Are the pts in the ICU mostly unconscious?

Specialties Critical

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Hi everyone...sorry for the strange question in advance (though I've definitely seen some strange ones reading through the archives lately!)

Anyway, I'm finishing up my last pre-req right now and am about to apply to 2nd degree accelerated BSN programs.

I've been reading this board and giving my career choice a lot of thought lately.

First, I absolutely love the idea of working in the ICU. Focusing on one or two patients with high acuity at a time and knowing absolutely everything about them.

Performing intricate procedures, monitoring, titrations, etc, being able to access my pts quickly/see them from the nurses' station, etc.

I'm very detail oriented and hate doing a lot of unrelated things all at once, so ICU is very appealing to me.

I have soooo much respect for Med/Surg nurses, but I know that I would never survive in that environment long-term. I feel like I would hate it. Being pulled in a million directions, taking care of between 5-8 patients at once...I would get so distracted. Mad props to y'all!

Anyway, now that I've prattled on, I do have one question for you ICU'ers out there.

Would you say that the majority of your patients are unconscious or only semi-conscious for the majority of their stay before they get transferred out?

I don't mean to say this in the wrong way but, if so, do you find that you kind of appreciate that fact?

Obviously, I would absolutely want my patients to get better asap, but I feel like it might be nice to be able to just go about your work, not having to worry about getting sucked into conversation or being embarrassed by performing intimate care, etc.

Just being able to focus on providing amazing clinical care without interruption.

I understand that a lot of the times, the pt's family/friends are there, so you are still constantly updating/teaching, etc, but on nights, that wouldn't be an issue.

I love interacting with people most of the times and I know that as a professional, I will need to get over the "embarrassment" of performing intimate care (I'm male, so I guess I just have a bit of anxiety about the female patients), but it seems like it might be kind of nice. Obviously, when they would start to wake up/get better, you would have that interaction, which I think would be nice, as well. Kind of a nice mix of both.

Conversely, do some of you find that you don't like it b/c you can't get any response from the pt and they aren't able to communicate what is wrong? Also, I would imagine providing personal care is much more difficult, since they can't assist in moving themselves around, etc.

I'm interested to hear everyone's thoughts!

Thanks in advance!

Specializes in Critical Care; Recovery.

I work in a surgical icu that takes postop hearts and a more general medical/surgical icu. Most patients are not unconscious in my experience. Yes it can be nice when you have sedated and ventilated patients that are therefore not using the call light constantly. However, you may have the same awake and oriented/disoriented patient several days or even weeks at a time that is needy or trying to climb out of the bed due to delirium. It just depends.

Specializes in ICU.

Unconscious/conscious really depends on the acuity of your ICU and the overall acuity of the patient population in your city at that particular time. I work in a relatively high acuity ICU - the lowest I have ever seen is about 50% of the patients on ventilators. We tend to move them down to stepdown pretty quickly once they're extubated if their main problem was respiratory. We even had some weeks in the summer that were 25+/30 vented. It's not uncommon in the worst parts of flu season to have every single patient on the ventilator and sedated.

High levels of vent sedation are only common for people who bear down and desat, really. We will just restrain agitated people who are throwing their heads around and trying to self-extubate before we snow them. The people who get snowed are the ones who drop their sats so bad that they have to be bagged if the propofol even beeps for 30 seconds. I agree that the days of heavily sedating people just because you want to are gone.

Regardless of what sedation protocol is used, in my experience at LEAST 8/10 of the people waking up from sedation are in full blown delirium, so no, it's not nice once they start waking up and interacting with you. That usually consists of them becoming combative and thinking you're trying to kill them, and/or attempting to get out of bed. Maybe a couple of days out they start to act like normal human beings again, but that first day when they're waking up is usually a real struggle.

You've also got another thing coming if you think families aren't going to be there asking a million questions and getting up in your face at night. Once the patient has been there a few days, family may start to not spend the night... but it's equally as common for a family member to be present 24/7/365, and they just trade off shifts so someone is always in the room. Also, night shift gets the same amount of admits as day shift, and when someone is admitted from the ED, their families are probably still going to be there and getting in your way. Not to mention the families that don't stay but blow up your phone all night long asking for status updates.

In the ICU I work in, very much not :) We can have several intubated patients, but it is not frequent. The patients are unstable, and sometimes intubating & sedating them can compromise their chances... increased chance of pulmonary infections, changes to haemodynamics...

We have a LOT of non invasive ventilation, though, Optiflow and positive airway pressure with a mask.

I talk to all my sedated patients, by the way. I treat them exactly as I treat the non sedated ones, even more gently. Especially when they starting weaning them off the drugs. Can you imagine : you're completely whacked out on psychoactive drugs, probably having weird half dreams/half reality, and for a non hospital person, the reality (machines, lines, restraints) is pretty scary ! And above it all, you can't speak, because you have a tube shoved down your throat. I'd be pretty agitated, I'd bet.

