Wanting to know the day in the life of an ICU Nurse

papawjohn · Sep 13, 2005

Hey 2-B

(Sorry, couldn't stop myself .) Your question has sorta sat out here for a while and I guess the reason is 'cause it really already has answers if you searched and roamed around this forum. But I've got a reputation as a softie and someone who loves to help the newbie along--so I'll pass on my thoughts. (Please don't tell anyone I'm a softie--I really try to be fierce and grumpy!!)

Sunday nite at 1900, 1st cup of coffee--glanced over the two charts of my two Pts. Get report from dayshift nurse. Room 2--83 yr old female, history of MI in '86 and cardiac arrhythmia, of breast Ca and lumpectomy in '94--no recurrence. Found to have a Colon mass on outpt 'scope. Friday had partial colectomy (removal of part of colon). NOT MALIGNANT--HOORAY! Went into irregular heart beat post-op (called atrial fibrillation). Cardiology consult and some meds added (diltiazem--a calcium channel blocker, digitalis). Had several issues with electrolytes, the dayshift nurse spent lots of time giving her IV potassium and magnesium. Now she's essentially 'fixed'. My job is to watch over her and make sure that nothing is going to slide back towards problems and crisis.

Room 1. 82 yr old female. End-Stage Renal Failure on Dialysis. Last dialysis was Friday--due for another in the AM. Respiratory failure--on ventilator but doing fairly well with that. The Vent is only giving her some extra pressure that makes each breath bigger than it would otherwise be, and extra oxygen of course. Bad heart. Has had cardiac arrest about 2 days ago (V-Tach--fast electrical activity that doesn't produce a real heartbeat) and is on an IV med for that which slows the electrical activity of the heart (Amiodorone).

2200. I've met my pt's and chatted with them. Room 1 can write notes and gesture only--the Vent of course is connected to a tube into her lungs so she can't talk. A little morphine for her, turning her and propping her onto pillows to left and an hour or two later onto right. Room 2 is sweet lil' lady--few needs, moves herself about. I've listened to their lungs and heartbeats, felt their pulses, squeezed their limbs looking for edema, evaluation the monitors and heart rhythms and started the routine medications. I've chatted with family members (sometimes more time consuming and needy than the Pts!!). I've looked at all the Dr's orders of the previous 24 hrs in case something was overlooked by prev nurses (it happens--I'm the last chance to catch new medications not yet begun or labs or treatments before a big mistake occurs.) I've written a short essay detailing what I've found in assessing these ladies and started charting their vital signs and our treatments--establishing the baseline for the next 12 hrs.

It's a busy three hour period. Like a sales clerk in the middle of a big sale--busy busy busy--one task to the next.

2400. I've stayed busy at intervals--Room 2 is awake enough and well enough to want to do things but sick enough to need help. (More ice chips, move her about for comfort, adjust the lights, etc.) Seem like small things until YOU need 'em and need help. Her heartbeat and vital signs stay good.

Room 1 sleeps after the morphine. Her heartbeat becomes more erratic--periods of slowing to 70/min, then 'bursts' of irregular rapid atrial fib (to 130s).

I've calculated the intake and output of both pts (empting foleys and drains and adding urine and all the other nasty 'output' of the human organism--then looking onto the IV pumps for how much we put into them.) Room 1 had a BM. Cleaned her and changed the sheets.

More bookwork. By midnite I have a personal deadline to know as much as possible about my pts and begin a paper on each one that I'll use to give the dayshift their morning report. Analyse each page of both charts. Find out when the big 'central vein' IVs were put in (they become an infection risk if left too long), when dressing were changed, what the last XRays showed, etc etc etc.

0100. Midnite meds going in and charting caught up. I'm eating ?lunch as I sit at the desk in front of the two rooms. Room 2 is sleeping. Room 1 suddenly has a change in heart pattern--slows to 48 to 50. I jump up, turn off the Amiodorone. Check her vital signs, listen to lungs & bowel sds. Don't find an immediate reason for this change. Place call to Cardiologist. (Lucky him--0100 on Monday when he's been on-call all weekend.) I draw the lab work that is ordered for Monday AM right now, thinking her electrolytes are prob'ly a big mess and that's going to be my focus for the rest of the night.

