I previously have [nearly] hated the teacher who was our clinical instructor. She was pretty alright this go around, I must admit. By the way...her last name starts with an 'A.' I think it is hilarious that the class sometimes calls her MRSA. (Mrs. A. MRSA is methicillin resistant staphylococcus aureus. A really bad infection causing bug. HA.) Now to see how she graded us last week.
I worked at a different hospital for this clinical and they have a really good team in ICU.
If you've never been to an ICU before, many are set up like this. Private rooms, secluded by sliding glass doors and/or curtains, with a dedicated table in front of each room for charting and for nurse perching.
My clinical experiences were with a woman who was heaven-bound in the throes of Septic Shock, who was very low on the Glasgow Coma Scale, a woman in CVICU post Femoral-Popliteal graft surgery, and a woman who let bronchitis/sinusitis go too long and ended up very dehydrated which caused Acute Renal Failure.
Thank god this very educated, prim and proper mother started hallucinating and talking about crazy stuff, or her kids may never have made her go to the hospital.
Lets see...what all did I see....
When you're dying of Septic Shock, you may third-space all of your fluids. That means fluids aren't in the veins (vascular space) and your kidneys no longer work (organ failure), so you're not peeing it out. So it seeps into your tissues until it weeps out of the skin or splits the skin. I was glad she was unconscious and had plenty of morphine ordered.
Fem-Pop graft surgery may change your life. If you have intermittent claudication (pain from lack of oxygen getting to your extremities) ask your doc about this surgery. My patient who had this was really doing well only 1 day post op.
Dehydration is serious. SERIOUS. Please don't kill your kidneys with infection and too little water, thanks.
If you do hurt your kidneys, I'll be forced to give you Sodium Bicarbonate. Heh, that's the same stuff as Arm and Hammer, you say. Yes, you're right, but putting that in a vein IV is pretty darn painful. The sodium bicarb is to help you not be acidic while your kidneys are unable to do that for you.
Not my patient, but saw a woman decompensate before my eyes. That was full blown Metabolic Acidosis, and she had no blood pressure. Pretty exciting. Everything was just like they taught us in class. Rapid, deep breathing (Kussmaul breathing) to blow off all the carbonic acid from the acidosis. We put her on her head (in bed, head lower than feet, "Trendelenburg" position) to try and get blood perfusion to her brain. She had a non-rebreather at 100% oxygen, and as they said, she kept trying to pull it off, saying she was smothering. We had to keep trying to tell her that she MUST keep the oxygen mask on.
The nurses got her going again, after the Hospitalist came down and ordered a couple of code-type drugs to be pushed. Except she wasn't in a code yet, so there were some questions. And then there was the almost-mishap in which the nurse pushed the med but did not flush the line after putting the med in the line...So the patient did not get better right away. Thank god she had fluids going and the fluids eventually flushed the medicine from the line and into her body.
It just goes to show how crazy things can get when a patient is circling the drain.
Oh, also, if you insert a PICC line into a patient, and the tip should be in an Atrium, and it ends up too far in, in a ventricle, you'll have a patient in V-Tach...one very small step away from getting a shock to fix the heart. 7 x-rays later and a pull-back on that line TWICE, the guy's heart quit with all the irritability and beat normally. Yay!
Also, when your mom was almost dying, treat your nurse with respect, you high-and-mighty-investment-banker types. You never know...your nurse may have been one, too.
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