ummwhome 2,970 Views
Joined: Oct 3, '07;
Posts: 18 (11% Liked)
; Likes: 2
Just wanted to know if you have received any feedback on UM ARNP program...I did apply and would like to get a personal view on the pros and cons of the program. Thanks!! and good luck.
Reviews test, labs, and meds commonly given on cardiac floors. Always treat the pt, not the numbers. Be sure the Cardiologist is on board with any changes in pt status. No parameters for all cardiac meds. Dont be afraid to ask if you dont know!!!
First off, I think that if the pt was admitted with as having "MI" then they should have not been admitted to that floor. Secondly, that pt should have had a stat order to have heparin gtt started in the ER or been on their way to the Cath lab! So that my dear is NOT your fault. Now, if its CHF and an old MI, then yes that person may be ok for tele. But a 3 hour old med order of any kind is bad. Now, think like this. When you get any admission, when you take report before you hand up ASK if there are ANY STAT ORDERS, consults( for what every body system is failing!!/Cardiologist) and have they been called. B/c once they come to your floor, if its 3am you will have to call a consult if that person has any cardiac complications. So while they are sitting in the ER on the stretcher have the RN ask the secretary to call. OK, next....what meds have they given...and NEED to be given. That way you will have clear communication and not have to fumble a chart as much to find what you need. Of course check the mar, but you will have an idea of what your pt has or needs. Another good thing to get in report are scans and test such as baseline EKG...for ALL cardiac pts...and what does it read. As far as labs, you want K, MG, Bun, Creat, PT/PTT/INR for minimum. These are specifically big on cardiac floors and pts can have arrhythmia based on low levels of these electrolytes alone. Bun/Creat if they have adequate kidney funct for poss cath in AM...guarantee Cardio consult will ask these. The others are for bleeding times bc 90% of cardiac pts are on bleeding precautions/blodd thinners. Know this baseline knowledge on any pt you have or will receive in report and you will be 2 steps ahead. Good Luck!!!
Dont be afraid to use your resources like charge or nursing sup if you feel slammed. I once had to start a heparin gtt and called my Nrsg Sup to start an IV and start it for me. Of course our floor was slammed. My charge had her own load. We had previously had a code rescue and there were 5 RNs, we had gotten 7 admissions by 0100!!!!!
I agree 100% with this post. If you are unsure, get a second opinion. Call charge RN, Call Nursing Sup and say ...hey, I need to run this by you...what do you think I should do, or I need HELP!!
I've found that some floors assign CODE tasks at the beginning of the shift so everyone has a more defined thought of the major part they will play. Not to say that things wont change or rotate but you wont be dazed and confused. When I am resource nurse in the afternoons, I find this works well. Especially with new nurses or unfamiliar float staff in the mix. That way by the time the code team arrives, we are Rocking!!
This may have some weight behind it!! Honestly speaking, I had been an RN for almost 5 yrs now almost 7. However, I had applied at a Catholic hospital for ICU/SICU/CCU and was passed over and given a CV stepdown position. The new grads, all white, filled 7 spots. All were in CCU, ICU and 1 even went to CVICU. Needless to say the one in CVICU went home crying every night and quit as soon as her mandatory year was up.
If medication is your problem, first are you using paper or emar???
Emar usually flashes a warning sign that says....Its too early, are you sure you want to give this med???
If your using paper mar, and you have someone that is calling you Q2-Q4 on the hour for pain meds, simply take your mar and a blank piece of white paper to the pt and make a time log so you and the pt are CLEARLY aware of the next scheduled dosing times.
If the medication dosage changes, ALWAYS RBV.. be sure to tell the pt you have new orders and the times still remain the same, adding additional time for pending pharmacy review.
Be sure to make intent known you are in the patients best interest and take time to double chk or have a charge or colleague dbl chk if you have ANY doubts. We are a team!! Good Luck ;-))
Rule of thumb..
All surgeries require CBC...H/H to see blood levels, plt for clotting, and wbc for poss infection
bmp: to check for renal function... BUN/Creat: they may need more or less ivf to flush kidneys, glucose for DM for NPO insulin coverage, K/Mg for Cardiac function.
Everyone you cut must have plt/pt/ptt/inr combo pack for bleeding/clotting factors.
CXR for smokers, COPD, asthma, obese, and elderly to decide if they may have complications in pacu.
lots more but you must do your homework.
hope this helps..!!
Its true!! I too started working nights and I usually eat my "lunch" between 2 and 4 am. And snacks are always available with the night staff. Anyway, on my nights off I am always snacking!! so yes, not only have I gained weight, I have inherited the cavities to go with it!!!!
Yes I was able to view them. However, I am not a student anymore. I was hoping for something a little more advanced, but tuned into MS or ICU specific patients. I do appreciate your response. I will keep my eyes open for other report sheet recommendations.
I am also a MS RN for 3 years and am looking to hire onto a ICU or CCU unit. I would love a copy of your sheet. Or anyones sheet!! I am very humble and am always open to learn how to make my routine better. Thanks All!!!
I have been a MS RN for 3 years and I want to advance my career. I assume the first step is to become Tele certified and then ACLS. Anyone care to comment on taking that first step, please do. I work on a CNS/ Neuro Surg floor at this time. We do have pts on tele and a screen showing rhythms and I study it all day. I have taken a course called "Basic Arrythmias", is that all I need to work on a Tele floor. Do I need a EKG course? Do I need ACLS? anyone with an insight before I take the plunge??
Thanks for the heads up Medic!!!
Can anyone help me understand.. do travelers get sign on bonuses or completion bonuses, or both, or neither?? What should I be asking for before extending a contract?
While all abbreviations are created to save time, remember, they have to be legible and universal so "medical errors" DO NOT occur due to misinterpretation, or guessing when following someones notes. Check the JCAHO website for a list of approved abbreviations.
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