare team m

embers in critical care and

performs the prescriptive roles w

ithin the authorized scope

Engages in ethical practice having a sound knowledge of law, ethics and regulation of advanced nursing practice

U

ses the training opportunities provided through well planned preceptorship and perform

s safe and competent

care applying nursing process

Applies the know

ledge of nursing theories in providing competent care to critically ill patients

Predicts future challenges of nurse practitioner’s roles in variety of healthcare settings particularly in India

Hours of instruction:

40hrs.

Sl. No.

TopicH

ours

1.G

lobal Health C

are Challenges and Trends(C

ompetency-1)

2

2.H

ealth System in India

Health C

are Delivery System

in India – Changing Scenario(C

ompetency-3)

2

3.N

ational Health Planning – 5 year plans and N

ational Health Policy(C

ompetency-2)

2

4.4

5.H

ealth Information system

including Nursing Inform

atics (use of computers)(C

ompetency-5)

4

Advanced N

ursing Practice (AN

P)

6.practice and N

urse Prescribing roles)(Com

petency-6&7)

3

7.R

egulation (accreditation of training institutions and Credentialing) &

Ethical Dim

ensions of advanced nursing practice role (C

ompetency-8)

3

8.N

urse Practitioner – Roles, Types, C

ompetencies, C

linical settings for practice, cultural com

petence(Com

petency-6)3

14

Sl. No.

TopicH

ours

9.Training for N

Ps – Preceptorship (Com

petency-9)2

10.Future challenges of N

P practice(Com

petency-11)4

11.Theories of N

ursing applied to APN

(Com

petency-10)3

12.N

ursing process applied to APN

(Com

petency-9)2

Self Learning assignm

ents6

1.Identify H

ealth Care and Education Policies and analyse its im

pact on Nursing

2.D

escribe the legal position in India for NP practice. W

hat is the future of nurse prescribing policies in India w

ith relevance to these policies in other countries?3.

Examine the nursing protocols relevant to N

P practice found in various ICU

S in you tertiary centre

Total40 hrs.

Bibliography:

Barkers,A

.M.(2009). A

dvanced Practice Nursing. M

assachussets: Jones & B

artlett Publishers

Hickey, J. V., O

uimette, R

. M., &

Venegoni, S. L. (1996).Advanced practice nursing: Changing roles and

clinical applications. Philadelphia: Lippincott William

s and Wilkins.

Schober, M., &

Affara, F. A

. (2006).Advanced nursing practice. Oxford: B

lackwell publishing.

Stewart,G

.J.,& D

enisco,S.M.(2015).R

ole Developm

ent for the Nurse Practitioner. U

SA: Springer Publishing

Com

pany

15

II. Research A

pplication and Evidence B

ased Practice in C

ritical Care

CO

MPE

TE

NC

IES

1. A

pplies sound research knowledge and skills in conducting independent research in critical care setting

2. Participates in collaborative research to im

prove patient care quality

4. Tests / Evaluates current practice to develop best practices and health outcom

es and quality care in advanced practice

5. A

nalyzes the evidence for nursing interventions carried out in critical care nursing practice to promote

safety and effectiveness of care

Hours of Instruction

(Theory: 56+L

ab/skill lab: 24hrs) =80hrs

Sl.No.

TopicH

ours

1.A

dvanced nursing role (Com

petency 1)2

2.R

esearch agenda for APN

practice :Testing current practice to develop best practice, health outcom

es and indicators of quality care in advanced practice (Com

petency 3,4,5), promoting

research culture

5

3.R

esearch Know

ledge and skills:R

esearch competencies essential for A

PNs (interpretation and use of research, evaluation of

practice, participation in collaborative research)R

esearch Methodology

Phases / steps (R

esearch question, Review

of literature, conceptual framew

ork, research designs, sampling,

data collection, methods &

tools, Analysis and R

eporting) w

riting research proposal and research report(C

ompetency – 1 &

2)

40(5 days

workshop)

4.W

riting for publication 5

(workshop)

5.Evidence based practice

- C

oncepts, principles, importance and steps

- Integrating EB

P to ICU

environment

- A

reas of evidence in critical care-

Barriers to im

plement EB

P-

Strategies to promote (C

ompetency – 3,4,5)

4

Total56hrs.

Practical / Lab &

Assignm

ents

16

Clinical Practicum

Bibliography:

Burns, N

., & G

rove, S. K. (2011).U

nderstanding nursing research: Building an evidence-based practice (5th ed.). Ist Indian reprint 2012, N

ew D

elhi: Elsevier.

Polit, D. F., &

Beck, C

. T. (2012).Nursing research:G

enerating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott W

illiams &

Wilkins.

Schmidt, N

. A., &

Brow

n, J. M. (2009). Evidence – based practice for nurses appraisal and application of

research. Sd: Jones and Bartlet Publishers.

17

III. Advanced skills in L

eadership, Managem

ent and TeachingC

OM

PET

EN

CIE

S

1. A

pplies principles of leadership and managem

ent in critical care units

3. A

pplies problem solving and decision m

aking skills effectively

4. U

ses critical thinking and comm

unication skills in providing leadership and managing patient care in

ICU

5. B

uilds teams and m

otivates others in ICU

setting

7. Participates appropriately in tim

es of innovation and change

8. U

ses effective teaching methods, m

edia and evaluation based on sound principles of teaching

9. D

evelops advocacy role in patient care, maintaining quality and ethics in IC

U environm

ent

10. Provides counseling to families and patients in crisis situations particularly end of life care

Hours of Instruction

(56+24=80Hrs)

Sl.No.

TopicH

ours1.

Theories, styles of leadership and current trends2

2.Theories, styles of m

anagement and current trends

2

3.Principles of leadership and m

anagement applied to critical care settings

4

4.environm

ent, Effective time m

anagement

4

5.Q

uality improvem

ent and audit4

6.Problem

solving, critical thinking and decision making, com

munication skills applied to critical

care nursing practice5

7.Team

building, motivating and m

entoring within IC

U set up

2

8.B

udgeting and managem

ent of resources including human resources – IC

U budget, m

aterial 5

9.C

hange and innovation2

10.Staff perform

ance, and evaluation (performance appraisals)

6

11.Teaching – Learning theories and principles applied to C

ritical Care N

ursing2

12.C

ompetency based education and outcom

e based education2

13.Teaching m

ethods / strategies, media: educating patients and staff in C

ritical Care settings

8

14.Staff education and use of tools in evaluation

4

15.A

PN – R

oles as a teacher2

16.A

dvocacy roles in critical care environment

2

Total56 hrs.

18

Practical / Lab = 24 hrs.

1. Preparation of staff patient assignm

ent

2. Preparation of unit budget

3. Preparation of staff duty roster

4. Patient care audit

5. Preparation of nursing care standards and protocols

6. M

anagement of equipm

ent and supplies

7. M

onitoring, evaluation, and writing report of infection control practices

8. D

evelopment of teaching plan

9. M

icro teaching / patient education sessions

10. Preparation of teaching method and m

edia for patients and staff

11. Planning and conducting OSC

E/OSPE

12. Construction of tests

Assignm

ent - ICU

work place violence

Bibliography:

Bastable, S. B

. (2010).Nurse as educator: Principles of teaching and learning for nursing practice (3rd ed.).

