interested in cardiac

[srleslie]

So I'm graduating in December with my BSN and I think I want to do cardiac. I honestly thought the heart would be boring, but now that I am taking Adult Health, so far all we have done this semester is heart and I am loving it. It is really fascinating me, probably more than any other part of nursing I have studied. I know I want to do ICU but was thinking a tele floor or stepdown might be a better place for me to get my feet wet. I know I don't want to do med-surg but I'm willing to do it for a while if I need to or can't find the job I want in January. I am going to apply to a hospital that has a 6-month residency program where you are with a precepter the whole time and two of the tracks are 1. Critical Care Track: Medical ICU, surgical ICU, cardiovascular surgery, cardiac care and 2. Cardiac Track: Progressive cardiac care/telemetry, preop cardiac procedure unit, short stay cardiac unit. You have to list up to 3 in the order you want and I am stuck between these two tracks. Which would be better to start out with? Either one precepts you for 6 months. 3 months are spent in every unit inside the track, then the last 3 months are spent precepting on the individual unit you will be on (med ICU, telemetry, etc.) so you are well prepared for either one. I know ICU is where I want to end up but I want to know a lot about cardiac too. I will have 18 months of LPN experience in long-term care when I graduate.

And I'm totally stressing out because our next exam is over about 15 arrythmias that we will have had 9 days to learn by the test. We have to be able to look at a strip and tell what it is, know the rythm, rate etc. It's the hardest exam of the course. Any advice on studying is appreciated...

[nyrn5125]

is the exam in school or for the job?

Dale Dubin has a book on strips that is helpful and easier to understand. Usually testing is on afib(irregular)/ flutter (regular), v tach( tombstones)/v fib, 1st 2nd 3rd degree blocks, sinus tach see p wave 100-150 rate ,atrial tach >150 don't see p wave, regular sinus 60-100,,sinus brady

the blocks get confusing but 1st degree is just long p wave

2nd degree type 1 wenkebach short p then longer then drop (irregular)

2nd type 2 classical constant p wave same length same then drops(irregular)

3rd degree has extra p wave (Regular) the p march at the same distance and will get buried in the t wave sometimes,regular and extra p's means 3rd degree

Make sure you don't mix up a pac with a fib

6 months is a long time( my place gives 12 shifts) you might go crazy having to be precepted that long especially being an LPN for 18 months. Stepdown is what I love but started in tele and would never go to icu out of school. There isn't much room for error and you are only human and who knows how many other nurses in that icu can be a great resource when you're on your own. What if they are not expert nurses. it would be scary. Wait for icu til you feel comfortable with your ability to assess and pick up on problems quickly and also ask RN that work there which icu is the best most supportive environment. In med/surg there is so much that we see go wrong many rapid responses and you at least are not expected to be the expert. You call for help. In icu it's all on you and you might not have the experience to know when things are going bad for the pt, you have less pt's which means less chaos which is nice but doesn't necessarily prepare you to be fast and able to manage time well.

[Lovely_RN, MSN]

I played with this, it's kind of fun.

http://www.skillstat.com/ECG_Sim_demo.html

I used this book. Schaum's Outline of ECG Interpretation (Schaum's Outline Series) It got the job done and it's inexpensive. http://www.amazon.com/Schaums-Outline-ECG-Interpretation/dp/0071736484/ref=sr_1_35?ie=UTF8&qid=1316607789&sr=8-35

I was an LPN with two years of LTC experience and I got 12 weeks on tele. I was going crazy by week 4...my preceptors had a great time, they sat in the charting room gossiping, had a lot of FB time, and one got her X-mas shopping done early.

[turnforthenurse, MSN, NP]

I second the skill-stat, great practice :)

There are two EKG books I recommend: ECG's Made Incredibly Easy and ECG Workout by Jane Huff, RN. ECG Workout was a required book when I took critical care in nursing school. Both are EXCELLENT. The ECG Workout book has A LOT of rhythm strips for practice - even more so than the ECG's Made Incredibly Easy book.

I honestly hated doing EKG's in the beginning because I felt like I didn't get it, but now looking and interpreting rhythms is like second nature to me. You just have to practice, practice, practice! Know how to interpret an EKG, know that 1 small block = 0.04sec and 5 small blocks = 0.20sec. Know the normal time for QRS and PR intervals. There should be 1 P wave (appearing before) to 1 QRS.

The hardest to learn (and keep straight!) for me are the AV blocks. Here is how I learned it:

* If your R is far from your P, then you have a 1st degree

PR interval is >0.20sec.

* Long, longer, drop....then you have a Wenckebach (2nd degree Type 1/Wenckebach)

Your PR interval will progressively get longer and then you have a missed QRS.

* If your P's don't go through, then you have a Mobitz II (2nd degree Type II/Mobitz II)

Here the PR interval remains CONSTANT with every beat, but then you'll have P waves without a QRS.

* If you're P's and Q's don't agree, then you have a 3rd degree

Complete AV-dissociation. Basically, the P waves are doing one thing and the QRSes are doing another thing!

Oh and in your EKG test, make sure you measure the distance from R wave to R wave. I almost wrote down "NSR" for a rhythm until I went back and measured the R-to-R distance and the answer was definitely sinus arrhythmia!

And what about a cardiothoracic ICU or coronary care unit (CCU)? I know those aren't options with this internship but if that sparks your interest, I think starting out in progressive care/telemetry is ideal. You will get a strong background and you will be able to move up. Also, I have heard of nurses working on a progressive care unit and then moving to ICU.