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AMA

I'm an intensive care nurse AMA

47 replies

tigertoast · 28/07/2018 16:37

As the title says ....

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brizzledrizzle · 28/07/2018 21:26

What happens when a person is admitted?

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AdventuresRUs · 28/07/2018 21:28

Are people usually unconscious in itu?

Im still curious as I woke up there after giving birth and cried lots for my baby. I also tried to walk to my baby!! (I couldnt move at all apart from being attached to 100 leads and things!)

I still get flashbacks as it was such a scary period. And i was only there one night - is that common?

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SlowlyShrinking · 28/07/2018 21:32

What other nursing jobs have you had?
Would you recommend a & e nursing?
Are your patients usually unconscious?
Can relatives visit at any time?
How many patients does each nurse have?
Quite a few there, sorry

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tigertoast · 28/07/2018 21:47

I'd say 65-70% of patients are unconscious, we don't like to keep anyone sedated for longer than we have to. It's better for recovery the less time you're artificially asleep.

@AdventuresRUs it's fairly common for people particularly post op to just visit us for a night or 2, usually just so we can keep an eye on your blood pressure or kidney function. Unfortunately you're not alone in feeling scared by it all, in my trust we have a debrief with patients once they are well and they can ask all the questions they want about their care. Most say it's very helpful.

@SlowlyShrinking I've mostly worked as a medical nurse on medical wards before ITU, I personally wouldn't want to work in a&e, that's because of understaffing a severe pressures. I admire those who do very much but I'm more of a neat freak who likes things tidy and in control. Which is why I love my job.
We have flexible visiting, depending on the sickness of the patient etc. Most of the time we are happy for relatives to stay but if someone is very sick it's sometimes tricky as we need to get to them constantly.

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Armchairanarchist · 29/07/2018 13:37

I've been in ICU twice. I was on a ventilator both times. I have no memories of the first time until after I moved into HDU. DH didn't let our children see me in there that time. The second time once I came off the ventilator DH brought the children into ICU. Do you think children (then aged 10 and 13) should be allowed in? I must say the nurse at my bedside was amazing gently explain everything.

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tigertoast · 29/07/2018 15:12

@Armchairanarchist I think it depends on the situation. It's quite distressing to see a loved one on a ventilator so we usually advise to wait until the patient is off the ventilator before allowing children in.
The other thing we think about is what other patients we have on the unit at the time, most ITUs are open plan and sometimes there are very sick people that relatives will walk past to get to you.

I think at that age if things are explained and the children want to visit then it's ok, I personally take great care in talking to any relative but particularly children.

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Armchairanarchist · 31/07/2018 18:39

She was amazing and made such a difference. There were four beds. She ushered the children to my bed and told them the other patients were asleep (and that the tube helped them breath.) DC are used to hospitals and lots of tubes and wires after my long stays in HDU. It was probably more difficult for our 22 year old DS because he knew the seriousness of the situation both times.

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Treasure114 · 31/07/2018 19:13

Do lots of your patients die? What's it like when someone dies? Have you got any "woo" stories? My friend who worked in a hospice would say she'd see the soul leaving the body!

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tigertoast · 01/08/2018 20:22

@Armchairanarchist I'm pleased to hear you had a positive experience.
Hope you manage to stay out of hospital now.

@Treasure114 unfortunately in this area we do have a slightly higher mortality rate than other areas in the hospital.
Patients pass away for different reasons, sometimes they're too sick and we can't fix them in time, others we've done all we can and there's no hope for recovery so we withdraw treatment and make them comfortable.
Not sure I have any 'woo' stories, sometimes you get the odd groan out of someone when you move them to wash them after they have passed. It's just gas leaving the body but has made me jump a few times.

There was a story I heard about a patient who'd passed away, the family came to see them and apparently they sat bolt upright in bed, leaving everyone very shocked, it's called the Lazarus effect, essentially there is a muscle spasm which causes a persons arms or torso to contract after death. I think I would have soiled myself seeing that. Incredibly rare I might add.

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Treasure114 · 01/08/2018 20:23

OMG never heard of that before!! I would definitely faint!

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ThomasRichard · 01/08/2018 20:32

I was in ICU for a night as I’d just had an op and the HDU was full. It was amazing. 1:1 care, someone helping me to raise the head of the bed just a bit to lower the risk to my lungs, someone else reminding me to breathe when I was out of it on pain meds and kept stopping. I was in a lot of pain but felt very safe. I did wonder afterwards though whether the ICU staff were a bit narked at having to spend their time and resources on someone who could have been in HDU rather than a proper ICU patient. What do you think?

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tigertoast · 01/08/2018 20:37

@ThomasRichard this happens a lot! I personally have no problem with it, unless of course they are using our last bed, then I get a bit twitched in case someone who really needs us come in.
I find it quite nice to chat to HDU patients and learn about them. It's quite rewarding making sure someone is comfortable and pain free after a large op, most people are very scared when they arrive and it's nice to calm them down.

