From Wharton to Intensive Care

(page 2 of 3)

8:40 p.m.—The wife of the lung transplant patient comes in. Oftentimes in nursing, it's not only about treating the patient but also about helping the family cope. The wife informs me she is going to sleep here tonight. This a common request; she has been sleeping here in the ICU the last few nights. We allow family members to stay in our ICU 22 hours per day. The other two hours are when we give shift reports to the following nurse.

9:00 p.m.—Just before the patient goes to bed, I wash him up a bit. He is weak, but I try to give him as much autonomy as I can. The loss of autonomy can be a very difficult thing for a patient, especially one who stays here for an extended period of time.

10:10 p.m.—As we are hooking up all the monitors to a patient in Bed 4—a 47-year-old who had coronary artery bypass surgery—he dumps 2.2 liters of fluid and starts to bleed from his chest tubes. His heart rate increases, and his blood pressure skyrockets. This is worrisome because high blood pressure puts a lot of strain on the heart and could cause one of the stitches in his heart to tear. We immediately administer drugs to lower his blood pressure. The surgeon also orders us to begin replacing the fluid that the patient has lost. I begin to push fluid into the patient's central line, which goes directly into his heart.

10:25 p.m.—The blood pressure remains high, so we start other vasodilators to try to lower it. In the meantime, I am still pushing fluid into the patient. We get lab results that show the patient has a low red-blood cell count. Through another central line, we begin to give blood. We tell the unit secretary to notify the blood bank to be ready in case we need more blood.

Lab results also show that the patient's electrolytes (such as potassium and magnesium, which can affect heart function) are low and must be replaced, so we begin to restore them. There are three nurses and the respiratory therapist inside the room as well as the hospital intensivist [a physician who specializes in the care of critically ill patients] and the surgeon directing. The great thing about working here is that everything is a team effort. As I'm helping stabilize this patient, another nurse is making sure my other patient is O.K.

11:00 p.m.—The patient is beginning to stabilize; however he's not out of the woods yet. We get word that one of the heart transplants is also coming up soon. One of the nurses leaves to prepare for the admission of this heart transplant.

11:30 p.m.—It looks like the patient is stabilizing. The other nurse begins to chart on the computer all the steps that we took to stabilize the patient. It's important to keep all charting up to date for future reference, so anyone who might look at our charts would get a good picture of what happened tonight even without having been there. A saying in our unit sums it up the best: "If you didn't chart it, you didn't do it."

Midnight—With the patient in stable condition, my fellow nurse—who has more than 10 years of experience—spends a little time explaining the intricacies of what happened on this admit. I have a good idea of the situation, but I've worked here only a year and am constantly learning. It's great to be in a unit where teaching is encouraged. I know that I have the freedom to ask any questions and not be frowned upon.

12:30 a.m.—I thank the other nurse for watching over my patient and begin trying to catch up. My patient across the way had a front-row seat to the whole admission process. Although ventilated and unable to talk, he has a conversation with me by writing everything down. We talk about his wife and his four kids and how this lung transplant has changed his view of life. I always find it a blessing and enlightening to talk to all my patients, who have so much more life experience than I do.

12:45 a.m.—Every night we draw blood and check a myriad of data and lab values.