Critical Care Medicine

Patient Care 

Goals and Objectives 

  1. Interpret the results of initial focused clinical evaluations (history, physical examination, laboratory data) performed on patients admitted to the intensive care unit to
    1. Identify patients who are at risk for organ failure
    2. Identify the patients who require mechanical ventilation
    3. Identify the patients who are in shock
  2. Interpret the results of daily focused clinical evaluations (history, physical examination, laboratory data) performed on patients admitted to the intensive care unit to
    1. Implement known strategies to minimize patient harm during intensive care unit admission
    2. Assess the efficacy of treatments and therapies
    3. Treat ongoing or new organ failure
  3. Describe how to evaluate a critically ill adult
  4. Become familiar with the implementation of goal directed ultrasound examinations.

Responsibilities and Expectations 

  1. Write admission and inpatient orders with the guidance of the critical care NP and attending physician
  2. Compose H&Ps, daily progress notes, and procedure notes.
  3. Attend daily morning rounds and be prepared to present patients in an organized and succinct manner
  4. Update the ICU patient list to facilitate the transfer of care from shift to shift
  5. Implement the clinical decisions made by the team during rounds.
    1. Communicate with the admitting service
    2. Arrange consultations
    3. Communicate with the bedside RN
    4. Review ongoing diagnostic studies
  6. Notify the service NP if unable to implement the clinical plan
  7. Communicate the results of consultations, diagnostic tests, and therapeutic procedures to the service NP in a timely manner
  8. Perform peripheral, central, and arterial cannulation safely 

Medical knowledge 

Goals and Objectives 

  1. Understand the evaluation of CNS failure resulting from
    1. Stroke
    2. Encephalopathy
  2. Understand the diagnosis and management of the following types of shock
    1. Hypovolemic
    2. Septic
    3. Cardiogenic
    4. Neurogenic
  3. Distinguish between the various sedative and analgesic medications available
    1. Opiates
    2. Benzodiazepines
    3. Alpha 2 receptor antagonists
    4. Hypnotics
    5. Propofol
  4. Understand the diagnosis and management of delirium
    1. Be familiar with the current guidelines for preventing delirium
  5. Understand the causes of respiratory failure
    1. Hypoxic
    2. Hypercarbic
    3. Structural/anatomic
  6. Distinguish between the various therapies for respiratory failure
    1. Supplemental oxygen delivery systems
    2. NIPPV
    3. Mechanical ventilation
  7. Describe the veins and arteries that are cannulated in the intensive care unit
  8. Identify the optimal management for patients with the following conditions
    1. ARDS
    2. Sepsis
    3. Respiratory failure
    4. Renal failure
    5. Cardiac arrest 

Practice-Based Learning and Improvement 

Goals and Objectives 

  1. Apply knowledge of study designs and statistical methods to critique the literature on diagnostic and therapeutic effectiveness of in interventions performed in the ICU.
  2. Analyze common complications related to ICU admission 

Responsibilities and Expectations 

  1. Attend morning educational conference
  2. Attend monthly critical care fellow conference
  3. Attend monthly critical care M&M conference to review and analyze treatment outcomes and complications
  4. Compile a list of all procedures performed and any complications
  5. Meet with the NP fellowship director at least once during the rotation to review goals and objectives 

Interpersonal and Communication Skills 

Goals and Objectives 

  1. Communicate effectively as a member of the multidisciplinary team which rounds together
  2. Communicate effectively with patients and families
  3. Work effectively as a member of a professional group
  4. Consistently demonstrate sensitivity to patients from different cultures 

Responsibilities and Expectations 

  1. Establish appropriate role in the multidisciplinary care team
  2. Maintain appropritate lines of communication within the care team and across disciplines 

Professionalism 

Goals and Objectives 

  1. Enhance the body of knowledge in advanced practice nursing through exchange of ideas and knowledge in professional organizations, conferences, research activities, and written publications.
  2. Understand ethical dilemmas that occur in the ICU
  3. Functions as a licensed independent practitioner 

Responsibilities and Expectations 

  1. Demonstrate respect, compassion, and integrity
  2. Demonstrate a commitment to excellence and on-going professional development
  3. Provides patient centered care recognizing cultural diversity and the patient or designee as a full partner in decision making 

Systems-Based Practice

Goals and Objectives 

  1. Understand the allocation of critical care services at UCSF
  2. Analyze the impact of critical illness on individuals and populations 

Responsibilities and Expectations 

  1. Practice cost effective, evidence based health care and resource allocation that does not compromise quality of care
  2. Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care discharge planning and transition out of the intensive care unit.
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