The first hours after a cardiac event are a critical time in a patient’s path to recovery, and especially so during the first 24 hours following cardiac surgery. Helping to shepherd patients along at this time is Jamie Chohon, acute care nurse practitioner.
Patients come under Chohon’s supervision when they arrive in the ICU, either to await cardiac surgery, or when they are moved there immediately after surgery.
“I meet with patients and their families before surgery, if possible, to explain what is about to happen, from the surgery itself all the way until they go home,” Chohon says. “I explain the tests they undergo that help us get a good idea of how their body is functioning before surgery.” These tests include, among other things, lab work, x-rays, ultrasounds and measurements of lung function.
“We outline our plan of care, including what they can expect to see and feel when they wake up in the ICU.”
This initial meeting can take about 45 minutes to an hour, and provides an excellent opportunity for patients and their families to have any and all questions answered.
After surgery, one or two nurses—depending on how critical the patient is—will be assigned to oversee their recovery. Chohon joins these nurses to serve as an extra set of eyes and hands. She works in close collaboration with the nurses, as well as the cardiac surgeon, the anesthesiologist, and the intensivist, to serve as a “roving bridge” between the physician, the medical staff, and the family.
“A patient’s recovery during these first 24 hours is actually guided by milestones known as a ‘clinical pathway with patient daily outcome goals,'” Chohon explains. Basically, that means a normal recovery would follow a general time line. “Patients should slowly awaken about three to four hours after surgery, and we should be able to take the breathing tube out in about six hours. It’s a nationally recognized time line, but we only push as hard as the patient will allow.”
Throughout the 24-hour window, Jamie and the nursing team monitor IVs and deliver medication through them, and continuously check blood pressure and heart rate to assure it is all well controlled. They’re also on the lookout for such things as post-operative bleeding, and improved pulmonary and gastrointestinal function.
The morning following surgery, many tests are repeated, such as x-rays, ECGs, and lab work, to see if the patient is ready and stable enough to transfer to the telemetry unit.
Since Chohon is following her patient’s recovery nearly every step of the way, she is able to develop personal, face-to-face relationships with them and their families, something that they not only appreciate, but also improves patient outcomes.
“I see them every day until discharge. It’s one-on-one, individualized, personalized care. The surgeons use their gifted hands in the OR; my gift is in the work I can do at their bedside, and in the relationships I can develop with my patients,” Chohon says.
1 comment on “Caring at critical moments in the ICU”
Ms. Chohon fulfills an integral role in the journey of a patient undergoing cardiac surgery. A consistent team member closely overseeing this journey undoubtedly impacts measurable outcomes and subjective experiences. It is likely that Ms. Chohon has positively impacted clinical outcomes, improved patient satisfaction, and alleviated physician workload. Additionally, having an immediately accessible practioner during the post-operative period surely increases nursing staff satisfaction and decreases delays in necessary interventions and treatments.