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Here is an excellent video showing you the patho of sepsis. You are on the right track and this explains the details. As for sedation of a vented patient, it can vary. Most of the time the patients are sedated for comfort or to increase effectiveness of mechanical ventilation. However there are some reasons not to sedate. If the pt. can't tolerate it-sedation lowers blood pressure, if you are already struggling to maintain BP then you don't want to add something that will lower it. If the patient is neurologically not responding they will often discontinue sedation so they can be sure they are able to get an accurate Neuro assessment. If they are planning to extubate a patient, they will turn down/off sedation to ensure that they can protect their airway after the tube is out. Because of Evidence-based practice, there has been a move toward less sedation. Some research says we should be walking our vented patients! Sedation can have negative side effects such as increased delirium in ICU patients so the idea is if we dont sedate them as much, risk is decreased. I am sure there are other reasons but these are the ones I have seen the most.

I'm a new hard and jumped right into the ICU. I think this is the best way. You just jump in and learn as you go. I've seen nurses who have experience now and started in the ICU and some who came from the floor. The new ones who started on the floor are behind the ones who jumped right in.

Were you working before? If you have not worked and gone to school at the same time, it will be an adjustment. A BIG adjustment, it is really hard balance family, school, home and work BUT it is completely doable. I worked full time as a tech in the ICU and completed byte hardest program in my area. The experience you gain is amazing! And you get to seebid it would be for you once you graduate or if you would prefer something different. How many hours will you be working? And are you ok with telling them no when they call for the second time this week asking you to pick up a twelve hour shift? Congratulations! You will learn sooooo much!

In nursing school, we were required to go to a board of nursing meeting where they deal with these things. I found that in most situations the board was more understanding if the nurse showed that he or she showed that they were taking steps to fix what they did. Many of the people who got probation over suspension of their license went to meetings, met with a counselor, and stated why they were wrong . The ones that said but it was just one little mistake and didn't show that they were working to make sure it didn't happen again seemed to be more likely to get more punishment.

Very true! In the hospital I used to work at, if you knew you were going to be in a patient's room a while, you could go to that patients monitor and pull up your other patient's monitor as a mini screen. It would flash too if it was alarming. I miss those monitors! Also, each one was portable and so you didn't have to unplug your patient to help them to the bathroom or to go down for a procedure, you just unhooked the monitor from the wall and away you went. Now we have to unplug patients from the monitor to help the to the bathroom and either stay with them or pray nothing happens to your seemingly stable patient ?

Thanks for the advice! Last night was my last shift on orientation! I can't wait but am scared to death!

Thank you, I am good at asking questions. I think that's why I'm nervous to be on my own because I don't have my own personal experienced nurse to ask anything to. I am prepared to put in the effort and the time to become great at what I do! Thanks for the reply :-)

I am a new nurse in a CICU. I am off orientation next week and I feel I am doing well. My preceptor got my orientation shortened because of how well I am doing. However, I am still so nervous. My question is for those of you who started as a new grad in the ICU. When did you start feeling comfortable? When did you stop getting the feeling that "you don't know what you don't know"? I am starting to feel comfortable with the unit, the policies and procedures, the meds and the charting but still nervous to be on my own! I study outside of work and look up things at work as I go and as things come up. I ask questions of my preceptors about policies and etc. But I feel like as I start to make more independent nursing decisions I am told "well I would've done it this way" or "you should've done this" and I understand that they want to help guide me but what happens when I don't have someone right there to guide me? I know I still can ask questions of my coworkers but I'm not going to be able to ask about every move I make because they will be busy with their patients...

Most other higher level professions require Baccalaureate degrees. Nursing has held out because of the "nursing shortage" and the need to create nurses in a shorter amount of time. BSN is the way nursing needs to go for the future nurses coming in to the field. I understand that there are EXCELLENT Diploma degree nurses and Associate degree nurses however, nursing needs to catch up in this regard.

I was a new grad in Indiana and started around $19/hour this year in the ICU...

I work in CCU and we get them quite often. Mostly for pt. waiting for heart transplants.

The questions will get easier with time. For now, I suggest prioritizing. Start with ABCs and follow Maslows the rest of the way. Always think of it as if you could do only one thing and walk out of the room. Also, try to determine exactly what the question is asking. Does it require you to gather more information before you can do something for the pt.? Or is there something you can do first? Rarely do you choose "call the physician" because most likely there is something you can do as the nurse first. Hope this helps, good luck!

