Patient Care Vignette
A 62-year-old male presents to the emergency department (ED) with fever, cough, and body aches for the past 3 days. He has three children and two young grandchildren, works full time in construction, enjoys sporting events and spending time with family. His family states that he was in his usual state of health until 3 days ago when he developed a productive cough, shortness of breath, and confusion. His past medical history includes insulin-dependent diabetes, hyperlipidemia, and hypertension. In the ED, he experienced increasing respiratory distress (difficulty breathing), desaturation to 88% on room air (low blood oxygen), and hypotension (low blood pressure, 82/50 mmHg). His chest X-ray showed bilateral lower lung field infiltrates consistent with pneumonia. He was poorly perfused and had signs of sepsis on examination as well as laboratory profiling. He demonstrated septic shock and acute respiratory failure due to pneumonia clearly establishing critical illness. He was intubated and placed on mechanical ventilation. He required fluid resuscitation, empiric antibiotics to treat pneumonia, as well as a vasopressor to support his blood pressure. Invasive monitoring devices were required to guide care.
This patient was admitted to the ICU for critical care. After 24 hours, his lung function worsened, requiring substantial increases in support from the ventilator. Accordingly, he was diagnosed with acute respiratory distress syndrome (ARDS), a condition that may follow many kinds of infections. ARDS is characterized by difficulty clearing carbon dioxide (a waste product) and onloading oxygen across an increasingly stiff lung. In order to help improve gas exchange, he required deep sedation and neuromuscular blockade by continuous infusion, as well as prone position therapy (while on the ventilator he is rolled from his back to his chest, the prone position). This meant that his family could no longer see his face for 16 hours of the day while he was prone, and received no feedback from him indicating that he knew that they had come to visit, hold his hand, and speak to him. The family is distraught having never experienced critical illness with any other family members and is worried that something has gone terribly wrong.
THE BEDSIDE CRITICAL CARE NURSE’S ROLE IN THE ICU
The bedside critical care nurse (CCN) is a vital team member to initially explain what is happening, address their questions, and develop a patient- and family-centered bond with this patient’s loved ones. This chapter provides insight into the nurse’s role in caring for a critically ill patient and their family toward recovery. When one thinks about caring, one may envision the nurse holding a patient’s hand, helping during a procedure, engaging in bedside titration of infusing medications, monitoring life-sustaining equipment, or serving as a point of contact for family. Besides all of these functions, the nurse coordinates care, provides support, and maintains a safe environment for healing and recovery.