INTENSIVE CARE UNIT

The ICU is also called Intensive Care or the Critical Care Unit. Here patients receive constant care and close monitoring with state-of-the-art equipment. The ICU has 16 beds for medical and surgical patients. A 1:2 nurse to patient ratio is maintained with a nursing assistant on duty every shift.

We appreciate that this is a difficult time for you and your family, as someone close to you requires our special care.

ICU GUIDELINES:

• Visiting time starts at 9 a.m. and ends at 10 p.m. Patient rest periods are from 1 p.m. to 4 p.m. and again from 6 p.m. to 8 p.m. and visiting is discouraged during these times. If patient care of any type is being performed, or unit activity is at a heightened level, you may be asked to leave. Your cooperation is expected and appreciated. You will be allowed to return as soon as possible.
• Visiting is limited to 2 persons in the patient's room at one time.
• Children under the age of 7 are not permitted.
• No visiting from 7 p.m. to 8 p.m. to allow for nursing shift change.
• Please hold phone calls concerning patient status until after 8:30 a.m. to allow for the nursing shift change. This allows nursing staff to provide you with better information.
• Patients up to age 16 may have 1 parent or parental designee stay (and sleep) in the patient's room at all times.
• No other sleeping in patient rooms, at any time.
• Cell phones are allowed, but not encouraged. Put cell phones in silent notification mode so they do not disturb the patients.
• Please limit the sending of flowers and plants to 1 small arrangement, as space is very limited in patient rooms. After the patient is transferred out of ICU, flowers may be sent.
• If the patient is in isolation, all of your personal items must be left outside of the patient's room. Preferably, these items will be left outside of the ICU/Hospital with other family members or in your car. This will help us to protect your loved one, other patients, and family members from spreading germs to others.
• If the patient is sleeping during a visitation hour we may request that you not visit at that time. Our patients need to get as much sleep as possible so that they may return home to you as soon as possible.

ICU VISITATION GUIDELINE EXCEPTIONS

As always, some exceptions to visitation guidelines need to be made and are handled on a case-by-case basis. They include but are not limited to:

• The imminent death of a loved one.
• The withdrawal of life support and the expectation that death will occur within the next 24 hours.
• Severe impairment of mental status that has yet to respond to medical treatment.
• Language barrier without an available translator.
• Hearing impairment that does not respond to known prosthetic devices and/or patient that doesn't read lips, i.e. the need for a sign language interpreter.

INSIDE THE INTENSIVE CARE UNIT (ICU)

The ICU is a busy place. There may be other patients with monitors in the same unit. Your loved one may look or act differently than he or she normally would.

Be prepared to see a lot of wires, tubes and equipment.

Your loved one may be unconscious or asleep. His or her skin may be pale, flushed or ashen. The person may look puffy or swollen, especially in the face, hands and feet. He or she may also feel cold or hot and clammy to the touch. This is the body's normal reaction to stress, low blood pressure, some medications, and some illnesses.

Alarms on monitors will sound to alert the nurse when something needs to be checked. Alarms are not always cause for concern. Sometimes, patient movements may sound an alarm.

IV Lines and Tubes Your loved one will have one or more IV (intravenous) lines and tubes. IV lines allow for the administration of medications and/or nutrition. Some measure blood or heart pressure. Don't worry if you see air bubbles in the lines. All lines and tubes are closely monitored.

Tests and treatments are frequently conducted. At these times, you may be asked to leave the room. Blood may be drawn frequently, but don't worry. The body contains a large volume of blood and replaces any blood that is drawn.

Pulse Oximetry measures the oxygen saturation of the patient's blood. The probe is a small red light located on the finger, tie, earlobe, forehead, or bridge of the nose.

Anthrombic Stockings may be applied to the lower extremities to help prevent blood clots.

Medication may cause sleepiness, nausea, or confusion. Your loved one may be receiving several types of medication. These can include antibiotics, sedatives, and painkillers. Let the nurse know if your loved one seems to be in pain.

Restraints prevent your loved one from pulling out tubes and wires. They are usually applied to hands, rarely to foot or chest. The nurse may allow you to remove them during your visit. If so, you need to watch carefully and keep your loved one from pulling on any tubes or wires.

WHAT YOU CAN DO

• Appoint a family spokesperson to serve as a link between the family and the medical staff.
• Establish a CODE WORD (chosen by the patient if he/she is able) to be used by those with whom you wish to have your medical condition discussed. Please limit giving this code word only to those with whom you do wish to have confidential information, remembering that those persons will be given any and all of the patient's medical information.
• Remember to take care of yourself. Your loved one is being taken care of by very competent staff. He/she needs rest most of all, and so do you. Eat healthy foods and arrange family visits in shifts.

THE YRMC MULTI-DISCIPLINARY TEAM

Although we work as a team, each of the people caring for your loved one has special knowledge and skills. Doctors plan your loved one's care. Nurses do most of the hands-on care and monitoring.

Others who may be on the care team are:

• Respiratory Therapists (RT) treat breathing difficulties and manage respiratory treatments/ventilators.
• Physical therapists (PT) and Occupational therapists (OT) help patients improve strength and flexibility.
• Dieticians give advice about special eating concerns and nutritional support.
• Social workers and case managers help the family with financial concerns, resources, insurance and long-term care assistance or placement.
• Pharmacists help monitor medications that patients receive.
• Clergy offer spiritual support to patients and family.

TERMS FREQUENTLY USED IN ICU

ABG: Arterial blood gas is a measurement of oxygen, carbon dioxide and acid in the blood, which is used to monitor how the lungs are working, with or without a ventilator.

Arterial Line: A special IV site that allows continuous monitoring of a patient's blood pressure and also allows us to draw lab work including ABGs.

Central Line: An intravenous line that is inserted into a vein in the neck, chest, or groin. It allows medication or special feeding to be administered to the patient.

EKG or ECG: Electrocardiogram that gives information about heart rate and rhythm. All patients are connected to an EKG monitor. A 12-lead EKG shows 12 different views of the heart's electrical activity.

ET Tube: A plastic tube passed through the mouth or nose into the windpipe. It assists in breathing and allows removal of secretions from the lungs. While the tube is in place the patient cannot talk.

Feeding Tube: A small flexible tube inserted into the nose or mouth that goes to the stomach or small intestine, allowing for the administration of nutrition or medication.

Foley: A tube inserted into a patient's bladder to allow urine removal and collection.

Hemodialysis: If a patient's kidneys fail to work adequately, the decision may be made to place them onto a dialysis machine, which will gently cleanse the blood. This is done through a special IV catheter placed in the patient's neck, chest, or groin.

Intubated: When a patient has either an ET Tube or Tracheostomy.

Naso-Gastric Tube: A plastic tube passed through a nostril into the stomach to empty stomach contents and prevent vomiting. Sometimes used to administer medications or nutrition.

NPO: Patient is not allowed to take anything by mouth. (No ice chips, water, food, etc.)

PA Line: Sometimes called a SWAN-Ganz catheter. Allows direct measurement of pressure in the heart. This allows us to know better how a heart is functioning and the patient's fluid volume status; i.e., are they dehydrated or overloaded.

PCA: Patient controlled analgesia. This pain medication device system allows the patient to safely administer his/her own pain medication whenever the patient needs it.

Suctioning: The removal of secretions from the lungs or mouth.

Tracheostomy: The trachea is commonly known as the windpipe. A surgical incision is made into the trachea, into which a tracheostomy tube is placed and through which a patient will breathe.

Ventilator: This machine is attached to the patient via the ET or Tracheostomy tube, and helps the patient to breathe.