Here we are. Mr. Johnson has arrived
with the ER nurse, that's
the nurse represented here in the black
scrubs. Now we've got
the ICU nurse who that's the role
that I want you to see yourself
in, in this part of the case study.
So, our priorities.
Let's talk about what do you do when you're
an ICU nurse and you receive a patient
from ER? Well, one of the first things you
want to do is make sure you safely transfer
Mr. Johnson from the TEC, the
gurney and their monitors to
the intensive care unit bed
and your monitors. So, you can transfer it
from the gurney to your bed and get
them on the monitors. Now, this is one
of my favorite parts of teamwork
of working in critical care, and that's
where I hung out mostly.
That you have, when a new admit comes in,
when you work with a good team,
people descend, and everyone will
help you get Mr. Johnson
safely settled on the monitor, transfer his
oxygen over, and get him all set up.
Now, you're still prioritizing A, B, and C.
So, you want to make sure that you get
a set of vitals on him, you're noting his
cardiac rhythm, and you're looking
at his blood pressure.
Most critical care nurses can just look at
the monitor and see what the rhythm is.
But eventually, you'll print out a strip
or look at it in the electronic
record and measure things to make
sure you have a clear picture of
exactly what the rhythm is. Now, the
concept here that's most important
is continuity of care.
Right now, the professional who knows
the most about Mr. Johnson is the
ER nurse. So it's the ER nurse's job
and their role to clearly, concisely
the most important points
of the care that was
provided for Mr. Johnson in ER.
So, the ER nurse will give
the situation, the background, and all the
assessment information, including the
procedures that Mr. Johnson
Remember, he had a CAT scan,
he got thrombolytics,
and this is the time where the ICU
nurse can receive the information,
also see Mr. Johnson, verify any
questions that they have
in a bedside report. So, hopefully, you get
that opportunity with a TEC nurse to do a
a bedside report, verify the neuro assessment,
make sure this looks similar
to what it was when he left ER. Look at
IVs and rates, any of those things,
and discuss are there any of the physician's
orders that have already been completed?
Because when a patient transfers
from 1 unit to the other,
sometimes some of the orders are done
in that unit before they come.
Sometimes they're not. That's
why it takes the 2 nurses
iscussing with each other, so it's very
clear what has been completed,
and what's left to do.
Now, as the ICU nurse, after the
ER nurse has left and you
have exchanged information, you'll do
an initial assessment head to toe.
You look at the healthcare provider's
orders, and you'll start prioritizing
care for this shift. Okay, so, what
were your immediate
nursing priorities? Picture in your
mind Mr. Johnson comes in,
safe transfer to your bed, your
monitors, your oxygen,
making sure he's stable A, B and C.
Ensuring continuity of care by getting
a specific report and asking any
questions that you have with
the ER nurse, verifying
IV rates, etc., then doing your
looking at the healthcare provider orders,
and prioritizing your care for this shift.
Now, I want you to know that the ICU
admit vital signs, just jot these down.
For Mr. Johnson, he still remains in atrial
fib. Now, a lot of times, we just write
that as AFib, and that means
He's got a rate of 108, which really
isn't that bad for atrial fibrillation.
His blood pressure is 172/88.
Whoa, usually, we'd be a little excited
about that, but we're not so concerned,
because we know it's okay to leave
that blood pressure elevated
because he has an ischemic stroke. We'll
talk a little bit more about that later on.
His respirations are 20, that's normal.
His pulse ox is 97%
on 2 liters, nasal cannula. Well, you
know, the order said to
keep it at 94% or above, so we're great
there, and his temperature is 99.9°F.
That's a little bit up, but he's been through
lots of things, so we'll just keep
an eye on that. But make sure you have those
written down. Let me say it 1 more time.
Atrial fib, heart rate of 108,
blood pressure, 172/88, respiration's 20.
Pulse ox, 97% on 2 liters nasal cannula,
and we usually write that as NC.
And his temperature is 99.9°F. Okay.
So you've got those written down.
e're looking at the orders. We're figuring
out what are the top priorities.