New grad advice (any little bit helps)...

deeDawntee, RN · Sep 11, 2007

Know your chest pain protocol inside and out. For instance, does your facility recommend that you get an EKG before administering nitro if possible, so that ischemic changes can be captured? Be very organized when managing chest pain: As you take their pressure, ask them their pain level, to describe it, does it radiate etc...are they nauseous, diaphoretic, pale? Did anything lead up to the chest pain? Record the exact time you gave the first nitro, along with that pain level and pressure. Remember to start O2. Morphine is also given if the SBP holds. You may need to give ASA as well, depending what the EKG says. Remember the goal for chest pain is always NO pain. I'm sure you know the rest...so I won't repeat it here. But being very able and confident with managing chest pain will serve you well. I'm sure you know the acronym MONA: for Morphine, Oxygen, Nitro, Aspirin, which is used in ACS (Acute Coronary Syndrome).

Be familiar with your ACS order set and what the specifics are there for. For instance, serial enzymes will be done, know the significance of those enzymes and when they peak, duration etc. A beta blocker will probably be ordered etc...

Know that if your pt is having a lot of ectopy it is within your scope of practice (I imagine, but you'd better be certain) that you can order K+ and Mag levels per protocol. If they are low, you call the Doc and get replacement orders if you don't already have protocols in place.

Know your basic rhythms and what is the likely treatment. For instance, if a pt converts into a rapid a fib, what are the possible orders you may receive. Know your Cardizem gtt protocol, because that is often what is started. How do you explain new onset a fib to a patient? They are often totally freaked out about it and the stress only makes it worse. What is true about a fib if they can't be converted? (People manage it successfully for years).

Once you do ACLS and even before, know how to operate your defibrillator. Know where the emergent intubation tray is kept, know where the temporary pacer is and the chest tube insertion kits. Make yourself available during a code, get in there and help even if it isn't your patient. Do compressions if you need to. Watch and learn. Run and get stuff if needed.

You are heading for a very exciting place to work!!! Know your protocols!! Get copies of them and know the reason everything is on there. If you don't know, ask.

CrazyPremed, MSN, RN, NP · Sep 11, 2007

Thank you so much!!

I'm actually going to print out your post and answer all of the questions!!!

CrazyPremed