Icu ward is the intensive care unit of the hospital, which is the most dangerous and critical place for patients' lives. The following is the doctor's self-evaluation of ICU study, please refer to it!
Article 1: icu 1 The short two weeks of doctor's self-evaluation passed quickly. Although two weeks have occupied a little time in my working career for more than 20 years, it is this time that has given me rich feelings and gains. Here, thank the head nurse for giving me the opportunity to study in ICU for two weeks.
ICU concentrates the best instruments and equipment in the hospital, and also the most critical patients in the hospital. Working there is stressful and busy. There, we should not only have a solid theoretical foundation and rich clinical skills, but also have various communication methods and general nursing knowledge. In ICU, I learned theoretical knowledge and operational skills that are not or rarely seen in the ward, or I have higher thinking and judgment ability than the ward.
1. The observation, treatment and characteristics of clinical emergency nursing are quite different from those of general clinical diagnosis and treatment. The life-threatening changes of patients are often sudden, except for a few foreseeable situations, most of them are random. Therefore, nurses are required to respond quickly to emergencies and have strong handling ability. Taking effective and scientific emergency treatment measures for clinical emergency and emergency patients, as well as the ability to use quick wits, seize the opportunity and make judgments without hesitation, and taking a series of specific contingency measures will play a practical and important role in saving patients' lives at a critical juncture.
2. The careful teaching and strict training of the nursing technology operation instructor enabled me to master the rescue technology, such as the performance, operation methods and indications of drugs and rescue equipment, as well as the nursing technology operation of various diseases and syndromes. Mainly familiar with the establishment of artificial airway, the use of ventilator, time and precautions, as well as how to suck sputum for patients, when to suck sputum and other precautions. Understand the indwelling process of PICC, master the nursing points, be familiar with the rescue of shock, participate in cooperation, understand the working principle of blood flow machine, alarm reasons and treatment methods, learn to use vibration expectoration instrument, turn over and pat back to expectorate, use air pressure therapeutic instrument, understand the technology of ECG monitoring and correct diagnosis of ECG by ECG machine, and use defibrillator to treat critically ill patients (cardiopulmonary cerebral resuscitation).
3. Medical cooperation Under the premise of good care, actively cooperate with doctors. It is generally believed that a nurse's job is to carry out the doctor's orders and complete all kinds of nursing work, while diagnosis and treatment are doctors' business. The concept that nurses don't need intervention or participation has been proved wrong. The nurse is waiting around the patient for 24 hours. They are the patron saint of patients and direct observers of patients' condition. Therefore, they must be able to comprehensively, accurately and accurately reflect the patient's condition. Nurses are no longer passive doctors, but should be able to work closely with doctors, communicate with each other and learn from each other's strengths. * * * shoulders the sacred task of saving lives.
4 Communication skills Most ICU patients are intubated, and their language skills will be temporarily limited. It is difficult to communicate with them. I really admire teachers for communicating in their unique language, such as writing, looking at eyes, observing lips, guessing and so on. I also learned a lot.
5 Basic Nursing ICU pays special attention to basic nursing. Coma patients who have survived for more than 2 years have never had any skin problems. They take a bath twice a week, turn over every two hours, change dirty clothes in time, deal with urine and feces in time, do meticulous oral care, trim their nails and beards in time, and everything is done in place.
In fact, there are many places in ICU that we need to learn.
Chapter two: icu doctors' self-identity. The short three-month study and study life is coming to an end, which is an exercise and a test for me. For me, I have just worked for three years, and my technical theory is still very shallow. This time, I can study in ICU and get a comprehensive exercise. Undoubtedly, opportunities are precious and gains are very rich. Thank the hospital leaders and all those who care about me for giving me this rare opportunity! It is this opportunity that has improved my professional skills to a certain extent, and I would like to share my learning experience with you.
ICU beds in Heping Hospital 10, including 8 open beds, 2 isolated beds and 6 doctors, including 4 residents and 2 rotation doctors. There are more than 30 nurses, except those studying abroad and on vacation. There are about 7-8 nurses in each class, and the bed utilization rate can reach 100% at ordinary times. They mainly treat some patients who need respiratory support, so there are few people and a lot of work every day. Director Dong Zhang is a student of Zhong Nanshan, doctor. The head nurse is a person who likes to study. She publishes two inventions every year. Therefore, under their strict requirements, the learning atmosphere in the department is very strong and the work pressure is quite high. I was fortunate to study in this department and learned a lot of knowledge.
ICU is a department integrating medical treatment, teaching and scientific research. It has strong technical force and advanced professional diagnosis and treatment equipment, such as monitors, ventilators (including invasive and non-invasive), micropumps (infusion pumps and injection pumps), blood filters, nutrition pumps, chest physical vibrators, head physical cooling devices, infusion systems, infrared electrocardiographs, defibrillators, blood gas analyzers, fiberbronchoscopes, etc.