New

Delhi: Jones &

Bartlett Publishers

Billings, D

. M., &

Halstead, J. A

. (2009).Teaching in nursing: A guide for faculty (3rd ed.). St.Louis, Missouri:

Saunders Elsevier.

Clark, C

. C. (2010). C

reative nursing leadership and managem

ent. New

Delhi: Jones and B

artlet Publishers.

McC

onnel.(2008). Managem

ent principles for health professionals. Sudbury, M. A

: Jones and Bartlet

Publishers.

Roussel, L., &

Swansburg, R

. C. (2010). M

anagement and leadership for nurse adm

inistrators (5th ed.). New

D

elhi: Jones and Bartlet Publishers.

19

A. A

dvanced Pathophysiology Applied to C

ritical Care N

ursing – IC

OM

PET

EN

CIE

S

plan of care

illnesses

diagnosis, treatment, care and prognosis


Theory: 30 hours

Unit

Hours

Content

I(8)

(4)

(6)

1. Cardiovascular function

A

dvanced pathophysiological process of cardiovascular conditions

2. Pulmonary function

A

dvanced pathophysiological process of pulmonary conditions

3. Neurological function

A

dvanced pathophysiological process of neurological conditions

AD

VAN

CE

D N

UR

SING

CO

UR

SE

20

Unit

Hours

Content

(4)

(4)

(4)

4. Renal function

A

dvanced pathophysiological process of renal conditions

5. Gastrointestinal and hepatobiliary function

A

dvanced pathophysiological process of hepatobiliary conditions

6. Endocrine functions

A

dvanced pathophysiological process of endocrine conditions

21

IV.B. A

dvanced Pathophysiology Applied to C

ritical Care

Nursing - II

Hours of instruction

Theory: 30 hours

Unit

Hours

Content

III III

IV

(8)

(2)

(8)

(6)

1. Hem

atological function

Advanced pathophysiological process of hem

atological conditions

- Polycythemia

- Anem

ia- Sickle cell diseases

- Leucopenia- N

eoplastic disorders

- Platelet disorders- C

oagulation disorders- D

isseminated intravascular coagulation

2. Integumenatry function

A

dvanced pathophysiological process of integumentary conditions

3. Multisystem

dysfunction

Advanced pathophysiological process of neurological conditions

- Hypovolem

ic - C

ardiogenic- D

istributive

- Thoracic - A

bdominal

- Musculoskeletal

- maxillofacial

4.

22

Unit

Hours

Content

V(6)

5. Reproductive functions

A

dvanced pathophysiological process of reproductive conditions

Bibliography

Huether, S. E., &

McC

ance, K. L. (2012). U

nderstanding pathophysiology (5th ed.). St. Louis, Missouri:

Elsevier

John, G., Subram

ani, K., Peter, J. V., Pitcham

uthu, K., &

Chacko, B

. (2011). Essentials of critical care (8th ed.). C

hristian Medical C

ollege: Vellore.

Porth, C. M

. (2007). Essentials of pathophysiology: Concepts of altered health states (2nded.). Philadelphia:

Lippincott William

s and Wilkins.

