On October 6th, I had the opportunity to spend my clinical day in the MICU, rather than on the floor on 8 South. I arrived in the MICU at seven and stayed until eleven-thirty. I was greeted by the night shift charge nurse who introduced me to the nurse I was to follow. I met my nurse, Katrina, when shift change occurred at seven-thirty. Katrina has worked in the MICU for the last eight years. She was very welcoming and excited to have a student. She was assigned two patients, and we listened to report from the night shift nurse. The role of an RN in the MICU setting is different than what I have observed on a general floor such as 8 South. One difference is the patient to staff ratio and the absence of nurse aids or techs. The MICU is full …show more content…
Katrina says the most important piece of this collaboration is having clear communication. When things are not communicated in the appropriate manner or with appropriate timing, it makes her job more stressful and more difficult. She works most often with physicians, wound care, the surgical team, the respiratory team, and palliative care. Clear communication is especially essential when the patient is admitted to or moved from the MICU. Collaboration between nurses was evident as they were extremely willing to ask each other questions and for help. Katrina and I helped with even basic care such as turning and changing a patient. These nurses truly are a team and they rely on each other to provide exceptional patient care. There were no family members present during my time in the MICU; however, Katrina communicated therapeutically with our patient throughout the day. This was especially important when he was talking about the struggles our patient had after he was unable to work after her got sick. It was difficult to step back as he was very active in construction working before his diagnosis of COPD. Katrina listened and validated his struggles and …show more content…
COPD impairs gas exchange due to chronic inflammation in the airways as well and over inflation of the lungs. He is chronically hypercapnic, and this diagnosis is related to his current and past history of smoking. When I met the patient, he was very stable and was waiting to be moved to the ward. However, he was certainly in critical condition just days before. He was brought to the ER on 10/1 by his sister after he could not breathe despite rest and the use of his rescue inhaler (Albuterol). While the patient was being monitored, he went into pulseless electrical activity. His heat was signaling to beat without any mechanical contraction. CPR was initiated and he was intubated with and endotracheal tube. He stabilized and the ET tube was later removed. The patient was experiencing chest pain at about a 2 related to the chest compressions when I assessed him. He did have some slight bruising around the sternum. Hemodynamic monitoring for this patient included continual pulse oximetry monitoring, blood pressure checks every hour, and ABGs checked twice a day. Maintaining a patent airway is essential for this patient due to his recent exacerbation as well as coarse lung sounds throughout. He was on 4 L O2 nasal cannula during the day, and he uses a Bipap at 6 L when he goes to sleep. The bipap is set to make him take at least 16 breaths a minute,