Sweet. We made it through
the first 24 hours. Now,
for 48 hours plus after alteplase, this
is the goals we're going to look
for Mr. Johnson's care.
Good news. Mr. Johnson's blood
pressures remain consistently
140/50 mm Hg systolic and
90/98 mm Hg diastolic.
Sweet. His facial drooping has resolved.
That is awesome. I told
you this drug is really beautiful when
it works. He's still got some
right-sided weakness of his arm
and leg, but we're seeing some
improvement, so that's pretty exciting.
Shortly after he came to ICU, he
spontaneously converted from
to sinus rhythm/ sinus tachycardia,
and he's now in sinus rhythm. Man,
Mr. Johnson, you're like a rock star
patient that we got going on there.
His blood pressure is good.
His facial drooping is resolved. He still
has some right-sided weakness,
but we can work with that. That's some
physical therapy. We can get on top of that.
After he came into ICU, he went from atrial
fibrillation -- remember, that's a -- That's
the atrium that kind of quivers and
isn't really efficient at completely contracting
and pushing all that blood out.
People in atrial fib are at
an increased risk for a clot
to break loose from that atrium, and
to travel through to the brain,
which is likely what happened with Mr.
Johnson. So, now that he's out of that
rhythm, he spontaneously
converted to sinus rhythm.
And that's the pretty rhythm, right?
That's the normal rhythm.
The only difference between sinus
rhythm and sinus tach is the rate.
So you've got a beautiful P wave,
QRS, just sinus rhythm. It's < 100,
sinus tach is > 100. Now he's in
sinus rhythm. So I'm telling you,
So I'm telling you, I wish everybody's
stay went this way.
So the healthcare provider has written
transfer orders for the Med-Surg unit.
He is ready to go. Now before
we move forward,
think about why did Mr. Johnson have
to come to ICU in the first place?
Yeah, he needed very close monitoring
for complications from the stroke
or from the thrombolytic therapy. So we're
watching his blood pressures, neuro status
very closely. Now, what things make him
eligible or stable enough to go to Med-Surg?
Everything we just talked about here.
His blood pressure is stable,
his neuro status is better,
and he's not showing us signs of
deteriorating, and now he's
now in a normal heart rhythm. So it's very
appropriate for the healthcare provider
to write orders to transfer to
Med-Surg. See, that's another
part of our role as an ICU nurse
is to help identify patients that are
ready to safely be transferred and
patients that need to stay.
That's another example of when you would
use SBAR. When you're communicating with a
physician about the patient's need to
stay on the unit for further monitoring
or to be transferred to a -- we call it a
lower-level care, but it's really a different
level of care, because every level of care
is an area of specialty. So now
your job is to practice in SBAR.
You, from the role of the ICU nurse, wants
you to get prepared to give report in an
SBAR format for the Med-Surg nurse.
So, pause the video,
you can use our script to help remind
you of the things that go with
situation, background, assessment,
And then we'll come back and I'll give you
an example of what you could have said
in your SBAR.
Welcome back. Okay, I hope you took
advantage of this opportunity because
by you doing the hard work now,
you're going to be that much
better and effective as a nurse communicator
in your own practice. Now,
we've provided for you an example, an idea
of what you could have said in your SBAR.
Take our example and compare your
answers to what you see on the screen.
This will give you an idea of things that
you could have said as a nurse
in preparing to give report and
pursuing continuity of care
with the next level in Med-Surg.