So the other night in CVICU, I got a really awful assignment. Kinda think it was unsafe, however I got through it somehow.
Pt #1: s/p bilat lung transplant, fresh out of the OR 3 hours ago; still intubated/sedated - staying that way till at least in the AM when they do the bronch. Swan reads still Q1 for a few more hrs; on Epi, propofol, Nitro, insulin gtt, Dopamine. Vitals essentially stable + hemodynamics (were kinda dry but thats how they want the lung transplants). SVO2 60's to 70's. Chest tubes x 4 + mediastinal tube - ok output. BG's q 1 hr bc of the insulin and epi. H/H stable so far. Low K (2.5) - gotta replete it. Low urine output x 2 hours ( 20 cc's & 15 cc's respectively). Surgeon wants some 5% for this, just not too much. Labs Q 6. Gotta start several of the immunosuppression meds/IV antibiotics. Temp spike from 99 to 101.5. Surgeon says just monitor for now. Negative airflow isolation per transplant protocol.
Pt #2: s/p heart transplant 2 days ago. Still intubated, sedated, but responds appropriately when awakened. Still Swan'd and line'd. VSS, but BP a kinda low (90's, high 80's). Hemodynamics stable, except high PA sys (50's). Prev shift started Nitric oxide @ 6ppm thru the vent. On Epi, Nitro, just a touch of Levophed, Milrinone, insulin, propofol. Pacer wires capped, NSR 80-90's. Incision stable. Chest tube output ok, but Hemoglobin down from 9 to 7.9 - surgeon wants 1 units RBC's - thinks some of it might be dilutional bc the pt hasnt been peeing much until recently. Q 2 hr blood sugars - has been stable on the insulin. Q 6 ABG's d/t the nitric oxide. Boat-load of transplant meds/antibiotics. And of course transplant neg airflow isolation, too. Few hrs later - up the Nitric to 8 ppm, PA sys now 40's and surgeon is happy with that for now. Pt now waking up too much, tapping on the siderails, being needy - up'd the propofol, gave pain meds. No time to sit and hold his hand for 30 minutes
Told the charge nurse that I thought this was an unfair assignment, even though everyone was relatively stable but still super busy in their own way. Asked her why I couldnt have had my 2nd pt be the stable pt with no drips who was sitting up in the chair all day - didn't get a clear explaination, just an "oh well, do your best. We will help you." Later she said something to the effect of "gosh this is busy, i'd be mad if I were you" LOL
Was still expected to bathe both patients too, otherwise I would have gotten frowns from the day shift
Don't know how I did it all but it sure wasn't pretty. No one was primped and the rooms/counters weren't clean, couldn't read up details in the charts. Manager better not bust me for staying late to chart or I will scream.