0130. As I reach for the phone to re-page the Cardiologist, Room 1 suddenly has her heartbeat slow to the 30s, then the 20s!!! I yell for help--other nurses run with the crash cart. I give emergency drugs (Atropine-Epinephrine--then repeat them). Someone can feel that she has a pulse so no CPR. Respiratory Therapist is here--we increase the Vent so it gives her 12 big breaths/min and 100% Oxygen. I yell at the first idle person I see "Repage Dr----- STAT" and holler out the number. Turns out the person I'm yelling at is the ER Doctor who's come up to manage a cardiac arrest. (She doesn't take this very well. I apologize.) Our vital signs amazingly begin to stabilize but Room 1 is now not awake at all--eyes rolled back in head, sluggish response when light shone into them, no jerk back when I squeeze the daylights out of her fingernails. Now paging all kinds of Doc's and the phone begins to ring off the hook.

0300. Many orders from Drs. Lab results come back--more phoning and lots of meds and such. Busy busy busy. (Fortunately, Room 2 is sleeping.) I call the family and they appear. ("Momma? Momma? We're here Momma?"--our job cuts very close to the bone.)

0600. Dialysis nurse arrives for stat treatment. Cardiac stimulating drugs are going and needing fairly frequent adjustment (we call this 'titrating') as her Blood Pressure is low (88/30 to 110/50) but if I 'touch' her heart with the stimulant (dopamine) to raise the BP her poor ol' heart takes off to 140/min.

More lab work sent. Results coming back. Calls from Drs as the 'regular' Doc's wake up and get report from their 'on-call' partners. ("What happened, John?") And I've still got routine antibiotics to give and Intake/Outputs to calculate and etc etc.

0730. Dayshift has finally arrived, gotten report from me about our ladies and I'm walking out the door.

And that's a busy but not totally unusual nite in a Cardiac/Medical ICU.

Lets go home and have a drink!!

(I'd have EMailed this to ya and spared the Allnurses' bandwidth--but you have your EMail 'blocked'.)

Papaw John

geekgolightly, BSN, RN · Oct 11, 2005

thank you papawjohn.

mona b RN, BSN, RN · Oct 11, 2005

Thanks for writing that, I really enjoyed reading about your experience:)

expatnurse · Oct 11, 2005

thanks for the overview I really enjoyed reading about your experience.

MOnurse · Oct 11, 2005

PAPAWJOHN

Thanks for a great pic of a typical night!

MOnurse

MamaTheNurse, BSN, RN · Oct 11, 2005

sounds like our ICU - sounds like you would do just fine in our ICU too!

if you're ever looking to come north (northern MI), PM me, we have a spot for someone on the ball like you!!!!

you have such a way with words, especially when you are teaching something (your answer to the question about vent stuff in the CCU forum was just great) - I hope you keep a journal of some sort keeping track of your life, not just work - it will be priceless for your kids in the future!!! (BTW, sorry if I sound like a little girl with a crush - I'm actually quite harmless!! )

to the OP - the ICU I work in is very similar to Papaw John's but I could never have told the story so well..........

**RosesrReder, BSN, MSN, RN** · Oct 11, 2005

Papawjohn, thanks for taking the time and sharing this. It has been very neat.

dorimar, BSN, RN · Oct 18, 2005

This is for Pawpawjohn... Can you really be a man? I have yet to meet another nurse that makes it a priority to check they're orders,charts, labs xray trends etc before taking lunch (and i have been nursing for 20 years). I have never understood how nurses have time to read a novel, surf the net, talk on personal calls all night, and do all they should be doing. I also read your post to the person angry with the lazy RT, & saw what you wrote about suctioning, oral care and shaving. You could take care of me anyday (but I still don't believe you are a man, lol).

Doris

papawjohn · Oct 18, 2005

Hey Dorimar

Obsessive compulsive works for me.

Regarding the XY chromosone, re-read the little remark about 'takes personal calls'--add a couple of hours for important gossip and relationship-minding, you'll see that being a guy in a female world makes lots of time available if ya wanna use it. Personally--I use it on reviewing the chart, learning my Pt's pre-admission history, things like that.

Before I seem miscegynistic (?sp)--let me add, everything I know about this job, I learned from a woman. I honor them for it.

But it's harder for a woman to isolate herself from peers and study the chart or do a couple of hours of 'grooming' the lines and tape and dressing than it is for me.

Papaw John

dorimar, BSN, RN · Oct 18, 2005

again papawjohn, you can take care of me or my family anyday.

nicuRN2007 · Oct 19, 2005

?