With advanced equipment, there must be advanced medical personnel accordingly, so every department
Every doctor knows how to intubate trachea and puncture deep vein. In addition to life nursing, nurses must also be general nurses to reduce the infection rate of patients and the loneliness of their families. The rescue of critically ill patients (cardiopulmonary cerebral resuscitation) and coordination technology are the most basic, because every patient who enters ICU is told that his condition is critical, and there are some advanced nursing technologies, such as nasal insertion of gastrointestinal tube (nutrients are directly transported to the small intestine, directly absorbed, and the retention time is much longer than that of gastric tube, which is difficult to pull out once inserted), nursing technology of deep venous catheter, blood gas collection, intervention, external chest physiotherapy, artificial airway management, etc. At present, the above technology has not been developed in our hospital. According to the existing technical level of our hospital, chest physiotherapy and blood gas collection (this technology has less investment, which reduces the exposure time of samples in the air and improves the accuracy of examination results), the utilization of nutrition pump can be used for diabetic patients, hypoglycemia coma patients or malignant tumor patients.
Due to the particularity of ICU patients, some systems are more advanced. For example, patients are managed by attending doctors and ICU doctors and nurses, so nurses are required to "know the patient's situation like the back of their hands". Therefore, the head nurse implements "retelling handover" to urge all nurses to understand the condition of all patients, and correct some nurses' improper descriptions of patients' condition during handover, which reduces misunderstandings caused by communication with patients and their families and is conducive to nurse-patient communication. When I work in the department, I can feel that they have a strong sense of self-protection, and can reasonably explain all kinds of problems raised by patients and clearly inform the development and prognosis of the disease.
During my study in ICU, I greatly broadened my horizons, especially their strong learning atmosphere and exploration spirit, which constantly inspired me to master new theoretical knowledge and technology as soon as possible. Through this rare learning opportunity, I improved my monitoring skills for critically ill patients. I will apply what I saw in medical school to my work in the best way, bring good style and experience to my work and improve the quality of our work.
Chapter three: icu doctors' self-identity. I am very grateful to the hospital for giving me the opportunity to study abroad, so that I can know myself better, enrich myself, prove myself and sum up my shortcomings. It makes me more confident to face my life and my future, so that I can learn knowledge and get friendship. Thanks to the support of hospitals, head nurses and colleagues. During my further study, I humbly consulted, studied hard and worked hard, which was praised by comrades in the department. Through special training, my theoretical knowledge of nursing and clinical nursing skills have been improved. That's what I learned.
First, study hard, take notes carefully and constantly improve theoretical knowledge.
Daping Hospital, the affiliated hospital of the Third Military Medical University, is a 3A hospital with advanced equipment and strong faculty. The ICU has 4/kloc-0 beds and more than 70 nurses. The system is strict and nurses at all levels are accepted for further study. ICU attaches great importance to continuing education, and specially arranges senior nurses in our hospital and ICU to give lectures, mainly focusing on basic theory and operation of clinical nursing, common pipeline nursing knowledge, clinical update knowledge, nursing care of patients with mechanical ventilation, etc. The lecture adopts various forms such as multimedia slides, clinical teaching, academic exchanges and seminars. , enriched the teaching content. During this period, I can take part in the study seriously, take an active part in the lectures held by the hospital, ask the teacher modestly, think carefully and take notes carefully. In my spare time, I take an active part in hospital lectures, buy relevant books for study, and constantly improve my theoretical knowledge.
Two, efforts, repeated practice, and constantly improve the clinical nursing skills. The ICU of Daping Hospital focuses on clinical practice learning, and teachers give lectures on the spot. Senior nurses and nurses in our hospital cross-optimize the combination, work in two shifts, and cooperate with clinical nursing. In nursing, experience the standard nursing mode of ICU in big hospitals, strengthen communication and improve nursing skills. Through studying, I see that they have many aspects worth learning from. We have gradually absorbed its essence. During this period, I can overcome difficulties and work hard; For difficult problems, consult more experienced teachers; For key equipment such as ventilators, monitors and various micropumps. Practice the operation repeatedly in your spare time. Through high-intensity standardized practice and operational communication, such as friendly address, patients are very comfortable, hand disinfection of medical staff can reduce the chance of cross-infection, and my nursing skills have been quickly improved. There are also monitoring of central venous pressure, monitoring of bladder pressure, monitoring of urine specific gravity, nursing care of tracheal intubation and tracheotomy with subglottic suction, nursing care of cooling ice blanket for picc, cystostomy and gastrostomy, etc. I haven't touched it before.
Third, strengthen communication, broaden our horizons, and update the nursing concept in time. In my spare time, I have extensive academic exchanges with nurses who are studying together in other county hospitals, exchange nursing experience, discuss good practices in my work, and learn from each other's strengths so as to better carry out nursing work after returning to work. For example, friendly address makes patients feel comfortable, strengthens hand disinfection of medical staff, and greatly reduces the chance of cross infection.