Urden, L. D

., Stacy, K. M

., & Lough, M

. E. (2014). Critical C

are Nursing- D

iagnosis and managem

ent (7th ed.). Elsevier: M

issouri

23

V. Advanced Pharm

acology relevant to Critical C

are Nursing

CO

MPE

TE

NC

IES

care conditions

critical care settings and guiding their families in self care m

anagement


Theory: 54 hours

Unit

Hours

Content

I2

Introduction to pharmacology in critical care

II4

Pharmacokinetics and Pharm

aco-dynamics

The rights of drug adm

inistration

Systems of m

easurement

Enteral drug adm

inistration

Topical drug administration

Parentral drug adm

inistrationIII

5Pharm

acology and Cardiovascular alterations in C

ritical care

Vasodilator,

Vasopressor,

Inotropes-

Cardiac glycosides – digoxin

- Sym

pathomim

etics – Dopam

ine, dobutamine, epinephrine, isoproterenol,

norepinephrine, phenylephrine-

Phosphodiesterase inhibitors – amrinone, m

ilrinone

M

edications to improve cardiac contractility

M

edications in the managem

ent of hypertension in critical care

Medications in the m

anagement of heart failure

M


ent of angina pectoris and myocardial infarction

M


ent of dysrhythmias, H

eart block and conduction disturbances

24

Unit

Hours

Content

M


ent of Pulmonary hypertension, Valvular heart disease,

Cardiom

ypathy


anagement of A

therosclerotic disease of aorta and Peripheral artery disease

M


ent of Deep vein throm

bosis

IV4

Pharmacology and Pulm

onary alterations in Critical care

Introduction

M

edications used on patients with m

echanical ventilator

Mechanical ventilation im

pact on pharmacotherapy – Sedation and analgesia, N

euromucsular

blockade, Nutrition

M


ent of Status asthmaticus

M


ent of Pulmonary edem

a


anagement of Pulm

onary embolism

M


ent of Acute respiratory failure and A

cute respiratory distress syndrom

e


anagement of C

hest trauma

M


ent of Chronic obstructive pulm

onary disease


anagement of Pneum

onia


anagement of Pleural effusion

M


ent of Atelectasis

V6

Pharmacology and N

eurological alterations in Critical care

Pain

NSA

ID

Opioid analgesia

Sedation

amino butyric acid stim

ulants

Dexm

editomidine

A

nalgosedationD

elirium

Haloperidol

A

typical anti psychoticsM

edications used for local and general anesthesia

Local- Am

ides, esters, and miscellaneous agents

G

eneral – Gases, Volatile liquids, IV

anesthetics

Non anesthetic drugs adjuncts to surgery

Paralytic Medications

N

on-depolarizing and depolarizing agents

Anxiolytics

Autonom

ic drugs

Adrenergic agents/ Sym

pathomim

etics

Adrenergic blocking agents

C

holinergic agents

Anti cholinergic agents


anagement of anxiety and insom

nia

Antidepressants

25

Unit

Hours

Content

B

enzodiazepines

Barbiturates

Neurological critical care conditions

M


ent of psychoses


anagement of acute head and spinal cord injury w

ith elevated intracranial pressure

M


ent of muscle spasm

M


ent of spasticity


anagement of C

erebro vascular disease and cerebro vascular accident


anagement of Encephalopathy

M


ent of Gillian B

are syndrome and M

yasthenia gravis


anagement of B

rain herniation syndrome

M


ent of Seizure disorder


anagement of C

oma, U

nconsciousness and persistent vegetative state

Appropriate nursing care to safeguard patient

Standing orders for neurology critical care emergencies

VI

5Pharm

acology and Nephrology alterations in C

ritical care

C

rystalloids

Colloids

Sodium

Potassium

C

alcium

Magnesium

Phosphorus

M


ent of Acute / C

hronic renal failure


anagement of A

cute tubular necrosis


anagement of B

ladder trauma

M


ent of Electrolyte imbalances

M


ent of Acid base im

balances

Medications used during dialysis

VII

5Pharm

acology and Gastrointestinal alterations in C

ritical care

M


ent of Acute G

I bleeding, Hepatic failure

M


ent of Acute pancreatitis

26

Unit

Hours

Content

M


ent of Abdom

inal injury


anagement of H

epatic encephalopathy


anagement of A

cute intestinal obstruction


anagement of Perforative peritonitis

M

edications used during Gastrointestinal surgeries and Liver transplant

VIII

4Pharm

acology and Endocrine alterations in C

ritical care

M


ent of Diabetic ketoacidosis, H

yperosmolar non ketotic

coma

M


ent of hypoglycemia

M


ent of Thyroid storm


anagement of M

yxedema com

a


anagement of A

drenal crisis


anagement of SIA

DH

IX5

Pharmacology and H

ematology alterations in C

ritical care

Erythropoietin

C

olony stimulating factors

Platelet enhancers

W

hole blood, Packed red blood cells, Leukocyte-reduced red cells, Washed red

blood cells, Fresh frozen plasma, C

ryoprecipitate

Album

in

alkaloids, hormones and horm

one antagonist, corticosteroids, gonadal hormones, anti

M


ent of Anem

ia in critical illness


anagement of D

IC


anagement of Throm

bocytopenia and acute leukemia

M


ent of Heparin induced throm

bocytopenia


anagement of Sickle cell anem

ia

27

Unit

Hours

Content

M


ent of Tumor lysis syndrom

e

X3

Pharmacology and Skin alterations in C

ritical care

M

edications used in burn managem

ent

Medications used in w

ound managem

ent

XI

5Pharm

acology and Multisystem

alterations in Critical care

Near drow

ning)

A

ntipyretics

NSA

IDS

C

orticosteroids

XII

6Pharm

acology and Infections in Critical care

Introduction

B

eta lactams – Penicillins, cephalosporins, m

onobactams, carbapenam

s,

Am

inoglycosides

Anti M

RSA

M

acrolides

Quinolones

M

iscellaneous – lincosamide group, nitroim

idazole, tetracyclins and chloram

phenicol, polymyxins, anti m

alarials, anti fungals, anti virals

M


ent of HIV, Tetanus, SA

RS, R

ickettsiosis,

Bibliography

Johnson, T. J. (2012). Critical care pharm

acotherapeutics.Jones & B

artlett Learning: United States of A

merica

Wynne, A

. L., Woo, T. M

., &O

lyaei, A. J. (2007). Pharm

acotherapeutics for nurse practitioner prescribers (2nded.). Philadelphia: D

avis.

28

VI. A

dvanced Health/Physical A

ssessment in C

ritical Care

Nursing

CO

MPE

TE

NC

IES

health care team m

embers, patients, and fam

ilies


Theory: 70 hours

Practical/L

ab: 46 hours

Unit

Hours

Content

(4)

(6)

(6)

(6)

(6)

1. Introduction

2. Cardiovascular system

imaging

3. Respiratory system

angiography, bronchoscopy, thoracentesis, sputum culture, pulm

onary function test

4. Nervous system

5. Renal system

29

Unit

Hours

Content

(4)

(4)

(4)

(3)

(6)

(5)

(4)

6. Gastrointestinal system

History

Physical examination

Nutritional assessm

entLaboratory studies – Liver function studies, blood param

eters, stool testD

iagnostic studies – radiological and imaging studies, endoscopic studies

7. Endocrine systemH

istory, physical examination, laboratory studies, and diagnostic studies of

Hypothalam

us and pituitary glandThyroid glandParathyroid glandEndocrine glandA

drenal gland

8. Hem

atological systemH

istory Physical exam

inationLaboratory studies - blood param

etersD

iagnostic studies – bone marrow

aspiration

9. Integumentary system

History


Pathological examination – tissue exam

ination

10. Musculoskeletal system

History

Physical examination – gait assessm

ent, joint assessment,

Diagnostic studies - R

adiological and imaging studies, endoscopic studies

11. Reproductive system

(Male &

Female)

History


Laboratory studies D

iagnostic studies

12. Sensory Organs

History


Laboratory studies D

iagnostic studies - Radiological and im

aging studies, endoscopic studies

30

Unit

Hours

Content

(6)

(6)

13. Assessm

ent of childrenG

rowth and developm

entN

utritional assessment

14. Assessm

ent of older adultsH

istoryPhysical assessm

ent Psychological assessm

ent

Com

prehensive history taking

Focused history taking (system w

ise )

Com

prehensive physical examination

Focused physical examination (system

wise)

Monitoring clinical param

eters ( system w

ise)

Invasive BP m

onitoring, Multi-param

eter Monitors, EC

G, Pulse index C

ontinuous Cardiac O

utput (PiCC

O),

Peripheral vascular status, AB

G, Pulse O

ximetry, End Tidal C

O2 (ETC

O2), Intracranial Pressure (IC

P), Glasgow

C

oma Scale (G

CS), C

ranial nerve assessment, Pain and Sedation score of critically ill, M

otor assessment, Sensory

assessment, Renal function tests, Fluid balance, acid base balance, electrolytes, Bow

el sounds, Abdom

inal pressure, R

esidual gastric volume, Liver function tests, G

RB

S, Lab tests, Radiological and Im

aging tests(system w

ise)

Ordering and interpretation of screening and diagnostic tests ( system

wise) (Enclosed-A

ppendix 3)

Assessm

ent of children-neonate and child

Assessm

ent of Older adults

Assessm

ent of pregnant wom

en

Bibliography

Bickley, L. S., &

Szilagyi, P. G. (2013). B

ates’ guide to physical examination and history taking (11th ed.). N

ew

Delhi: Lippincott W

illiams and W

ilkins.

Rhoads, J. (2006). A

dvanced health assessment and diagnostic reasoning. Philadelphia: Lippincott W

illiams &

W

ilkins.

Wilson, S. F., &

Giddens, J. F. (2006).H

ealth assessment for nursing practice (4th ed.).St. Louis, M

issouri: Saunders Elsevier.

