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- by trulyblessed2 Mar 1, '12hi. i am new to icu and is desperate need of learning things. i have been in the unit for less than a year and it seems as if i am not digesting the material. my preceptor is no help at all. i need help in interpreting labs since this is a crucial part of the patient care, when to call the doc, when to withhold meds, abgs, electrolytes imbalances what should i suggest to the doc, icu skills. anyone up for grab in this? i don't want to have to transfer to another floor because i kind of like it, but i want to go to work loving what i do. i think what is holding me back is knowing the material and being sure of myself.
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- Mar 1, '12 by trulyblessed2okay i will start this off...
when a patient is hypotensive, give vasopressors, such as dopamine or isotonic fluids.
give 5% dextrose or 1/2nss (0.45%) to a patient who has hypernatremia to balance the salt outside the cells.
if a patient is already getting at least 40 mg of lasix and is still having problems voiding, recommend the doc to order albumin to help remove the waste.
withhold blood pressure medications if patient is receiving dialysis. dialysis lowers blood pressure. less volume, less pressure.
withhold insulin before surgery,pt.may bottom out.
if a patient has chf, and the doc orders 120 mg lasix, question the order and make sure the patient kidneys are functioning. where would the fluid go if the kidneys aren't working?
- Mar 1, '12 by Sun0408How long have you been on orientation and what classes does the hospital offer? Learning is something you will do every day, every shift. You will also need to do your own homework and look things up. Ask questions, go to your unit director or educator for tips and resources. Also check out www.icufaqs.org it is a very helpful place that breaks things down..
ICU is a beast on its own, if you are a new nurse; your learning curve is steep, just ask, read, question, asking the MDs what they would like to do will help you learn for the future, also ask for their rational for orders you are confused about will help you in the long run put it all together.
- Mar 2, '12 by trulyblessed2I have been in orientation almost 4 months. The hospital offer classes such as ACLS and rhythm strip interpretation. I am also spending time on my off days researching stuff I don't understand. I have visited the icufaq.org site and find it very helpful.
Thanks. I am in the process of putting together a notebook on labs and diagnostic tests, different drips used in ICU,and stuff like that. Also, any new meds and what questions are pertinent to ask when receiving report.
- Mar 6, '12 by chansenYou need to really start developing those critical thinking skills. It's not enough in an ICU setting to just memorize things like, "if my patient has low blood pressure, put them on a pressor." You need to know what that's doing, why it's increasing the blood pressure, what difficulties is it causing by doing so, and if it's even safe to administer it (What is your patient's fluid volume status? What is going to happen if you're titrating a vasopressor to someone who is hypovolemic?).
Example two: why are you recommending to the physician to order albumin on someone that isn't voiding with lasix? How long will the albumin shift fluid to the vasculature before it's moved out to interstitial space? What is something else you could use instead? How much of each liter of an isotonic crystalloid remains in the vasculature after a few hours?
Basic information like lab values, drip rates, common critical care drugs (class, moa, uses, contraindications, adverse effects, off label uses) and things that are on your pre-printed order sets are great to have memorized or handy in a notebook. However, nothing will replace your experience and critical thinking when it comes to the outcome of your patient. The icufaqs.org site is a great start, though depending on where you work, the information can be dated at times (CVP monitoring is mostly out the window anymore, for example). Beyond that, check out books like "Hemodynamic Monitoring made Incredibly Visual," listen to podcasts like ICU Rounds or EMCrit (geared towards physicians primarily, but the information is still invaluable), and most importantly, use the educator of your unit and the experienced nurses around you. ICU nursing is a team sport. Just don't make the team do everything - come to them and say, "here's the situation with my patient and I'm thinking X might be happening, and we could treat it with Y, what does your experience say?" People are much more receptive to someone putting forth the effort compared to someone who just expects an answer (not that you're this type of person!).
Best of luck in the ICU.
- Mar 7, '12 by trulyblessed2Thanks a lot. I will check out the books you suggested.
- Apr 4, '12 by Stevenyzwifetrulyblessed2
If you pm me your email address I can email you some information if you like?
I always say that I pity those people who come straight from university into ICU and in my opinion I don't think it should happen as I think we learn (at least in Australia) a LOT more in our first year of nursing than we did in all three years at university.
- Apr 8, '12 by blucrnasome new grads dont make the jump staight into the icu well however many do. Most grads are willing to learn and are receptive to being taught because they know there is a ton of stuff they dont know. You take a med/surg nurse with 3+ yrs experience and tell them they arent doing something right i suggest you stand back because they arent going to take that well. Granted, alot can be learned from floor nursing but your not going to learn titrating drugs, monitoring hemo status, and other icu specific tasks anyway so why not just jump in and learn what you need to?
Either way i hate making generalizations about which types of nurses do better and would rather base it off of individual traits/ willingness to learn. Truly blessed it seems like your taking the right steps in becoming a competent nurse in the ICU. Good luck.
- Apr 16, '12 by turnforthenurseRNIf a patient is hypotensive, you need to think about WHY they are hypotensive. If they are hypovolemic, you may just need to give some fluid OR give some fluid before you start loading them with vasopressors. You don't want to "squeeze" a "dry tank," KWIM?
Withholding insulin a doctor's preference. You should clarify. I know where I work, our diabetic educators state that we should not hold correctional (sliding scale) insulin on a patient who is NPO, but again, it is the doctor's preference.
It takes time to function at a fully competent level, especially as a new grad and especially in the ICU. Your best bet is to get in there and do things hands on. I don't think you will learn otherwise. Don't be afraid to ask questions and don't be afraid to ask the MD's their rationale on something that you don't understand.
I also recommend icufaqs.org and the Hemodynamic Monitoring Made Incredibly Visual book. Both are great sources. Another great source is "The Manual of Critical Care Nursing." There are also some great podcasts on iTunes. The New Nurse Podcast is great, but there are only 11 episodes. ICU Rounds is by an MD but still has great information. I also like the Nursing Show.
Best of luck to you. :redpinkhe