[deeDawntee]

Originally Posted by BeckyKRN

I am planning on taking the CCRN exam in the near future. I am trying to find some online material without having to buy too much to study for it. Let me know what you find out!

YYYYAAAAAYYYYYY BeckyKRN, you have found the right thread!! This is what the consensus here has been basically: Get Laura Gasparis Vonfrolios DVD course it is $150 from her website greatnurses.com. Some people have found it on ebay and you could certainly sell it on ebay afterwards if you felt you could part with it!! (She is something else, what an empowering teacher, you may want to keep it!!) Then get her book of questions for the CCRN and their rationales: Critical Care Examination Review by Laura Gasparis Vonfrolis, the best price for this is on Amazon.com 19.11. Also there is one more highly recommended resource Pass CCRN by Robin Donohoe Dennison, it is a huge resource which is good for a reference only, but what is important is that it comes with disc of questions only and their rationales. People on this thread said those questions were a very helpful practice. I'm not sure what the going rate is for material maybe 40-50, you can get that on Amazon.com. Also people on this thread have found some really good websites.
www.chartingandassessment.com/CCRN (from ruralRN) and www.pacep.org (from Burnt2).
I am so glad that you have found us!!! Hope this helps, others will respond as well.

:groupwelcome: the 9 of us after we pass!!

[deeDawntee]

Hi everybody!
How was the weekend? How is studying going? I have to share with you all a patient I had this weekend. He is a 55 yo 3 ppd smoker who came in with pneumonia and was intubated. This man's lung's are so tight and his COPD so severe that he has an internal PEEP of 30 (without being vented). OK, I don't understand how that is even possible? I just don't get it. Air is constantly trapped in his lungs.
Has anyone heard of that before? This is the first time for me!
The guys fingers are clubbed, obviously he's been in bad shape for a long time. Very sad. They have his vent set at a PEEP of 8. (Why?)
I'll have to try to google this and see if anything comes up. Very strange. I know that COPDers are CO2 retainers, but I thought that meant in the blood gasses. I am confused. No one last night at work seemed to know either.

[cjmue12]

Originally Posted by Burnt2

I have such a tiny brain though....oh well, you're right....I tend to have a negative attitude sometimes


does anyone here do cvvh/prisma? I'm looking for some kind of online ed thing

We do CVVH/CVVHD. Our current machines are through Baxter but we will be changing to Nexstage soon. Try searching for CRRT (continuous renal replacement therapy).

[Burnt2]

Originally Posted by deeDawntee

Hi everybody!
How was the weekend? How is studying going? I have to share with you all a patient I had this weekend. He is a 55 yo 3 ppd smoker who came in with pneumonia and was intubated. This man's lung's are so tight and his COPD so severe that he has an internal PEEP of 30 (without being vented). OK, I don't understand how that is even possible? I just don't get it. Air is constantly trapped in his lungs.
Has anyone heard of that before? This is the first time for me!
The guys fingers are clubbed, obviously he's been in bad shape for a long time. Very sad. They have his vent set at a PEEP of 8. (Why?)
I'll have to try to google this and see if anything comes up. Very strange. I know that COPDers are CO2 retainers, but I thought that meant in the blood gasses. I am confused. No one last night at work seemed to know either.

Man that's alot of physiologic PEEP. PEEP of 8 seems entirely insufficient - did they have him set on some kind of pressure support mode with target volumes? Maybe they loaded him with so many beta agonists that it opened him up a little

I may be wrong, but i think an inverse I:E (like 3:1)sometimes helps with those people with wicked stiff lungs
............this is a great ccrn thinking type scenario right here

[Burnt2]

Addendum: what was his blood pressure with that kind of peep? talk about putting the squeeze on the heart

[deeDawntee]

Originally Posted by Burnt2

Addendum: what was his blood pressure with that kind of peep? talk about putting the squeeze on the heart

He was on Vt of 580, his systolic pressures were 130-150's. How does that kind of physiological peep develop? The vent was IMV at 22. There was no overbreathing the vent. I had him on Diprivan at 90 mcgs for the night. When I came on he was diaphoretic, although afebrile. I stripped him down, gave him a good bath, got him a fan. He seemed much more comfortable with the cooler temp and the higher sedation (for the night anyway). This poor man at only 55 had been living in a VA home. Estranged from his family and had some severe OCD.

[stressgal]

Are you talking 90 mcg/kg with the diprivan? I haven't gone that high unless someone is ETOH dependent.
Sounds to me link emphysema, not just pneumonia. I have a pt. curently that is end stage emphysema, yet the family is just accepting the dx. So sad. Mom (patient) is an emaciated 60+ year old barrel chested COPD pt. You know.... Yet the family just now realizes the extent. So SAD. There is truly nothing worse than watching a loved one "struggle" for breath. Say a prayer please.
Thanks!
Stressgal

[deeDawntee]

Yep 90 mcg/kg, that is up from 80-85 during the day. Not that unusual really for large people. This guy definitely has SEVERE emphysema with a physiologic peep of 30! VERY stiff lungs. I doubt that he really wants to wake up or get better, to tell you the truth. Looks like a case of slow, deliberate suicide. Very sad.

You are right, I think dying of COPD is the worse death.

[cjmue12]

In our institution we we get that high on Diprivan, its time to start a different drug (Ativan Versed, etc). Diprivan at 100 mcg is considered anesthesia, not to mention the astronomical cost, around 150.00/ 100 ml bottle. At that rate and with a large person you are probably hanging a new bottle every 2 hours. Plus dietary hates when we keep people on Diprivan for more than a few days with all the lipids and empty calories.

[deeDawntee]

You are right about the Diprivan, but at the hospital I work it is not uncommon to see doses that high for no more than a week in most cases. It is anasthesia, in people who are hypoxic, at times we use paralytics to keep their O2 consumption at a minimum as well, but that is far less common. Is that an unusual practice?