eCCU 3,721 Views
Joined Aug 31, '10.
Posts: 208 (34% Liked)
I can understand perhaps in your experience that an ECMO is just like a VAD.
But as a BSN that went on to get my MS and CCP, I have to disagrees with your statement. VADs and ECMOs are not remotely the same.
I run a variety of VADs and ECMOs. From biVADs, HeartMate2, impellas, Syncardia TAHs, and using a cardiohelp for picking up ECMO/VAD patients.
Each curcuit, machine, and (obviously patient) is different. The insertion process and discussion and decision of which to use is quite complex. How can you say a post partem heart failure patient on a syncardia or heartmate2 that will go home with the device is anything like an ARDS ECMO patient?
I understand that while you watch them and chart every hour, it may feel the same. However, I've been in the room when RNs have described an ECMO/VAD as "just like dialysis".
Statements like "ECMO and VADs are the same" or it's just like IABP or dialysis show a major lack of understanding
Nursing is a calling much like a priest or nun.
"A lot of codes" is not a good thing..
I did not say that they shouldn't be an NP because they can't keep up their GPA. I said if they were not passing a course nor meeting the bare minimum requirements to stay in their program, that would be a red flag.
Also, I have a learning disability. I mentioned I have ADHD. It affected me all throughout NP school until I was finally treated starting near the very end of my program. A prudent student would make accommodations and adjust as needed. That's what I had to do.
I also realize that smart people fail out of school. Academics isn't for everyone, nor is it a gauge of how smart someone is. But to become an NP, it is a requirement for licensure. What happens when these NP schools graduate these people that repeatedly failed classes and they can't pass boards? They'll feel even more screwed for having wasted more money. And I NEVER EVER EVER said that the NPs with the best GPAs make the best providers. NOWHERE did I say that. I was speaking about minimum competence, and those with self-image problems read it the way they wanted to.
The poster doesn't need sugarcoated fairy tales. They need the truth and all options. I never said she didn't deserve to be an NP. However, if she is finding the coursework insurmountable, maybe it isn't for her at this point in time, or maybe there is another avenue in nursing she could pursue that would suit her best. I would probably fail miserably as an ICU nurse, for example. It's just not in my natural skill set. And there's nothing wrong with that.
But I'd hate to be an ICU nurse that repeatedly messes up and being told that I just need to try harder and I'll turn out great. I'd rather be told "nope, this isn't for you. Maybe you should try another area of nursing."
Except to get into medical school you need to already have a stellar undergrad GPA and pass the MCAT.
We shouldn't lessen our standards for NP school more than they already are.
You're generalizing people when each person should be treated as an individual it's not the license it is who the person is.
I don't want this to come off as harsh, but if someone is getting poor grades in school, do we REALLY want them prescribing meds and diagnosing people? Just because it is your dream to become an NP doesn't mean it has to come true or the world is unfair. I had ADHD and wasn't treated for it until my second to last semester in NP school, but I was never, ever in danger of failing out and my first BA had a GPA of 3.9 and my BSN a 3.7.
As an NP you'll have people's lives in your hands. Either study until your eyes bleed if you're not getting the material, or choose another path in nursing.
The people in my classes that were in danger of failing were the ones that we all thought should not even be in the program as it is.
I really don't understand the vitriol or superior attitude about B&M programs vs online programs. I went to a B&M program for my MSN, but honestly, what's the difference with "online" programs except that you don't sit there at lectures? I barely went to lectures anyhow - I don't find them useful, my teachers sent out the slides in advances, I went when needed for exams or if I had an issue with something. Online is just a delivery method like classroom teaching or anything else. You still have to do clinicals, physical exam and assessment etc in person for the required number of hours. Just another case of nurses (or NPs) fighting amongst ourselves instead of focusing on things we can and should change.
First Congratulations on your son! I am so sorry you had such a scary beginning.
Welcome to AN! The largest online nursing community! As per the Terms of Service we cannot give medical advice but we can give you general normality that go on inside the ICU.
It is impossible to know the why's of what they did. It is easy for her regular OB to play Monday morning quarterback. Many times in the emergency department patients are intubated for the sole purpose of sedating to keep a patient still to obtain the necessary exams when they are confused or combative. It is not uncommon to be agitated/confused after a seizure and in the presence of unknown etiology...to cover all angles, meaning, Lumbar puncture, antibiotics/heavy and strong...to cover all possible bases.
