Tuesday, November 1, 2011

Critical hit

I have my permanent placement! I am now a staff nurse in the critical care stepdown unit. I've had a few shifts there already, and so far, it's a blast.

On this unit I have only two or three patients at a time, instead of the six on the pulmonary floor, but I'm still exactly as busy. It's just a different kind of busy. The patients are more acutely ill here, so they need closer monitoring, and their care usually has more complex technical requirements.

For instance. One of my patients today had an arterial line hooked up to a transducer for constant monitoring of her blood pressure. She needed that because she had been admitted for hypertensive crisis-- a blood pressure of 230/118 (which can be described as scary high). We were giving her a constant infusion of nitroglycerin to lower that pressure, but dropping it too quickly could interrupt blood flow to the brain, which would be a bad thing. So every N minutes I had to check the trend line of her BP measurements, and titrate the infusion rate slightly up or down to keep her pressure in the target range ordered by her physician. Similarly I had to titrate another drip based on heart rate to keep her cardiac output up, and a third based on blood coagulation tests to prevent stroke. That's not to mention diuretics to remove excess fluid, an hourly tally of urine output, electrolyte runs to counter a side effect of the diuretic, and the obligatory O2 cannula and monitoring of her oxygen saturation. Et so forth and cetera.

And my patient in the next room had his own set of completely different issues.

Overall it was a very busy day, but I think it's a kind of busy that suits me well. I'm picking up the technical skills really quickly. Once I figure out exactly how the policies and schedules differ, and modify the timing habits I developed on med/surg, I think I'll have a really good handle on the job.

Oh, and about that skills assessment I had to do a little while back? The one all new grads are expected to fail? I aced that sucker. Go me.

1 comment:

  1. You're such an over-achiever!

    Actually, I'm proud to say I know you and I know you're going to make the best nurse there could ever be. Go, you!