what do you do in the ICU

meandragonbrett · Apr 2, 2009

Common meds include: epi, norepi, vasopressin, dopamine, dobutamin, diltiazem amiodarone, neosynephrine, Isuprel, fentanyl, versed, ativan, valium, morphine, dilaudid, phenergan, zofran,xigris, levaquin, cipro, tygacil, meropenem, unasyn, vanc, etc (you get the idea) The ICU RNs use many drugs that are not found outside of the ICU.

Other equipment we must know how to use, troubleshoot, monitor: Ventilators, bedside monitor, SVO2 boxes, balloon pumps, swan ganz catheters, ICP bolts, ventrics, different oxygen set ups, wound vacs.

Lots of blood products are given in ICU including FFP, PRBCs, Platelets, Cryo, Albumin.

Typical diagnoses include: Sepsis, SIRS, septic shock, hypovolemic shock, bowel obstructions, multiple traumas, pneumonia, GI bleeds, post-op thoracic surgery, and many others.

Typical day in my unit: Spend a good 30-40 minutes getting report on TWO patients. Assess. Check alarms, Check gtts for correct rates/calculations and that you have an extra levo and vaspressin in your room so that you don't run dry. Check your 4 chest tubes. Check the patient's bowels to make sure they are moist, pink, and moving. Is your ICP bolt intact? Appropriate waveform? Is your swan ganz in the PA or is it wedged? Are the numbers you're receiving making sense? Do I need to adjust my pressors/CV drugs because of the swan numbers/patient assessment or not? If so, which gtt do I need to alter. Don't forget those q15m vitals because you changed your drip. Do your q1h accu checks and adjust your insulin gtt. Serial labs. Coordinate the interdisciplinary team. Send serial labs. Electrolyte replacements, ABX, trying to keep your intubated patient in the bed and from extubating themselves. Then go to your other patients room and do the same thing all day as well.

Lots of traveling to CT, MRI, interventional radiology. We recover our own patients post-op. Lots of bedside procedures: Swans, bolts, ventrics, line insertions and changes, intubation, chest tubes, bedside ex-laps,

The tasks in the ICU can absolutely consume you for the entire 12 hours to the point where you have difficulty doing real monitoring and noticing changes in your patient's CO/CI, HR, and RR that might clue you to impending disaster.

Don't forget LOTS of bowel movements and linen changes with all of this equipment attached. It can sometimes take 3-4 people at the bedside just to gain control of a bowel movement.

Hope this helps

newtoICUau · Apr 2, 2009

Hi to everybody. I am fairly new to ICU and need to ask a question, it probably sounds like a stupid one but I still dont get it. What does E SENS mean on the ventilator settings? The following definition is "Expiratory sensitivity, the percent of peak inspiratory flow at which the ventilator cycles from inspiration to exhalation for spontaneous breaths." Can somebody please explain what this means?

leesespieces · Apr 19, 2009

i'd say that sounds about right meandragonbrett! and at my hospital, in addition to caring for our own patients, the icu rn's have to respond to all codes throughout the hospital, rapid responses, we do all bioz's on the floor, we are often called to start iv's on the floor. now we also have to respond to c-ports, and acute cva's.

don't forget that we also have to deal with family members who can sometimes be more needy than our critically ill patient!

stiltarget · Apr 21, 2009

And that's why ICU nurses rockkkk!!!!!!!!:heartbeat:yeah:

