July 23, 2013 (ICU)

Second day at ICU, for me was such a good experience. I am a fresh graduate and passer so I am 101%, a novice. I never had an experience at the ICU when I was in college. So I felt a little bit scared yesterday like it was my first day in high school because for me being an ICU nurse needs the analytical, logical and critical mind. So my patient was the same as yesterday, 70 years old female. The chief complaints were seizure and aspiration; upon assessment patient has GCS of 11, (E4-verbal response M5-localizes to pain, V2-incomprehensible sounds). Not really that toxic except that I had to take vital signs and neurovital signs every hour, patient is on cardiac monitor, attached to foley bag catheter, 02 at 2L with pulse oximeter and has NGT. The diagnosis of the patient is multiple chronic ischemia infarct at right mid coronary artery and left parieto temporo occipital area, symptomatic seizure secondary post stroke genesis. Patient had a lot of medications so I had to pound and plus I have to turn her to sides every two hours and I changed her diapers and linens. On two days she vomited and noticed it, right after feeding for 9am. I elevated the bed in order to prevent aspiration and vomiting and slowed down in feeding her but still she vomited. I learned how to suction secretions, do oral care in your shift, importance of turning because bed sores may occur if you would just take turning for granted. I can hear my patients incomprehensible sounds and she had contractures and was trying to put a force when I tried taking vital signs to her. I have learned the color of French tip catheters: 16 orange, 14 green, 12 white and the smallest is 10 for pediatrics. I have learned a lot from my staff nurse because she never left me behind and discussed a lot of things to me on how to deal orders made by doctor, updating the kardex and the chart. Shes very dedicated in her work which means that she takes it seriously not faking every vital sign and that is one good thing I really appreciated. On the other bed, 2 beds apart from my patient was a patient on peritoneal dialysis though I havent observed very well since I was busy with my patient it was a first time for me and another patient on a private room was on endotracheal intubation and mechanical ventilation; it was my first time to witness also though I have read on books and online references how it is done yet it is different on books and practical basis. I have studied about how ET tube is inserted after seeing it, using the laryngoscope, patient is hyperextended and the physician would insert it and you can see the epiglottis and insert the tube, inflate the balloon and patient is oxygenated with the manual ventilation then attached to the mechanical ventilation. Ive read also about mechanical ventilation the types of it: Assist Control, SIMV and CPAP. So I kind of just refreshing myself right now, try to test if some information went into my brain after reading the stuffs. In AC there is a preset tidal volume whether the breath is initiated by the patient or the machine. In SIMV, it synchronizes to the patients breathing and in CPAP it is used in weaning the patient. My duty hours went well you wont notice how time clicks so fast if you are doing a lot of things at a time. Even if I ended late, it felt alright to me because I was given the chance to endorse to the next shift about my patients status. It felt good if you

know your patient very well and what exactly happened during your shift and you relay the information to the next nurse who would handle your patient. It needs not only the knowledge and skills in working as a nurse but also the passion and the attitude in dealing with your work. I know that being a nurse is very tough and I realized that right from the moment I started my training. I was able to compare the life of being just a student and now a registered nurse having the training; well it is really far different right now. This time it means real business and you have to be serious in dealing your patients you need to have the presence of mind and to focus yourself into your work not to float away thinking about your off or the things you would do after your work in order for you to lessen errors and to deliver the care for patients efficiently.