What will Cardiac Surgery Stepdown be like?

I start working October in the Cardiac Surgery Stepdown Unit. I interviewed for the ICU and they offered me this because ICU was full. They say I will have post op CABG, Vascular, Valvular type patients. I'm just curious what to expect? Will it be like med/surg?

Tiffany

[NYNewGrad]

Thanks for your replies. This is definitely something for me to think about, probably more so than MedSurg.

In checking out this unit, what are some things for me to ask about or look out for? Nurse:Patient ratio, floating, RN responsibilities on this unit... what else?

[challenged annie]

Cardiac surgery is surgical with some medical outliers. Its fab the patients are generally young ish so you can have a giggle as well as be serious. Very busy though I work in Wales and not very often do I finish on time. We get pre op and post op. It a fab job

enjoy

[RN12345656]

Hello,

No it will not be like med surg at all. You will be dealing with cardiovascular patients with a variety procedures being perform on their heart. I love Cardiac very much.

A step down unit (that I am familar too) is a patient that is stable enough to move out of the cvicu. They can be unstable as well at times. The patients may come in for a procedure and stay for several of days after the procedure. Many of them will come in because they were unstable at home or the physician told them to come in.

You will have them on small ekg boxes which will relay the rhythm to the front desk and they may have some in their rooms. You will do vitals, adminster medications, assess them in the beginning of your shift, making sure your fluids are adequate for the shift and record them, follow the orders of the physicians (I know that is a given), watching for any abnormalities that may occur with the patients, will provide patient and family education, write progress notes (hopefully you will have a computor), maintaining contact with the patients and physicians during the shift, sometimes you will have patients that may have trouble and it is emergency....this where you will learn and bust your butt, and most of all, you will grow to be a great cardiac nurse.

I never compare cardiac with med surg. Because med surg you will recieve any and every thing on the floor. Whereas you will be dealing with cardiac patients and that is it.

Sometimes they would send a patient up to the floor that does not need to be there and you are like why are they here? Well, one is because they have a cardiac history and to fill the specialize beds...and the cardiac unit is specialize. I just to laugh when I have a teenagers with a broken ankle or arm and etc. And med surg floors would close and the rns would go home or if they wanted to stay to work...then be reassign for the evening. I could not stand low census in my hospitals because the cardiac units would be filled all year around.

Emm, you will know your rhythms very well, how to function in a code, learn your patients, recognize s/s of of cardiac problems, and most of all, you will feel like you have accomplish a lot with each shift.

Do not allow them to give you a lot of patients that are requiring alot of care; no more than two unstable patients; do not allow them to dump on you and speak up as well; do not be a runner for anyone....do your work first and then be a team player because there are some nurses who will take advantage of you; do not allow the patients, coworkers or physicians or supervisors or family members disrespect you at all; always ask a questions regardless how small they maybe and keep a note pad; lastly, mark your stethoscope because it will be missing and if you lend it to a physician..get it back.

Oh I forgot, know heparin, coumindian, levonox, like the back of your hand. Know what reverse heparin and coumindan. Remember do not ever run anything with heparin and other anticogulants. Make sure you look at the compatibility of your medications and especially iv meds.

If a patient is on lasix make sure they have a K+ level and oral K+ on board. Make sure you know the different catergory of the cardiac medications. What two cardiac medication catergory should not be together? ace inhibitiors, ca++ channel blockers, beta blockers, and etc. Which two should not be given together?

That all will come in time

Alright that should assist you.

Good Luck and Congrats,

Buttons

Buttons,

It is Coumadin & Lovenox. And Heparin is compatible with other meds, like Nitro

[hrtprncss]

Vit K and Protamine r used for reversals of excessive anticoagulation at times.

[button2cute]

Vit K and Protamine r used for reversals of excessive anticoagulation at times.

Hello,

Correct.....

[ManyRN2B]

Wow! Thanks! I feel overwhelmed! LOL... I studied CT's like crazy for the boards until I knew them well. They use to confuse the heck out of me. It gives me a good idea of what to review before I start work. I took notes from you guys. Sounds like this will be an interesting floor to work on. I was getting nervous at first. Believe it or not when I graduated I had no idea where I wanted to start. All my fellow grads new exactly what they wanted. Me.....not sure. I was interested in L&D then ER, then PACU! I was going to go into the ICU until I delayed my start date until their October fellowship. Seems they didn't like that very much and said ICU was no longer available. Oh well. When I was in school I always did well on cardiac tests. So maybe it's fate.

Thanks alot for the information. I'm feeling better it won't be like med/surg but also nervous because it will be challenging.

Thanks.

Tiffany

[ManyRN2B]

Thanks Rose and Shay,

After digesting those last few posts and feeling overwhelmed it took a few days to feel better. :rotfl: I'm excited about all the things I will be learning. Sounds like I will get excellent experience on this floor. I heard from the nurse educator yesterday and they said the first week will be hospital orientation for one day, 3 days of nurse training and then our classroom fellowship starts and we will be learning dysrhythmias that friday. I guess that was a hint to get studying! LOL.

I love teaching and was curious to know since I would be on a stepdown unit would I need to teach more because they will be d/c from our unit to home. In school I always loved doing patient teaching.

Oh, the other funny thing is for graduation my husband got me a Littman(sp?) Cardiology III stethoscope with my name engraved on it. I told him I didn't need a heavy duty stethoscope like that. Now that I'm on a cardiac floor I'm glad I have it.

Thanks again, I will let you all know how my training goes.

Tiffany