31

(Foundations of Critical C

are Nursing Practice, C

ritical Care N

ursing I and Critical C

are Nursing II)

CO

MPE

TE

NC

IES

stability

managem

ent of critical illness, palliative care and end of life care

care

and comm

unities

discontinue therapeutic relationships

improvem

ent

CR

ITIC

AL C

AR

E SPE

CIA

LTY

CO

UR

SES

32

VII. Foundations of C

ritical Care N

ursing PracticeH

ours of instruction: T

heory: 96 hours,

Practical/skill lab: 48 hours

Unit

Hours

Content

I10

Introduction to Critical C

are Nursing

Liver, Pancreas, Thyroid, Adrenal and Pituitary gland)

and care of various type of monitors &

ventilators, Flow sheets, supply lines and the environm

ent)

II5

Concept of H

olistic care applied to critical care nursing practiceA

pplication of nursing process in the care of critically illA

dmission and progress in IC

U- A

n overall viewO

verview of IC

U M

anagement

Ensure adequate tissue oxygenationM

aintain chemical environm

entM

aintain temperature

Organ protection

Nutritional support

Infection controlPhysiotherapy and rehabilitationFam

ily visiting hoursR

estraints in critical care – physical, chemical and alternatives to restraints

Death in critical care unit: End of life care/C

are of dying, care of family, organ donation

Transport of the critically ill – By air am

bulance and surface ambulance

Stress and burnout syndrome am

ong health team m

embers

III10

Appraisal of the critically ill

General assessm

entR

espiratory assessment

Cardiac assessm

entR

enal assessment

Neurological assessm

entG

astrointestinal assessment

33

Unit

Hours

Content

Endocrine assessment

Musculoskeletal assessm

entIntegum

entary assessment

Monitoring of the critically illA

rterial blood gas (AB

G)

Capnography

Hem

odynamics

Electrocardiography (ECG

)G

lasgow C

oma Scale (G

CS)

Richm

ond agitation sedation scale (RA

SS)Pain scoreB

raden score

Evaluation of the critically ill

Evaluation of pre critical illnessEvaluation of critical illnessO

utcome and scoring system

sA

cute Physiology and Chronic H

ealth Evaluation ( APA

CH

E I-IV)

Mortality probability m

odel (MPM

I, II)

Organ system

failureFull outline of unresponsiveness (FO

UR

)M

odel for end-stage liver disease (MELD

)IV

14A

dvanced Concepts and Principles of C

ritical Care

Principles of cardio-pulmonary-brain resuscitation

Emergencies in critical care : C

PR

BLS

AC

LSA

irway m

anagement

Oxygenation and oxim

etry, care of patient with oxygen delivery devices

patient with invasive and non invasive ventilation

Circulation and perfusion (including hem

odynamic evaluation and w

aveform graphics)

Evaluation of acid base statusTherm

oregulation, care of patient with hyper/hypo-therm

iaLiberation from

life support (Weaning)

Glycem

ic control, care of patient with glycem

ic imbalances

V8

Pain and Managem

entPain in C

ritically ill patientsPain – Types, TheoriesPhysiology, System

ic responses to pain and psychology of pain Review

Acute pain services

Pain assessment – Pain scales, behavior and verbalization

Pain managem

ent-pharmacological (O

pioids, benzodiazepines, propofol, Alpha agonist,

Tranquilisers, Neurom

uscular blocking agents)

34

Unit

Hours

Content

Nonpharm

acological managem

entTranscutaneous electrical nerve stim

ulation(TENS)

VI

8Psychosocial and spiritual alterations: A

ssessment and m

anagement

Stress and psychoneuroimm

unologyPost traum

atic stress reactionIC

U Psychosis, A

nxiety, Agitation, D

eliriumA

lcohol withdraw

al syndrome and delirium

tremens

Collaborative m

anagement

Sedation and Relaxants

Spiritual challenges in critical careC

oping with stress and illness

Care of fam

ily of the critically illC

ounseling and comm

unicationV

II4

Patient and family education and counseling

Challenges of patient and fam

ily educationProcess of adult learningFactors affecting teaching learning processInform

ational needs of families in critical care

Counseling needs of patient and fam

ilyC

ounseling techniquesV

III5

Nutrition A

lterations and Managem

ent in critical careN

utrient metabolism

and alterationsA

ssessing nutritional statusN

utrition supportN

utrition and systemic alterations

Care of patient on enteral and parentral nutrition

IX4

Sleep alterations and managem

entN

ormal hum

an sleepSleep pattern disturbanceSleep apnea syndrom

eX

5Infection control in critical care

Nosocom

ial infection in intensive care unit; methyl resistant staphylococcus aureus (M

RSA

) and

Disinfection, Sterilization,

Standard safety measures,

Prophylaxis for staffA

ntimicrobial therapy- review

X

I6

Legal and ethical issues in critical care-N

urse’s role

Issues giving raise to civil litigationR

elated laws in india

Medical futility

Adm

inistrative law: Professional regulation

35

Unit

Hours

Content

Tort law: N

egligence, professional malpractice, intentional torts, w

rongful death, defamation, assault

and batteryC

onstitutional Law: Patient decision m

akingE

thical IssuesD

ifference between m

orals and ethicsEthical principles, ethical decision m

aking in critical care, Strategies for promoting ethical decision

making

Ethical issues relevaqnt to critical care :w

ithholding and withdraw

ing treatment,

Managing Scarce resource in critical careB

rain death, Organ donation &

Counseling,

Do N

ot Resuscitate(D

NR

), Euthanasia, Living will

Nurses’ R

oleX

II8

Quality assurance

Design of IC

U/C

CU

assurance models applicable to IC

Us

Standards, Protocols, Policies, ProceduresInfection control policies and protocolsStandard safety m

easuresN

ursing audit relevant to critical care

XIII

3E

vidence based practice in critical care nursingEvidence based practice in critical careB

arriers to implem

entationStrategies to prom

ote implem

entation5

Class tests

Total96

CPR

(BLS and A

CLS)

Airw

ay Managem

ent o

Laryngeal mask airw

ayoo

Care of ET tube

oTracheostom

y careo

Suctioning – open/closedo

Chest physiotherapy

Oxygenation and oxim

etry, care of patient with oxygen delivery devices

oD

evices to measure oxygen/oxygenation

-Fuel cell

-Para m

agnetic oxygen analyzer

36

-PO

2 electrodes-Clark electrodes

-Transcutaneous oxygen electrodes

-O

ximetry – Pulse oxim

etry, Venous oximetry

oC

apnographyo

Non invasive ventilation -

face mask w

ith reservoir bags-

masks, T pieces, breathing circuits

oPostural drainage

Ventilation and ventilator supporto

Connecting to ventilator

oW

eaning from ventilator

oExtubation

ooN

ebulizers – jet, ultrasonico

Inhalation therapy – metered dose inhalers (M

DI), dry pow

der inhalers (DPI)

