ktliz

Managing your lines is something that will come with experience. I remember being a new nurse, and tracing my lines over and over and over to make sure I knew where everything was going. We do the 3 labels thing, with one at the patient, one by the bag, and one directly on the pump--our pumps don't show the drug name when they are on hold. I like to know at a glance that my pressor is running, not on hold! Yes, you can disconnect just about anything for a few seconds, even your pressors, just make sure you know exactly where you are going with it before you disconnect it. Pressure cables can be unhooked, you will just have to re-zero them once you reconnect. You can disconnect your suction tubing (ETT, OGT, etc.), just make sure no secretions are going to come dripping (or flying) out. :)

A previous poster said they found the ICU over-stimulating. Personally the combination of routine and adrenaline in the ICU has been perfect for me. But, a couple years into my career, I'm starting to have more issues with inattention. Now that I'm more comfortable, I'm starting to go on auto-pilot for certain tasks, and my mind begins to wander. I do silly things like empty a foley or urinal, and 3 seconds later, I couldn't tell you how much I emptied, even though I "looked" at the measurement before I emptied it (looked, but didn't process, obviously!) That is just one example of the problems I'm starting to have that weren't an issue previously. I do have an appointment with my doc, hoping to get back on a stimulant of some sort. In short, I do believe that ADHD nurses thrive in certain types of work environments, with the most important factor probably being your interest in the area. But, I also agree with previous posters who stated the importance of symptom control.

One of my worst days on the unit--up to 16 pumps running at once, including abx, electrolytes and blood products. Four stacks of four pumps each. Patient was on CRRT so I was doing hourly Is&Os, clearing the volume on every one of those pumps every hour. Patient died that day on 30 of Levophed, 20 of epi, 50 of dopamine, 300 phenylephrine. Don't remember what the patient was on for sedation but I think it may have been fentanyl & versed. Nimbex, bicarb.... I don't remember what else.

We are moving toward a paperless report in our unit, using the computer to look up information rather than referring to a written Kardex. Previously, the off-going nurse would make a copy of the patient's Kardex for the oncoming nurse to take report on. The Kardex covers a full SBAR report--code status, allergies, history, full assessment, etc. The problem is, often the information wasn't updated. The staff is VERY resistant, since they are used to having that instant reference folded up in their pocket when needed. Now, if the oncoming nurse wants a complete reference, he/she needs to write it all down during report. I'm interested in hearing if anyone else is doing electronic or "paperless" report, or if you use a Kardex or some other written reference.

I've been told never to strip an intrapleural chest tube, but it's ok to strip the smaller, mediastinal drains.

Propofol is our go-to drug, usually with 50-100 of fentanyl Q1H PRN, or sometimes a fentanyl gtt. If propofol (max of 80) doesn't keep the patient adequately sedated, then we will go to midazolam. We don't check trigylcerides routinely, only if the patient has been on the drip for a while (around a week). Have seen symptomatic bradycardia once that I can remember. I feel like a patient is either the type that will tolerate being intubated, or the type that won't. Some people will never achieve that RASS of 0 or -1, no matter what drug or what dose you give them. They're either agitated or snowed. Only other thing I have to add is that although RNs are forbidden from pushing propofol, I know some people will jack the rate way up on the infusion in a pinch, then turn it back down once the patient settles....

Propofol. Or sometimes fentanyl with prn ativan. We will use dex when trying to extubate a patient who wakes up WILD when you turn the propofol off. In our facility, dex absolutely cannot be used for longer than the fda-approved 24 hours.

Sounds about right. The completely wiped-out feeling does diminish with time, but will never completely go away. You just learn to work through it. I will say that the mental exhaustion seemed to get much better after a year. Now it is just the physical exhaustion. I work 3 12's a week, and plan on doing absolutely nothing on the 4th (and maybe 5th!) day. That still leaves several full days for being productive and social. I agree with what others have said about just forcing yourself to get out there and do it. You might enjoy going out with coworkers and venting over a drink, or maybe you want to completely forget about work while chilling with friends or family. And speaking of family... I am in the same boat of wanting to start my own. From what others have told me, when you have kids, you adapt because you have no choice!! Those little ones need you. :)

Sorry, Rhia, I didn't start at USA after all, due to finances. Hoping to start my MSN this fall but at a different school (with the help of tuition deferment!)

Just about 2 years of experience in the ICU. Highs.. -Making my patient as comfortable as possible. Whether that means a bath, getting up and sitting in a chair, allowing them a few hours of uninterrupted sleep or providing just the right PRN med. -When my assignment is busy (like a new admission), but I'm just "in the groove," feeling totally competent and on top of things. -Wound care. I'm a weirdo... I love assessing wounds and changing dressings. -Just interacting with my patients and/or their families. I love 98% of the people that I meet in this job. When they acknowledge my hard work and thank me for a job well done... it doesn't get any better than that -Oh, and I love everyone I work with, too!! From nurses to techs to therapists to doctors, we have a great team. Lows... -Like others have said, all the unnecessary and futile care. I HATE having to stick little old ladies and little old men for labs when their arms are already covered in bruises. Or when a patient clearly didn't want intubation/resuscitation/trach/PEG/whatever, but the family insists we "do everything." -Frequent fliers who refuse to take care of themselves. -When I have a busy assignment and I just can't seem to get on top of things, and feel like I'm leaving a ton of work for the next shift. Neutrals -Assessments, meds, charting. We do "safety huddle" at the beginning of every shift and I'm pretty neutral about that.

