Dr. Lynn Simko PhD, RN, CCRN
Nursing is the profession that is with the patient 24/7. We do complete physical assessments on the patient at least every four to twelve hours, we know if they are in pain, have to go to the bathroom, or need repositioned for comfort. We check on them every hour and let them know that we care about their well being. Yes, Nursing is the heart of patient care. The physician only comes once a day, assesses the patient and gets the report from the Registered Nurse (RN) as to how the patient did the previous 23 hours of the day. They look at the lab work, X-rays and other tests to help plan the care of the patient. They write their orders and then leave the hospital to visit more patients in other hospitals or in their offices.
Having worked in the Intensive Care Unit (ICU) setting for all of my professional years I have learned a great deal about the nursing care needed in a Coronary Care ICU. I have resuscitated patients by defibrillating them before the code team and physician arrived. I have saved lives with the nursing care I have developed over the years. Coronary Care ICU usually sees patients with heart attacks (Myocardial Infarctions), congestive heart failure, pulmonary edema, pulmonary embolism, heart transplant candidates, acute respiratory distress syndrome (ARDS), ventricular assist devices (VAD), and extracorporal membrane oxygenation (ECMO). We also get patients with cardiogenic shock, septic shock, and hypovolemic shock. We treat these patients with vasopressor agents that help increase the Blood Pressure (BP) so that the patient doesn’t end up with permanent brain damage from inadequate cerebral blood flow. Patients in cardiogenic shock may need an intra-aortic balloon pump (IABP) inserted to help with coronary artery perfusion and to decrease afterload which makes it easier for the left ventricle to pump out its contents and helps increase cardiac output. The Cardiovascular ICU usually sees patients post open heart surgery. They may have had coronary arteries bypassed or have had a valve replacement or both. They also see patients post-operatively from aortic aneurysm resections, peripheral artery bypasses, pneumonectomy (for lung cancer), heart transplant, and other vascular surgeries. So the cardiovascular ICU is a post-surgical ICU, where as the Coronary Care ICU is a medical type ICU. The skills required in a cardiac ICU can be transferred to care of other patients in other types of ICUs. I work at West Penn Hospital and I float to the Cardiovascular ICU, Medical-Surgical ICU and the Burn Trauma ICU.
And, on some occasions, I work in the Neonatal ICU with premature babies or drug addicted infants. I only go there when they are very short staffed, because I use to work full time in that unit in the late 1980’s, before some of you were born.
Yes, nursing is the heart of patient care and you should love it as a profession. We stay with patients in their happiest times (after a birth of a child), and in the darkest of times (death of a patient). I love nursing and I hope that you will too!!!
Picture from DUSON