I believe I have seen this as a nursing care plan at my facility. If your instructor says it's fine, then use it! I would suggest Altered Elimination r/t abdominal wound AEB need for bowel diversion via ileiostomy.

Thank you, thank you, thank you!! I found this and tweaked it a little to my unit. I have been using it this week and it really helps! It prompted me to ask some really good questions during report! This is for EMSnut45

Gotcha, thanks :-)

While I agree with much of this reply, the first line seems harsh. Experienced nurses get scared when your mouth is closed, ASK QUESTIONS! Yes, take in everything they have to say because they have so much to teach you, you will be blown away! However, jump in, help out and ask anything and everything! Good luck.

Yes, it is possible to get a job in the ICU as a new grad. When I graduated, I had job offers from 4 ICUs. I do not agree that you need med surg experience first. They are way different from eachother. That's like saying before you buy a dog you should start with a lizard. Yes there are basic similarities like charting and time management but I believe there is nothing to gain by starting in med surg if your ultimate goal is to be ICU. ICU requires special skills and working in med surg will not teach you those skills. Network and apply! That's the key.

Oh, also I do now an hourly list of "to do" on my report sheet.

I am a new nurse just started in CICU. But I worked as a tech in the ICU for a year and a half and had my final clinical of 200 hours in the ICU. I do my assessment literally head to toe. Start with pupils, orientation as appropriate, vent placement and settings, assess heart, lungs and bowels. Look at IV sites abd check drips. Peak at the groin as appropriate (art line or Cath lab abd Foley). Thorough check for edema and pulses in extremities. Turn pt. and look and listen to their backside. Pt. Will be in a monitor so take a look at vitals and don't forget temp on those who don't have a temp probe in Foley or something. And check that Foley bag. I like to cluster my care the first time. So when I go in for my first assessment, I just go ahead and bring stuff for oral care, Foley care, I do range of motion if sedated and release restraints. when I turn them I will make sure there is nothing in the bed there shouldn't be like caps, tape, etc. And reposition the pt. Maybe a quick sweep to tidy up the room. That way I know if anything goes down hill I know my other pt. is all tucked in, clean and ready to go. I prefer to do both my assessments and then chart but some nurses prefer to chart right after each assessment so they don't get them mixed up. After I do both assessments and chart them I look at orders. Look at meds and labs as well, core measures and plan if care. As a new grad, I look up my meds right away if I'm not sure what they are and normal dosages. Then I do my 0900 med admin. On both pt. And I go ahead and assess again and reposition because we assess every 2 and 930 or so is close enough for me. The rest of the day is just kind of this cycle unless pt. Are more unstable then of course you assess more and titrate drips as needed. When pt. Are stable but on a vent, I try to titrate drips down during my med pass. I think it is crucial to cluster some care and make sure you think of what you might need before you enter the room so you don't have to make multiple trips. If you are turning them, do you need wipes or new sheet, if you are giving meds, do you have syringes and alcohol, if the pt. is able to drink, go ahead and take fresh ice in with you etc. You will save yourself trips and your patients will appreciate you anticipating their needs. Hope this helps!

I don't know how it works where you are located but at my hospital, they organize the ACLS certification and any others we need. Most likely if you are not in a Neuro area, you probably won't need the NIH scale. However, some hospitals are requiring all ICU nurses to get it...

Yes, I took care of a patient like this as a tech. All the nurses were so worried and amazed the doctor was sending her home with a sat. of 60%!

I absolutely love my Alegria shoes! They are so comfortable and have really good arch support. They run about $100-130 but you don't have to replace the shoe every time, you just buy a new insert which run around $20. Some nurses have had theirs for over 5 years... And it only took me a couple days to break them in. Many people like Danskos too but I found them not tall enough with my high arch.

Is the charge nurse a RN? Are there any other RNs on the floor? In my opinion, start with notifying the person directly above you. If they say it is no big deal, you can chart who you notified and what the outcome was. You can always assess the pt. More often if you are still worried and then notify the physician when they see the pt. But charting that you took it up the ladder and nothing was done will protect you and more frequent assessments will help the pt. If during a later assessment you find further pt. deterioration, make sure you notify someone again. If you really feel that your patient is in trouble, make a suggestion when you notify the charge of the problem. For example say pt. A has been having these new symptoms and I don't have a good feeling about it, what do you think about putting some oxygen on or contacting the physician? If they say it is fine and you are still really worried, ask the charge to come and assess the pt. with you.