Unit 6 ICU Word Formation pedo child iatro

Unit 6 ICU

Word Formation ped/o ( child) iatr/o ( medicine) e. g. pediatrics tele- ( distance) e. g. telemetry -metry ( measurement) -meter ( instrument) e. g. oximeter endo- (inside) e. g. endotracheal trache/o (trachea) ex/o (outside) e. g. extubation diet-(food) e. g. dietetics

para-(outside, abnormal) enter/o ( intestines) e. g. parenteral -ia (diseased condition) e. g. arrhythmia -lysis ( dissoved) e. g. thrombolytic orth/o (straight, normal) e. g. orthopedic calc(i)- ( calcium) e. g. hypercalcemia vas/o (vessel) e. g. vasopressor brady- (slow) e. g. bradycardia tachy- (fast) e. g. tachycardia

cardi/o (heart) -pnea ( respiration) e. g. tachypnea spir/o (respiration) e. g. respiratory therm/o (heat) e. g. thermal encephal/o ( brain) e. g. encephalopathy dia- ( apart from) e. g. dialysis intra- ( inside) e. g. crani/o ( skull) e. g. intracranial

anesthesia/aneasthesia ----(Greek word aisthēsis means “sensation”, a/an----without ) 1. 感觉缺失, 麻木 2. 麻醉 angina----from Greek meaning “strangling“(窒息) pectoris---- from Latin meaning "chest" angina pectoris can therefore be translated as "a strangling feeling in the chest".

Questions to consider: 1. What do you know about ICU ? 2. Are you familiar with some common devices in the ICU ? 3. Do you have an idea about general requirements for both doctors and nurses in the ICU ?

ICU Overview v Definition An intensive care unit, or ICU, is a specialized section of a hospital that provides comprehensive and continuous care for persons who are critically ill and who can benefit from treatment.

Intensive care has been shown to benefit patients who are severely ill and medically unstable—that is, they have a potentially life-threatening disease or disorder. v ICU care requires a multidisciplinary team that consists of but is not limited to intensivists (clinicians who specialize in critical illness care); pharmacists and nurses; respiratory care therapists; and other medical consultants from a broad range of specialties including surgery, pediatrics, and anesthesiology.

The ideal ICU will have a team representing as many as 31 different health care professionals and practitioners who assist in patient evaluation and treatment. The intensivist will provide treatment management, diagnosis, interventions, and individualized care for each patient recovering from severe illness.

Description ICUs are highly regulated departments, typically limiting the number of visitors to the patient's immediate family even during visiting hours. The patient usually has several monitors attached to various parts of his or her body for real-time evaluation of medical stability. The intensivist will make periodic assessments of the patient's cardiac status, breathing rate, urinary output, and blood levels for nutritional and hormonal problems that may arise and require urgent attention or treatment. v

v Patients who are admitted to the ICU for observation after surgery may have special requirements for monitoring. These patients may have catheters placed to detect hemodynamic (blood pressure) changes, or require endotracheal intubation to help their breathing, with the breathing tube connected to a mechanical ventilator.

In addition to the intensivist's role in direct patient care, he or she is usually the lead physician when multiple consultants are involved in an intensive care program. The intensivist coordinates the care provided by the consultants, which allows for an integrated treatment approach to the patient. v

Nursing care has an important role in an intensive care unit. The nurse's role usually includes clinical assessment, diagnosis, and an individualized plan of expected treatment outcomes for each patient (implementation of treatment and patient evaluation of results). The ICU pharmacist evaluates all drug therapy, including dosage, route of administration, and monitoring for signs of allergic reactions. v

In addition to checking and supervising all levels of medication administration, the ICU pharmacist is also responsible for enteral and parenteral nutrition (tube feeding) for patients who cannot eat on their own. ICUs also have respiratory care therapists with specialized training in cardiorespiratory (heart and lung) care for critically ill patients. v

Respiratory therapists generally provide medications to help patients breathe as well as the care and support of mechanical ventilators. Respiratory therapists also evaluate all respiratory therapy procedures to maximize efficiency and cost-effectiveness.

Large medical centers may have more than one ICU. These specialized intensive care units typically include a CCU (coronary care unit); a pediatric ICU (PICU, dedicated to the treatment of critically ill children); a newborn ICU or NICU, for the care of premature and critically ill infants; and a surgical ICU (SICU, dedicated to the treatment of postoperative patients). v

ICU Ventilator

ICU Ward

ICU Bed

Understanding the Text Para. 1 Question: 1. Why are the numbers of ICU on the rise in hospitals nowadays ? Because the need for ICU is growing. 1) There are more and more critically ill patients nowadays such as the most premature infants, adults with cardiovascular disease, the severely injured and so on. 2) People nowadays can live much longer, when they become ill they need a series of intensive care in hospitals.

Para. 2 Question: 2. What does this paragraph mainly talk about ? Para. 3 -4 Question: 3. What are the general qualifications of both physicians and nurses in the ICU ?

Para. 5 Question: 4. What do respiratory therapists usually do in the ICU ? Para. 6 Question: 5. What are the responsibilities of a pharmacist in the ICU ?

