I got an ICU Preceptorship

SuesquatchRN, BSN, RN · Aug 30, 2009

:ancong!:

That's all I got.

:)

CharlieRN2009 · Aug 31, 2009

Make sure you get the best experience and milk this experience! Come on time, be prepared, and make the best out of every learning experience. Dont let the vents scare you!

meandragonbrett · Sep 2, 2009

What type of ICU will you be working in?

icufaqs.org is a good place to learn some foundational things in nursing that you need to know to work in the unit (i.e. drugs, emergency situations, vents, swans, a-lines, CVP, etc.)

Working in a ICU you will likely have a lot of abdominal and vascular surgeries on sick old folks with major comorbidities (i.e. previous MI, CHF, DM, HTN, COPD, etc.) that will make their ICU stay very difficult and complex.

Drugs that you will give on a regular basis include: morphine, hydromorphone, fentanyl, midazolam, lorazepam, alprazolam, propofol, diazepam, heparin gtt, argatroban, integrilin, insulin gtt, cardizem, amiodarone, nipride, cardene, vasopressin, dopamine, isuprel, epi, norepi, dobutamine, digoxin, metoprolol, labetalol, dilantin, keppra, lasix, bumex, vanc, imipenem, meropenem, cefazolin, and all kinds of other abx.

Find out if your unit utilize pulmonary artery catheters. Learn your hemodynamics. Know the various hemodynamic profiles of various shock states (sepsis-->warm vs. cold, cardiogenic, neurogenic, hypovolemic). Know that using epi or dopamine in an old person is not necessarily a first line of treatment for hypotension (when speaking of pressors) and why. You'll do a lot of fluid boluses in these folks and sometimes albumin (depending on the surgeon's beliefs). What's the normal CVP? What factors alter your CVP? How does PPV change your CVP compared to yours or mine? What is considered an adequate CVP in your unit population? KNOW what receptors your drugs antagonize or agonize and you will be far ahead of the game. Know the mechanism of actions will help you to understand which drugs are desirable in different hemodynamic states.

Does your ICU recover their own patients straight from the OR? Ventilated only or all? Be aware of various advanced airway management techniques. Know how to use oral and nasal airways.

Learn your ABG values and KNOW what the numbers mean. Learn what your base excess/deficit means in your hypotensive shocky patient. Learn how various ventilator setting changes alter your gas. Oxyhemoglobin disassociation curve is another thing that's important. How does monitoring serum lactate come into play in the ICU? What are you looking for with it?

One GREAT way to learn and prepare for what you'll see in the ICU is to get you PASS CCRN! by Robin Dennison. It can be a difficult book to read because of the volume of the content and it's format but it's a great resource. The ICU Book is another great resource. I always advise new folks to start studying as though they were preparing for CCRN. It's the best way to gain the textbook learning that will help you and your patients.

A ICU is a GREAT place to learn. It's high tech, fast paced, and has very sick people. Learn everything you can during your orientation and pick your preceptors brain. Be open to being taught new/better/easier ways of doing things that you might not previously have done before. Some of us ICU RNs can be pretty crazy and can easily start spinning around the unit like tops at the drop of a hat. Just be flexible and experience as many things as you can while you're in orientation.

Some links of interest:

ICUFAQS.org

Surgical Critical Care

Pulmonary Artery Catheter Exploration Project

Critical Care Medicine Tutorials

Good luck! Let us know if you have more questions.

**All Heart RN** · Sep 6, 2009

What type of ICU will you be working in?
icufaqs.org is a good place to learn some foundational things in nursing that you need to know to work in the unit (i.e. drugs, emergency situations, vents, swans, a-lines, CVP, etc.)
Working in a ICU you will likely have a lot of abdominal and vascular surgeries on sick old folks with major comorbidities (i.e. previous MI, CHF, DM, HTN, COPD, etc.) that will make their ICU stay very difficult and complex.
Drugs that you will give on a regular basis include: morphine, hydromorphone, fentanyl, midazolam, lorazepam, alprazolam, propofol, diazepam, heparin gtt, argatroban, integrilin, insulin gtt, cardizem, amiodarone, nipride, cardene, vasopressin, dopamine, isuprel, epi, norepi, dobutamine, digoxin, metoprolol, labetalol, dilantin, keppra, lasix, bumex, vanc, imipenem, meropenem, cefazolin, and all kinds of other abx.
Find out if your unit utilize pulmonary artery catheters. Learn your hemodynamics. Know the various hemodynamic profiles of various shock states (sepsis-->warm vs. cold, cardiogenic, neurogenic, hypovolemic). Know that using epi or dopamine in an old person is not necessarily a first line of treatment for hypotension (when speaking of pressors) and why. You'll do a lot of fluid boluses in these folks and sometimes albumin (depending on the surgeon's beliefs). What's the normal CVP? What factors alter your CVP? How does PPV change your CVP compared to yours or mine? What is considered an adequate CVP in your unit population? KNOW what receptors your drugs antagonize or agonize and you will be far ahead of the game. Know the mechanism of actions will help you to understand which drugs are desirable in different hemodynamic states.
Does your ICU recover their own patients straight from the OR? Ventilated only or all? Be aware of various advanced airway management techniques. Know how to use oral and nasal airways.
Learn your ABG values and KNOW what the numbers mean. Learn what your base excess/deficit means in your hypotensive shocky patient. Learn how various ventilator setting changes alter your gas. Oxyhemoglobin disassociation curve is another thing that's important. How does monitoring serum lactate come into play in the ICU? What are you looking for with it?
One GREAT way to learn and prepare for what you'll see in the ICU is to get you PASS CCRN! by Robin Dennison. It can be a difficult book to read because of the volume of the content and it's format but it's a great resource. The ICU Book is another great resource. I always advise new folks to start studying as though they were preparing for CCRN. It's the best way to gain the textbook learning that will help you and your patients.
A ICU is a GREAT place to learn. It's high tech, fast paced, and has very sick people. Learn everything you can during your orientation and pick your preceptors brain. Be open to being taught new/better/easier ways of doing things that you might not previously have done before. Some of us ICU RNs can be pretty crazy and can easily start spinning around the unit like tops at the drop of a hat. Just be flexible and experience as many things as you can while you're in orientation.
Some links of interest:
ICUFAQS.org
Surgical Critical Care
Pulmonary Artery Catheter Exploration Project
Critical Care Medicine Tutorials
Good luck! Let us know if you have more questions.

Wow, this is so helpful! I'll be starting my senior practicum in a few days in a MICU and this is a tremendous help.

Thanks!