The First Year: Conversations with a New ICU Nurse
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I apologize it is going to be a long post. I've been holding this in for a while. My back story: I'm 28, male, history of depression, in good physical condition. In September of , I was walking, tripped, and hit my head R. Got checked out in the er I was working at the time. Got only 2 days off work. I was sent home, and was able to see a neurologist a few days later. Diagnosed with Post Concussive syndrome.
Told to take a month off work. Fast forward 2 months. I ended up leaving that job, left Seattle, and moved back home with my parents. I got offered a job in the ICU at the hospital I had worked at before.
I have about 4 years of nursing experience, mainly in the ER. No Previous ICU experience. Apparently I had gone into status epilepticus. So I suffered my way through 2 months of orientation, while on mg keppra bid for about 4 weeks, Then weekly medication changes transitioning from keppra to lamictal, but had to stop because the lamictal was dangerously negatively affecting my mood. But the whole time I felt overwhelmed, and frequently heard the other nurses gossiping about me "Thats just common sense", "Whats wrong with him", etc They also make fun of my speech deficit the rears up when I get overwhelmed.
You're expected to function at a very high level as an ICU nurse. Taken both ways, on both arms, his pressure was 70 over 30, much too low. The poor kid had to sit on the toilet while we all stood in the dark and talked about him.
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I most remember a swirl of activity. The resident, the more senior M.
I told the resident the story. He seemed stressed, or maybe I was just projecting my own feelings onto him. Putting more fluid in the veins is an easy way to increase blood pressure and cardiac output. The resident called in the fellow an M. The doctors asked me to keep taking blood pressures, but Sean never climbed much above his early low.go here
The First Year : Conversations with a New ICU Nurse by Kay Zincus Ph. D. | eBay
I watched all this with only a vague understanding of what was going on. The resident and the fellow had a couple of huddled negotiations in the dark hallway; the fellow made a few phone calls, then they told me Sean would be sent to the PICU, that he needed the more intense technical support available there.
Things calmed down while we waited for the call to transfer Sean to intensive care. Around in the morning I went to check on him. But he was awake, and he had some questions. His earlier cheekiness was gone, and I found myself confronted by a very scared eleven-year-old boy. I sat down on the edge of his bed.
So I told him that.
Maybe because you were having trouble breathing, your chest tightened up. It could be because your blood pressure was so low, I told him. Every answer I thought of to this question seemed overly technical, but also just inadequate. To me, all my answers sounded lame, but Sean seemed to find them comforting. As soon as I finished giving my explanation for the third question, he stopped talking and relaxed back into bed.
There we were, nurse and patient, talking quietly in a dark room, confronting the vagaries of life and death. For me, this moment finally put to rest any questions I had about why I quit being a professor and became a nurse instead. Around that morning the staff initiated the transfer to the PICU. My preceptor had taken over for me at this point. Before they left, though, I went back into the room to say good-bye and to see if Sean had any more questions.
His face held such an intense look of distress that I wanted to look away. His eyes were hollowed out, almost sunken, and he stood there, stooped and silent, as if his only choice in life was to keep receiving blow after blow and hope he could stand it. This is love, I thought, and all the agony that love can bring. Do you have any questions? I asked him gently. That was all I could offer him. If only I could have wiped the slate of his face clean, taken the pain that was driving his shoulders in and down and thrown it out the window, but unfortunately I do not have that power.
In answer to my questions, he shook his head no and stood silently in the room while the doctors and I talked to Sean, and Paula got him ready to go. I looked at my watch and realized I needed to hang feeds for one of my babies. This little guy had been born with a multitude of birth defects, and he got his food through a tube in his stomach. New bags of food have to be hung at specified times, and his was due now.
Many doctors work in the ICU including anesthetists, intensivists, cardiologists, nephrologists, and endocrinologists. Each specialist will care for a patient in their area of expertise, for example, a cardiologist will care for someone who has had a heart attack, and an endocrinologist will care for the diabetic patient. Other health professionals include pharmacists, physiotherapists, speech-language pathologists, and social workers. Each of these professionals will work together to give the ICU patients comprehensive and intensive care.
Intensive care requires the use of many pieces of equipment including cardiac monitors, ventilators, IV pumps, and specialized hospital beds. If any of these measurements enter a dangerous range the monitor will alarm letting the nurse know.
The First Year: Conversations with a New ICU Nurse
Some alarms are critical, while others are not and it can be distressing for patients and families to hear these bells when they are not sure what they mean. A patient on a ventilator will have a tube that enters their mouth and goes down their throat into their lungs. The soft whooshing sound of the ventilator and the warm bubbling of water for hydrating the air can be very relaxing. ICU patients are often connected to multiple IV pumps. These pumps deliver lifesaving medications or fluids to the patient. They sometimes alarm because they have run out of fluids or because something has gone wrong with the pump.
When working well, they make a soft clicking sound at different speeds. Patients in the ICU are at high risk for bed sores from lying in bed all the time, so they are often given specialized beds to rest in. These beds are filled with air and are always filling and emptying in different locations.