Circulation and perfusion (including hem

odynamic evaluation and w

aveform graphics)

oInvasive blood pressure m

onitoringo

Non-invasive B

P monitoring

oVenous pressure (Peripheral, C

entral and Pulmonary artery occlusion pressure)

oInsertion and rem

oval of arterial lineo

Insertion and removal of central line

oPulse index C

ontinuous Cardiac output (PiC

CO

)o

Electrocardiography (ECG

)o

Waveform

sFluids and electrolyteso

Fluid calculation and administration (crystalloids and colloids)

oA

dministration of blood and blood products

oInotrope calculation, titration and adm

inistration-

Cardiac glycosides – D

igoxin-

Sympathom

imetics – D

opamine, dobutam

ine, epinephrine, isoproterenol, norepinephrine, phenylephrine

-Phosphodiesterase inhibitors – am

rinone, milrinone

oElectrolyte correction ( Sodium

, potassium, calcium

, phosphrous, magnesium

)oEvaluation of acid base statuso

Arterial blood gas (A

BG

)Therm

oregulation, care of patient with hyper/hypotherm

ia

37

oTem

perature probeso

Critical care m

anagement of hyper and hypotherm

iaG

lycemic control, care of patient w

ith glycemic im

balanceso

Monitoring G

RB

So

Insulin therapy (sliding scale and infusion)oo

Managem

ent of hypoglycemia – D

extrose IVPharm

acological managem

ent of pain, sedation, agitation, and deliriumo

Calculation, loading and infusion of – M

orphine, Fentanyl, Midazolam

, Lorazepam, D

iazepam,

Propofol, Clonidine, D

esmedetom

idine, Haloperidol

oEpidural analgesia- sensory and m

otor block assessment, rem

oval of epidural catheter after discontinuing therapy, change of epidural catheter site dressing, insertion and rem

oval of subcutaneous port for analgesic adm

inistration, intermittent catheterization for urinary retention for patients on

epidural analgesia/PCA

, dose titration for epidural infusion, epidural catheter adjustment, purging

epidural drugs to check patency of catheter and also for analgesiaC

ounselingFam

ily education

38

VIII. C

ritical Care N

ursing IH

ours of instruction: T

heory: 96 hours, Practical: 48hours

Unit

Hours

Content

I6

Introduction

II16

Cardiovascular alterations

- H

eart block and conduction disturbances-

Coronary heart disease

- M

yocardial infarction-

Pulmonary hypertension

- Valvular heart disease

- A

therosclerotic disease of aorta-

Peripheral artery disease-

Cardiom

ypathy-

Heart failure

- D

eep vein thrombosis

- C

ongenital heart disease(cyanotic and acyanotic)

- C

ardiac transplant-

Pacemakers

- C

ardioversion

- Throm

bolytic therapy-

Radiofrequency catheter ablation

- Percutaneous Translum

inal Coronary A

ngioplasty(PTCA

)-

Cardiac surgery –C

oronary artery bypass grafting( CA

BG

)/ Minim

ally invasive coronary artery surgery)M

ICA

S, Valvular surgery, vascular surgery-

Mechanical circulatory assistive devices – Intra aortic balloon pum

p-

Effects of cardiovascular medications

- Ventricular assist devices(VA

D)

- Extra corporeal m

embrane oxygenation(EC

MO

)

III15

Pulmonary alterations

Pulmonary conditions requiring critical care m

anagement

- Status asthm

aticus-

Pulmonary edem

a-

Pulmonary em

bolism-

Acute respiratory failure

- A

cute respiratory distress syndrome

- C

hest trauma

- C

hronic obstructive pulmonary disease

39

Unit

Hours

Content

- Pneum

onia-

Pleural effusion-

Atlectasis

- Longterm

mechanical ventilator dependence

- Thoracic surgery

- Lung transplant

- B

ronchial hygiene: Nebulization, deep breathing and coughing exercise, chest

physiotherapy and postural drainage-

Chest tube insertion and care of patient w

ith chest drainage

IV15

Neurological alterations

Review

of Clinical assessm

ent, pathophysiology, and pharmacology

Special diagnostic studies N

eurological conditions requiring critical care managem

ent-

Cerebro vascular disease and cerebro vascular accident

- Encephalopathy

- G

illian Bare syndrom

e and Myasthenia gravis

- B

rain herniation syndrome

- Seizure disorder

- C

oma, U

nconsciousness-

persistent vegetative state-

Head injury

- Spinal cord injury

- Therm

oregulationN

eurologic therapeutic managem

ent-

Intracranial pressure – Assessm

ent and managem

ent of intracranial hypertension-

Craniotom

yR

ecent advances and development

V15

Nephrology alterations

Review

of Clinical assessm


Special diagnostic studies N

ephrology conditions requiring critical care managem

ent-

Acute renal failure

- C

hronic renal failure-

Acute tubular necrosis

- B

ladder trauma

Nephrology therapeutic m

anagement

- R

enal Replacem

ent therapy: Dialysis

- R

enal transplantR


VI

12G

astrointestinal alterationsR

eview of C

linical assessment, pathophysiology, and pharm

acologySpecial diagnostic studies G

astrointestinalconditions requiring critical care managem

ent-

Acute G

I bleeding-

Hepatic failure

- A

cute pancreatitis-

Abdom

inal injury-

Hepatic encephalopathy

40

Unit

Hours

Content

- A

cute intestinal obstruction-

Perforative peritonitisG

astrointestinal therapeutic managem

ent-

Gastrointestinal surgeries

- Liver transplant

Recent advances and developm

entV

II12

Endocrine alterations

Review

of Clinical assessm


Special diagnostic studies Endocrineconditions requiring critical care m

anagement

- N

euroendocrinology of stress and critical illness-

Diabetic ketoacidosis, H

yperosmolar non ketotic com

a-

hypoglycemia

- Thyroid storm

- M

yxedema com

a-

Adrenal crisis

- SIA

DH

Endocrine therapeutic managem

entR


5C

lass testsTotal

96 hours

C

ardiovascular alterations o

Thrombolytic therapy

IAB

P)

Pulm

onary alterationso

Tracheostomy C

areo

Nebulization

o C

hest physiotherapyo

Chest tube insertion

o C

hest drainage

N

eurological alterationso

Monitoring G

CS

o C

onscious and coma m

onitoringo

Monitoring IC

Po

Sedation scoreo

Brain D

eath Evaluation

N

ephrology alterationso

Dialysis

Priming of dialysis m

achine

41

Preparing patient for dialysis

C

annulating for dialysis

Starting and closing dialysis

G

astrointestinal alterationso

Abodm

inal pressure monitoring

o C

alculation of calorie and protein requirements

o Special diets – sepsis, respiratory failure, renal failure, hepatic failure, cardiac failure, w

eaning, pancreatitis

o Enteral feeding – N

G/G

astrostomy/ Pharyngeal/Jejunostom

y feedso

Total parenteral nutrition

E

ndocrine alterationso

Collection of blood sam

ples for cortisol levels, sugar levels, and thyroid harmone levels

o C

alculation and administration of corticosteroids

o C

alculation and administration of Insulin – R

eview

42

IX. C

ritical Care N

ursing - II


Theory: 96 hours,

Practical: 48 hours

Unit

Hours

Content

I12

Hem

atological alterations

- D

IC-

Thrombocytopenia

- H

eparin induced thrombocytopenia

- Sickle cell anem

ia-

Tumor lysis syndrom

e-

Anem

ia in critical illness

- A

utologus blood transfusion-

bone marrow

transplantation

II8

Skin alterations

- B

urns -

Wounds

- R

econstructive surgeries for burns-

Managem

ent of wounds

III12

Multi system

alterations requiring critical care

IV10

43

Unit

Hours

Content

V9

Critical care in O

bstetrics

- A

ntepartum hem

orrhage-

PIH-

Obstructed labor

- R

uptured uterus-

PPH-

Puperal sepsis-

Obstetrical shock

- H

ELLP syndrome

- D

IC- -

AR

DS

- Traum

aV

I10

Critical care in children

- A

Asphyxia neonatarum

- M

etabolic disorders-

Intracranial hemorrhage

- N

eonatal sepsis-

Dehydration

- A

RD

S-

Poisoning-

Foreign bodies-

Seizures-

Status asthmaticus

- C

yanotic heart disease-

congenital hypertrophic pyloric stenosis- -

imperforate anus

- A

cute bronchopneumonia

- Traum

a in children

- Ventilatory issue

- M

edication administration

- Pain M

anagement

VII

10C

ritical Care in O

lder Adult

- B

iological issues-

Psychological issues-

Concepts and theories of ageing

- Stress &

coping in older adults-

Com

mon H

ealth Problems &

Nursing M

anagement;

