Progressive Pulmonary Care Unit Immersion

Hi! I am nurse Jea (Jea is the nick name I am using at work, because Jaea is difficult to spell and to pronounce for my patients). I am a Patient Care Services – Float Pool Nurse. I have no permanent unit, so I have been rotating to different units in the hospital.

I will be sharing my experience with Pulmonary Care Unit – Progressive Care for this last month’s immersion. I have started my immersion from June 22 up to August 2, 2020.

From June 22 up to July 1, I was assigned to Sir Luigi as my preceptor. He was nice, but there were times that he reprimanded me because of some things that I forgot and failed to do: such as late referral to the MROD for the hourly urine output measurement, poor time management, being stiffly book-based, but I’m thankful for it.

CLABSI Notes (Central line-associated bloodstream infection)

With Sir Luigi, I learned how to do PICC line flushing of pre and post medication, once daily usually if not used (with 0.2 ml Heparin and with 50 cc of NSS), to use 3 or 5 cc.

  • First, use clinell wipes (green for device and blue for skin) on the port for 30 seconds.
  • Flush Heparin 5 cc
  • Flush medication
  • posi flush of 10 cc NSS
  • Then, Heparin 5cc again.

On the other hand, upon cleaning a central line, I should be wearing clean gloves; then put cutasept, then wear sterile gloves.

  • Use clinell wipes (green for device and blue for skin)
  • put biopatch. (blue – face the sky)
  • then clean with clinell, always away from the center
  • then, place tegaderm
  • dress unused ports of the central line with curos. (hang unused curos to the pole)

CAUTI Notes (Catheter-associated urinary tract infection)

  • It is very important to do perineal washing every shift even when the patient did not poop
  • Lower foley catheter below the bed
  • hang the foley catheter to the bed not the side rails

VAP Notes (Ventilator Associated Pneumonia)

  • It is important to suction
  • tracheostomy care must be done per shift
  • silent ventilator
  • clean inner cannula, by removing inner cannula to disinfecting solution in hydrogen peroxide plus NSS in a kidney basin), but replace the inner cannula with fenestrated cannula
  • Put back to mechanical ventilator
  • hyperoxygenate the patient
  • Then, remove the non woven gauze dressing surrounding the tracheostomy, disinfect with hydrogen peroxide using a cotton applicator then put gauze

Code Blue Notes:

If I am the bedside nurse of the patient who is pulseless, immediately flat the bed.

  • Never leave the patient. Patient may have his/ her sensorium decreased.
  • Call bell if the patient is deteriorating. Tell the Vital signs of the patient. Remember the time called for code blue which is 3221.
  • Usually, upon arrival of the other health care team, one is assigned for the oxygenation of the patient and the suctioning (O2 @10L ambubag, pump every 8 seconds. Disconnect MV then do ambubagging), then the other is assigned in the Ecart and one does the compression (the bedside nurse, 1st set is 120 CPR)
  • Usually, all the drips of the patient are stopped! Then, fast drip of 900 cc NSS is done but make sure to check patency of the line first.
  • The Ecart person, must remember the time the 1st Epi was given. It must be timed for every 3 minutes.
  • In a code blue, the MROD is there, the AROD intubates, there’s xray as well post intubation, the HM oversees and the Patient Experience is the social worker who explains the process to the relatives.

RRT Notes:

  • Note the O2 saturation of the patient.
  • must be placed in high back rest
  • hook O2 or hyperoxygenate
  • refer to MROD
  • Don’t stop inotropes such as (Levophed, Dopamine, Dobutamine, Epinephrine and Phenylephrine)

Even when I have been a floater for so many months now, I still feel like I have so many things to learn. I am thankful for the learnings Sir Looj taught me.

Also, I have been reproached by some of my senior nurses and charge nurses in the area. I understand why I was scolded and I appreciate it, however, I wish they did not say it in a loud manner, because it is humiliating, especially for an introvert like me, but I just took it all in. I made mistakes and I humbly accept them.

Also, it is important to remember to transfer a patient having an O2 with a nursing aid or a porter but most importantly with MROD overseeing the transfer of bed to another room (such as when the patient is for hemodialysis, or for CT scan for progressive care patients). Also, the Neuro Resident is the one overseeing for patient’s transfer for MRI.

On the other hand, upon giving medications, always let a senior nurse check the medications prior to administration. Upon going to the patient’s room, I should make sure that the EMAR is with me. I must ask for the patient’s identifiers (name and birthday), then double check the dose of the medication in the EMAR with the medication at hand.

I also learned how to do bed bath, how to change linens and on how to change the diapers of the patient.

Note to self: I must be a safe nurse all the time. I must render safe nursing care, and must avoid errors.

I am thankful to God for this experience. I am thankful for Maam Gretchen, the Nursing Unit Manager of the 6 Main A and Sir Neil, the Assistant Nursing Unit Manager and Sir Mike, the Clinical Unit Based Educator of the unit, Sir Luigi, my preceptor and my senior nurses (Maam Aya, Maam Tama, Maam Andrea, Sir Dom, Sir Rein, Sir Kiko, Sir Coco, Sir Ja, Maam Kim, Maam Barbie, Maam Felice, Sir Thoi, Sir AJ, Maam Van, Maam Ven, Maam El, Sir Alvin, Maam Mers and Maam Arlene, Sir Clive and Maam KC, Maam Faye, Sir Earl, and Maam Lyka) and fellow floaters Sir Ric and Maam Lanie. I am thankful for all of them, but these are just the names that I remembered.

See you again sometime soon, 6 Main A! Thank you God for all the learnings.