Amazing cheat sheet guide for your ICU nursing placement

by | May 9, 2019 | Australian Nursing Blog, Graduates & Students, Intensive Care Nursing | 0 comments

icu nursing placement

How to ace an ICU nursing placement

The following will cover

  • What to expect and some general must know tips
  • Haemodynamic Monitoring and common equipment
  • Common medications and pharmacology
  • Common conditions
  • Other things to read up on
Interviews with ICU nurses & educators
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We asked the Australian nurses and nursing students in The Nurse Break’s facebook group, what their tips were for an ICU placement. 

Some other articles you will enjoy

Some general tips

It’s normal to feel worried and scared. Knowing your luck, you’ve probably only done aged care and community placements or an acute ward which wasn’t very acute. And you are probably feeling like you know nothing. Well firstly, you do know things and secondly, you’ve come to the right place to guide you in the right direction. You are a student and are not meant to feel in control at all times. The nurses in speciality areas do not expect you to know everything.

Develop knowledge of normal anatomy and what happens when it becomes abnormal. Study your basics of anatomy and physiology, refresh the concepts. Go watch Khan Academy on Youtube and Google Quizlet on certain areas (ie: quizlet, cardiac system nursing flashcards) as these resources are filled with free teaching.

Progress Notes. Practice thorough and contemporaneous progress notes as you’ll be with the one or two patients for the whole shift.

Bring a Stethoscope. We are nurses, they are not there for show. Use it constantly. Listen to everyone’s lungs and bowels and hearts. Go read up on different heart sounds, lung sounds and what they mean, could suggest. Check out this link to learn and hear all about lung and heart sounds

Ask Questions. The nurses and doctors are normally always willing to answer questions. Just pick the timing…write things down that you don’t know!

Equipment / Monitoring

When patients become really sick, we need to monitor thier cardiovascular system using more indepth methods. We can use both non-invasive and invasive methods to do what is called haemodynamic monitoring.

Non-Invasive Examples

  • Blood Pressure using manual/automatic cuffs
  • ECG’s
  • Temperatures (surface)
  • End Tidal CO2 monitoring
  • Pulse Oximetry
  • Urine Output

Invasive Monitoring Examples

  • A nurse or doctor may insert an arterial or central catheter.
  • They give continuous and accurate blood pressure measurement
  • Allows adjustments of treatments and medications more appropriately
  • Allows regular blood samples to be taken

Arterial Line (Invasive)

An arterial line is a cannula placed into an artery so that the actual pressure in the artery can be measured. This provides continuous measurement of the patients blood pressure. This includes Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP). It may be inserted in different places such as the radial, femoral brachial or pedal artery. The MAP is normally maintained above 70mmHg in order to maintain adequate renal and cerebral perfusion.

Central Venous Catheter, CVC (Invasive)

Check out Ausmed’s article on CVC’s. Email hello@thenursebreak.org if link broken.

Swan Gants Catheter / Pulmonary Artery Catheter

A 110cm long balloon-tipped catheter that is inserted via a large central vein and floated through the right atrium, right ventricle and into the pulmonary artery. It is used to obtain haemodynamic measurements which together with clinical observations indicate how efficiently the heart is functioning.

CRRT

Continuous Renal Replacement Therapy is a special type of dialysis that is done for unstable patients in the ICU whose bodies cannot tolerate regular dialysis. Instead of doing it over four hours, CRRT is done 24 hours a day to slowly and continuously clean out the waste products and fluid from the patient.

Read this document for more on CRRT

LUCAS

An automotive machine that is used to deliver CPR via continuous chest compressions. Indicated for prolonged arrests (e.g. asystolic arrest or PEA), it delivers high-quality compressions and free’s up staff for other resuscitation activities. Check this video out

Fun Fact FYI: Pulseless electrical activity, or PEA, is a occurrence during arrest situations. In PEA, the monitor will show electrical activity in the heart/on the monitor but the patient will have no palpable pulse. Check this out

EVD

An External Ventricular Drain circuit that allows the drainage of cerebral spinal fluid from the cerebral ventricles to an external closed system. EVD monitors intracranial pressures, cerebral perfusion pressures, and under extreme caution, CSF sampling can also be obtained.

An EVD may be used (From RCH Guidelines):

  • In cases of Hydrocephalus 
  • Following surgery, particularly tumour surgery, until the CSF circulation is re-established
  • To enable drainage of infected CSF (e.g. meningitis)
  • In patients with a severe head injury to provide both a means of measuring ICP and allowing CSF drainage to treat raised ICP

Intracranial pressure (ICP) monitoring

A temporary device allowing measurement and recording of intracranial pressure.

ICP monitoring may be used in patients with (from RCH guidelines):

  • Severe traumatic brain injury
  • Complex hydrocephalus
  • BIH (Benign intracranial hypertension)
  • Patients who may need an objective 48hours of monitoring of their ICP to help clarify symptoms or the significance of scan findings

Tracheostomy

Or “trach” (say “trayk”) tube. This is a breathing tube that goes directly into the windpipe. One indication is when a person needs to be on a ventilator for a long time. It also helps remove mucus and fluid from the lungs. Check out this link for more. Or this link also has great content.

