New to ICU? What have you learn so far?

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I am new to the ICU. I thought we could start with experiences to help us use our critical thinking skills. Any one?

Specializes in floor to ICU.

This thread is great. Keep posting!

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Specializes in critical care, PACU.

dont forget to check your chest tubes to see if the water seal chamber is at the prescribed level

no matter how swamped you may be, turn your patients. I followed one newbie RN like myself who admitted a patient at 2 and charted turning all shift, but didnt have an extra pillow in the room or under the patient to have possibly done so. That's 7hrs flat on her back!

whenever calling a physician, try to consolidate phone calls. think about any labs that may be pending and if the phone call can wait for those labs. think about anything your other patient may need (if they have the same patient)

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Specializes in CVICU.

This thread should probably be made a sticky. It's already filled with excellent tips and hints for people new to ICU and it would be great for people to continue to add to it.

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Specializes in floor to ICU.
:up::up:

Your eyes and ears are your best assessment tools! Being able to perform a good and comprehensive physical assessment is so important and seems to be lost amongst some nurses and other clinicians. The monitors, the technology, the numbers are all fantastic adjuncts in patient management but always assess your patient. Does your assessment data agree with your technological data?

So true. treat the patient not the monitor.

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Calling docs is mentioned a lot in this thread. My tip is that I try to write down each thing I want to say. Labs, my request, any change. Have an idea what you want before the call. Its a pain to hang up and then you realize you forgot to tell them something.

When reporting labs, see what the previous result was too.

ICU nurses have more autonomy when ordering labs, etc in my hospital. No post-op (or pre-op) labs becausepit was an AM admit... you might throw a BMP or something in there. Happened to me last week. K was 3.2 and starting to show PVCs.

Where I work, resp therapy mostly manages vents and settings. We can change anything except mode. If you make a change, like O2% or rate... either leave them a sticky with the time of the change or mark it on the flowsheet to let them know!

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One thing I learned a few days ago: In terms of Atropine IV push administration, give 0.5(mg) if they're alive, 1mg if they're dead.

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Specializes in Anesthesia.

Assess your patient(s) as quickly and as thoroughly as possible. Your assessment skills are the most important thing, esp in ICU. At noon, you don't want the doc to discover something you should have seen at 0730.

Your pt WILL have changes in the course of your shift, and you need to know what their baseline is!

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Specializes in critical care, PACU.

if your patient is on a PCA, make sure that the nurse before you connected a flush or the main to it so that your slow slow PCA rate will actually reach the patient. I trusted the nurse preceding me and I shouldnt have. It's a good reminder to always follow your lines back.

and conversely, make sure if your patient is on nitro that no main with IVPB is connected to it.

I checked the nitro but didnt follow my PCA which cost my patient untreated pain until I finally figured it out.

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Specializes in CVICU/SICU-MICU/OR/PACU.

LABEL your lines! especially when you have many drips hanging, don'y rely on the previous nurse, who you thought labeled the lines correctly, imparitive in a code situation. DOCUMENT restraints, expecially when you started them and get the doc to sign for the order. Keep your room CLEAN and rid of clutter, no telling when chaos will erupt. Make sure your empty bed is READY for a new admission at all times, O2 is a must! TRY to do all your traveling in the beginning of the shift (before 2pm), your fellow nurses will be more willing to help, showing that you know how to manage your time and not conflict theres. When in doubt...CHECK your chart...might be something you missed from a new admission (it happens). Best advice is to RELAX and think SAFETY first.

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Specializes in floor to ICU.

In our unit, we have an older section and newer section (remodeled). The code buttons are in different places. I make it a point to locate them when I walk in the room. The light switches are in different places too which can be annoying. Sometimes I fear the patient will have doubts about my nursing care because I am running around trying to figure out which light turns on what!

Also, I had a patient on cardizem drip. Heart rate was still a bit high but the blood pressure was a little low (occasionally high 80s/mostly low 90s). I was hesitant to up the cardizem because I didn't want to bottom out their pressure. Charge nurse suggested that if I up the cardizem, it may slow the heart enough to allow the chambers to fill, therfore, increasing the blood pressure. Awesome learning new things. BTW, it didn't work but nice to know for future use.

If time allows and you can swing it, go into the other patient rooms with the nurses if they are doing something you are not familair with or hanging an IV med you haven't worked with before. Let the charge nurse know that you are interested in pulling Swans' or chest tubes so you can get experience. We do OHS and I try and go to the room when the pt comes from CVOR. Good practice setting up the art line and drawing blood, connecting the CO/CI monitor, helping to organize and detangle IV lines, label and mark chest tubes, check the blood sugars an initiate the insulin gtt if necessary.

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Specializes in floor to ICU.

Had a pt on Neo, levo, Epi, Vasopressin. We eventually turned off the vent and he died. At one point his pH was 6.9 and blood pressure was in the low 70s. After the bicarb, he came up a bit (high 80s). The charge nurse said "thanks to the bicarb". I am still learning so I asked him to explain. He said the pressors wouldn't work well in the acidic environment. He went on to explain that acidosis also decreases the body's response to catecholamines.

Love learning all this stuff.

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Something I learned recently... be aware of what the costs are if you work with Medicaid pts. I had a pt that needed a Flexi-Seal, and two things happened. One, my coworkers said I could call the MD in the am to get an order to cover the tube, and the Cdiff culture I wanted. Two, they said the Flexi seal is too expensive, and urged me to use a regular rectal tube from xray instead. I DID call the MD, because its just not worth my license to place an invasive tube in a pt when he might not have wanted it, or ordered a lab he felt was unneccesary. Thankfully, the doc is a nice guy, and gave me the orders for both. But I did end up using the rectal tube from xray, one because it was easier to get ahold of then the high dollar one from the house supv, and two because it was cheaper for the pt. I don't like it as much, because I don't think it works as well (smaller opening in the top of the tube) but for pure watery stools, it worked great.

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