**LaurelRN 3,825 Views
Joined: Jan 21, '08;
Posts: 94 (34% Liked)
; Likes: 90
6 year(s) of experience
Open Heart ICU
Unfortunately, it seems this is the trend in healthcare. Hospitals don't want to continue to pay experienced nurses- it's cheaper to train nurses. Not safer- just cheaper- at least that's the way I see it
So here's the thing... I have done numerous papers and alot of research about this topic (not tube feeding specifically- but it ties in). If a patient is in the ICU, there is already a reason to do FSBS- sepsis, MI, neuro issues, cancer, infection- whatever. The inflammatory response is the same no matter the diagnosis. Now add into the stress and release of cortisol and on top of that add tube feedings, yep- you bet I'd be doing FSBS. Advocate for the patient. Euglycemia has been proven in numerous studies to decrease morbidity and mortality related to ICU admissions.
annie.rn- I'm like you- I want them all labeled and pretty- so I know what's where and it's not a spaghetti mess
Are you referring the secure to the patient? We use 12 inch Tegaderms and of course the MD sutures to the leg.Then the helium line should run parallel to the patient.
I did the Laura Gasparis DVD's and questions from her book. I did them nonstop for 3 weeks, had been in ICU 1 year and passed. It depends on alot of things. Are you a good test taker? Do you critically think well? The worst you can do is have to take it again...
Our hearts routinely come out with Amicar. DDAVP is kinda a last resort- if bleeding doesn't stop with FFP and Plt's, they'll go to cryo, then DDAVP- if it doesn't stop then- they go back to OR
The funny thing is JACHO found that their own standards inhibit the ability of nurses to care for patients and their own inspections create part of the problem in health care. That's why I have left the bedside. I'm tired of not being able to actually take care of my patients. It's more about charting, HCAPS scores and patient/family satisfaction than anything else.
Poll: Are your induced hypothermia patients kept 1:1 throughout cooling/maintenance and rewarming?
Thanks in advance
Though what everyone else has said could quite possibly seem feasible. I am more inclined to think (though without labs, trending vitals, and pt history, it's a guess) someone who is in renal failure quite often has electrolyte imbalances. What was the potassium? Mag? Calcium. I have seen more codes from electrolyte imbalances than I would care to. I do agree that the D50 IVP was just coincidence. Don't get too hung up on it- good luck
Nugget...As with everyone else (for the most part)...Inexperience does not mean you screwed up...The Dilaudid...I don't know that I wouldn't have given it...Yes it can cause respiratory depression...however..."below 8, intubate" is not necessarily true..many factors go into whether we intubate someone or not...NARCAN is a wonderful thing (well to reverse narcotics) intubation is for people who cannot maintain adequate oxygenation/co2 exchange and maintain a neutral acid/base balance. translation..if they are breathing 6 times a minute and are pink, good sats, and arousable to verbal stimuli...my book- that's ok.---that said...I may hold it if they are already lethargic- depends on their pain level.
As for the hypoglycemia...nope..not on you (well..except the cookies...I mean...real sugar, high carb ones)...as said before...regular insulin is short acting...a late night, early morning hypoglycemia...nothing to do with you unless you gave Lantus or some other long acting insulin.
My one problem with your post is that your "preceptor" is barking orders to you. Though she is there to guide you..barking orders is not OK. Hang in there. You've done the hard part...you're a nurse!
I don't think it really depends what unit you start out on- I think we all feel that overwhelming sense of OMG!! How am I going to do this and did I make a mistake. Relax, take a deep breath and think.
You need to get into a habit of organization. If you don't have a sheet you use to make a list- get one, make one, borrow one..whatever. Get into the habit of writing a "to do list". If your patient has serial H&H's Q 4..write down, 8,12,4 (or whatever time they are..and check them off as you get results)
Whatever your facilities charting is make a to do list for that too. Like head to toe (8am..or pm..depending on night or day), Pain 8,12,4...Plan of care- NIC/NOC(or whatever you use there)...you get the point.
See what time you have meds due...write them down and check them off when you give them...PS.just a side note here...take it from an ICU nurse who goes to the rapid responses...PLEASE, PLEASE, PLEASE...check BP's before you give meds, Check Potassium levels before you give K+, and make sure there's a decent FSBS and the patient is eating before you give insulin.
And always check your labs/xrays at the first of your shift!!
Once you get into the habit of things...you'll get to the point where you won't need it.
you've done the hard part! You're a nurse!!
Just my ....Hope it helps
There are alot of things at play here.
1) as most everyone here has said, the insulin drip is not really to bring down the blood sugar ( I mean it does, but that is not the primary reason). In DKA, A) you have the absence of insulin B) you have acute dehydration C) electrolyte imbalances D) acidosis.
so A) give insulin- brings down blood sugar
B) Give NS until blood sugar is under 250-300 ( depends on your facility), corrects dehydration- helps correct the acidosis.
C)sometimes people with DKA will have K+ levels at 7 (The highest i've seen - well, and the patient is still alive is 7.6) Insulin chases potassium back into the cell.
D) This is the biggie- Ph of 7.30, 7.25, 7.2, I even seen 7.0 ( well and he was still breathing)- This is the real reason you're giving insulin and fluids. Correct the acidosis- its metabolic. You just have to do it slowly- because remember, for every tenth ph you go up, you potassium comes down by 0.6. You don't want to cause hypokalemia...most facilities start fluids with K+ added once the blood sugars normalize and the Ph starts to get near normal. (which is why we do labs so often)
Eating..well.... that's up to the doc. Some will let them eat- others won't. It makes it a bit difficult, but you're doing Q1 hr FSBS- so it really isn't a big deal.
Lantus- again, so do some don't. We have one endo guy that swears by it and one that won't start it until they are off the gtt.
You just have to be careful. Correct slowly. And if you have a question- you ask it. As a advocate for your patient- (and your license) you have the right to question any order a MD gives you.
Hope we've helped
The Hospital website or career sites like career builder or monster. One thing that bothered me when I looked on the career sites was it was very vague about expectations, pay ranges, and shifts available. But I did look there
[font='comic sans ms']though there still may be times when no one can get there- my hospital went to cna's coming in 15 minutes earlier (and they get off 15 minutes earlier)..that way report is staggered to free up the cna when nurses are giving report and vice- versa
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