Latest Comments by mpccrn

mpccrn 5,031 Views

Joined Mar 9, '08. Posts: 539 (42% Liked) Likes: 453

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    Looking for how different units handle patient's home meds. We are horrible at returning them upon discharge. Currently, we put them in a bag with the patient's name on and put them on the countertop in a locked med room. I find them there long after the name on the bag even rings a bell and I'm looking for a better practice. Any ideas?

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    **LaurelRN likes this.

    I haven't had lunch in 35 years....rarely get paid for it. It comes down to staffing by numbers. You can't leave 1 nurse in an ICU and when they staff only 2...oh well, you loose. Administration won't understand why we won't leave because that would be admitting that staffing by accuity makes more sense than staffing by patient numbers, but hospital's are a business now and patients are our customers. Boy was that a mistake. Morally staff does not leave because we truely care about the safety of our patients, more so, than our own sanity. We are currently making an all our effort to try and take lunches, some days it works, some days it doesn't.....again, it's what going on in the unit that is the determining factor. Just having 1 more set of hands would make all the difference but that does not make economical sense to the accountants running the place. Maybe they need to become patients and see how it would be to suddenly not have a nurse for 30 minutes....maybe then......

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    ICU ratio's at my hospital are anything that is required.....1:2, 1:3, 1:4

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    canoehead, Manatee111, Esme12, and 2 others like this.

    Perhaps if nurses didn't have to use our vacation time when we get sick, we'd stay home and prevent passing on illness to our patients!

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    How does everyone feel about the latest trends in hospital administration's demands that all nurses must receive the influenza vaccine or wear a mask the entire time they are on duty....including eating lunch!

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    In Vap

    oral gastric tubes decrease the changes of sinus infections. By bypassing the nose you deminish the risk.

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    mwboswell likes this.

    online ACLS is just fun! It's like a video game. It'll let you do anything you want.....even give epi during VT haha. I wouldn't go back to the regular course!

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    our ratio for Cardiac SDU is 5:1, working hard to cut it to 4:1. Is 5:1 do-able? sometimes, does it suck? Always. There is something about that 5th patient that just puts the assignment over the edge

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    1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults?
    a. Yes and it is clear, concise, and easy to understand
    b. Yes, but I don't quite understand it
    c. No
    d. Not sure

    2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?
    a. Always nasal
    b. Always oral gastric
    c. Whichever is easier
    d. The purpose of the tube drives my decision (for the purposes of draining or feeding)
    e. Other_________________________________________

    3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated?
    a. Salem Sump (gastric)
    b. Other Gastric______________________________________
    c. Post pyloric (Nasojejunal : NJ tube)
    d. Not sure
    e. Other_feeds are usually started with the already placed NGT. If there is a prolonged intubation, a dubhoff or fredric-miller tube is placed.

    4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated?
    a) Bowel sounds auscultated in all four quadrants
    b) Lack of abdominal distention
    c) Patient has been intubated for more than 72 hours
    d) The therapy has been ordered so there is no other criteria necessary
    e) Other_________________________________________

    5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?
    a. 10 milliliters an hour and advance to goal as tolerated
    b. 20 milliliters an hour and advance to goal as tolerated
    c. Bolus feedings
    d. I start my feedings at the goal rate
    e. Other (please describe)___________________________

    6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?
    a. Gastric residual volumes
    b. Promotility agents
    c. Patient positioning
    d. All of the above
    e. Other HOB is always elevated 30 degrees at least. If the patient has to be placed flat for whatever reason, the feeds are stopped and restarted once the HOB is elevated again.
    7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy
    a. Bowel sounds auscultated in all four quadrants
    b. Lack of nausea and or vomiting
    c. Lack of diarrhea
    d. Gastric residual volumes
    e. Other______________________________

    8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?
    a. Every hour if residuals remain high
    b. Every four hours
    c. Every eight hours
    d. Once a shift
    e. Other_____________________________________

    9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?
    a. There should be no gastric residual volume
    b. 10% of amount of feeding instilled
    c. 20% of amount of feeding instilled
    d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy
    e. Other_Less than 150cc ___________________________________________

    10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.
    a. Greater than 50% of the amount of feeding instilled
    b. Greater than 250 cc in a four hour period regardless of the rate
    c. Greater than 500 cc in a four hour period regardless of the rate
    d. Greater than 100 cc in an hour regardless of the rate
    e. Other __150cc_in 4 hours, protocol calls to stop the feeds for 1 hour and then restart feeds, check residual in an hour, if it is still high, contact the physician.
    11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?
    a. I discard all gastric contents
    b. I return all gastric contents
    c. I return only 250 cc of gastric contents
    d. I return only 500 cc of gastric contents
    e. If the residual is 60cc or less, I return it to the patient, if over, I discard it all.
    12.) How often do you flush your feeding tubes?
    a. 60 cc every 2 hours
    b. 60 cc every 4 hours
    c. 60 cc every 6 hours
    d. After administering medications
    e. Other__100cc q 4 hours if their NA levels are ok.
    Please feel free to add additional comments:

  • 0

    We do sedation vacations on every patient. It not only gives us time to evaluate the neuro statis of the patient, their readiness for extibation but also allows a better idea of how much sedation is actually needed for the patient. Too sleepy is not always good, comfortable is better. We do VS and a Ramsey scale every 15 minutes during the trial. Hope this helps.

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    I don't think it will hurt your attempts at returning. Life needs change our ability to devote ourselves to the job, any good manager will recognize that. Try to go back when you can devote the time off shift to make yourself the kind of nurse invaluable to your patients. Express that in the interview: your regret at having to leave before, your reasons you had to leave and how your place in life changed so that success is within your reach. A good manager will give you points for being honest to yourself and doing what was best for your patients

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    yep, 20 minutes minimum, then groin and circ checks q15 min x4, q 30min x4, q1hr x4 then q4hrs

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    icuRNmaggie likes this.

    I currently work in a rural community hospital where I rotate between ICU and stepdown. Our ratio is 5:1. Most days it's a nightmare....there is something about that 5th patient that makes the goal of the day to stay just one step before impending disaster. We are currently working really hard now to get that ratio decreased to 4:1......and it looks like we'll win! Can't wait!

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    It's been a few years, but yes when I worked shock-trauma, we use to prone people as a last ditch effort to try and oxygenate them. There are always risk when proning a patient, risk of dislodging tubes of any variety including the ETT. I found it did work on increasing O2 levels but can't really say it did much for the big picture. As mentioned, it was always a last ditch effort when all else failed. Having said that, it only takes one patient saved to make it worthwhile.