MilliePieRN 4,672 Views
Joined: Aug 18, '12;
Posts: 182 (45% Liked)
; Likes: 360
I've worked 0630-midnight several times. But I work in Cath Lab (single shift) and we have no relief coming. We work til we're done.
I'm not an CCL expert either, but frogging around with the right side, most often causes some type of bradycardia and or asystole. Not saying ventricular tachyarrythmias can't happen, it's just the former that happens more. If I had to guess, I might say that RV stunning from the contrast causes a fall in return to the LV with concomitant fall in LM perfusion. In an already diseased cardiovascular system (they're not getting cath'd for nothing) the LV doesn't tolerate that and misbehaves.
Just my speculation.
The sa and av nodes are more likely to cause the ventricular arrhythmias that we're talking about?
I would never hold amiodarone without a specific "this time, this patient" order. I would be very surprised to hear any cardiologist wanting a single dose held for a one time low hr/bp. I wouldn't even call a dr over it.
The sa and av node is supplied by the right and much more likely to cause arrhythmias, from what I've witnessed. The conus branch can be cannulated and cause us nurses to have some arrhythmias, too. ������ We did just have a complete heart block with injection of the left though. Fun times..
I'd choose 1:3 with no pct's over 1:4-5 with minimal pct's any day. Vote no... sounds like you're trading nurses for techs and that's not a good trade.
At our hospital, even lpn's cant draw from a picc (which is preposterous). I would never consider any phlebotomist to be able to.
Also, NS is considered a med.
Sounds pretty weird for her to complain about the situation, you probably really sounded annoyed. Maybe from her perspective, she's constantly feeling like nurses get annoyed when asked to do their job (maybe not even you at that time). I got secretly annoyed when I had to draw picc labs every morning for the lpns' patients (not at the lpn, but it might have seemed that way to them if the caught ever caught my annoyance vibe).
I doubt any more will come of it
"Nursing Diagnosis #1 Decreased cardiac output R/T alteration in heart rate and rhythm AEB EKG showing abnormalities noted with no distinguishing P waves."
I'll take a stab at this one.
Your AEB (evidence/proof) should be pt symptoms/data that support your nursing diagnosis NOT evidence/proof that prove your r/t. This is a common mistake nursing students make.
Decreased cardiac output R/T cardiomyopathy and atrial fibrillation AEB dyspnea with minimal exertion, weight gain of 5lbs over 1 week, and pt report of increased fatigue.
(Just an example, not saying this dx suits your pt). The other dx you wrote don't have the same mistake.
I learned in nursing school "it's not yours, put it back". I'd document the family request. Maybe pass along to day shift the request and how you handled it. I don't know why your hospital policy is to discard, I agree with the family. (And they sound like they know what they are doing and have handled the peg on their own?). Depending on the amount you are removing, there is a possibility of messing with ph taking it away q2h.
I'm assuming this is a long term peg that the family manages on their own and not a fresh peg and surgeon ordered protocol. My view would change if that's the case.
One of the vital signs is obviously far out of normal range. Which one?
I'd say a almost 50% increase in the hgb level is pretty good. Really, 3.2 is sooooo low, it's gonna take more than 1 unit to get it back up to normal. Plus, I've noticed the next day levels to even be a little higher after a transfusion. You didn't run it too fast. I'm surprised only 1 unit was ordered before the H&H.
Got it but where do you live? :0 Also I double check the job market often and I'm also still doing my prereqs so I still have time to consider. Also I took into consideration that a nurse friend of mine went straight for her BSN and she had to go back to become an LVN because she wasn't getting a job on a degree alone. Of course it's different for everyone so I have to consider that too. I'm definitely gonna double check while I still have time. Thank you though.
I don't know if you know, but lots of cc adn programs are tougher (more competitive) to get into than bsn programs. I would vote hold on the bachelors now and get into a bsn program. If you must take classes, take prerequisites for the bsn you're ultimately seeking.
I'd say $22-25per hr is what a new grad will be offered if your lucky.
We only get 1.5x pay when we go over 40hrs. I've worked 18h shifts and had no extra pay on my check . I'm in southern middle tn.
Advertise With Us