Good question. I had this perception that most patients in the ICU were sedated as well, boy was I wrong.. lol. I work in MICU at a large teaching hospital. Lots of intubated patients, some tubed for only 24 hrs some for weeks until they get trached. The majority of our patients are not sedated. My hospital is very big on preventing 'icu delirium'.. some will have continuous sedation if they are constantly fighting the ventilator. Others will have intermittent sedation (ie. usually an order for fentanyl q5 min prn for a rass of 0 or resp compromise).

I'd say about 50% of the vented patients have some sort of delirium and are not communicating, but the other half are able to communicate via writing or typing on a cell phone/hospital provided ipad.

Specializes in Postpartum, Med Surg, Home Health.
Have you ever been in or visited an ICU? Not everyone is unconscious and patients are even discharged right from the ICU. There are MANY nonverbal ways to communicate. You have a lot to learn as a prenursing student.

Oops, I tried to quote this comment but accidentally "liked" it.

Your comment is of no help. Obviously OP knows there's a lot he has to learn, that's why he is here asking these questions even before nursing school! Instead of commenting "you have a lot to learn as a prenursing student", why don't you say something helpful like the other posters have said. I have to ask, do YOU even work in an ICU? (How does it feel being asked questions In a condescending tone)

People and their snarky attitudes are really irking me lately.

OP, I liked the ICU as a nursing student. I liked being able to really focus on my 2 pts, as I am very detail oriented as well. I think I totally understand what you are trying to say in your post. Please ignore the snarky comments made by others. Don't worry too much about the personal care to pts (I was worried about it as well as I was still in my teens when I started nursing school) you will get more comfortable with time and find a good way for you to do it. You sound very conscientious which is an excellent trait to have as an RN, good luck to you.

Jitomim:

Thank you for talking to them. My brother just spent several weeks in ICU sedated and intubated. He was generally unresponsive but now that he's awake, he remembers nurses who did and did not talk to him. He remembers being scared by not being told what was happening. Thank you

Like others said it depends on which ICU specialty unit you work for. A rough average would probably be 50% are on vents with sedation and restraints. Although that doesn't mean that the other 50% are fully coherent and functional. Probably 40% of the other 50% are still in and out of awareness, on tons of pain meds or have advanced disease processes that leave them lethargic or obtunded.

Probably 10% of my patients are Alert and Oriented X4 with a Glascow Coma Score of 15, able to get out of the bed and essentially awaiting transfer orders to move to a medical floor. Those are usually your inappropriate admissions to the ICU where the MD didn't want to get called all night by the floor nurses. It's a babysitting gig.

In our ICUs (very large hospital, high acuity) we try to minimize sedation. I would not expect my vented patient to be "unconscious" unless it was within the first 24 hours of intubation. Usually we would be trying to have them wake up before that time, anyway.

This varies a lot from place to place. Last winter we had a travel nurse for a few months whose previous jobs had been in the south and east--Virginia down to Florida. She said over and over that she had never seen awake, vented patients until she came to us.

I have had unconscious (usually encephalopathic) patients who had no family or visitors. Task completion might be easier, but the sadness of the situation cannot help but affect you--therefore, it doesn't make for your best work day.

Specializes in CVICU, post-codes.

I work a CVICU that ranges from ODs, CRRT, post-codes to sheath pulls on AMIs or just your general post-cath patient. Patients may or may not be sedated on the ventilator. It depends on each specific patient case. It is still EBP to perform sedation vacations and to have interactions and assess the neurological status of your patient. The only time that this doesn't happen on my unit is if the patient is on hypothermic protocol (they weren't waking up after coding, so we cool them) or it is ordered by a physician for a very specific out of the ordinary need. I still have to deal with all of their family. ICU nurses still deal with being pulled in so many directions, by family, by different physicians for your two patients, by different physicians for just one of your patients, charge nurses, managers, rounding, etc. Any sort of nursing requires you to juggle a lot. It gets easier with more experience. I never thought I could handle being an ICU nurse when I started nursing school. I started as an ICU nurse - it was my calling when I was doing clinicals. Keep your eyes open to what brings YOU joy, not what seems more manageable. If you keep your eyes open for something you are good at and that you enjoy, it will come to you :)

I think it also depends on what type of icu you are looking for. In some icu units, the nurses perform every bit of care so having 2 patients is a lot. Other units may have a tech to assist. There is a huge difference in having icu patients over medsurg patients. And while yes having 5 patients on a medsurg unit is very busy, 2 patients on an icu unit is comparable. A neuro icu unit may have more sedated patients. There are all kinds of different icu units, but generally, they are a mixture. It also depends on how high acuity the hospital is. A bigger city hospital will have higher acuity and generally more sedated patients than a rural hospital icu that kind of lumps things together.

Having 5 patients on the floor is comparable to 2 in the ICU - except you really don't just have five on the floor when you account for discharges and admissions - both of which are usually multiple in one shift. I've done both, and floor nursing is way, way busier than ICU nursing, and I have worked in high acuity ICUs at a large hospital.

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