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heart27 945 Views
Joined: Oct 19, '08;
Posts: 7 (29% Liked)
; Likes: 2
CCU RN
Specialty:
9 year(s) of experience
in
Cardiovascular
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heart27 945 Views
Joined: Oct 19, '08;
Posts: 7 (29% Liked)
; Likes: 2
CCU RN
Specialty:
9 year(s) of experience
in
Cardiovascular
I have found these two books informative and a great reading resource:
Handbook of Hemodynamic Monitoring by Darovic Second Edition (2004 but still good!)
Cardiac Surgery Essentials for Critical Care Nursing Second Edition by Hardin and Kaplow (2016)
My my auditory and visual learning of concepts I really like YouTube Med Cram
I recently had a pt admitted for recurrent Firing of AICD. This was his third admit for same reasons. Last admission his pacer was interrrogated and he was loaded on amio gtt, transitioned to po and dc. Within the same day of dc, he returned back to ED because his ICD fired 6 times on him. So this admit, he was started on an amio bolus AGAIN. EKG prior to gtt QTc 485ms. Prior EKG's from past showed his longest QTc at 545ms. During monitoring of gtt, his QTc slowing trending up, reaching 545-552, and at one pt 566 nst. ED labs = Mg 2.0 with K+ 4.8...Tele SR/SA w 1degree avb, bbb, rate 46-50's, BP stable, pt NAD. I called cards in concern for QTc, Cards MD oncall stated that he was not concerned with his QTc and that he needed his antiarrhthmics and pt had a pacer anyway. I asked him when should I be concered w this pt, he stated if his QTc >550 and sustained.
What do you guys think of this QTc in this situation? Also pt receving another amio load with in 24hr of last admit!? Im thinking its his prolonged QTc that is triggering torsades or PVT and ultimately firing his ICD.
Thats how I've learned to give it. My pt MAR usually has the same directions as prescribed by pharmacy. If I were the pt thats how id want it cause the smell is so foul! I would not want the taste to be similar to the smell.
WOW, Im glad that the facility is being under investigation. It sounds like someone is trying to prevent the facility from shutting down.
Dont be too hard on yourself if your new to this stuff. Learning your strips comes with time. But you should train your mind to recognize arrythmias that need quick intervention, ie 3rd degree AVB, VT or pt demonstrating symptoms! Look at the WHOLE picture, what meds may be causing tachy arrthymias or bradycardias? What is the admitting Dx? Any history? Most recent labs? Potassium? Magnesium? Consult with your resources and never be afraid to ask for help. I may suggest to review EKG interpretation books and prepare to take your ACLS course. Offer to accompany your charge nurse if a code is called in the hospital (just designate another RN to cover your pt's ahead of time if a code should occur). Do what you can to seek out learning opportunites that will increase your knowledge and provide safe and efficient care to your pt's. Good luck!
Just curious, what med was it? my best advice is if you are not sure and the noc RN is not sure, have the on duty nurse call the doc to clarify. Always think safety for your patient. The noc nurse can refer to the doc prog note, but any order change requires a vorb from the md, regardless. Your first year as a nurse can be nerve racking but look for ways to relax your mind. Maybe try the gym, yoga, or dinner with a friend. Soon you'll get the swing of it and develop your own way of organizing your shift. Hang in there cause in the end have your day figured out.