44

Unit

Hours

Content

- A

uditory changes-

Visual changes

- O

ther sensory changes-

Skin changes-

Cardiovascular changes

- R

espiratory changes-

Renal changes

- G

astro intestinal changes-

Musculoskeletal changes

- Endocrine changes

- Im

munological changes

- C

ognitive changes-

Abuse of the older person

- A

lcohol abuse

- D

rug absorption-

Drug distribution

- D

rug metabolism

- D

rug excretion

- C

are transitions-

Palliative care and end of life in critical careV

III10

Critical C

are in Perianesthetic period

- R

espiratory-Airw

ay obstruction, Laryngeal edema, Laryngospasm

, Bronchospasm

, N

oncardiogenic pulmonary edem

a, Aspiration, H

ypoxia,Hypoventilation

- C

ardiovascular – Effects of anesthesia on cardiac function, Myocardial dysfunction,

Dysrhythm

ias, postoperative hypertension, post operative hypotension-

Thermoregulatory – H

ypothermia, shivering, hypertherm

ia, malignant hypertherm

ia-

Neurology- D

elayed emergence, em

ergence delirium,

- N

ausea and vomiting

IX10

Other special situations in critical care

5C

lass testsTotal

96 hours

45

H

ematological alterations

o B

lood transfusiono

Bone m

arrow transplantation

o C

are of Catheter site

B

one marrow

aspirationo

Skin alterations

o B

urn feeds calculationo

Burn dressing

o B

urns batho

Wound dressing

M

ulti system alterations requiring critical care

o Triage

o Traum

a team activation

o A

dministration of anti snake venom

o A

ntidotes

o Isolation precautions

o D

isinfection and disposal of equipment

C

ritical care in Obstetrics, children, and O

lder Adult

o partogram

o equipm

ents – incubators, warm

ers

C

ritical Care in Perianesthetic period

o A

ssisting with planned intubation

o M

onitoring of patients under anesthesiao

Adm

inistration of nerve blockso

Titration of drugs – Ephedrine, Atropine, N

aloxone, Avil, Ondansetron

o Sensory and m

otor block assessment for patients on epidural analgesia.

o Technical troubleshooting of syringe / infusion pum

ps.

O

ther special situations in critical careo

Disaster preparedness and protocols

The skills listed under the Specialty courses such as Foundations of C

ritical Care N

ursing Practice, C

ritical Care N

ursing I and Critical C

are Nursing II are taught by the faculty in skill lab. T

he students after practicing them

in the lab, will continue to practice in the respective IC

Us. T

he log

46

Bibliography

Diepenbrock, N

. H. (2008). Q

uick reference to critical care (3rd ed.). Philadelphia: Lippincott William

s and Wilkins.

John, G., Subram

ani, K., Peter, J. V., Pitcham

uthu, K., &

Chacko, B

. (2011). Essentials of critical care (8th ed.) . C

hristian Medical C

ollege: Vellore.

Morton, P. G

., & Fontaine, D

. K. (2013). C

ritical Care N

ursing: A H

o;istic Approach (9th ed.). Lippincott W

illiams

and Wilkins: Philadelphia

Perrin, K. O

. (2009). Understanding the essentials of critical care nursing. N

ew Jersey: Pearson Edcuation.

Urden, L. D

., Stacy, K. M

., & Lough, M

. E. (2014). Critical C

are Nursing- D

iagnosis and managem

ent (7th ed.). Elsevier: M

issouri

Wyckoff, M

., Houghton, D

., &Lepage, C

. (2009).Critical care. N

ew York: Springer publishing com

pany.

47

Appendix 1

EQ

UIPM

EN

T LIST FO

R A

TE

N B

ED

DE

D IC

U

1. A

djustable electronic cot with m

attress – 102.

IV stand – 20

3. B

ed side locker – 11 (10 – patient; 1 – stock)4.

Over bed trolley – 10

5. D

ressing trolley (Small) – 5

6. D

ressing trolley (medium

) – 27.

Syringe pump – 60

8. Infusion pum

p – 359.

Monitors- 11 (10 –patient; 1- stock)

10. Transport m

onitor/pulseoximeter – 2

11. Ventilators – 12 (10 – patient; 2 – stock)

12. Portable ventilators -2

13. A

BG

machine – 2

14. EC

G m

achine – 115.

Ultrasound m

achine – 116.

Doppler m

achine – 1

18. Peripheral N

erve Stimulator – 1

19. B

lood warm

er – 320.

Patient warm

er – 521.

Sequential Com

pression Device – 10

22. A

lpha mattress w

ith motor – 15

23. LED

shield – 124.

Crash cart – 1

25. Transfer trolley – 4

26. O

R trolley - 2

27. Safe slider – 2

28. C

omputer – 4

29. Printers – 2

30. B

ain circuit – 12

32. Suction port w

ith jar – 15

48

34. R

efrigerator – 3 (1- feeds, 1- drugs, 35.

Metal foot step/foot stool – 10

36. A

mbulation chair – 5

37. U

PS -138.

Flat trolley -139.

Dialysis m

achine -140.

Spot light – 241.

Labelling machine – 1

42. G

lucometer – 2

43. A

mbu bag w

ith different sizes – 10 sets44.

Fiberoptic bronchoscope – 145.

Intubating videoscope - 146.

Minim

um standards for Indian IC

US (IC

U 6-12 beds) (ISC

CM

, 2010)

Bed space – m

inimum

100 sq. ft.A

dditional space (storage, Nursing station, doctors room

and circulation space)- 100% extra of the bed space.