cardiacRN2006, ADN, RN · Apr 21, 2009

Common meds include: epi, norepi, vasopressin, dopamine, dobutamin, diltiazem amiodarone, neosynephrine, Isuprel, fentanyl, versed, ativan, valium, morphine, dilaudid, phenergan, zofran,xigris, levaquin, cipro, tygacil, meropenem, unasyn, vanc, etc (you get the idea) The ICU RNs use many drugs that are not found outside of the ICU.
Other equipment we must know how to use, troubleshoot, monitor: Ventilators, bedside monitor, SVO2 boxes, balloon pumps, swan ganz catheters, ICP bolts, ventrics, different oxygen set ups, wound vacs.
Lots of blood products are given in ICU including FFP, PRBCs, Platelets, Cryo, Albumin.
Typical diagnoses include: Sepsis, SIRS, septic shock, hypovolemic shock, bowel obstructions, multiple traumas, pneumonia, GI bleeds, post-op thoracic surgery, and many others.
Typical day in my unit: Spend a good 30-40 minutes getting report on TWO patients. Assess. Check alarms, Check gtts for correct rates/calculations and that you have an extra levo and vaspressin in your room so that you don't run dry. Check your 4 chest tubes. Check the patient's bowels to make sure they are moist, pink, and moving. Is your ICP bolt intact? Appropriate waveform? Is your swan ganz in the PA or is it wedged? Are the numbers you're receiving making sense? Do I need to adjust my pressors/CV drugs because of the swan numbers/patient assessment or not? If so, which gtt do I need to alter. Don't forget those q15m vitals because you changed your drip. Do your q1h accu checks and adjust your insulin gtt. Serial labs. Coordinate the interdisciplinary team. Send serial labs. Electrolyte replacements, ABX, trying to keep your intubated patient in the bed and from extubating themselves. Then go to your other patients room and do the same thing all day as well.
Lots of traveling to CT, MRI, interventional radiology. We recover our own patients post-op. Lots of bedside procedures: Swans, bolts, ventrics, line insertions and changes, intubation, chest tubes, bedside ex-laps,
The tasks in the ICU can absolutely consume you for the entire 12 hours to the point where you have difficulty doing real monitoring and noticing changes in your patient's CO/CI, HR, and RR that might clue you to impending disaster.
Don't forget LOTS of bowel movements and linen changes with all of this equipment attached. It can sometimes take 3-4 people at the bedside just to gain control of a bowel movement.
Hope this helps

And that's just the summary!!!

And to boot, we usually don't have a CNA or tech. (my unit never does...)

meandragonbrett · Apr 21, 2009

And that's just the summary!!!
And to boot, we usually don't have a CNA or tech. (my unit never does...)

Same here.....and you have 3 patients. Two of which are usually destined to crash on you.

adhdrn · Apr 26, 2009

as meandragonbrett, cardiacrn2006 and leesepieces, explained so well that is what we do. as icu nurses we are expected to know and anticipate what a patient needs and be able to report our assessment and recommendations clearly and calmly. when i was considering making the move from med-surge to icu i had a dr. explain that when an icu nurse calls the physician he does not want to hear "the patient is sick" according to him he will respond "then give him some medicine".

our physicians expect us to have a good understanding of pathophysiology and to be very familiar with our hospitals protocols so that when we call even though we may not know exactly how to correct a problem we should at least have an understanding as to why the patient is having "a problem" and be able to recommend a treatment for when he asks "what do you need".

sometimes it is more difficult on the night shift because not only do you not have the advantage of face time with the physicians when they make their daily rounds and are more likely to explain disease processes and expected outcomes, we may be calling a physician who has never laid eyes on the icu patient that is being treated by multiple specialties and a complex disease process that it would take you 30 minutes just to give them an overview of how the patient ended up in the icu.

icu nursing is rewarding and fulfilling. and for those who love patho it is the place to be. :up:

celclt · Apr 26, 2009

thanks for the great responses! where did you all start out as a graduate nurse?

adhdrn · Apr 26, 2009

I started out in Med Surge/Pulmonary-that is where I first developed a love for ventilator and respiratory focused nursing...I liked the variety of a med/surge unit I had patients with everything from snake bites to post CABG patients. As I became more confident and competent in my nursing skills I liked the challenge of caring for patients with complex conditions requiring lots of critical thinking and specialized care.

Because I started out in Med/Surge where the patient ratio was much higher than in ICU I learned time management and developed very good assessment skills. I still like to work on my old unit on occasion but I believe I would get bored quickly if I tryed to go back to med/surge full time.

cardiacRN2006, ADN, RN · Apr 27, 2009

I started out in the same ICU that I'm in today....I wouldn't have changed a thing.