During the study period, the ICU environment is elegant and scientific (living area and working area are separated). Wards are divided into single rooms, double rooms and triple rooms. Arrange patients reasonably according to the condition. Each ward has complete facilities: water and electricity are installed in place, power supply, suction, oxygen absorption, adjustable infusion and pump devices are fixed on the frame, and there are gaps around the sickbed. This will not waste time because it is inconvenient to save patients. The patient's meals and nutrient solution are put in a special refrigerator and marked with bed number, which can be effectively preserved and distinguished. Strict system and standardized management, through further study and personal experience, have broadened their horizons, updated their nursing concepts, and enhanced their confidence and sense of honor; The rules and regulations, operating norms and other software of ICU in this hospital are of great guiding significance to us.
Through special study, I further enriched the theoretical knowledge of nursing, improved clinical nursing skills, updated nursing concepts and improved comprehensive quality, which will definitely play a positive role in promoting my future work.
According to the arrangement of the hospital, I was lucky enough to go to the intensive care unit (icu) of Zigong First People's Hospital for a three-month study, and the three-month study has been successfully completed in a blink of an eye. Through these three months' study, I have a further understanding of the basic work flow, nursing characteristics, main equipment and use of ICU, and mastered some basic work skills. I think that through this period of study, I have basically achieved the expected goal.
First, the basic situation of the intensive care unit of Zigong First People's Hospital
There are 54 medical staff in the intensive care unit of Zigong First People's Hospital, including doctors 13 and nurses/4 1 person. The head nurse 1 and the deputy head nurse 1 in the nursing group (post-adjustment), and the shift nursing adopts a class of 6 people and 5 nurses.
Department beds 10 (30 after relocation) are often in short supply. Usually, a nurse is responsible for 2-3 patients, and critically ill patients are given one-on-one care.
The department is equipped with about 20 sets of main medical equipment, including ventilator, ECG monitor, infusion pump, injection pump, electric sputum aspirator, infrared therapeutic instrument, blood gas analyzer, defibrillator and blood purifier. Each bed is equipped with ventilator, ECG monitor, infusion pump, injection pump and electric sputum aspirator.
The ICU in the hospital is expensive. The total daily charge of patients in ordinary care is more than RMB 1000, and that of patients who need emergency care is usually more than RMB 10000.
Second, the characteristics of ICU in intensive care unit
As a specialized ICU, intensive care unit (ICU) provides better conditions for clinical treatment of critically ill patients than ordinary treatment. ICU is characterized by its unique intensive care and intensive care, or intensive care and intensive care. The contents of intensive care should include consciousness, respiration, heart rate, blood pressure, oxygenation, body temperature, laboratory examination and special examination. There are two purposes of intensive care: first, through monitoring, problems can be found and handled in time to improve the safety of patients; Secondly, monitoring, timely evaluation of the effectiveness of intervention measures and timely adjustment are conducive to further improving the success rate of critically ill patients. The contents of critical care should include: 1) critical care procedures or airway management, respiratory management and circulation management in cardiopulmonary resuscitation; 2) Maintain internal environment stability, including water, electrolyte, acid-base balance and blood sugar regulation and maintenance; 3) organ function protection; 4) Nutritional support and immune regulation; 5) Other treatment measures, including etiological treatment and infection prevention.
Third, the use of main equipment in ICU ward
The main equipment used in the ICU ward of a hospital in Zigong is ventilator, electronic monitor, infusion pump, injection pump, infrared therapeutic instrument, blood gas analyzer, defibrillator and blood purifier.
1, ventilator
Symptoms requiring such equipment: severe ventilation, severe ventilation disorder, neuromuscular paralysis, after heart surgery, increased intracranial pressure, neonatal tetanus requiring respiratory support when using large doses of sedatives, asphyxia, cardiopulmonary resuscitation, respiratory arrest or will stop for any reason.
Contact with patients: In case of emergency or when the indwelling time of intubation is not expected to be too long, newborns and premature infants generally adopt oral intubation, and in other cases, they can choose nasal intubation or tracheotomy.
Adjustment of working parameters of ventilator: tidal volume, pressure, flow and time (including breathing frequency and inspiratory-expiratory ratio). The use process should be further adjusted according to blood gas analysis: first, check whether the respiratory tract is unobstructed, the position of tracheal catheter, the air intake of both lungs is good, whether the ventilator delivers air normally, and whether there is air leakage.
Adjustment method:
When PaO2 _ 2 is too low: (1) increase the oxygen concentration (2) increase the PEEP value (3) when the ventilation is insufficient, the ventilation per minute can be increased, the inspiratory time can be prolonged, and it stays at the end of inspiratory period. When PaO2 _ 2 is too high: (1) reduce the oxygen concentration; (2) Gradually reduce the PEEP value.