Oxygen outlets 2

Vacuum outlets 2

Com

pressed air outlets 1Electric outlets (2 on each side of patients)W

ith 5/15 amp pins

Central nursing station

49

Appendix 2a

CL

INIC

AL L

OG

BO

OK

FOR

NU

RSE

PRA

CT

ITIO

NE

R (N

P) PR

OG

RA

M IN

CR

ITIC

AL C

AR

E I Y

EA

RS.N

o.SK

ILL

SN

UM

BE

R

PER

FOR

ME

DD

ATE

SIGN

ATU

RE

O

F TH

E

PRE

CE

PTOR

*I

RE

SEA

RC

H A

PPLIC

ATIO

N A

ND

EV

IDE

NC

E B

ASE

D PR

AC

TIC

E1

Preparation of research instrument

2Preparation of a m

anuscript for publication3

Writing system

atic review

4D

issertation Topic:

IIA

DVA

NC

ED

SKIL

LS IN

LE

AD

ER

SHIP, M

AN

AG

EM

EN

T, AN

D T

EA

CH

ING

1Preparation of staff patient assignm

ent2

Preparation of unit budget3

Preparation of staff duty roster4

Patient care audit 5

Preparation of nursing care standards and protocols

6M

anagement of equipm

ent and supplies7

Monitoring, evaluation, and w

riting report of infection control practices

8M

icro teaching / patient education sessions9

Preparation of teaching method and m

edia for patients and staff

10Planning and conducting O

SCE/O

SPE11

Construction of tests

IIIA

DVA

NC

ED

HE

ALT

H A

SSESSM

EN

TS

1C

omprehensive history taking

2Focused physical assessm

ent(System w

ise)2.1

Respiratory system

2.2C

ardiac system2.3

Gastrointestinal

2.4N

ervous 2.5

Genitourinary

2.6Endocrine

2.7H

ematological

2.8M

usculoskeletal

50

S.No.

SKIL

LS

NU

MB

ER

PE

RFO

RM

ED

DAT

ESIG

NAT

UR

E

OF T

HE

PR

EC

EPTO

R*

2.9Integum

entary2.10

Sensory organs3

examination

3.1G

eriatric 3.2

Adult

3.3C

hild3.4

Neonate

4H

istory &Physical exam

ination of a Pregnant w

oman

IIID

IAG

NO

STIC

PRO

CE

DU

RE

S1

Collecting blood sam

ple1.1

Biochem

istry 1.2

Clinical pathology

1.3M

icrobiology 1.4

AB

G2

Assisting procedures

2.1Paracentesis

2.2Thoracentesis

2.3Lum

bar puncture2.4

Liver biopsy2.5

Renal biopsy

2.6B

one marrow

aspiration3

Witnessing procedures

3.1C

hest X – ray

3.2ER

CP

3.3PET scan

3.4Endoscopy

3.5M

RI / C

T 3.6

Ultrasound

3.7EM

G3.8

Echocardiogram4

ECG

IIIG

EN

ER

AL C

OM

PET

EN

CIE

S1

Adm

ission2

Transfer 3

Transport 4

Discharge / LA

MA

5M

edico-legal compliance

6Fam

ily education andcounselling

51

S.No.

SKIL

LS

NU

MB

ER

PE

RFO

RM

ED

DAT

ESIG

NAT

UR

E

OF T

HE

PR

EC

EPTO

R*

7End of life C

are7.1

Brain death

7.2 O

rgan donation8

After life C

are9

Setting up, use and maintenance of C

ritical care equipm

ent9.1

Ventilator 9.2

Monitor

9.3Transducer / pressure bag

9.4Tem

perature probes9.5

SpO2 probes

9.6Sequential com

pressing device9.7

12 –lead ECG

monitor

9.8W

armer

9.9Fluid w

armer

9.10ET C

uff pressure monitor

9.119.12

Pacemaker

9.13Syringe pum

p9.14

Infusion pump

9.15A

lpha mattress

9.16C

RA

SH trolley

10Triage

11C

are during transfer by air ambulance and

surface ambulance

52

Appendix 2b

CL

INIC

AL L

OG

BO

OK

FOR

NP IN

CR

ITIC

AL C

AR

E

II YearS.N

o.S K

ILL

SN

UM

BE

R

PER

FOR

ME

DD

ATE

SIGN

ATU

RE

OF

TH

E PR

EC

EPTO

R*

IG

EN

ER

AL C

OM

PET

EN

CIE

S1

Setting up, use and maintenance of C

ritical care equipm

ent1.1

Ventilator 1.2

Monitor

1.3Transducer / pressure bag

1.4Tem

perature probes1.5

SpO2 probes

1.6Sequential com

pressing device1.7

12 –lead ECG

monitor

1.8W

armer

1.9Fluid w

armer

1.10ET C

uff pressure monitor

1.111.12

Pacemaker

1.13Syringe pum

p1.14

Infusion pump

1.15A

lpha mattress

1.16C

RA

SH trolley

1.17C

PAP / B

iPAP

2M

onitoring of critically ill patients2.1

Arterial blood gas A

BG

2.2O

xygen saturation2.3

Endotracheal tube cuff pressure2.4

Capnography

2.5H

emodynam

ics2.6

Electrocardiogram (EC

G)

2.7Intracranial pressure

2.8Invasive B

P monitoring

2.9N

on invasive BP m

onitoring2.10

PiCC

O2.11

Peripheral vascular status2.12

Glasgow

Com

a Scale

53

S.No.

S KIL

LS

NU

MB

ER

PE

RFO

RM

ED

DAT

ESIG

NAT

UR

E O

F T

HE

PRE

CE

PTOR

*2.13

Sedation Scale 2.14

Pain Score2.15

Braden Score

2.16B

owel sounds

2.17G

RB

S2.18

Partogram3

Adm

inistration of medication

3.1Sedation

3.2M

uscle relaxant3.3

Electrolyte infusion3.4

Insulin infusion3.5

Ionotropeadministration

3.6Throm

bolytic drug 3.7

Corticosteroid

4Infection control

5U

niversal precaution6

Disinfection / Sterilization

7Preparation of standards/policies/protocols

8B

LS9

AC

LS10

Managem

ent of Cardiovascular A

lterations10.1

Fluid administration (C

olloid/Crystalloid)

10.2 B

lood and blood product administration

10.3A

pplication of TED stocking

10.4Insertion and C

are of CV

P line10.5

Rem

oval of CV

P line10.6

Assisting w

ith insertion of arterial line10.7

Care of arterial line

10.8R

emoval of arterial line

10.9A

ssisting with insertion of pulm

onary artery catheter

10.10C

are of Patient with Pacem

aker10.11

Blood collection from

arterial line11

Managem

ent of Pulmonary A

lterations11.1

Airw

ay application11.2

Laryngeal mask airw

ay11.3

Assisting w

ith intubation11.4

Care of ET tube

11.5Extubation

11.6A

ssisting for tracheostomy insertion

11.7Tracheostom

y care and suctioning

54

S.No.

