Intensive Care Unit- ICU
As I walk to work, I often get to wonder how busy the intensive care unit gets. I have worked as a critical care nurse, for the last six years, in the intensive care unit. The acuity of the patients is unpredictable. Patients get admitted with a variety of medical conditions.
An ICU patient faces life-threatening injuries or illnesses that require critical care. It requires a specialized team of health care professionals to provide the treatments and care needed for such patients in the ICU. The team of healthcare professionals in the ICU includes; doctors, residents, interns, APRN's, nurses, respiratory therapists and a pharmacist.
Work covered at the ICU
A patient's health care needs in the ICU can range from complicated surgeries, accidents, infections and severe breathing problems. If proper treatment does not get accorded to such patients, these conditions may result to death.
Patients get placed on cardiac monitors or ventilators, in order to sustain their lives. These patients may present with abnormal blood pressures, irregular heartbeats, inadequate blood volume or values and unable to breathe independently. Incase of abnormal blood pressures, potent medications reserved for the ICU get used to increase or decrease blood pressure within seconds. Other intravenous drugs can regulate the heart rate or make the heart contract faster. Vasodilators and vasoconstrictors are medications administered to improve blood pressure via distinct intravenous lines which get placed under emergent conditions. These drugs affect the diameter of the blood vessels.
The ICU admits patients from the emergency department- ED, or inpatients with worsened medical conditions. The health care team at the ICU responds to codes. Codes refer to the medical emergency situations, which get relayed when patients get to experiencing respiratory or cardiac distress, or an arrest.
Once the system gets activated, cardiopulmonary resuscitation-CPR gets initiated and maintained until additional rescue personnel arrive. The physician in charge directs the resuscitation efforts. The physician offers directions on issues regarding drug administration, defibrillation, termination and or continuation of efforts.
An Anesthetist establishes an airway by placing an endotracheal tube. The respiratory therapist assists the anesthetist with tube placement, setting up the ventilator equipment and drawing arterial blood gas.
The pharmacist prepares or sets up the drugs to be administered by using the code cart.
The nurse assigned to the patient stays with the patient to answer questions and provide information such as; history, interventions and events leading up to the code. A second nurse assists the assigned nurse to administer drugs, blood products or titrating the medication. A third nurse records pertinent data during the code for complete nursing documentation.
During these rushed resuscitative efforts, the rooms become crowded and many of the tasks get performed simultaneously. During the code, family members get invited as witness in accordance to the hospital’s policy. The family maintains a distance as they observe the efforts of the healthcare team. This scenario is unique. During codes in other hospitals, family members get removed from the room immediately.
Recently, we received a patient from the ED. She was a 23 year old female suffering from a blood disorder. I was working that night when a group of nurses, respiratory therapist and a doctor transported the patient to the ICU. She already had a tube inserted, on ventilator support, and receiving intravenous fluids, blood and drugs to maintain her blood pressure and support her heart. Due to her severe blood loss, her heart rate was irregular. Her blood pressure was also low, and she suffered a cardiac arrest. Soon after arrival to the unit, her heart stopped beating.
While at the waiting room, her family was unaware of the severity of her case and the efforts underway. One of the residents and an advanced practice registered nurse- APRN delivered the patient’s prognosis. They invited the family to observe the team’s heroic efforts as they tried to save her life.
The patient’s mother, her two sisters, and the uncle desperately cried from a corner of the room as they observed the team work to save the patient’s life. While crying, the mother kept begging the doctors not to stop. "Doctor please, I know to you she is a patient, but she is my daughter. Save her, God please do not take my daughter. Marguerite fight, fight Marguerite".
We coded for two hours, thus making it the longest code we worked on. Despite the team’s efforts that night, Marguerite died. Her mother was inconsolable. The staff was disappointed, somber, and quiet. I am sure every team member was analyzing the situation mentally. The dead body got prepared and sent to the morgue.
Every patient and the outcome are different. As a critical care team member, we work towards saving lives while using the latest technology and equipment. A nurse’s daily ICU experience entails dealing with life and death cases. Not every patient’s life gets saved. Nurses are in charge of caring for patients with complex health care needs. Nurses are also in charge of the patient’s family needs during their hospitalization. It is a stressful and rewarding job. Nurses are like detectives, vigilantly monitoring patients to detect any changes, and always anticipating for the next move.