Cardiac nurses....allow me to pick your brain : )

[shhnack]

Ok, so I'm an RN new to cardiac floor, and as my personality is: I am having anxiety over "all things I don't know".

Soooo, I thought this would be an excellent forum to be able to pick your brain. Little tips, things to ALWAYS do, things to NEVER do, all things helpful in the cardiac arena. Any and all advice would be appreciated....thanks much!

[sharifi9879]

about drip calculation I advice you that you must be learn founamental of drip calculation VS memorizing some number for some dosage.

[betterlatethennever]

Know how your cardiac meds work. Always remember asymptomatic vs symptomatic. and education,education,education. It can take a long time to get the pathophysiology down. Sometimes i feel like i have learned something 10 times and still need to refresh my brain. Good luck to you :)

[anh06005, MSN, APRN, NP]

I am still fairly new but one thing I must stress: If you're unsure GET HELP from someone you trust!!!

I have been on my unit for almost 2 years and still ask my charge nurse (or a few of the other nurses) questions every day just to make sure my line of thinking is correct.

Also: when in doubt, call the doc. Even if they get angry and upset what are they going to do?? They can't fire you. YOU have to look after your own LICENSE. And if they do get upset, don't take it personally. Again...they aren't your boss.

And take the time to get your own system down when it comes to keeping track of assessments, meds, charting, etc. Just because your preceptor does it one way does not mean you have to do it that way. There is another thread on here discussing/sharing 'brain sheets.' They're a good way to stay organized and learn what is important to know and give/get in report.

[tRiguN]

These are all great pieces of advice and very true, having just survived my first year as a nurse on a cardiac step-down. As a (fairly) new nurse, I will use some of my more cringe worthy mistakes at the beginning and valuable lessons learned through the year.

1. Sometimes artifact can look very convincing on multiple leads at a quick glance and sometimes paced patients without spikes CAN look like they're in idioventricular rhythm (usually you can tell they're paced even if the spikes aren't there, but there was one patient on our unit that had the charge nurse running in there before their nurse came and said, "it's okay, he's paced, I forgot to put the pacer settings on!") When in doubt, run to the patient's room. My doing so has saved 2 patients and all the other times, I didn't allow myself to feel too silly.

2. Beta-blockers. ACE inhibitors. Calcium channel blockers. Blood pressure? Heart rate? Borderline? Page the doctor and if they order you to give it, especially if it's a new med for the patient who has borderline vitals and they're supposed to be getting other vasoactive meds, document who told you to give it! Cover your butt. One of my first patients off of orientation, I gave ordered metoprolol to and he went into a very symptomatic junctional rhythm. Needless to say, docs decreased his dose from 50mg to 25mg and I learned a valuable lesson.

3. Get comfortable with basic neuro. Check all of your patient's pupils and pulses. There are so many times when I've gone into a room after seeing another nurse's assessment "pupils bilateral equal, reactive...." when in fact they are fixed or unequal. Check your new, unanticoagulated afibs (especially w/ rapid ventricular response) for signs of stroke or PE. I had a guy who had just had a stroke and NO ONE other than the neurology team had done a neuro assessment on him (when I put him through the paces he was like, "are you from physical therapy?" haha). I put it in the order for routine neuro checks....especially since I found he had left hemiplegia and a drift.

4. Do not be afraid to talk with the doctors and barge in politely, especially the attending MDs during rounds if you're at a teaching hospital. I hope that some of the interns will come back as attendings someday to our floor because they are going to be excellent "bedside" doctors and colleagues. Others I have not been happier to have seen gone because of their complete idiocy (not to say I'm perfect obviously, but some of these interns should just stick to research and stay the hell away from real patients).

5. Related to above. PAGE PAGE PAGE the doctor when in doubt or try to hunt them down if you have any doubts or something isn't right, be it something a patient said, or a questionable set of vital signs.

6. If a patient is feeling dizzy and they are able to stand safely, you should always automatically do orthostatic BPs and check the most recent creatinine and look at your I&Os. It might just mean a simple fix to a fairly simple problem (dehydration) and save a lot of paperwork for you if your stubborn patient decides to go to the bathroom when he's wobbly as a new fawn and falls down.

7. If you have time and your patient wants to talk, listen to them. Not all of the therapeutic communication stuff you learn in nursing school is ********. By cultivating my listening skills, I was able to learn from a patient exhibiting subtle drug seeking tendencies that he was suicidal and had plans. But when I asked him why he hadn't killed himself yet, he said he still had a little hope that things would get better. I went through the appropriate channels to do my best to get him help.

8. Codes. You WILL be TERRIFIED. When someone else's patient codes, jump in there, preferably as the recorder. You have a very valuable role, but you are away from the action and get to observe and learn. Don't worry if you make mistakes on the recording sheet..everyone does..just recopy it if it looks like a huge mess. Make sure you get names and don't be afraid to ask what the drug is that's being pushed so you can write it down with the time.

9. GET ACLS CERTIFIED. YOU WILL NOT REGRET IT.

These are just some of the tidbits I can share from my both terrible and wonderful first year as a nurse on a chaotic cardiac step-down unit.