Clinical tidbits I wish someone would've told me. - page 2
by Mully | 14,917 Views | 32 Comments
Hey everyone, I'm a new graduate nearing the end of my orientation at my first job on a busy Stepdown unit at my local hospital. Although we don't deal with vents, we do most every common gtt (cardizem, dopamine, insulin,... Read More
- 1Sep 18, '12 by detroitdanoQuote from CreamsodaI remember hearing a story about a middle-aged guy drove to McDonald's after taking Ambien. Started yelling nonsense at the order taker, then moved his car back and forth between the first and second windows on the building, then parked his car in the lot and walked home.Ambien isnt even good for regular folks, my boyfriend used to take it when I first me him, he quit because it turned him into an "ambien monster". Hallucinating, acting out the hallucinations, the whole nine yards. Hes in his 20's, its not just the old folks it affects.
Called the police the next day reporting his car stolen. They knew where it was. He had no recollection of the story LOL
- 6Sep 19, '12 by Esme12, BSN, RN Senior ModeratorQuote from crisxfourUnderstand that the vagus nerve is not retransplanted (the chest/heart is denervated) after transplant and so Atropine would be useless in symptomatic bradycardia. It has also been shown that after transplant a significant proportion of patients respond paradoxically to atropine, leading to asystole as the result of sinus arrest or AV block. Although a plausible explanation for this effect remains speculative, there is data to indicate that the use of atropine or other anticholinergic drugs in patients after transplant is contraindicated.Why won't Atropine work on a Transplant patient? I had never heard that before, very interesting!
Atropine Often Results in Complete Atrioventricular Block or... : Transplantation
- 4Sep 19, '12 by turnforthenurseRNQuote from Esme12...because atropine works on the vagus nerve and heart transplant patients do not have a vagus nerveAtropine will not work on heart transplant patients......
Edit: looks like Esme beat me to it!
And while on the subject of atropine, it works on the AV node and higher...so think about your heart blocks. A 1st degree is at the SA node. A Wenckebach (2nd degree type I/Mobitz I) is at the AV node. A Mobitz II (2nd degree type 2) is at the Bundle of His and a 3rd degree block is at the purkinje fibers. Atropine will only work on blocks at the AV node or higher. It wouldn't really hurt to administer in a patient with a Mobitz II or 3rd degree but it probably won't help because those blocks are below the AV node. These patients need to be paced.
If a patient is admitted with bradycardia, keep atropine and some pacer pads at the bedside should they become symptomatic.Last edit by turnforthenurseRN on Sep 19, '12
- 2Sep 19, '12 by sapphire18 GuideAlways listen to your patient when they say that something "just isn't right." try checking a blood sugar- then if WNL and sense of impending doom persists, grab an ABG.
Get ready to clamp the NG/OGT ASAP (or hook to sxn) after placement, those things can become a pressurized fountain of stomach contents!
A normal HR can mean disaster if the pt had previously been very tachy- have had 2 pts recently with HR in the 70s who were minutes away from asystole- luckily both were DNRs (but still being treated).
- 4Sep 19, '12 by eatmysoxRNPress Ganey is the devil.
Always make sure the patient doesnt have a test that requires NPO before giving a snack.
Dont draw labs from a hep line without flushing really well first.
Explain what you are doing to everyone, even if they are confused or are not conscious.
Label every line. Check every line at shift change.
If you run a drip as a secondary, make sure the clamp is open. I have come into work to find drips programmed but not infusing. Eek incident
If you make a mistake, own up and learn from it. Seek advice and let the md know so it can be treated.
Get vitals every time you call the doc.
Make sure all patients with any heart problems or potassium issues are monitored.
Pharmacy is awesome as a resource. Ask them to help manage drips and such. Any med questions they can usually advise you some.
Make sure SCDs are plugged in and running correctly. I hate seeing SCDs charted as on when they are not plugged in.