titrating cardizem - page 4

by ark-two | 57,172 Views | 41 Comments

Our TCU floor does not titrated cardizem gtts. What is involved with the titration of a drip. It would be nice if we could and cut down on patient expense. If the cardizem needs to be titrated, they are to be transferred to... Read More


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    Quote from ~Anne~
    Its really not hard to titrate a cardizem gtt . Our tele unit does not transer pts on cardizem gtts. We start them , titrate them ,and DC them . Its a lot of nursing judgement on our part and calling the docs comes after the fact. They write the orders ,but its not always clear , so we do have a standing policy on titrating ... and like i said alot is nursing judgement, but you get used to it just like everything else they throw at us!
    Us too. We have a telemetry guy(M.T.)that keeps an eye on the heart rate for us. We let him know that they're on the drip and he lets us know how it's affecting their heart rate.:typing
  2. 0
    Quote from Nightrn16
    The floor I work on, a tele floor, we hang, titrate, and manage a cardieziem drip, all while looking after normally 9 patients total. We have our HUC's watch the monitor's. It's never left unattended. Normally we tell them when we start them on a drip, or give anything that could affect a heart rate (like pushing lopressor), and they let us know if something happens. If for whatever reason, we need to put them on a frequent BP's, we throw a dynamap on them, and try to check in on them when it should be going off. Cardiziem is actually one of our very frequent drugs, so I guess we tend not to think too much about it. (We also do dopamine, dobutamine, nitro, heparin, integrillin, amniodarone, and various other critical drips.)
    Ditto all that! You sure you're not working a hospital in Central Illinois?? Sounds just like my home town hospital unit. I tell folks that Nitro and Heparin gtts were our "bread and butter" on my floor there, and we titrated all those others besides. When I got to MO, they literally freaked out about the Nitro, especially. Only use nitro paste on anyone not in ICU/CCU. Imagine....no more hourly BPs with 8-10 patients I'm assigned to!! But you know.....I really miss my nitro gtts. And the paste just doesn't always do the trick.....just MHO! So interesting to find the differences in hospitals! I love it!
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    We titrate cardizem but our ratio is 4:1 maximum, rarely 5:1, full time monitor tech and charge RN with no patients..and only 18 patients on the unit maximum..we are cardiac step down/IMCU..
  4. 1
    Quote from gator mom
    Hello-I work on a ortho/PCU post surgical floor. I am ACLS certified as required. Our nurses are offen required to float to ICU where we are given 1-2 of the least critical pts. The other night I floated and was told I would be getting an admission from ED. Pt. being admitted for CVA,Resp failure and rapid a-fib. She was to be on BIPAP and a cardizem drip to be titrated. I was not comfortable taking this pt. We do not have BIPAP on my floor if it is being used for rescue breathing. Also I have zero experience with titrating drips (we also do not take these pts). The charge RN understood my concern and gave me her one pt. who was basically stable. I had a RT comment to me that the pt was a DNR so I could not hurt her and why did I not want to learn new skills? I was totally amazed by the RT comment. I always want to learn new skills, BUT.....1) I do not believe I am even allowed to take a titrated drip (will clarify this tonight) 2) I am not an ICU nurse-would not this pt. be better off with an experienced ICU nurse? 3)I believe this pt. was beyond my scope of practice and accepting her would be both morally and legally wrong 4) When did it become acceptable to practice nursing skills on a pt because they are a DNR?
    Your feedback would be appreciated.
    I am sorry that I have no sympathy..well maybe just a very little. This is perhaps my pet peeve in nursing. ICU nurses and floor nurses take the same nursing boards and have the same nursing license, but why is the ICU held to so much more accountability and responsibility than a floor nurse. In your case you even have ACLS certification. I can understand that you may have been out of your comfort zone but without taking full responsibility you could have been involved in taking care of the patient to LEARN so that the next time you get pulled to ICU you can take care of that patient. There is too much already expected from ICU nurses without any fair compensation...for example MET Team calls. Surprise there is no magic fairy dust that falls on patients when they come to ICU...it is the knowledge skill and EXPERIENCES of the ICU nurses that make the difference and only because they have sought out the opportunities to learn instead of cowering behind it is "legally and morally wrong for me to learn." I believe every nurse has the responsibility of learning from every patient so that increase their skill and knowledge to better serve the ones they care for in the future. Too many sit back complacent and quiet in their comfort zones and administrations backs them to the point that they become disabled.