Was doing a little googling for my own information, and found this page explaining the types of ketoacidosis... http://www.anaesthesiamcq.com/AcidBaseBook/ab8_2.php

I think you may have missed the part where the OP states that the patient is a type I diabetic. Therefore, the patient does require insulin and the DKA protocol would be appropriate.

Great thread. Just this week I had a patient in torsades requiring compressions and defibrillation. Following the code, we started a milrinone drip with a loading dose. Apparently his heart did not like that loading dose because he went into a rhythm that had me ready to jump on his chest, until I looked down at the patient and he was looking at me quizzically. Once I composed myself, I realized it wasn't even vtach, just an aberrant tachyarrythmia.

There may be a few tidbits that are outdated (meds, maybe?), but as every document on the icufaqs site states, it is not intended to be the "last word" on anything. It is a general overview of things you will encounter in the ICU, and still an excellent read for new critical care nurses.

True. So far haven't had this happen though. Often, when we withdraw care and the patient is too sick to go to hospice, they already have a central line/picc/port or something. If I lost IV access on my minimally conscious patient, I would be highly uncomfortable. Have gotten a some good info on this thread though... I like the atropine drops sublingually!

If a patient is in the ICU, it's because they require close monitoring. Hourly vitals, Is&Os, q2 or q4 assessments. Constantly watching that cardiac monitor, spO2, etc. That is why they are 1:2. The only time I would accept a tripled assignment would be if 2 of the patients had transfer orders, and therefore could be treated with the same level of care they would receive on the floor, e.g. q8 assessments. Edited to add: This is only theoretical. In reality I've never been tripled. Always 1:1 or 1:2.

I completely agree with Nalon1 that it is best not to get too attached. Luckily, I have always been the type of person who can feel extremely connected to someone in the moment, yet be able to say goodbye fairly easily when it's time to move on. Sometimes I wish I knew what happened to patients clinically, more so for my own knowledge than anything else. I have to say there is only one patient that I still think about, though. If I knew he eventually succumbed to his cancer, I would grieve. But, it wouldn't take away from any of the fulfillment I got from taking care of him. He was the most positive person I've ever met, making the most of every single day on this planet, and I know I helped him make the most of his stay in our ICU. We do have a bulletin board in the staff break room where we post thank yous and updates from patients/families, and sometimes the stories are really neat. We just had an older gentleman send us a picture of him figure skating, holding his partner above his head. He had been a surgical patient. Of course, medical patients generally don't do as well, with some exceptions. I remember in nursing school I had a patient who was as septic as someone can get. A year later, working as a nurse on the unit, I was thrilled to see a picture of him on the bulletin board. He had survived with bilateral BKAs to show for it, and the picture was him at physical therapy, walking on his new prostheses. Pretty cool.

You're right... I think chillceb's reply could be considered "hijacking" a post which leads to confusion. Chillceb, not sure if you realize it but this post is in the MICU/SICU forum.

You might get a better response in the hospice forum. In the ICU, our patients have IV access, so we use it. Hospice nurses will have more experience with PO or SL administration. Although, I probably would have given morphine instead of Ativan.

Almost nothing is autonomous in nursing. Just about everything is collaborative. Personally, I love my role. I will advocate for my patient all day and question doctors orders if necessary. But when it comes down to it, the brunt of the medical decision making is on the physician. That is why they went to school at least twice as long as we did, make hundreds of thousands more than we do, and pay thousands more in liability insurance than we do. I have enough on my plate right now as an RN without the added responsibility of being a health care practitioner.

Have you been offered both of these jobs? What sort of feedback did you get from the hiring managers about the units?

You said yourself that you are happy there and the unit has offered you great opportunities. That, combined with the fact that your co-workers are getting accepted, makes me think you should stay. It doesn't hurt to show a little job loyalty, either. Do you have the opportunity to float to other critical care areas? Or you could pick up a per diem job somewhere.

I'm not sure what you mean by having the stopcocks open to both the CVP and the infusions. If you are getting a CVP reading, the stopcock should be turned "off" toward the infusion. If you are infusing, it is off toward transducer/pressure bag, and if you are zeroing the CVP it is off to the patient. The CVP will not be accurate while anything is infusing through it (other than the pressure bag).

It is the thick white kind. We are only supposed to remove it with daily baths using soap & water. There are some nurses who want to remove it with every clean- up but we are working on educating. We are also working on getting the clear cream...that stuff is cool!

We also use the Mepilex on all intact sacrums, including Stage I. For a sacral Stage II (and a skin tear is not a pressure ulcer, btw) we use a heavy-duty barrier cream (same as for moisture - associated skin damage). For stage 2 elsewhere, we would probably use a non adhesive foam such as Allevyn. I am on our unit skin integrity committee and designed a flowchart to help nurses choose the correct skin care for most situations. It's pretty nifty.