Critical care Nursing Placement

I have just finished my two month Nursing placement in critical care, specifically an intensive recovery unit looking after patients who have had major surgeries.At first I was disappointed with my critical care allocation as I had hoped to be placed in ICU but I ended up really loving this placement and I am even considering applying for a job there one day!

The unit receives patients after major surgeries, mainly cardiac (Valve replacements, bypass grafts, congenital cardiac surgeries),vascular patients (open and endovascular repairs of aortic aneurysms),GI surgery (oesophagectomy, gastrectomy ).The unit has a really fast turnover and the majority of patients are discharged to high dependancy units/wards within 48 hours.

I have learnt many new skills such as blood gas samplings from arterial lines, analysing blood gases, extubating patients, how the ventilators are used and caring for ventilated assessing and evaluating the care for level 2 and 3 patients, setting up syringe and infusion pumps, caring for patients with spinal drains, handing over critical care patients and so much more!I have taken part in unit micro-teaching on cardiac pacing and emergency chest opening simulations.

in terms of cardiac surgery I have learnt about the risks associated with the surgery and cardiopulmonary bypass (a machine which replaces the function of the heart and lungs when the heart is arrested) such as acute lung injury, compromised renal and hepatic function, pulmonary oedema, systemic inflammatory response, reduced ventricular compliance.I have learnt how to identify signs of complications on the unit such as tamponade, surgical emphysema, pneumothorax and how these are then managedI have learnt about managing hypothermia, sedation, analgesia, cardiac pacing, optimising fluid and electrolyte balance post surgery.I also learnt about congenital heart defects such as atrioventricular septal defect and heart failure.

I have learnt about different drugs used on the unit such as inotropes. These are drugs which alter the contractility of the heart e.g Dobutamine or Noradrenaline which causes vasoconstriction, used to raise/maintain blood pressure to maintain perfusion pressure  in hypotensive patients.I have learned about the risks associated with these and  pros and cons.For example Noradrenaline can raise blood pressure to maintain adequate perfusion but it can also cause ischeamia or malperfusion due to vasoconstriction so therefore the right balance must be found.

I have learnt about management of cardiac arrest post surgery and how it is different from advanced life support.on the unit we had emergency chest opening simulations on a mannequin and one time I even got put on the spot, told to scrub up and be the surgeon!Another nurse and I had to open the chest, remove the wires holding the chest together, suction out any blood compressing the heart and then internally shock the patient (mannequin).

I have learnt a bit about GI surgery such as oesophagectomys where part of the oesophagous or all of the oesophagus is removed.This is most commonly done due to carcinoma.I learnt about TPN (Total parenteral nutrition) this is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs.

I really enjoyed he busy, stressfull days on the unit when it was non-stop.I love busy hectic environments.Some days were a bit boring when it was quiet and we were just waiting on ward/HDU beds so patients could be discharged from the unit.But overall I really enjoyed the experience especially the last three weeks when I would be confident to “take” patients Providing them with all the care under the supervision of the nurse.

I received such wonderful feedback from patients and really enjoyed discharging patients and seeing them improve in such a short space of time.I really enjoyed caring for patients.The staff also gave such nice feedback, the ward sister said to come back and work for her!I am actually considering it!

I am really so proud for completing this placement as the first few weeks were really rough.Mentally I was in a pretty awful place with suicidal and self harm thoughts, having breakdowns and panics everyday. Everything seemed hopeless to me and going in and having to be brave was exhausting.But I am so glad to have pulled through and things are on the up now.

After doubting wether or not I made the right degree choice for so long after this placement I know I have.I feel much more passionate about nursing and a lot more hopefull for the future.

peace out,

Ula xxx

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