mamsrn

I absolutely agree that you should have had introduction to critical care class and add additional classes as your orientation progresses. There appears to be a mismatch with your preceptor. Investigate if a different preceptor is available(I know, you don't want to step on toes-but you need a supportive preceptor) Is it possible that the sensory overload that your experiencing is sensitizing you and when instruction given, it feels as your being scolded? If you haven't, purchase pocket book guides on critical care to guide you. The American assoc. of critical care has many references and apps that you can purchase. I'm an experienced critical care nurse and I always carry my palm pilot to research new meds, check on interactions, obtain information on critical care(sepsis bundles), etc.. Many of the companies that produce the equipment you use have education on their web sites. When you enter a patient's room utilize ABC+Ds: airwary,breathing, circulation and drugs(IV fluids, IV pressors present) to start with. There are some free online articles/classes that you can take to help yourself build the knowledge you need,but-------You need an interpreter on your side to help you utilize what you are learning. Find out from the staff members which nurses they go to for information/analysis of information. Get somebody to support you.

Utilizing the Glasgow coma scale can be frustrating at times. The total no. scale can vary if the pt is on Ventilator. My facility using "T" for verbal when pt on ventilator and the total score is not involved with assesment of possible outcome. I find it particularly frustrating when I care for a post-resuscitated patient: example is a pt that has flaccid extremeties but can move head away to avoid oral care and beginning to open eyes. This Pt does not follow commands. I have been scoring motor as a "1" since limb movement does not occur, but with hesitation since the pt is moving her head to avoid a stimulus. I have been carrying a card I made for a different coma scale: "FOUR score " measurement. I obtained this inormation from a Nursing Spectrum article , 2006 FALL CRITICAL CARE SPECIALTY GUIDE (www.nursingspectrum.com). The source for this artical is Annals of Neurology, 2005;2005;58(4);585-593. It utilizes a score of 4 possible points or "0" score for 4 parameters: eye response, motor response, brainstem activity and respiration. I carry this card because I'm hoping someday to have a better assessment criteria in place. It takes into consideration activities such as eye tracking, and respiratory status (apnea, breathes above the vent, not intubated, etc.). My question: should the patients motor score be "1" since limbs do not move or higher since she moves her head to avoid oral care?