Bronx1560, MSN, CNS 3,103 Views
Joined: Jan 18, '07;
Posts: 54 (26% Liked)
; Likes: 21
Agree with my fellow nurses MAP <60 is decrease perfusion to all your major organs. Remember the correlation between your aline pressures to get your MAP. Diastolic <60 can cause your MAP to drop.
I remember when i was in my critical care course (no going to tell you how long ago ) i was taught MAP >65 is all organs perfused , MAP 60 is brain only & MAP < 60 nothing perfusing.
Hope this helps
wedge is a no no with fresh hearts in my facility. We aren't risking busting the artery or valve when PAD is close enough to wedge. Besides in combination with your other hemodynamic you can tell if the issue is (cardio or pulmonary). We are old school as well swan is preferred method for open hearts (CT surgeon). However we are also using The Vigileo monitor for our CHFers/septic pts. but i have issues with it cause you need a working a line for my #'s to be write. We wedge pts only if the don't have any cardiac surgery PRN &'its usually cardiology who like this they swear by it but we all know wedging is going away cause of the risks.
No such thing with on the job training with this population. My facility had a program specifically for fresh hearts. Its not only about meds it's about the equipment & the situations you can be in with these very ill pt. Agree learning the routine & the procedures to handle any thing that can happen. It was a very strong, educated structured 6 program for me. When i was on my own. I was ready. I was in a heavy CVICU they do these surgeries like an assembly line.
Congrats to everyone who recently passed the CCRN. I know it's a hard exam. Good Job.
I personally am not ashamed of confessing I failed by 1 question. I still have my results. I was so angry I decided not to retake it. This was 10 years ago March 7 2003.
I understand today I'm not the newbie (only 5mons in ICU) that I was back then. Today I'm the seasoned Open Heart Trauma Flight OIF Veteran who trains everyone & then they get certified. When they see I'm not certified they're shocked.
It's not mandatory to be certified to work on my CTICU, but it's highly recommend. There's also no extra payment for any certifications in by job. This is why some of us aren't certified. However, the unit has names of all CCRN/CMC/CSC certified nurse on board.
I studied my brains out for this exam once & didn't make it. Even today I have doubts to taking any certifications all related to my 1st experience sitting for the CCRN as a new ICU nurse 10 yrs ago.
I plan to apply for the MSN in Nursing Education. I spoke with them today. This school is very military friendly a + for me. I was disappointed they ended there Adult Acute Care CNS program which I was very interested in but I noticed the classes are still taught at the school. I just have to speak with the nursing director for the course. I haven’t been contacted yet. I’m a little nerves going to an online school I’ve never done this before. Can any one recently describe their experience with the school’s program? I will appreciate it.
I have to agree hands on training is definitively important to Open Heart Recovery. Especially that wonderful 1st 12hrs.
There's nothing wrong with reading books. I also have "Cardiac Surgery Essentials for Critical Care Nursing" on my Nook. You'll gain a wealth of knowledge from the CT team of nurses, RT, Surgeons, Anesthesia, & CNS b/c you'll work with them every day on every case coming through & out the door.
However there should be a protocol competency list & training program in the hospital. It's about 1yr along were the new orientees will take classes & have a 1:1 preceptor ship with an experience CT nurse. 50-60 cases with minimal assistance & of course your preceptor feels competent enough to give you the autonomy to care for the pt independently. As a reward you're given the CT Surgery patch on your fleece & have a hospital wide graduation. It's hard training where we believe you should be rewarded. These pt can be very ill. I went through it 4yrs ago.
I just found this tread. I'm planning on applying for the online Nurse Education MSN program.
I was wondering if anyone can tell me about the courses & all the papers needed to be written. It's been over 10yrs since I got my BSN.
This online program is great for it's concept on focusing on content in 8wks semesters for each class. This is great for nurses like me who can't stop working full time but can go to school part time taking one course at a time still finishing in 2yrs.
The recruiter was get to speak too also.
I'm working on my application for Graduate School. It's not a simple processes. I've been at the bedside for 12yrs so I really don't know to much about new entry RN school. I think you should go to the website & investigate. I do know however for Graduate School there's 4 program one can do all on line.
Is anyone on this site in this program. I'm seriously thinking about applying. I just want know how the programs is like. I did the online seminar session already, however I would like to get feedback from those already in the program.
Levophed max is 40mcg/min. I've worked in some hospitals that will not allow over 20mcg/min & a order is required to go above this. I recently worked in an hospital where the Pt was on 75mcg/min with a Vasopressin at 0.02U/min. Of course the pt's in septic shock but my Maps were lingering between 60-65. I eventually did go up on the Vasopressin.
I've been in this nursing field for 12 yrs. Critical Care/ Trauma is all I know. I attempted to take the CCRN in 07 & failed by one question. I still have my score card. I was so upset I never open another book or took a practice test again. Today I'm preparing to go to Grad school after so many years at the bedside. I'm thinking of retaking the test b/c of course my focus is critical care. I took the old exam. Is there anything out there other than the Gasparis & Dennison. This was 5 yrs ago & I'm wonder is there anything new out that can be helpful. An On line seminar will be great.
We don't use Precedex at all for our hearts. My experience with Precdex isn't great b/c it doesn't work all the time & it does cause hypotension & bradycardia.
It's for short term intubations & easy neruo checks, but it doesn't work for every patient.
We've used it for 2 yrs now & I'm not a fan of it, it usually causes me more work for fix the side effects for such an expensive drug.
go to the main website http://www.precedex.com/ it should explain dose there.
This is a medication of mcg/kg/hr & I agree bolus of medication does cause issues with hypotention & I usually give it in 10 mins but stop it before then & just start the maintenance rate.
LOL! This is to much for me. I never heard of any such policy. I personally have taken care of 2 pt's with Levo & multiple drips at once & both intubated.
This is a daily life of the ICU nurse.
I think you should look up the policy in this hospital. However as a Med Surg Nurse & the drip started you will not be caring for this pt anymore, I would as Rapid Response Nurse b/c I'm ICU & have the portable monitor & the knowledge to care for this pt until the bed is ready which should take no longer then 30mins.
Yea been in this situation on the regular medical floors it was solved with getting ICU nurse to go to the floor to start the care. Pt care is #1 so RRT is assign to this situation.
I think I would have gotten fired this day b/c there is no way I will I will allow this until I called Datascope (MAQUET) & taken out the hospital policy to explain to the Cardiologist I question his method.
We are using the new fiber-optic technology & the it's clearly recommending the sheath & the balloon is removed as a whole. Any anticoagulants should be shut off for 4-8hrs & a fem-stop is used.
My hospital is a teaching facility & there is no issues when a heart nurse questions a MD & pulls out policy, calls the CNS & supervisor involved.
We don't play out with IABP or ECMO.....
I love to see newbie proud of themselves. This of course couldn't have happen without the hospital critical care program & your preceptor.
Don't forget the nursing is a forever evolution & new things come out every day. Don't forget to look up the thinks you don't know & of course always ask when you feel that nursing intuition for a 2nd look.
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