Excellent posts.
I agree the most important thing you can do as a student in the ICU is to get a good report and perform a really thorough assessment. The learning opportunity for you is substantial, so soak up everything.
When I take/give report I like to start out by finding out why the pt is in ICU. Where did they come from (ER, MRT call, Cath lab, OR, etc.?) What events lead up to their hospitalization/history.
After I have a good idea of why they are in ICU, I go thru my ROS. Neuro...are they alert/sedated/confused. Respiratory...vent/o2/lung sounds. Cardiac...HR/BP/Rhythm. GI/GU...diet/feeding tubes/foley/I&O balance/accuchecks.
Then I ask about IV access, Drips they are on, Incisions/drains/CTs, who their physician's are and what specialties they are, Labs, recent interventions, scheduled tests/diagnostics.
I also like to know about the psycho/emotional needs and the family.
As the report is given, feel free to ask questions. Ex: If they have had a fever ...have they recieved tylenol, have blood cultures been drawn, what abx are they on, do they need to be screened for sepsis, etc.
After report, I like to take a minute to reflect on what my plan for the day is and 'worst case scenario' type situations to help me feel more prepared for the unexpected. Am I going to be weaning any drips? What do I do if my pressure bottoms out? If they are on an insulin gtt, do I have a copy of the hypoglycemia protocol on the chart? Do I need to call the physician about an abnormal lab? What happens if they pull out their ET tube?
Once I feel prepared, I check my Mars for Meds that I need to give that day to make sure I am familiar with all of them and give me an idea of how I need to schedule my time for the day. Do I need to get a morning accucheck and take 8am meds in the room with me. It is important to try and get as much done while your in the room, instead of running back and forth...especially if they are in isolation.
Once in the room, I go through my physical assessment in roughly the same manner that I recieved report...system by system.
I give them the once over (are they in any distress? diaphoretic? possibly in pain? sleeping? etc.) Then I check my vitals and get a wt. Next I check my lines and infusions to make sure everything is connected appropriately and infusing at the correct dosage and rate, especially wt based meds. Then I go thru the systems...Neuro, Resp, Cardiac, etc. I compare my findings to the report I recieved. Are there any changes? If so, why? Maybe something was left out in report...maybe it has changed.
After I get a good assessment on my patient, I then prepare myself for speaking to the physicians and family members. Are there important changes I need to report...which physician does it need to be reported to? Is it something that needs to be called ASAP or can it wait until the physician rounds? What updates need to be communicated to the family? The more you prepare yourself to answer questions, the more the families and physicians will feel confident in your competence.
Finally, I chart. Our system allows you to copy the previous charting...so I always do that to check my charting against the nurse before me. Again, it is just one more way of catching some important info that may have been missed.
Then I start working on my plans for the day. Dressing changes, transporting for tests, weaning drips/vent, giving blood, etc. etc. Whatever the pts needs are.
