Nurse practitioners (NPs) are playing an increasingly vital role in critical care settings. Their advanced training and expertise equip them to manage critically ill patients alongside physicians, surgeons, and specialists. This article explores the specific medications, investigations, and therapies that NPs can administer and order within the ICU environment, ensuring optimal patient care. In 2016, the Indian Nursing Council (INC) established a curriculum and regulations for the Nurse Practitioner in Critical Care Post Graduate Residency Program.
Medications Permitted to NPs in Critical Care
NPs who have completed a critical care program can administer various medications following established institutional protocols and standing orders. These protocols ensure the safe and effective administration of drugs crucial for critically ill patients. Here’s a breakdown of some common categories and medications NPs can manage:
- Catecholamines:
- Adrenaline
- Noradrenaline
- Dopamine
- Dobutamine
- Antidysrhythmics:
- Adenosine
- Amiodarone
- Lidocaine/Xylocard
- Adrenergic Agents:
- Ephedrine
- Bronchodilators:
- Aminophylline
- Deriphylline
- Non-Depolarizing Skeletal Muscle Relaxants:
- Atracurium (Vecuronium, Pancurium)
- Anticholinergics:
- Atropine Sulphate
- Antihistamines:
- Avil
- Antihypertensives:
- Clonidine
- Glycerine Trinitrate
- Isoptin
- Corticosteroids:
- Hydrocortisone
- Dexamethasone
- Antiepileptics:
- Levitracetam
- Phenytoin
- Sedatives & Relaxants:
- Valium
- Midazolam
- Morphine Sulphate
- Pentazocin Lactate (Fortwin)
- Pethidine Hydro Chloride
- Propofol
- Electrolytes & Acid-Base Correction Agents:
- Soda Bicarbonate (8.4% & 7.5%)
- Magnesium Sulphate
- Potassium Chloride
Additional ICU-Specific Medications
While the above list covers common medications, some drugs are specific to different ICU units:
- Surgical Intensive Care Unit (SICU): Naloxone, Pitocin, Protamine Sulphate, Digoxin
- Medical Intensive Care Unit (MICU): Tranexamic Acid, Verapamil
- Cardiothoracic Critical Care Unit (CTCCU): Sodium Nitroprusside, Amrinone, Milrinone, Decadron
- Cardiac Critical Care Unit (CCCU): Sorbitrate, Angised, Streptokinase, Urokinase
- Emergency Services & Pediatric Intensive Care Unit (PICU): Elaxime, Methylprednisolone, Emeset, Antisnake Venom
- Neurological Intensive Care Unit (NICU): Dilantin, Tensilon, Neostigmine, Thiopental, Mestinon, Prostigmine
Investigations Ordered by NPs in Critical Care
NPs play a crucial role in ordering essential diagnostic tests to guide patient care. Some commonly ordered investigations include:
- Electrocardiogram (ECG)
- Arterial Blood Gas (ABG)
- Chest X-ray
- Basic Biochemistry Panel (Hb, PCV, TIBC, WBC count and differentials, ESR, Electrolytes, Platelets, PT, aPTT, Bleeding and Clotting Time, Procalcitonin, D-dimer, Creatinine, HbA1C, Liver Function Tests (LFTs), Lipid Panel)
- Basic Microbiology (Blood Cultures, Catheter Tip Cultures, Endotracheal Tube Cultures)
Therapies Initiated by NPs in Critical Care
NPs can initiate various therapeutic interventions to optimize patient outcomes. These therapies encompass:
- Nebulization
- Chest Physiotherapy
- Insertion and removal of urinary catheter for female patients
- Test feeds
- TEDS
- Distal colostomy wash
- Starting and closing dialysis
- Pin site care for external fixators
- Surgical dressing changes
- Application of Icthammol Glycerin/Magnesium Sulphate dressings for thrombophlebitis/extravasation
- Isometric and isotonic exercises
- Pin site care for patients on external fixators
By understanding the scope of medications, investigations, and therapies NPs can manage in critical care, we recognize their significant contribution to patient care. Their expertise allows for efficient and comprehensive management of critically