Many times in medicine we never find out the exact cause but the patients remain very ill or present critical and the final diagnosis remains an enigma. Intubation to protect an airway is usual and customary especially in the emergency department. It is best that if there would be any doubt of the airway protect it immediately. The emergency department doesn't play and wait until the least minute when it is a code situation....they simply can't wait. Time is of the essence.
Leaving her intubated may have been an over cautionary length of time, however, once again always side on the side of caution. IN the presence of her acute presentation I can understand the staff's nervousness.
Depending on the time of day...meaning night...certain things are just not done (again on the side of caution) like extubation until there is more experience and actual bodies present in case something goes wrong.
Propofol....wonderful drug! I recently had to have emergency surgery for ischemic bowel, small bowel obstruction, sepsis. They left me intubated (or so I was told) for a couple of days....to "let me rest" and unstable vitals.
I remember NOTHING! Apparently I was a piece of work on the vent. Propofol, Ativan, Fentanyl, and Dilaudid and I still would fight the vent, get my hands untied, moved constantly with only very brief moments that I was actually resting. My B/P was low as was my urine output and my heart rate was 140. They decided to stop fighting me and extubate me. I am told I promptly told them what I thought about being left intubated and how to fix my B/P, volume, sepsis, urine issues. Rolled over and went to sleep. I was told that my surgeon said...."Well she told us....do what she says". (I am a long term critical care nurse of 35 years and completely embarrassed at my alleged behavior )
The next thing I remember was 4 days after admission at 7 at night when my children came to see me. I am so happy my husband didn't let them see me with all that crap however they did see me newly extubated still talking turkey from the meds.
I think this has been very scary for your fiance and you...I think talking to the patient advocate will help you piece together the pieces. Ask to speak/have a meeting with the attending or medical director of the ICU to get the best perspective on this traumatic event. Maybe even seek some counseling to help you process this trauma.
In the end...you have a healthy son and fiance.....Merry Christmas
I asked today actually. and I have built a relationship with my preceptor it was a question (a few questions) on my mind and I wanted to ask at that moment on AN. If you're not an ICU nurse, why bother answering a question under critical care nursing. Not to be rude i'm sure you're trying to make a suggestion, but it's obvious that I should ask my preceptor.If the whole point of going on AN was to tell people to ask someone else, what would be the point of AN in the first place? Waste of time, no offense.
Once had a VAD pt in slow VTach for a WEEK. Rhythm was unresponsive to all therapies, but the VAD still kept pumping so BP was fine. Final outcome not good. Crazy stuff.
You just called your husband stupid.
That's where you lost me.
Hey now! Not every hospital that doesn't use protocols is old-fashioned, not forward thinking or don't use EBP. Maybe they don't have the money for departments dedicated to evidence-based practice. Maybe they don't see critical patiens all the time. Maybe it's a critical access hospital that staffs only two nurses. And I'd like to see the research that says it's okay to not have specific orders for vaso-active drugs.
Let's look at a possible example. Say the medics bring you in a patient that's coding, your ER doc being such an awesome and smart guy is able to revive her with the help of your wonderful team. During all the commotion you were able to gather that she has the following: DM, HTN, CHF, previous MI. The doc decides he wants to put a swan in this lady, so you help him set it all up and he throws it in her right IJ.
He writes you the following orders: Epi gtt 2.5mg/250cc NS PRN titrate for MAP >65
Neo gtt 20mg/250cc NS PRN titrate for MAP >65 and finally in case you screw up Nipride 50mg/250cc NS PRN for SBP>160.
Now the numbers pop up and the lady has a CO of 1.4 CI 0.8 and SVR is 2750. The orders don't say anything about titrating the drips to her hemodynamics, but are you going to just let her numbers look like crap because the orders don't specifically say "start EPI at 5cc/hr, titrate by 5cc every 10 minutes to attain a CI >2"...
I've never had a physician tell me what to start a drip at or how much to titrate it by. As a nurse you should know that you don't start a nitro gtt out at 200mcg or a cardene gtt at 15mg/hr.
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