Non Invasive Ventilation

Non-invasive respiratory support is a means of providing ventilatory support to children with either upper airway obstruction or respiratory failure.  Respiratory failure constitutes either failure of ventilation or failure of lung function.
Non-invasive respiratory support encompasses CPAP and Continuous Bi-level Positive Airway Pressure (BPAP).

Check out LITFL link

Check out this RCH Link

Some Common Medications

GO here for our MUST READ article on pharmacology resources for students and nurses.

Adrenaline

Patho: Adrenaline stimulates receptors within the sympathetic nervous system resulting in increased myocardial contraction (positive inotrope), increased heart rate (positive chronotrope), increased systemic vascular resistance and relaxation bronchial smooth muscle.

Used for:  increasing cardiac output and heart rate, mean arterial blood pressure and coronary blood flow. Additional indications are cardiac arrest, anaphylaxis, bronchospasm and at times as a local vasoconstrictor for bleeding wounds.

Noradrenaline

Patho: Noradrenaline is a sympathomimetic vasoconstrictor, causing increased vascular resistance, therefore, increasing blood pressure.

Used for:  increasing blood pressure in acute, severe, hypotensive states when low systemic vascular resistance persists despite adequate fluid resuscitation- a common example is a septic shock.

Vasopressin

Patho: Vasopressin is a hormone secreted by the pituitary gland that acts as a vasopressor. Vasopressin cause peripheral vasoconstriction increased systemic vascular resistance and increased blood pressure, as well as an antidiuretic effect in the kidneys by promoting water reabsorption.

Used for: To increase blood pressure in refractory vasodilatory shock when low systemic vascular resistance persists despite adequate fluid resuscitation. Usually, the introduction of vasopressin is delayed until the patient’s noradrenaline requirement is greater than 20 to 30microg/min.

Glyceryl trinitrate (GTN)

GTN is used for venous vasodilation, decreasing venous return to the heart, reducing pre-load and therefore relieving a failing heart. It increases coronary perfusion and is often used for hypertension, angina, heart failure and to prevent vasospasm after CABG – coronary artery bypass surgery.

Metaraminol

Metaraminol is a vasoconstrictor that causes peripheral vasoconstriction, therefore increasing blood pressure. Metaraminol is the vasoconstrictor of choice for the short-term management of acute hypotension and can be administered by a peripheral IV cannula. If low blood pressure persists despite adequate fluid resuscitation, it is usual practice to switch to a noradrenaline infusion once central access is available.

Amiodarone

Amiodarone is a potent class III antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. The drug is used in compromising tachyarrhythmias (atria, supraventricular or ventricular) including a cardiac arrest for VF or pulseless VT. 

Propofol

A rapid short-acting intravenous anaesthetic that results in a decreased level of consciousness and a lack of memory for events.

It is rapidly distributed into the subcutaneous tissue, and patients who have recreational drug use or frequent alcohol consumption may require higher dosing of sedation.  It is used for induction and maintenance of general anaesthesia.

Midazolam

A short-acting benzodiazepine, which induces sedation and hypnosis and amnesia. It has no analgesic properties.

IV dosing is used as an agent for conscious sedation before short surgery or endoscopic procedures, induction of anaesthesia and for prolonged sedation in ICU.

Atropine

Atropine increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart. It is also used to reduce salivation and bronchial secretions before surgery or as an antidote for overdose of cholinergic drugs or mushroom poisoning.

Adenosine

When given as a rapid IV bolus, adenosine slows cardiac conduction particularly affecting conduction through the AV node. The rapid bolus of adenosine also interrupts reentry (SVT causing) pathways through the AV node and restores sinus rhythm in patients with SVT. When clinically advisable, appropriate vagal manoeuvres (Valsalva manoeuvre), should be attempted before adenosine administration.

For some great information on other medications you might see in ICU CHECK OUT HERE

Common conditions

Check out this link

Other things to read up on

  • Patient systematic assessments – head to toe. This is a great time to work on your patient assessment skills A-G and practicing the documentation. As you are 1:1 1:2 with a patient, you will have soo much time to consolidate your indepth knowledge of the patient. 
  • Don’t get distracted by all the bells and whistles
  • Do all necessary checks of equipment on start of shift.
  • Ask lots of questions. I mean LOTS.
  • Basic patient care (PAC, eye/mouth care, toileting)
  • Re-cap your drug calculations
  • Trachy and NG Tube care
  • Read up on ABG basics and how abnormal results affect patients (ie: metabolic & respiratory acidosis/alkalosis). Here is ABG Ninja –> a website with ABG quiz questions!
  • Refresh normal and abnormal lab results/values
  • ECG interpretation
  • Delerium and it’s management
  • Invasive vs Non-invasive monitoring and ventilation
  • Respiratory Concepts like PEEP, CPAP, Pressure Support

Having a basic understanding of the above, will allow you to hit your placement running and have a better understanding of what you will see and experience.

A remember, to have fun, smile, laugh, relaxed and down to earth. Easy said than done, we get it.

NOW: have a read from those nurses working in ICU! Here is our ICU blog archive including articles on both paediatrics and adult ICU.

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