    We practice nursing skills on all DNR patients...DNR does not mean that you don't take care of them just that your do not resuscitate them..BIPAP is not intubation and is not a resuscitative measure..the patient has to be breathing on their own which is a natural process. Many patients in our facility are on the floor on BIPAP what about the people with sleep apnea that use BIPAP everynight? This is not out of the scope of a floor nurse .
    Many Tele units have cardizem drips and push dig and lopressor...once again not out of the scope of a floor nurse. The only difference is the setting. What are you not capable of doing..what is out of your scope?
    Last edit by burn out on Jan 17, '09 : Reason: wrong word
    Beverage likes this.
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    I agree, work cardiac floor and can have IMCU patients but would of been ok with that patient especially with other experienced RN's around to answer any questions....would of been a great learning experience...we have to have ACLS on our floor too.
  6. 1
    Quote from burn out
    I am sorry that I have no sympathy..well maybe just a very little. This is perhaps my pet peeve in nursing. ICU nurses and floor nurses take the same nursing boards and have the same nursing license, but why is the ICU held to so much more accountability and responsibility than a floor nurse. In your case you even have ACLS certification. I can understand that you may have been out of your comfort zone but without taking full responsibility you could have been involved in taking care of the patient to LEARN so that the next time you get pulled to ICU you can take care of that patient. There is too much already expected from ICU nurses without any fair compensation...for example MET Team calls. Surprise there is no magic fairy dust that falls on patients when they come to ICU...it is the knowledge skill and EXPERIENCES of the ICU nurses that make the difference and only because they have sought out the opportunities to learn instead of cowering behind it is "legally and morally wrong for me to learn." I believe every nurse has the responsibility of learning from every patient so that increase their skill and knowledge to better serve the ones they care for in the future. Too many sit back complacent and quiet in their comfort zones and administrations backs them to the point that they become disabled.

    We practice nursing skills on all DNR patients...DNR does not mean that you don't take care of them just that your do not resuscitate them..BIPAP is not intubation and is not a resuscitative measure..the patient has to be breathing on their own which is a natural process. Many patients in our facility are on the floor on BIPAP what about the people with sleep apnea that use BIPAP everynight? This is not out of the scope of a floor nurse .
    Many Tele units have cardizem drips and push dig and lopressor...once again not out of the scope of a floor nurse. The only difference is the setting. What are you not capable of doing..what is out of your scope?
    I guess it's all a matter of opinion. Your opinion seems to be that "a nurse is a nurse is a nurse." I disagree. Administration seems to back me on that by giving the ICU nurses lots more instruction and orientation, plus a lengthier mentorship. The P&P also backs that up by stating that the float nurse may care for patients who are "not really" ICU patients, but patients who could move to tele or a lower level if there were enough beds on that unit.

    The fact that ICU nurses and tele nurses get paid the same is perhaps the reason that there is a shortage of critical care nurses -- I decided against going to a critical care floor due to that very reason. Dealing with sicker patients, more education, more training, more liability. However, telemetry, stepdown, and ICU are not the same. Otherwise, why would Policy also state that an ICU nurse floating to our floor may only take 4 patients? (The norm for us can be up to 8, usually 6.) And why does Policy state that we cannot titrate on our tele unit? Obviously, there's a distinction made not only between the type of training the nurse has, but the type of patient she's expected to take.

    Finally, the nurse was not "participating" in the patient's care, the nurse was legally liable for that patient's care. The nurse, who had no ICU-specific training, was going to be held to the standards of an experienced ICU nurse if anything happened to that patient down the pike.

    Here's how I used to determine if a patient was appropriate for me to handle when floating to ICU. I'd ask myself, "Could this patient be transferred to my floor, right now , as she is?" If yes, then I'd take the patient. If not, then I felt justified in refusing the assignment.
    noyesno likes this.
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    We are talking apples and oranges. I am sure every hospital has their own policies about what ICU nurses and floor nurses can do. However, in the grand scheme of things it is our own states Board of Nursing the ultimately that determines the scope of practice and at that level there is no difference between the two (same license, same test, same pay, same job) We all are created equal it is our experiences that make us different and many nurses hide behind their fears and are afraid to make new experiences for themselves to learn new skills, new techniques that makes them better nurses.
    Last edit by burn out on Jan 18, '09 : Reason: to add to.
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    I can see both sides of this. I worked tele, stepdown but did have to float to ICU occasionally. As stated above, i would also get uncomplicated patients. I do feel we need to be open to new learning experiecnes. No problem in that if we were not in such a liability oriented world today. No matter how you slice it, once you have accepted report, you are working under your own license and have basically agreed that you have the expertise to handle it. I understand that ICU nurses are still nurses, but the experience they have in their particular area does make a great deal of difference. I do think critical care nurses deserve better pay for what they do. Too bad there arent more opportunities for learning and more extensive training. I know I would have welcomed it and been open to vent pts with lines etc. Its how we gain competency in new areas of care. But then.....old liability rears its ugly head!!
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    Reading the above post, I guess the difference is that in my hospital you would NEVER have to float to ICU if you didn't work in ICU..as soon as a friend of mine transferred to HSU (heart surgical unit), when necessary she floated to ICU and if it was during her 6 month preceptorship she floated with her preceptor..never alone..so my hospital always made sure you had the experience to go with where you floated to...I wouldn't be comfortable floating to ICU if I didn't have the experience either..I had a 6 month preceptorship for my IMCU floor and did float to ICU once with my preceptor so I would be able to have a patient on a vent...diffentely seeing both sides to this..
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    As far as I know it is relatively common practice for tele nurses to float to ICU. I guess its a matter of how comfortable the float nurse feels with the assigned patients. You are fortunuate to work in a facility where it appears they are aware of the possible dangers. Beyond that a float needs to be assertive and not accept pts he/she does not have the skills to care for safely. I was never put in that situation.


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