What to Expect in the Intensive Care Unit (ICU)

The Need for ICU:

Being in the Intensive Care Unit (ICU) is a very scary and frightening experience. Patients are there because they are critically ill. There are many types of ICU’s, including Medical, Surgical, Neuro(logical) , Cardiac/Coronary, Pediatric & Neonatal.

Patients in Medical ICU’s may have conditions such as liver disease, kidney disease, complications from diabetes, gall bladder disease, bleeding ulcers, etc. The Surgical ICU cares for post-operative patients who require critical intensive care. Neuro ICU’s are for patients who have suffered a back or neck injury, stroke, head trauma. Coronary/Cardiac ICU’s care for patients suffering from some type of heart disease, such as Heart Failure, Heart Attack, coronary surgery. Pediatric ICU’s care for children who require critical care. Neonatal ICU’s care for sick and premature newborn babies.

Patient to Nurse Ratio:

The ICU patient to nurse ratio is usually 2:1 which means that there is usually one nurse caring for 2 patients. While this may sound like a small workload for the nurse, it can be quite overwhelming when caring for 2 critically ill individuals.

Patient Care Equipment in the ICU:

Patients in the ICU are connected to lots of machines and other equipment. One of these machines is a monitor that will measure heart rate (pulse) , oxygenation (how much oxygen is in the blood), blood pressure (BP), and breathing rate (respirations).  Monitors elicit a “beeping” noise that can be quite annoying, but the beeping means they are working properly, providing the staff with vital patient information. The staff is able to view these monitors from various places within the ICU. If any of the other equipment being used in the care of your loved starts making a different type of beeping sound, be sure to call for the nurse.

The ICU patient will most likley have one or more Intravenous (IV) lines inserted into an arm or neck for the administration of fluids, medications or blood. Mulitple bags of IV fluids may be hanging at any given time.

The patient may be receiving oxygen therapy. Oxygen can be administered through a facial mask, nasal cannula, a tube inserted into a surgically created opening in the neck or a tube inserted into the nose or mouth.

Some patients may have a tube down their throat (endotracheal tube) or a tube in a hole made in their neck (tracheotomy) which may be hooked up to a machine called a ventilator that helps the patient breath or actually breaths for them. Visitors should be aware that the patient will be unable to speak with such a tube in their throat or neck.

Patients may have a tube down their nose (nasogastric tube) or inserted directly into the stomach (gastrostomy tube) which can be used for feeding purposes. Sometimes the tube down the nose is used for the suctioning of stomach contents.

Patients may have an indwelling urinary catheter inserted through their urethra and into their bladder for the purpose of promoting urinary drainage. The tube will be hooked up to a urinary drainage bag hanging off the side of the bed. NEVER raise the bag of urine above the level of the bladder as the back flow of old urine back into the bladder can cause a bladder infection. The tube may be taped to the thigh to prevent its being pulled out accidently during patient movement.

Some patients may require a chest tube inserted through the wall of their chest. The purpose of such a tube is usually to reverse a “collapsed” lung. Just for the record, lungs themselves don’t really collapse. What collapse are the alveoli which are small air-filled sacs found in the lungs. The tube will be attached to a water filled gravity or suction drainage container that is usually placed on the floor next to the patient’s bed. DO NOT DISCONNECT THE TUBE OR KNOCK OVER THE CONTAINER. This may cause the lung to re-collapse.

Change of Shifts:

Most nurses in ICU’s work 12 hour shifts. During shift changes, the nurses and doctors may not available for questions as they are giving patient reports to the incoming staff and.or making rounds. At these times, the staff need to share information with each other that is critical for the safety and continuity of care of patients. Be assured that your nurse will check with you before the shift change to address any needs or questions that you or your family may have before s/he leaves at the end of the shift.

Quiet Time:

Some ICU’s have Quiet Time during the change of shift at which time hall lights are dimmed and visitors and patients are asked to refrain from disturbing the staff unless it is something important to the well being of the patient. Quiet Time gives patients a break from the stress and fatigue of daily care routines. Patients are encouraged to rest during this time and visitors are encouraged to take a break from the unit.

Infection Control in the ICU:

Tens of thousands of patients die each year from hospital-acquired infections (HAIs). That means they didn’t come into the health care setting with the infection – they acquired it while they were in the health care setting. Hand washing remains the number one way to reduce the risk of getting or spreading such infections. You should foam your hands EVERY time you enter or leave the patient’s room. ” Foam in, Foam Out “. There may be times when you need to wear a gown and gloves before you enter a patient’s room. This is called ” Contact Precautions “. If the patient has a respiratory infection, you may even be asked to wear a mask. The staff will provide you with instructions on what protective items you may need to wear. Be mindful that if you are gowned and gloved, you should not leave the room with the gown and gloves on and you should be sure to wash your hands after you remove the gloves.

