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himilayaneyes, MSN, APRN 8,923 Views

Joined: Jul 4, '10; Posts: 502 (44% Liked) ; Likes: 668
ARNP; from US
Specialty: Critical Care/Coronary Care Unit,

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  • May 15

    I personally have seen PEG tubes to suction...but few and far between. It's not something that's done on a regular basis. At the end of the day, you have to follow the MD's orders. If you don't feel comfortable, ask the GI doc on the case unless it was GI who ordered it....more than likely the attending doc isn't going to go against GI. And sticking a NGT or Dobhoff in can damage the mucosa...it's a foreign body...follow the orders. If there's an order, then your butt is covered. You can also politely ask the doc the rationale behind suctioning through the PEG vs. a NGT.

  • May 13

    there are some things that take nurses a long time to learn, especially a new nurse. i would brush up on the signs and symptoms of a stroke/heart attack/respiratory distress/hyperglycemia/hypoglycemia. a snf has a lower acuity level than a hospital. however, i wouldn't suggest risking your license. i would suggest that you continue to look for work elsewhere while you work at this nursing home, a staff position. you may also want to take a pocket guide for nurses to work with you. good luck to you.

  • Aug 31 '17

    Beta blockers as you know decrease the workload of the heart. They also as you say decrease afterload. This is going to be your best friend. CO = HR x SV. Cardiac output = Heart rate x Stroke Volume. Cardiac output = volume of blood pumped by heart per minute (liter/min). Stroke volume = volume of blood pumped from one ventricle per minute (usually left ventricle). Remember that stroke volume consists of preload, afterload, and contractility. If any of these three things are affected, it affects stroke volume....thus affecting heart rate and cardiac output. When one goes up, the other usually goes down. If stroke volume goes down, HR goes up. If beta blockers decrease afterload (resistance heart must work against to pump blood into periphery) and contractility, the blood pressure will decrease b/c you're vasodilating. Heart rate goes down, stroke volume (compensatory mechanism) goes up.

    However, the easiest way to think of it is that you know that beta-blockers affect the sympathetic nervous system which causes you to vasoconstrict and increase heart rate. If it's working against the SNS, it'll have the opposite effect..lower BP and lower HR. However, that formula I gave you is still good to know especially for the cardiac section of your med-surg class. Good luck.



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