**LaurelRN 3,822 Views
Joined: Jan 21, '08;
Posts: 94 (34% Liked)
; Likes: 90
6 year(s) of experience
Open Heart ICU
The wedge wouldn't be accurate with mitral stenosis either, so yeah I don't know why she did that. In order for a wedge pressure to accurately be a measure of LVEDP, equal pressure across the system must be present. In other words, the pressure has to be equalized across the capillaries, pulmonary veins, left atrium, and left ventricle during diastole or else your number isn't accurate. During mitral stenosis, blood backs up and increases left atrial pressure. Therefore, during diastole (when the mitral valve is open), there isn't enough time for pressure to be equalized. So your wedge never has a chance to be accurate.
Better question, as pointed out, is why wedge? Ever?
Learn as much as you can and show your assertiveness to your senior managers. The transition doesnt happen overnight. It takes time and patience for you to be ready. It might not be cake and ice cream, but it'll sure be worth it. Goodluck!
Nurses leave the profession for a myriad of reasons, including:
3. Treated badly by patients
4. Treated badly by families
5. Treated badly by managers
6. Treated badly by other nurses
7. Treated badly by other members of the interdisciplinary team (physicians, PT, OT, ST, social workers, case managers, dieticians)
8. Too much responsibility
9. Not enough authority
10. Administration treats us like we are as replaceable as the roll of toilet paper in the restroom
11. Mentality that the patient is always right
12. Increased focus on patient satisfaction scores
13. Decreased focus on proper patient care
14. Dangerous nurse/patient ratios
15. Feeling trapped in a lose/lose situation
In the trauma ICU had a pt with a temp of 104, purely from the head injury. Meds wouldn't work so we packed him in ice. Ran into them a few months later and the wife reminded me that I gave him snow balls!!
Warning: Proceed with caution! The following is so sickeningly sweet, so saccharine, that it will rot your teeth.
And I do mean rot 'em good. I am a cynic to the core of my soul and I think, for just one moment last night, I may have known how the Grinch felt with that sudden onset of cardiomegaly that occurs when he decides to return his spoils of victory (the fool).
Anyway...on with the tale.
This week has been the week of chests. Pick something in the chest and it has randomly started or resumed bleeding to the point that crashing over, pouring and cutting has been the name of the game in a weird macabre version of "rock, paper, scissors".
So this gent goes all pear shaped over in Cath Lab, the Blue Calvary is called (that would be us) and we swoop over, lickety-split, banners flying and trumpet sound and saw our way in to get control of what was a truly ugly, no good very bad situation.
Everything is settled, we're on pump, all is right in the world (as much as it can be) and there is a phone call from the waiting area that the family is a bit worked up and would like to know how things are going.
Right. Fair enough.
I am one that prefers face to face interaction with surgical families. I have found that there is a better outcome in expectations regarding pain, recovery, prognosis, and perception of the patient--especially when they are going to next be seen in critical care wired and lined to high heaven. It is proven that knowledge decreases anxiety.
So I went and changed my scrubs, as there is nothing good that comes out of going out to see a family looking like I just came out of a horror film, before heading to the surgical waiting area. Finding them did not prove a challenge.
There was quite a gathering of family, holding each other close, talking in low voices and weeping. Beneath their conversation was the palpable pulse of fear and dread. As I approached, I noticed a kidlet lying on a couch, swaddled in blankets, clutching one of those novelty teddy bear plush sold around this time of year (you know, the ones with the bear "holding" a heart stitched between its two paws) and dozing beneath her mother's tearful, doting gaze.
The conversation went as well as could be expected. I got hugged. A lot. Still not quite sure how I feel about that....but just as I turned to excuse myself back to the suite, I heard the mother's gentle alto call out to stop me.
In her arms is what I'm fully confident was a cherub, rubbing her brown eyes a bit sleepily and hugging the little red stuffed heart last seen between two plush bear paws. I returned to them, bewildered, and the tiny one extended her hand and offered me the heart.
"For Grandpa 'cause his is broken."
Holy crap. I swear to you there was something in my eye. Bilaterally. Universally.
But I am nothing if not a woman of action, so I accepted the proffered palm size plush heart and swore that I would take it with me to give to her grandfather.
Normally that would probably be where this story leaves off, but no. Not this time. Your teeth are intact. And your blood sugar is well below one hundred. I know these things. No, there is more.
Let's fast forward a touch, shall we?
