Posts

Day 6 – E.R.

BP: 40/20
HR: 20
Temp: 102.2
O2: 50%

WBC: 19.0
Bands: 16%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 22 mg/dL
Cr: 2.4 mg/dL

pH: 7.15
PaCO2: 88 mmHg
PaO2: 20 mmHg
HCO3: 23 mEq/L

Tracheostomy placed
Code called
A/C ventilator setting
RR: 12
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

Pt became unarousable. V-fib was present on the monitor with a HR in the low 20-30s. Pt’s pulses were barely palpable. Skin was cyanotic and cool to the touch. Pt’s BP remained low despite maximum use of vasopressors and fluid resuscitation.

Pt became pulseless and a code blue was called. Chest compressions were immediately initiated. Rhythm assessed every 2 minutes. The code team continued CPR for the next 20 minutes. Patient’s wife at bedside refused tracheostomy and refused further treatment. The physician confirmed the pt’s time of death on 04/03/2015 at 0143. Pt’s family continues at bedside.

 

Final Blog

I can’t believe this is the last homework assignment of my last class of nursing school. It’s so bittersweet to think that we are finally at the end. I’m more than ready to be an RN and start my nursing journey, but on the other hand, it’s so weird to think that I won’t be with the people that I have come to think of as family for the last three years. When we were told at orientation that these three years would go by fast, I didn’t believe it. And even during it, I didn’t really believe it. But now that we’re here, at the end of the road, I realize that, as much that has happened with us, it has sped by. We went from being little babies to the big sibling ready to leave and enter the world. Crazy.

I feel that our knowledge shot up this semester in critical care. We learned a great deal when we started in patho, and we continued learning in pharmacology. I feel like everything since that was based on those initial building blocks. However, this semester was where we really got to put everything into place as it was our pinnacle class. So much of what we learned was based on topics we were already knowledgeable in, and this was so beneficial to us in learning the more complicated aspects of critical care. This semester, to me, I really felt like a nurse as I took care of patients. There was much less reliance on a nurse or clinical instructor as we really took the reigns and pulled out all that we have learned in these past three years.

Additionally, it took me a while to adjust to this blogging aspect. I have run a blog in the past (now that I think about it, I wonder what happened to that blog?), but this is a new format that my previous host. And while I feel like blogging is a lot like writing a discussion board, I do find this more enjoyable than discussion boards. However, on the flip side, I wish that this would have been introduced to us sooner than our last semester. It felt like, at the beginning, we’re trying to adjust to everything that the final semester was throwing at us (graduation, job applications, critical care, NCLEX) while also finishing up our papers for Ireland, and then learning a whole new technological platform was added on top of that. It was stressful at first because of that, and I wish we had more time to work with it. I would’ve loved to have used it to it’s full potential, and I had grand pipe dreams of making this site into a virtual CV, but I didn’t want to spend all the time on it if we weren’t going to get to use it after graduation.

Overall, I think this course utilized greatly diverse learning methods which benefitted us greatly. I enjoyed the lectures with powerpoints, but I also enjoyed watching videos and acting out scenarios. I feel that, when we utilize more than one part of our brains, we really do experience greater learning that will benefit us in the long run.

So here’s the close-out to the last piece of homework. It’s been a great three years, and I’m going to miss everyone. Now, here’s on to the next big journey!

Last Blog of Critical Care Nursing 420

WOW! I can hardly believe that the semester is over, let alone our nursing program coming to a close! I have to say, this semester is truly where everything “clicked”. I always thought I was strong in clinical, but this was the semester that content such as lab values and ventilator settings actually made sense! I felt like I was able to have conversations with the nurses and doctors during rounds about why certain treatments were being given, rather than just listening to their discussion.

 

For all of nursing school, the entire three years of the program, and even before I started nursing school, I always thought that ER was going to be where I wanted to be. In my leadership rotation, I got to see a different side of the MICU and SICU, and critical care nursing fascinated me. I have completely enjoyed every aspect of critical care nursing being able to experience it now in clinical.

 

I feel like all of the previous work that we put in during this program showed during this rotation. Pulling information from pathophysiology, pharmacology, therapeutic comm, and med surg made all the difference. Having that strong background made this semester feel like everything clicked. By the end of the semester, I cant even compare to where we were on our first day of nursing school. I have grown so much and I know it is for the better. I have learned how important it is to stress patient advocacy because when your patient knows you are looking out for them, they make your job easier and more fulfilling. Critical care as a last semester of nursing school couldn’t have been a better experience, or at a better time. WE DID IT!IMG_9107

Leadership Reflection Video

Wednesday Presentations

Construction in Progress

We will soon be migrating our AARR blog to this permanent home.  For now, please see our existing site:

 

https://csuciaarr.wordpress.com

Day 6 – ICU

BP: 40/20
HR: 20
Temp: 102.2
O2: 50%

WBC: 19.0
Bands: 16%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 22 mg/dL
Cr: 2.4 mg/dL

pH: 7.15
PaCO2: 88 mmHg
PaO2: 20 mmHg
HCO3: 23 mEq/L

Tracheostomy placed
Code called
A/C ventilator setting
RR: 12
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

Day 5- ICU

BP: 88/44
HR: 102
Temp: 103
O2: 90%

WBC: 18.0
Bands: 16%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 24 mg/dL
Cr: 2.3 mg/dL

pH: 7.24
PaCO2: 68 mmHg
PaO2: 44 mmHg
HCO3: 20 mEq/L

ET tube 22cm at the lip
A/C ventilator setting
RR: 10
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

Day 3 – ICU

BP: 92/78
HR: 98
Temp: 102
O2: 87%

WBC: 19.0
Bands: 14%
HgB: 13
HCT: 42%
PLT: 350
Glucose: 230 mg/dL
BUN: 22 mg/dL
Cr: 2.4 mg/dL

pH: 7.32
PaCO2: 66 mmHg
PaO2: 47 mmHg
HCO3: 23 mEq/L

ET tube 22cm at the lip
A/C ventilator setting
RR: 12
Peep: 5
VTE: 500
I/E: 1:2
FiO2: 1.0

Ejection Fraction: 25%
Left & Right Sided Heart Failure

Day 1 – E.R.

BP: 100/58
HR: 120
O2: 78%
Temp: 102.4
Resp: 9

WBC: 18.0

Bands: 14%
HgB: 14
HCT: 50%
PLT: 350
Glucose: 250 mg/dL
BUN: 20 mg/dL
Cr: 2.4 mg/dL

pH: 7.30
PaCO2: 68 mmHg
PaO2: 45 mmHg
HCO3: 26 mEq/L

Sputum and blood sample positive with S. pneumoniae