When PaCO2 _ 2 is too high: (1) increase the respiratory frequency; (2) increase the tidal volume: constant volume type can be directly adjusted, constant pressure type can increase the preset pressure, constant pressure type can increase the flow rate and increase the pressure limit. When PaCO2 is too low: (1) slow down the breathing frequency. Exhale and inhale time can be extended at the same time, but it should be extended mainly, otherwise it will have the opposite effect. If necessary, you can change it to IMV mode. (2) Reduce tidal volume: constant volume type can be directly adjusted, constant pressure type can reduce preset pressure, and timing type can reduce flow and pressure restrictions.
Evacuate ventilator: gradually reduce oxygen concentration, PEEP to 3~4 cm water column, change IPPV to IMV (or SIMV) or pressure support, gradually reduce IMV or support pressure, and finally transition to CPAP or completely evacuate ventilator. The whole process requires close observation of respiration and blood gas analysis. Indications of extubation: spontaneous breathing, strong cough, good swallowing function, basically normal blood gas analysis results, no laryngeal obstruction, extubation can be considered. Tracheal intubation can be pulled out at one time, and tracheostomy can be pulled out gradually by changing thin tube, half blocking tube and full blocking tube.
2. ECG monitor
Patients who are critically ill and need to continuously monitor frequency, rhythm, body temperature, respiration, blood pressure, pulse and percutaneous oxygen saturation generally need to use it. Blood pressure monitoring:
1). Main functions: divided into automatic monitoring, manual monitoring and alarm device. Manual monitoring is to use the start button at any time; Automatic monitoring can be set at regular time and manually, and the machine can automatically monitor according to the set time.
2) When using sphygmomanometer, we should pay attention to the following points: First, we should pay attention to exhaust the residual gas in the cuff every time we measure, so as not to affect the measurement results. Second, choose the right cuff.
Percutaneous oxygen saturation monitoring;
1). Fix the infrared probe of the percutaneous oxygen saturation monitor on the patient's fingertip, and monitor the percentage of oxygenated hemoglobin in hemoglobin when the arteriole at the patient's fingertip pulsates.
2). Precautions: 1. When using, the probe should be fixed, and the patient should be as quiet as possible to avoid giving an alarm and not displaying the results. Second, when the peripheral circulation is poorly perfused, such as severe hypotension and shock, the accuracy of the results will be affected.
3, micro injection pump
Accurately control the infusion speed, so that the drug can enter the patient at a uniform, accurate and safe speed. Main operation flow: fix the trace on a suitable infusion stand; Plug in the power supply, turn on the power switch, and hear the beep, indicating that the internal circuit self-check is completed and the micro-pump is in standby charging state. Connect a syringe (20ml or 50ml syringe) with liquid medicine inserted into it to the connecting pipe of the micropump and discharge it into the syringe seat. The edge of the syringe must be clamped into the syringe seat. Move the pusher to the rear of the syringe push rod and push the syringe into the pusher slot. After setting the parameters according to the doctor's advice and the patient's condition, press the start key, press the quick key, press the stop key after the air in the scalp needle is exhausted, then connect the needle to the heparin cap or trigeminal tube on the infusion set or puncture the patient's vein (artery), and then start the micro pump to start infusion.
Fourth, some suggestions.
Through further study in other hospitals and related departments, combined with the characteristics of our hospital, some suggestions are put forward for leaders' reference.
1, changing nursing operation exercise into operation exercise, making the operation process closer to reality and improving the actual nursing emergency ability;
2. Conditions: It is suggested that there is only one passage between ICU ward and operating room, which is convenient for nurses to pick up patients in the operating room, reduce pollution, and facilitate ICU patients to go to the operating room for rescue when their condition deteriorates;
3. When configuring the power supply around the ICU bed, power sockets should be configured on the left and right sides, and more power sockets can be set in the ward to use more convenient equipment at the same time;
4. There can be communication doors and glass windows with movable curtains between wards, so that patients will not interfere with each other and it is convenient for nurses to observe their illness.
5. If conditions permit, it is suggested to set up a nurse station in the center of the ward. The center can have an ECG monitor to monitor the general patients, and the ECG monitor in each ward can also display the electrocardiogram of the general patients. The application of modern high technology in nursing management greatly reduces the labor intensity of medical staff and improves work efficiency.
6. Oxygen can be transported by pipeline and managed by special personnel, which can shorten the first aid time, improve nursing efficiency and reduce potential safety hazards.
After three months of further study in ICU, my ability in all aspects has been improved through this period of study. I sincerely thank the hospital leaders and nursing department for giving me this opportunity to study, and also thank the medical staff in a hospital for giving me a lot of support and help.
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