Case goes well, we're wrapping up and preparing to transport our gentleman to Cardiac ICU, when the surgeon spies the little fabric heart lying on the nursing desk. After I explained what it was and how it came to be in OR, he cradles it in his big ol' size nine bear paws, finds a clean silk suture and puts a couple of stitches in it, before dotting it with a Band-Aid and placing it in his lab coat pocket.
When I continued to stare at him in dumbfounded curiosity, he just drawled something along the lines of, "Well, if it was broken, I fixed it. I'll give it back to her when I see the family. She'll have to look after his fixed heart for a while." I dunno if that was verbatim or not as I was in the middle of a full blown Grand Mal brought about by an overdose of cuteness and drowned out by the chorus of "aaaaaaaawww" from the neighboring staff.
Oh my sweet mercy, when in the world did my life become a Hallmark special?!
Got all your teeth?
Yeah. I thought not.
Happy Singles Awareness Day!
Love and snuggles,
~~Your Friendly Neighborhood Sociopath~~
I got floated to another unit last night. I am not familiar with their type of patients and I am not chemo certified. At one point, while already drowning and getting an admission (which gave me 6 patients while all other nurses on the floor had only 5) a patient came out into the hallway vomiting everywhere. I did not know what was wrong with her, but I helped her back to bed and called her nurse. The nurse told me to give her something and hung up. I called back and asked what the patient was in for and what can she have. She said she was busy and hung up on me again. I looked up the patients chart (even though I had NO TIME FOR THIS), she had a bowel obstruction and she had already maxed out her nausea meds and it was 6 hours too early to have anymore. I called the nurse and told her it was too soon. She told me to give it anyway and chart it as "condition warrants". I was not comfortable with that and told her so, but she hung up again. I called the Charge Nurse who told me to call the Dr, I explained that I had my admission and still was very behind with all of my own patients. I had 2 patients getting blood and i getting platelets. She screamed at me told me to call the dr. So I did. I tried to answer the Doctors questions the best I could with the chart in front of me, he ordered an NG tube. I wrote the order, called the nurse and told her she would need to do it I did not have time. I later found out that she was just giving her routine meds, so she was not busy with anything emergent.
Anyway I got an email this morning that the Charge Nurse from that floor emailed my boss to say I was not being a team player and that I refused to put in the NG tube. I ended up staying an hour late trying to get MY OWN patient stuff done. That other nurse left on time. I literally spent an hour dealing with this other patient which was NOT MINE. I feel like I did as much as I could and never even got a thank you from the rude nurse I was helping. I asked to meet with my manager to tell her how I was treated on that floor and the mess I was left. I have also told her I will not under any circumstances go back to that floor.
I really felt like they dumped the worst assignment on me to begin with. Should one nurse have all the patients getting blood and platelets? And then get the first admission? It was hard enough having to find where they keep everything and look up every single med since there were a lot I was not familiar with.
Home phone rings
Me: Hello, Unit B, this is Nurse Pixie how may I help you.
Any Alarm rings (microwave, preheating oven, dryer cycle done etc)
Me: turning on heels to go find the offending infusion pump
Needing to use the bathroom
Hands over cell to daughter and asks she cover my phone for a couple of minutes
People on here need to realize that when you complain on here (and for some that all those individuals do) it really dissuades us new grads from continuing into the profession. First and most obvious question, Does anyone actually like being a Nurse? I mean granted I don't think anyone loves all aspects of their job, but does it seem like a nightmare every day? Secondly, name the best part of your area and your biggest pet peeve.
Sorry had to rant.
Oh, by the way, most people post here without regard to new grads because they are not the epicenter of our existence or jobs or topics .
I wanted to let you guys know that it's official...I'm a CCRN. All the studying and prep payed off!
I am being polite Esme. You don't want to hear what I really think!:***:
I 100% agree with the OP. Sometimes, I read some of the grossly detailed patient information
here and I cringe. This is such a violation of HIPAA and is extremely unprofessional.
Patient information should be protected at all cost no ands, ifs, or buts about it.
promote the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite....we also ask that you please refrain from name-calling. This is divisive, rude, and derails the thread. Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.
Our call is to be supportive, not divisive. Because of this, discrimination, racial vilification and offensive generalizations targeting people of other races, religions and/or nationalities will not be tolerated.
On another note it would be nice to have the OP respond - to their 5 pages of replies . . .
Why do nursing students always eat the old nurses? I'm tired of being bullied by students yelling at me for being unprofessional!!!!
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