Para. 7 medical social worker Who are medical social workers and what do they do? v Medical social workers assist patients and their families with health-related problems and concerns. They lead support group discussions, help patients locate appropriate health care and other health services, and provide support to patients with serious or chronic illnesses.

They help patients and their families find important resources they need to overcome unhealthy conditions such as child abuse, homelessness and drug abuse. They also help patients with finding legal resources and financial aid for paying for health services.

How do medical social workers typically spend their workday? As a medical social worker, you will likely work in a hospital, nursing home, health clinic or community health agency. You will work closely with patients and other health professionals. For example, you may help a patient find nursing home care or you may visit hospitals to counsel patients who have life-threatening diseases. You may help new mothers find specialized care for their disabled infants or you could lead a support group for these women. You also help meet outpatients' needs by helping them obtain needed equipment and support, such as meal delivery and home health aides. v

Question: 6. What are the qualifications of a dietician in the ICU ? Para. 3 -7 Question: 7. Why is ICU called a physician-led, multidisciplinary team ?

Because ICU consists of an intensivist physician as the team leader and other physicians who may participate as consultants or coattendings in the ICU, as well as the critical nurses, physician assistants, respirotary therapists, a pharmacists, a dietitian, medical social workers, a unit secretary, residents, and other trainees. Optimal care to the critically ill patients depends on the teamwork of ICU.

Para. 8 Question: 8. What kind of patients are usually admitted to ICU ? Para. 9 -15 Question: 9. What are the common reasons for the patients to be admitted to ICU ?

Question: 10. Catheterization is an important intervention in ICU. Give examples from these paragraphs. 1) An A-line is inserted in patients who require numerous arterial blood gases in order to avoid repeated punctures. 2) A central venous catheter allows measurement of central venous pressure (CVP). 3) A pulmonary artery catheter allows continuous display of pulmonary artery pressure, and variables such as cardiac output and pulmonary artery occlusion pressure or wedge pressure, can be intermittently obtained.

Para. 19 Question: 11. In what ways are bedside monitors helpful according to this paragraph ? Para. 20 v FIO 2 is short for: Fractional Inspired O 2 Concentration Question: 12. In what conditions are ventilators usually used in the ICU ?

1) When the patients aren’t able to protect their airway due to encephalopathy or massive stroke; 2) When the patients have refractory hypoxemia; 3) When the patients have respiratory failure and are unable to take adequate tidal volume.

aspiration v Definition Aspiration occurs when liquid or solid material enters the windpipe (trachea). sputum aspiration 吸痰 aspiration pneumonia 吸入性肺炎 ----form of pneumonia where infected matter is inhaled from the bronchi or esophagus

Causes The body has important protective mechanisms (reflexes) that usually allow only air to enter the windpipe. If these reflexes are temporarily or permanently disturbed, then foreign materials, such as food, saliva or stomach contents can enter the windpipe. The protective reflexes are most commonly disturbed when a patient is unconscious for any reason (e. g. , head injury, drug overdose, or general anesthesia). Some forms of brain injury, such as strokes, are also associated with aspiration.

v Comments Many people become seriously ill after aspirating a substance that damages the lung mucosa. Aspiration is very serious because the potential damage to the inner lining of the lung. Aspiration is an important cause of acute respiratory distress syndrome (ARDS) and in the most severe forms may lead to death.

Para. 16 -21 Question: 13. What are the common devices of ICU mentioned in the text ? Cite a few. 1) bedside monitors, 2) mechanical ventilators, 3) intravenous mediation pumps, 4) Foley catheters, 5) transvenous pacemakers, 6) dialysis machines , 7) intraaortic balloon pumps, etc.

Phrases in the Text 1. Attending physician 2. Premature infants 3. Aggressive / surgical intervention 4. Cardiopulmonary / invasive monitoring 5. Perioperative care 6. Multiple organ dysfunction 7. Intensivist physician 8. Respiratory therapists 9. Forced vital capacity

10. Negative inspiratory pressure 11. Endotracheal intubation 12. Dosing schedules 13. Medical social worker 14. Chart maintenance 15. Respiratory distress 16. Mechanical ventilation 17. Hemodynamic compromise 18. Myocardial ischemia

19. Myocardial infarction 20. Thrombolytic agents 21. Cardiac catheterization 22. Neurologic checks 23. IV fluids 24. Volume overload / status 25. Electrolyte abnormalities 26. Metabolic crises 27. Orthopedic injuries

28. Extensive thermal injures 29. EKG leads 30. Automatically inflating blood pressure 31. Arterial blood gases 32. Superior vena cava 33. Hypertonic parenteral fluids 34. Cardiac output 35. Pulmonary artery occlusion 36. Pulse oximeter reading

37. Oxygen saturation / desaturation 38. Massive stroke 39. Refractory hypoxemia 40. Preselected tidal volume 41. Respiratory rate 42. Sequential compression devices 43. Transvenous pacemakers 44. acid-base disturbances 45. Intraaortic balloon pump