Help a fellow nurse do better for her patients

cleback · Nov 15, 2018

What kind of coronary syndromes? non/STEMI? CHF? What medications are you giving?

I find your question to be an interesting one. There's probably a lot that you could do but time is always a limiting factor.

A lot of what I've done is monitoring for effectiveness of the medication. If they're on continuous iv nitroglycerin, I will monitor their BP and chest pain. On places I've worked, we have had a dosing algorithm to adjust the med up or down depending on pain, blood pressure. For CHF, we give a lot of furosemide for diuresis and monitor their weight and urine output. I haven't given tpa but the monitoring for that is intensive.

Otherwise, we do prevention that's common across all patient population--oral cares, ambulation if stable enough, maybe advocating for pt/ot if they're very decondititioned, cardiac rehab.

Education is big too. Talking to them about low fat/low salt diets, activity restrictions when they get home, how to take care of any incisions (from cardiac caths), what to expect if they will have home health, who to call or where to go if they have symptoms/weight gain/etc.

There are/were also metrics for heart failure and heart attacks that are tied with reimbursement or are reportable to government agencies. Some nurses track and report these metrics, although not all are owned by nursing (for example, % of patients prescribed beta blockers by their physician at discharge).

Anyway, that's just what comes to mind. Let me know if that's what you were looking for.

liluiass · Nov 15, 2018

Thaaaaaank you for your kind reply

the main diagnosis are : STEMI, high risk non stmi when there is place; cardiogenic shock; sometimes like any other unit we have an stmi patient with other problems like a digestive hemorrhage or a severe infection so sometimes we do care for septic shock patients ..

as for the medication used generally furesimide, dobutamine, noradrenaline, amiodarone iv and orale, lidocaine iv, anticoagulants,rarlely Iv nitroglycerin ...

as for tpa we only use streptokinase and monitor for regression of chest pain/ st elevation

what I want to know is how globally you take care of the cardiac patient

what are the arterial pression aims that are acceptable for the resting patient ? the doctors here don't care for any signs of shock unless the patient turns cold

arterial pressure of 7/4 is acceptable for them...is it elsewhere too?? what are the glycemic aims that you want on your patients ?

education is very important but as charged the work is I almost always leave that to the young trainee :$ my only remarks generally is a NO salt, don't drink lot of water and no sugar for the diabetics is it worth it to give them more time for that ?

also there is this big big problem of agitation of patients

how do you deal with someone screaming, hallucinating and wanting to go home in the middle of the night?

why does that happen a lot ? is it because they're elderly ? how to prevent that from happening ? what do you do for them?

generally we do some inhuman practice of tying the patient down just so I can keep up with the other 9 who need me as I can't afford the time to monitor the agitated scared patient closely but I always feel bad about it ...

I talked a lot I'd be happy for any kind of reply

sallyrnrrt, ADN, RN · Nov 15, 2018

Bless you

Critical patients often suffer from what I call ICZu psychosis,

From lights , monitors, and frequent assessments.... they sometimes are severely sleep deprived...

I don't know if this helps you ? But what are we to do... we must do the assessments, the monitors are. Necessary.....

liluiass · Nov 16, 2018

From lights , monitors, and frequent assessments.... they sometimes are severely sleep deprived...
.

I didn't even think that my frequent assessments would cause that kind of suffering... Thank you.. That's smart