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Tedious but Rewarding:  The  Journey of an ICU Nurse
                                                        by : Michael Ian Redito, RN

Ever since  I was in college, I told myself…”Someday I’ll be an ICU nurse.”  I got interested in critical care nursing because of the challenges and rewards in taking care of a critically ill patient and how he progresses to be saved from a life threatening situation. It’s also gratifying to care for an end-of-life patient as an opportunity to render palliative care when cure is no longer possible. When I was accepted in Capitol Medical Center I was initially assigned in the ward and transferred to the Medical Intensive Care Unit (MICU) after 6 months.  It was then that my journey started.  A jam packed day at the ICU is when two patients were assigned to me during my tour of duty. One of  them  had severe heart disease CHFIII with sepsis while the other had CVA Bleed, status post hemicraniotomy for the past 3 days with uncontrollable blood pressure and shooting blood sugar yet cognizant and interactive. Both patients are on critical stage where anytime almost all vital systems may shut down. They were hooked to mechanical ventilators to assist their breathing, with feeding tubes to provide nutrition and foley catheters into bladders to monitor their kidney function and measure their urine output. Not to mention as well is a myriad of contraptions or IV lines connected to them regulated by infusion system machines to accurately administer complex medications.  Aside from wall mount continuous patient monitor attached to them, one patient is placed on bedside cardiac defibrillator since he had episodes of ventricular tachycardia, which is a life threatening dysrrhythmia.
          An order from the Pulmonologist of patient who is post OR 3 days ago was to wean him off the ventilator so he could eventually breathe on his own. The basis of weaning him off the ventilator was his good ABG results for the past 3 days of extraction. When I tried to take off the ventilator and shifted to T-piece he became tachycardic, tachypneic and blood oxygen level decreased. His face turned ash and he was increasingly restless. Manual mask valve bagging was done and suctioning was rendered as needed.  I had to pay attention to this patient since airway is the particular problem and was able to get to the other, only when I had the symptoms under control.
I needed to lower his blood pressure had to sedate him as ordered by the Doctor and closely monitor his oxygen levels and blood pressure until he is stable. ABG extraction was done after an hour with fair normal values. When finally patient’s condition stabilized, I then moved to my second patient, with severe blood infection.  I did a quick head to toe assessment. His temperature was quite high, at 38.5oC. I did tepid sponge bath and placed droplight and assessed comfort.   I took samples of his urine, blood and sputum as a standing order for temperature more than 38oC.  Samples were sent to the laboratory for a culture and sensitivity test and updated the resident doctor on what was happening. . I noticed that oxygenation level was border line and that the blood pressure was dropping. I immediately lowered the head of the bed and elevated the lower extremity. Manual BP was taken and it was significantly low. Patient was manifesting symptomatic hypotension hence Inotropic drips were started and titrated accordingly. The patient was on myriad medications, delivered through intravenous line. I noticed his output was not good for the past hour and he seem to be developing lung congestion. A diuretic was given and he responded quite well.
          The whole time I’m with one patient, I also worry about the other, and just hoped that no significant change took place while I’m out of the room. Good thing I have helpful colleagues, ready to assist me all the time. There are alarms connected to the monitor that rings when things really go bad, but I guess the true essence and value of a nurse is being directly with the patient to recognize trouble BEFORE it occurs. At this point of my career, I can walk into a room and just by looking at a patient, I can now sense how the day will go on.
Seeing  these patients gradually recover and transferred to regular room creates a fulfilling experience for us Nurses realizing that we are able to share with them our time, effort, knowledge, care and even agony at a point when they are critically ill.  We gain self confidence in the process knowing we were instrumental in their recovery and ease their suffering and pain.  As they are wheeled out of the ICU we look forward to seeing them in other areas of the hospital not as patients but visitors and we would be happier to see them back in their prime health. This is the challenge and the crucial yet rewarding phase in the life of an ICU nurse.