Staff Rounds:

Throughout the day, multiple health care team members will visit and care for the ICU patients. These team members include physicians, nurses, physical therapists, respiratory therapists, just to name a few. Ask the nurse when these rounds are made and try and be present for them as this may be the only time you get to meet with the patient’s health care team. Remember to ask questions and express any concerns you have when the health care team visits the patient. Bring paper and pen with you so you can write down your questions and be sure to get them answered.

Visiting in the ICU:

Each ICU has their own visiting procedures. Become familiar with those in your ICU. They should be posted in the waiting area. Speak to the nurses. While visitors are welcome, there are times when you might be asked to leave, especially during discussions of confidential nature unless you have been designated as the Patient’s Advocate or Health Care Proxy…or if the patient consents to have you stay. Visitors are often limited to two at a time in ICU’s. This is to prevent the patient from getting too exhausted, overstimulated or stressed out. Many hospitals have specially trained staff that work with children, preparing them for their visit to the ICU. Many ICU’s will not allow anyone under 18 into the unit for fear of exposure to infection. Remember that you need to be sensitive to the patient’s condition while visiting. Patients who are critically ill or recovering from such illness require lots of rest.

Spending the Night With Your Loved One:

Ask the ICU staff about the policy for spending the night with your loved one. If you don’t get a satisfactory response from them, ask to speak with the ICU Nurse Manager. Oftentimes, there will be a bed or recliner in the room that will accommodate a single visitor. If you do spend the night, don’t be afraid to ask for a sheet, pillow, blanket and anything else you might need. More often than not, you will be welcome to stay.

Family Spokeperson:

The health care team recognizes that each member of the family has a vested interest in their loved one, but it is not fair to expect the staff to answer the same questions or share the same information over and over again with multiple family members. Your family should select one person to act as your family spokesperson. This individual will partner with the staff as part of the patient’s health care team and will disseminate information accordingly to the rest of the family.

Personalizing the Patient’s Room:

It is not uncommon for your ICU space to be cluttered with patient care equipment. As such, there is little room for personal items. Ask your nurse about personalizing your loved one’s room. If the room is cluttered and small, additional clutter can get in the way of patient care. If space does allow for it, feel free to bring in photos, cards, artwork, balloons, a small radio (music is very soothing & relaxing), etc. Valuables are encouraged to be left home as their security cannot be guaranteed. Lives plants and flowers are usually not allowed in the ICU.

Being Transferred Out of the ICU:

Once the patient is no longer considered in critical condition, they will probably be transferred out of the ICU. Oftentimes the decision to transfer a patient out of the ICU and into a regular hospital room is made very quickly and unexpectedly. This can be very traumatic to the patient and family who have become accustomed to the astute monitoring, observation and care provided by the ICU staff. There is a definite comfort level in having one nurse care for two patients as is found in the ICU. The good news is that when transfer happens, it means that your loved one is getting better!

Anecdotes:

My father was in the ICU after suffering a stroke during the removal of his gallbladder. We soon discovered after further testing that he was in the late stages of pancreatic cancer. I was alone and hysterical in the ICU waiting room after hearing of my father’s grim diagnosis. I noticed a woman about my age walk by the room. She also was hysterical. I invited her to come in and cry with me. It was a very cathartic experience for the both of us. Visitors who are frightened by their loved ones critical condition, and most likely fearful of the prospect of losing that loved one, frequently, will find themselves reaching out to others going through the same thing, becoming a community of support. Open your own heart during your time of great need. Reach out to others in need and help each other heal.

My young adult son was in the ICU of a large teaching hospital. One afternoon, one of his alarms started beeping and his nurse came in to see what was wrong. I was in the room with a friend who was visiting at the time. The nurse walked in with a frown on her face and did what she had to do. She never acknowledged my presence and she did not say a word to my son. He struggled with his pillow while she did her thing, and she never even stopped to help him. She did what she needed to do without saying a word to any one of us in the room. Not a smile. Not a hello. Not a ” how ya’ doing? “. I was incensed. It was a display of total disregard for my son and for me. Her job was to make my son feel safe and secure. She certainly didn’t do her job that afternoon. Later on, I asked to speak with the head nurse and shared our very negative experience with him. He thanked me for sharing and assured me that he would speak with the nurse about her behavior. I had a voice and used it to advocate for my son.

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