Interview for Transitional ICU Position

RescueNinjaKy · Sep 6, 2015

Is that like a cardiac progressive care unit then? I don't really know what a transitional care is.

I work on a cardiac progressive care unit that hires new grads so they didn't really go too in depth about things but they did ask what would you do if your patient was reporting chest pain? My answer was assess them, are they diaphoretic, what's the pain like, quality location radiation and scale? Start them on oxygen, get a 12 lead on them. If they're diaphoretic and have any signs of MI then call a rapid response team.

Anywho, in terms of what I see on my unit, we give a lot of metoprolol, amiodarone, lisinopril, plavix, imdur, xarelto, lasix, insulin, hydralyzine, labetalol, heparin, lovenox. The drips we see are amiodarone, cardizem, heparin, lasix, insulin.

We get chest pain, mi, dysrhythmias, chf, copd, endocarditis, post op cabg, valves, pvi, stents, cath, lobectomies/thoracotomies.

We also have the telemetry monitors on our unit for the entire hospital except for the critical cares areas, so we get cross trained to be a tele tech if we want to.

Not sure if that was what you were looking for. But hey, good luck.

OrganizedChaos, LVN · Sep 6, 2015

It's a step down/transitional ICU. They see patients after surgeries but said they see a lot of post cardiac patients. That helped a lot! Thanks!!!!

am27 · Sep 6, 2015

You mean a TCU?

OrganizedChaos, LVN · Sep 6, 2015

You mean a TCU?

No, TICU. That is what it is called.

OrganizedChaos, LVN · Sep 6, 2015

You mean a TCU?

Just in case you were curious. It is in fact, the TICU.

icuRNmaggie, BSN, RN · Sep 6, 2015

Rescue ninja summed it up very well.

I would add that you could review care of patients post CABG, sternal precautions, care of patients post heart Cath and groin precautions.

Good luck!

OrganizedChaos, LVN · Sep 6, 2015

Rescue ninja summed it up very well.
I would add that you could review care of patients post CABG, sternal precautions, care of patients post heart Cath and groin precautions.
Good luck!

Thanks for these suggestions! :)

calivianya, BSN, RN · Sep 6, 2015

I love how many different names there are for these types of units. My hospital used to call ours TICU, too - now it's ICCU: Intermediate Critical Care Unit. I think we should rename it every year just for maximum confusion.

I would definitely ask about ratios in the interview. These sorts of units can vary wildly on ratios - I have worked places that took as few as three to places that took five, and five is unacceptable when you are titrating drips. It's just way too much to keep track of.

One other thing you could do is buy/rent an ACLS book and start studying if you don't have your ACLS already. You're definitely going to want to know those meds/doses cold.

OrganizedChaos, LVN · Sep 6, 2015

I love how many different names there are for these types of units. My hospital used to call ours TICU, too - now it's ICCU: Intermediate Critical Care Unit. I think we should rename it every year just for maximum confusion.
I would definitely ask about ratios in the interview. These sorts of units can vary wildly on ratios - I have worked places that took as few as three to places that took five, and five is unacceptable when you are titrating drips. It's just way too much to keep track of.
One other thing you could do is buy/rent an ACLS book and start studying if you don't have your ACLS already. You're definitely going to want to know those meds/doses cold.

I was ACLS certified but I let it lapse because I wasn't working. I tried to get it recertified before the interview but there wasn't a class soon enough. But that sounds like a great idea!

RescueNinjaKy · Sep 6, 2015

For my post op cabg patients, we have a heart pillow for them to splint when they cough or move around. Get to know what your surgeons preference is for dressing changes. One of mine likes to use a mepilex, and only sterile water and gauze to clean. Our goal for them is to be up in chair x3 for meals and up and waking x4 in one day. IS 10 times qh while awake. They also receive beta blockers post operatively and have ssi at meal and hour of sleep. Cardiac rehab also follows them. Foleys come out on day 2 unless they aren't voiding adequately.

For our cath/stent patients, if it's a radial approach they are not to use the arm of possible. They have a hemoband on and we slowly take air out while monitoring for oozing. Usually I think we start taking air out 2 hours after procedure, can't remember exact policy right now. We take out like 2ml of air every 15 mins or so as long as site looks good and no oozing. We assess for bleeding, and circulation. Whether pulse sat is good on that arm still and whether pulses are strong. If there's bleeding or oozing after removing air/band we put it back on.

For our femoral approach patients they're on bed rest for 6 hours after procedure. No more than 30 degrees elevated hob. Inspect site for bleeding, swelling, tenderness, and pulses. Have to be careful of a hematoma developing. If it bleeds we put manual pressure slightly above the site. If it still bleeds and doesn't seem to help then we get a femstop. Usually those patients with stents can go home in a day or 2 after procedure. They get plavix to keep the stents open.

For cath lab patients they are on clear liquid diet at first and advance as tolerated, which really doesn't take long to get back to normal diet. It's just a precaution. And they usually have an order for continuous normal saline infusion for like 3 hours or so.

OrganizedChaos, LVN · Sep 6, 2015

For my post op cabg patients, we have a heart pillow for them to splint when they cough or move around. Get to know what your surgeons preference is for dressing changes. One of mine likes to use a mepilex, and only sterile water and gauze to clean. Our goal for them is to be up in chair x3 for meals and up and waking x4 in one day. IS 10 times qh while awake. They also receive beta blockers post operatively and have ssi at meal and hour of sleep. Cardiac rehab also follows them. Foleys come out on day 2 unless they aren't voiding adequately.
For our cath/stent patients, if it's a radial approach they are not to use the arm of possible. They have a hemoband on and we slowly take air out while monitoring for oozing. Usually I think we start taking air out 2 hours after procedure, can't remember exact policy right now. We take out like 2ml of air every 15 mins or so as long as site looks good and no oozing. We assess for bleeding, and circulation. Whether pulse sat is good on that arm still and whether pulses are strong. If there's bleeding or oozing after removing air/band we put it back on.
For our femoral approach patients they're on bed rest for 6 hours after procedure. No more than 30 degrees elevated hob. Inspect site for bleeding, swelling, tenderness, and pulses. Have to be careful of a hematoma developing. If it bleeds we put manual pressure slightly above the site. If it still bleeds and doesn't seem to help then we get a femstop. Usually those patients with stents can go home in a day or 2 after procedure. They get plavix to keep the stents open.
For cath lab patients they are on clear liquid diet at first and advance as tolerated, which really doesn't take long to get back to normal diet. It's just a precaution. And they usually have an order for continuous normal saline infusion for like 3 hours or so.

You are amazing! Thank you so much!!!! I wish I could hug you!