Not The First Time but My First Reality in ICU

As a nurse, we have different fields to choose from and we have an option which department we're comfortable to work with. You can choose Emergency Department, Intensive Care Unit, Ward, Operating Room, these were only the most common areas I will mention but too many to mention.

Sometimes we choose an area that we like but regret it afterward. In each area, the struggle is real but backing out is not an option. It is always difficult at first but in the end, if you were shaped and mold with so many experiences, hard work will be worth it.

For new nurses, it is an exciting phase of our lives where we can choose or either we will be assigned to a special area. We felt very ecstatic on how it feels being there. Others may feel that it is not their chosen area, but all I can say is, we all experienced that. Just think of how you will be taught where you were assigned now. All knowledge and skills will not be acquired only in one area. It is still a ladder in becoming a competent one. Ups and downs are our partners.

Even if we have a long time experience, we will always meet something new. As a Nurse that specializes in Critical Care, I think it is one of the most challenging areas one could be assigned. It is the end stage of patient care if I may call it. Hundreds to thousands of things you need to consider when handling critically ill patients. This is the point where I can say that nursing is really a "calling".

Knowledge, skills, and attitude are your topmost armor. Everything is critical, you need to think fast and your best judgment is important especially in the matters affecting your patient. 

At first, everything is new. It seems like your mind is floating everywhere how to handle such equipment.

Code blue will be your best friend. :D when we are new in this field, it feels like we're the one needed a shock at 200joules. :)) kidding aside, reviving a patient is very satisfying when you see him coming back. Having your friends in the unit during a code blue, even if everything in your room was a mess, it is totally okay. 

Unlimited patient's bowel motion, every positioning comes with great responsibility. We are a self-proclaimed superhero. :))

Morning care, afternoon care or any care you may call it, "call a friend" is our favorite tag line. ICU life is difficult if you will work all by yourself. It is always a team. 

For others, first thing in the morning, checking an allocation is not about the patient's acuity, it is about who will be your team in your station. :))

Always ask if you don't know something, it is always the life of our patient.

For nurses who will about to embark on their chosen area, don't be afraid. There is always a time to learn everything. Start your journey, it might be a bumpy one, but still you will be proud of yourself after all.  You may cry and about to give up, just stay strong, it is part of learning process and you are not alone. "Been there, done that".  

So this is my chosen journey. 

Thanks for reading.:D

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When the Nurse became the patient

Being a nurse has complexities to consider. Lots of challenges to encounter, be it mentally or physically. It is not just about taking care of our patients but also taking care of ourselves. 

From the toxicities of our patients to not being able to notice that you did not eaten your meal or haven't gone to comfort room just to pee.

A nurse has a lot in his/her mind going on, since time is very essential. We have goals to meet at the end of the shift. 

When i had my dose as a patient, realizations sink in. Hard work is vital but your vital signs were also important. :D

To my colleagues to the other side of the world, don't forget to place your health at the top of your priority.

Proper meals, vitamins and adequate sleep should be our goal. For 12 hours shift, at least a target of 7 hours sleep is already nutritious for our soul to get us going.

Healthy diet leads to healthy body. At least no instant meals. Most of the nurses has no time for cooking, but at least plan ahead what to cook even an easy meal.

Lots of sleep on your rest day is the best.

Increase fluid intake, advisable not just for your patients.

Take time to value exercise. 

Just a friendly reminder from a nurse on the other side of the world. :D

What is fasciotomy?

Working in a Critical Care setting, I had the privilege to handle a patient with a case of lower leg swelling. The patient had a crushing injury to his left lower leg.

Fasciotomy is a limb-saving procedure to be done for compartment syndrome. Compartment syndrome usually develops when one of the veins or muscle has an insufficient blood supply. This condition usually associated with numbness and swelling of the affected site since circulation was impeded. Other indications of this procedure are for those who were obese and with severe burns.

The next picture is a case of a severe burn. In severe burn injury, there is an increase in vascular permeability, increased interstitial osmotic pressure and cellular edema. Due to fluid shifting, there are translocations in the distribution of water and solute. In order to prevent compartment syndrome, fasciotomy is the best procedure to be done.

I had the chance to assist with the procedure at bedside since it was an emergency procedure. This procedure is usually done by a Vascular Surgeons. I was astonished as of how the procedure was done.

If not done as soon as possible, impede blood circulation, will cause amputation of the affected leg. This is done to relieve pressure to the patient's leg with severe swelling. More often than not, a patient with compartment syndrome, the affected site has greater than 2 seconds capillary refill and nail-beds appears dusky or cyanotic.

As a Nurse, we have duties and responsibilities for cases like this.

Monitor vital signs to include Blood pressure, respiration, pulse rate and oxygen saturation.

Sterility is our utmost priority when assisting the procedure and dressing.Monitoring of patient's coagulation profile.
Monitor signs of bleeding to the operative site.

Measurement of the post fasciotomy site should be done daily, once swelling improved, sutures will be tightened little by little.

Hope I have given you some input.  Feel free to comment below for additional ideas.

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