givadarn

Another vote for the Kathy White book. It's only $45 or so and is almost pocket-sized. Everyone on my critical care unit carries one. kathywhite.com

My vote also goes to the Sage products... so easy to use, with the handy thin suction attachment to do deep suction once a shift down to the cuff of the ETT... lots of saliva and nasty stuff hangs out there and can give the patient the constant urge to cough. Can't do this deep suction to the cuff too often though, or else you'll traumatize those sensitive membranes at the back of the throat. P.S. Also verifies gag reflex, much to the patient's dismay! (obviously, this long thin suction catheter is only for use on vented patients)

It takes guts to jump right into critical care, but it is definitely do-able. Those first six months you have to be a sponge, soaking up everything the more experienced nurses have to teach you. Recognize the learning opportunity in each patient situation, and ASK QUESTIONS! Anytime you are unsure about an assessment, something looks or sounds or smells funny or whatever, ASK! You may catch something and save a life. Trust me, I am still in my first year in cardiac ICU. There is still so much I don't know, but I do ok as long as I ask a million questions anytime I am unsure or confused. The only time new nurses get into real trouble is when they DON'T ask questions first. If you don't know how to do something, get someone to help you. Then next time you can do it yourself. Learn what people you can rely upon for help, and what people have been there forever and know just about everything. THese are the people who will help make your first year in critical care a success! Good luck! P.S. Go easy on yourself at first... you will make mistakes and miss stuff, but as long as you are careful and ask lots of questions you'll do fine. Nobody's perfect, not even the most experienced nurse on the planet!

I agree with many of the other nurses' replies; you always want to eyeball the documentation of the last shifts' vital signs DURING REPORT so if everything is blank or something looks out of whack, you can address it right there face-to-face with the night nurse. It is all of our responsibilities to ensure that standards of care are upheld, and in the ICU q 1 hour vital signs are a minimum. Unfortunately, it sounds like this patient was too far gone by the time you came on shift. It's definitely a learning experience; those night shift nurses should DEFINITELY be reported. Also beware if a patient is acutely confused/agitated - this can signal an emergency like hypoxia, hypoglycemia, electrolyte imbalance, poor perfusion due to low BP. Only once all these things have been ruled out can you CAUTIOUSLY consider antipsychotics. When I start my shift, I always think: which of my patients is the sickest/most unstable or needs to be assessed first? In this situation, even the MI patient comes second. Hang in there; you're getting trial by fire but you'll survive!