burghrn

We are mandated to give baths every night to all ICU patients as well. We even have to bathe them with chlorhexadine. Some patients refuse, and unless they smell we don't usually push the issue. However, the charge nurses and supervisors do audits on who gives their baths and if we chart "patient refused" they are not happy. I understand if the patient is going for an invasive procedure the next day that a bath is necessary. But otherwise in my opinion it is just another contributing factor to ICU psychosis.

This one's pretty specific to a cardiac ICU: If your patient has a Swan and you're adding/titrating Milrinone, Dobutamine, Flolan, Remodulin etc, make sure you have your patient's mixed venous blood gases done before the Drs round! They will will want to see the most recent CO, CI, SVR, etc. Tips for when you draw the mixed venous: make sure the patient has been sitting still/not exerting him/herself for at least 30 minutes before you draw. Make sure the transducer is level to the phlebostatic axis. Make sure you also get a wedge pressure (as long as your PA pressures are not too high- if so, let the doctor wedge for you) so that you can calculate all your numbers. You'll also need a current BSA and hemoglobin and they'll want to see a pulse ox level at the time of your draw.

Liver. DIC.