My first 100 days on the job: Week 5

Published Aug 18, 2015

396 Posts

Specializes in Critical Care.

Days 9,10, & 11

A little late, but here it is! I had a hard time deciding what to talk about this week. A lot happened. So, I'll touch on a bit of everything. Let me know what is most interesting to read about (whether it's what I learned, patient dx and treatments I see on the ICU, mistakes, random unit stories from the week, ect)

Experiences with my newest preceptors:

- Preceptor #5 is a 30yr old blonde who greets everybody with smiles and witty comments. As we begin our work together I soon find her youth and bouncy personality deceiving: she is tough on me. She is never unfair, but she pushes and drills me on everything. She has me call doctors, complete admissions, write notes, and give report. She depends on me to get my assessments and charting done on time. I feel the pressure and stress... But I respond best to this style of teaching. I learn a lot. Information clicks. I understand things I didn't before. If I had to pick a preceptor to stick with for the rest of my orientation, I'd pick her.

- Preceptor #6 tells me about the time a resident killed a patient by inflating the Swanz balloon even when they felt a lot of resistance, rupturing the pulmonary artery. One minute the patient is sitting up and alert, the next there is blood coming from every orfice. She tells me this so that when the MD allows me to check the wedge pressure I don't repeat that resident's mistake. Only certified personel are allowed to check wedges now, but they let me try so that I can get the feel of it. Talk about intense.

- My patient population wasn't too different this week. Heart failure, Post Cath, A-fib, Vtach/Vstorm, STEMI. What is cool (and what I love about the ICU) and that every treatment plan ends up being a little different.

My mistakes....

- I'm disappointed in myself for some of the mistakes I made this week. I forgot to give heparin on time to one of my patients. I titrated a drip and forgot to press start. I allowed myself to get distracted during a blood draw and opened my patient's Swan before attaching a syringe, causing air to start seeping into the line (which I quickly and discretely pulled back out without causing harm, but this could have been very bad). I forgot to do hourly checks on the Swan placement and for good waveform.

Things I learned:

- Even a heart attack won't change eating habits in people. My post cath/ AICD pt with a CABG hx still wants burgers and sugar when he gets home. Also my DM pt got the wrong tray for breakfast and didn't tell us till after his finished his juice, fruit bowl and french toast with real syrup. "It just looked soooo good. I knew I should have called for a new tray but couldn't." This amazes me.

- CIWA: Familiar with but never actually performed this assessment until this week. You ask about n/v, headache, tremors, orientation, anxiety, agitation, feeling pins and needles, being diaphoretic, and having hallucinations. Per order pt was given Ativan which knocked him right out.

- Guillain Barre: My super time consuming, anxious patient last week did in fact have this diagnosis! It's a rare disorder in which the body attacks its own nerves. Unknown cause. Usually follows an infection of some sort. S/S: tingling, weakness, changes in BP, difficulty breathing. There are three types. Was confirmed by the lumbar puncture she kept denying. There's no cure but can be treated with plasmapheresis (removing plasma from pt body, returning RBCS, and then allowing RBCs to make new plasma) or immunoglobin therapy (from donor blood)

- The feeling of gathering a wedge pressure on a Swan is similar to the feeling of blowing up a regular balloon: you feel some initial resistance that gives way slightly once you get enough air into it. You push slowly and steadily until you get your waveform. If you feel a lot of resistance, you're probably in to far into the artery. DO NOT keep pushing that syringe!

- I finally did a central line dressing change this week!

- Mesenteric artery stenosis can be a side affect of amiodarone (and other pressors), may need to keep these patients NPO!

Needs Improvement:

- Being more mindful and focused. It'll help prevent mistakes. If my patients or their family starts talking to me or if staff interrupts me while I'm working on something that requires my focus (meds, blood draw, working with equipment) I need to get better about politely asking them to wait until I'm done or in a good spot to pause.

- My comfortability with distressed families. I don't get too awkward, but I'm not always sure what to say.

Victories:

- Things are making a lot more sense after week 5. I can follow through a patient's plan and understand the indications for medications and treatments. The gaps are starting to close in. Speaking to doctors, doing blood draws, completing medication administration, offering pt education, doing assessments and charting are all pretty simple now. Distressed families and friends no longer make me nervous. I can find things rather quickly. I don't feel totally useless anymore. I feel pretty at ease on the unit. As I was leaving, one co-worker I particularly like gave me a hug as she was arriving. This really surprised me. I love ending my shifts with hugs!