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Sharptic · 01/08/2018 21:36

I've visited ITU regularly as a radiographer. I always think how calm, controlled and friendly the nurses are there. I also worry about their backs with all the manual handling required.

What kind of advanced clinical skills do need to learn as an ITU nurse, do you have much autonomy? Is is a lot more emotional than other nurse disciplines?

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ThomasRichard · 01/08/2018 22:11

Oh that’s good. I wasn’t very chatty but I did breathe on demand!

What’s your favourite procedure?

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Canshopwillshop · 01/08/2018 22:24

My sister spent time in ICU before she died from sepsis. Towards the end the nurse kept wanting to turn down her oxygen right down which would have hastened the end but would have made it so much more uncomfortable for her. Is this normal practice?

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tigertoast · 02/08/2018 08:43

@Sharptic it definitely is a lot more manual handling than other areas!

You don't necessarily need any extra skills to get a job in ITU, a few years acute experience is a must and preferably some experience in a high care area. The rest is learnt on the job, we use a lot of equipment like ventilators and filters that you just don't get exposed to elsewhere in the hospital. After a year or so working in ITU most places will offer a Cristal care course linked with a university. There is zero point in doing it before you've experienced ITU for a while as you wouldn't understand the terminology etc.

Once you're more settled there is a fair bit of autonomy, you have a patient that is solely your responsibility and you can adjust meds and Oxygen, tinker with settings on the ventilator or filter in line with the plan the doctors have made.

I find it more emotional than other jobs as I'm so invested in a single patient for potentially a long time. And I see more sadness too.

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tigertoast · 02/08/2018 08:44

@ThomasRichard favourite thing is waking someone up and taking the breathing tube out and hearing them speak for the first time. A lot of patients arrive unconscious and you have no idea what they sound like. It's always a surprise when they have a different accent to what you imagined.

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tigertoast · 02/08/2018 08:50

@Canshopwillshop first of all, very sorry for your loss 💐
It's difficult for me to say without knowing a lot more about her condition and clinical state.
There's a common misconception that oxygen therapy cures breathlessness, in some cases it does but mostly breathlessness is caused by high carbon dioxide levels.
If a patient is palliative and we've done all we can but sadly that patient will not survive it is common to withdraw treatment, be it medication to help blood pressure or removing the ventilator. It's varies massively depending on the patient and the circumstances around there care.

I think if you feel there was any foul play there that you should contact your local PALS service who would help you get a debrief with some of the team involved in her care.

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weebarra · 02/08/2018 08:55

I just wanted to say thank you! My DS2 spent 5 days in PICU as a baby and my sister spent time in there too. So much kind and gentle care from the nurses at a worrying time.

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SleepingStandingUp · 02/08/2018 09:56

I have no questions but my baby spent a lot of time in NICU and PICU, IC nurses are amazing, just wanted to remind you that. Thank you x

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Canshopwillshop · 02/08/2018 10:30

@tigertoast - thank you. I’m sure the nurse was just doing what she thought was right and I don’t think there was any foul play. It was 5 years ago now anyway.
One last thing I’d like to ask but not sure if you’ll be able to answer. Although my sister was heavily sedated/unconscious I worry that we had conversations with the nurses by her bedside about how long she had left etc. I hate to think that she could hear us and knew what was happening to her and that she was frightened. Any thoughts? Thank you so much.

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tigertoast · 02/08/2018 15:48

Thank you @weebarra and @SleepingStandingUp that's kind of you.

@Canshopwillshop we always get asked if sedated patients can hear us. Or those who've suffered brain damage. The honest answer is we don't really know.

I imagine that if they could hear it would be difficult to understand with all the other noise and distractions around.

A lot of patients that I've met who've come back for a visit say that they had weird dreams or disjointed memories of being sedated, none of them said they felt scared or understood what was happening while asleep.

Not sure if I've answered you well there but hope it helps.

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Canshopwillshop · 02/08/2018 18:34

@tigertoast - that is really helpful, thank you and thanks for the amazing job you do.

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Dapplegrey · 02/08/2018 18:41

The treatment I received after a 4 1/2 hour operation was so amazing that I felt utterly humbled and if I were to stand here saying thank you all day every day for a week it still wouldn't express my gratitude.
One question:
I had to have a tube pushed up my nose and down my throat. I hated having it done and had to use every bit of self control not to panic.
Is that normal? I mean, do patients always hate having that done?

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tigertoast · 02/08/2018 19:02

That's good then @Canshopwillshop and thank you.

@Dapplegrey thank you! I think you're describing an NG tube which is a nasty thing to have done. Yes everyone absolutely hates it. Including the person shoving it up there! Best thing to do is try and swallow it down. Absolutely hideous though, I agree.

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