S KIL

LS

NU

MB

ER

PE

RFO

RM

ED

DAT

ESIG

NAT

UR

E O

F T

HE

PRE

CE

PTOR

*11.8

Endotracheal suctioning - Open

11.9Endotracheal suctioning - C

losed11.10

Assisting w

ith insertion of chest tube11.11

Care of patient w

ith Chest drainage

11.12C

hest tube removal

11.13N

ebulization 11.14

Oxygen adm

inistration11.15

Care of patient on M

echanical ventilator11.16

Non – invasive ventilation

11.7C

onnecting to Ventilator11.18

Weaning from

ventilator11.19

Use of T-tube andVenturi devices

11.20Postural drainage

11.21W

eaning from tracheostom

y11.22

Chest physiotherapy

11.23A

ssisting for bronchoscopy12

Managem

ent of Neurological A

lterations12.1

Sensory stimulation

12.2C

onsciousness/Com

a status monitoring

12.3B

rain death evaluation13

Managem

ent of Genitourinary A

lterations13.1

Cannulating for hem

odilysis13.2

Starting and closing of hemodialysis

13.3C

are of patient on hemodialysis

13.4Initiating peritoneal dialysis

13.5C

are of patient on peritoneal dialysis13.613.7

Care of patient w

ith continuous urinary drainage14

Managem

ent of Gastrointestinal A

lterations14.1

Estimation of dietary allow

ance14.2

Enteral nutrition14.2.1

NG

feeding14.2.2

Gastrostom

y / Jejunostomy feeding

14.3Test feeds

14.4Parenteral nutrition

14.5Therapeutic diet planning

15M

anagement of Endocrine A

lterations15.1

Titrating insulin 15.2

Calculation of steroid adm

inistration16

Ordering procedures and investigations

55

S.No.

S KIL

LS

NU

MB

ER

PE

RFO

RM

ED

DAT

ESIG

NAT

UR

E O

F T

HE

PRE

CE

PTOR

*16.1

ECG

16.2A

BG

16.3C

hest X ray

16.4U

ltrasound16.5

Biochem

istry investigations16.6

Microbiology investigations

17O

rdering Treatment

17.1N

ebulization 17.2

Chest physiotherapy

17.3D

istal colostomy w

ash17.4

Insertion and removal of urinary catheter for

female patients.

17.5Test feeds

17.6TED

S17.7

Surgical dressing17.8

Starting and closing dialysis17.9

Adm

inistration of TPN infusion w

ith written

order 17.10

Magnesium

Sulphate dressing for Throm

bophlebitis / extravasation.17.11

Application of Ictham

mol G

lycerin / 17.1217.13

Isometric and isotonic exercises

17.14H

ot and cold applications

* - When the student is found com

petent to perform the skill, it w

ill be signed by the preceptor

56

Appendix 3

CL

INIC

AL R

EQ

UIR

EM

EN

TS FO

R N

P CR

ITIC

AL C

AR

E

NU

RSIN

G PR

OG

RA

M

S.No.

CL

INIC

AL R

EQ

UIR

EM

EN

TD

ATE

SIGN

ATU

RE

OF

TH

E PR

EC

EPTO

RI

Clinical C

onference

Drug studies on standing orders

IIC

ase/ Clinical Presentation

IIIN

ursing Rounds

IVC

linical Seminar

VJournal C

lub

VI

Nursing Process(N

P)/Care study R

eport

VII

Advanced H

ealth Assessm

ent

VIII

Faculty Lecture

IXSelf directed learning

XW

ritten Assignm

ent

57

S.No.

CL

INIC

AL R

EQ

UIR

EM

EN

TD

ATE

SIGN

ATU

RE

OF

TH

E PR

EC

EPTO

R

XI

Case study analysis

XII

Workshop

58

Appendix 4

STAN

DIN

G O

RD

ER

SN

UR

SE PR

AC

TIT

ION

ER

IN C

RIT

ICA

L CA

RE

critically ill patients. They collaborate with Intensivists, physicians, surgeons and specialists to ensure accurate

therapy for patients with high acuity needs. O

n completion of the program

, the NPs w

ill be permitted to adm

inister drugs listed in standing orders as per the institutional protocols/standing orders. They w

ill also be permitted to

order diagnostic tests/procedures and therapies

The following intravenous injections or infusions m

ay be administered by the N

urse Practitioner during em

ergency in any of the ICU

s

Catecholam

inesA

drenalineN

oradrenaline D

opamine

Dobutam

ine

Antidysrhythm

icA

denosineA

miodarone

Lidocaine/ Xylocard

Adrenergic agent

Ephedrine

Bronchodilators

Am

inophyllineD

eriphylline

Non depolarizing skeletal m

uscle relaxantA

tracurium ( Vecuronium

, Pancurium)

Anticholinergic

Atropine Sulphate

Antihistam

ine Avil

59

Antihypertensive

Clonidine

Glycerinetrinitrate

Isoptin

Corticosteroid

Hydrocortisone

Dexam

ethasoneA

ntiepilepticLevitracetamPhenytoin

Sedatives & relaxants

ValiumM

idazolamM

orphine SulphatePentazocin Lactate (Fortw

in)Pethidine H

ydro Chloride

Propofol

Electrolytes &

acid base correction agentsSoda bicarbonate 8.4%Soda bicarbonate 7.5%M

agnesium sulphate

Potassium chloride

SUR

GIC

AL IN

TENSIV

E CA

RE

UN

IT (including nephrology, burns, obstetric and gynaecologic patients)

MED

ICA

L INTEN

SIVE

CA

RE U

NIT (including

nephrology, hematology,

dermatology and infectious

patients)

CA

RD

IOTH

OR

AC

IC

CR

ITICA

L CA

RE U

NIT

CA

RD

IAC

CR

ITICA

L C

AR

E UN

IT

Naloxone

PitocinProatam

inesulphate

Digoxin

Tranexamic acid

Verapamil

Sodium nitroprusside

LargactilA

mrinone

Milrinone

Decadron

SorbitrateA

ngisedStreptokinaseU

rokinaseElaxim

e

EMER

GEN

CY

SERVIC

ESPA

EDIATR

IC

INTEN

SIVE C

AR

E UN

IT

NEU

RO

LOG

ICA

L IN

TENSIV

E CA

RE

UN

IT

Methylprednisolone

Emeset

Antisnake venom

Dilantin

TensilonN

eostigmine

ThiopentoneM

estinonProstigm

ine

60

The following investigations and therapies m

ay be ordered by the Nurse Practitioner

OR

DE

RIN

G IN

VE

STIG

ATIO

NS

OR

DE

RIN

G T

HE

RA

PIES

ECG

AB

G

Chest X

ray

Basic B

io chemistry investigations – H

b, PCV, TIB

C,

WB

C Total, W

BC

differentials, ESR, Electrolytes,

platelets, PT, aPTT, bleeding and clotting time,

procalcitonin, D diam

er, creatinine, HbA

1C, A

C, PC

, H

DL, LD

L, TIG, C

holesterol total, HIV, H

bsAg, H

CV,

Basic M

icrobiology investigations – blood samples for

culture and sensitivity, tips of vascular access and ET tube for culture,

Nebulization

Chest physiotherapy

Distal colostom

y wash

Insertion and removal of urinary catheter for

female patients.

Test feeds

TEDS

Surgical dressing

Starting and closing dialysis

Adm

inistration of TPN infusion w

ith written

order

Application of Ictham

mol G

lycerin / Magnesium

Sulphate dressing for Throm

bophlebitis / extravasation.

Isometric and isotonic exercises

Nurse Practitioner in Critical Care Post Graduate Residency ...

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