What I do, Part I

I’ve held off describing my job because I wanted to get my head around it first. It’s going to take a good year before I’m comfortable in my role, but I think I’ve got the basics down enough to at least sketch in an outline. I work in the CVRR, cardiovascular recovery room. The purpose of the unit is to receive patients directly from the operating room where they’ve undergone surgery on their heart or vasculature, recover them from anesthesia, and stabilize them to the point where they can be transferred to an acute care floor or ICU.

Some of the common surgical procedures are carotid endarterectomy (removal of plaque to prevent further blockage), coronary artery bypass graft (CABG, or “cabbage”), heart valve repair or replacement, femoropopliteal bypass (fem-pop, should be a music genre), and arteriovenous graft creation for dialysis. We also get transplant patients - heart, lung, kidney, and I think liver – but that’s much higher level nursing than I’m capable of at this point. The workflow right out of surgery differs according the procedure done, but generally the receiving nurse sets up the bedside with monitoring (which displays EKG, blood pressure, heart rate, oxygen saturation, temperature), suction for oro-nasal and/or chest tubes, oxygen, and supplies like tubes for lab blood draws. When the patient wheels in the nurse hooks up the lines, takes report from the anesthesiologist, and does a rapid assessment of the patient.

Assessment is a huge part of a nurse's job, whatever area of care they're in. It means collecting data such as vital signs, the look and feel of a patient, the statements they make and documenting it to establish trends. It's also the first step of the nursing process known by the acronym ADPIE, assess, diagnose, plan, intervene, evaluate. The nursing process is how nurses organize their care. I'll go into more detail about patient assessment in a future entry.

Getting back to the fresh surgical patient, the goal is for the patient to remain stable in terms of blood pressure, heart rate, oxygenation, etc. This is often accomplished with medications given intravenously. Doctors will write an order like, "Titrate to keep SBP <150." This means the nurse will adjust the rate of infusion of the specified medication so that the systolic blood pressure, the top number representing peak pressure, is maintained below 150. Learning the medications used and why, the interactions between them, and the starting dose to the max dose are pieces I'm slowly acquiring.

Man. I just read over this and realized that I've left a lot out. By way of explanation I'll say this, there's a thing that happens to nursing school students about halfway through their first semester of upper-division classes. They're not civilians anymore. They have a hard time talking or even thinking like non-medical professionals. When they try to explain something, their speech is full of acronyms and jargon before they backtrack and start again, trying to translate effectively. The ability to summarize complex info and relate it on a developmentally appropriate level takes a while to catch up, if it ever does. All this is to say that I forget sometimes how much medical stuff is crammed in my head that I take for granted. So, if I vacillate between being overly simplistic and talking far above your heads, just let me know.

Whew. This post really just flew off the cohesion rails. Oh well. I'll get the train back on track tomorrow.