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Charge200J

Charge200J

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  1. Simple clinical questions that we like to ask for an adult CVICU: -explain the different types of shock (eg septic shock, hemorrhagic, cardiogenic, distributive, etc). What do these patients look like? What are initial interventions for them? -give an example of a time you escalated/advocated for a patient's clinical situation (eg rapid response/code situation) Just do your best, try to relax and let your enthusiasm and knowledge shine through. Listen to what the people interviewing you are saying. Good questions to ask your interviewers are: what your orientation would be like (length of time, experience on both day shift & night shift, weekly classes, how many preceptors will you have (having a couple preceptors is good so that you see different styles, but too many preceptors make it challenging for you to get your feet on the ground.)
  2. Charge200J

    Septic vs Cardiogenic Shock?

    So without the use of a swan...an Echo is a great tool...cardiogenic shock often shows global hypokinesis, elevated filling pressures, wall motion abnormalities, and a dramatically reduced estimated EF. This often correlates to a picture of a cold shock/low flow/perfusion state. I find that often these patients are either orthopnic/tachypnic/hypoxic and agitated or very very quiet, cold, and obtunded. The septic patients on echo sometimes have a hyperdynamic LV, flat IVC, etc. Their clinical picture correlates with infection, positive cultures, fluid/vasopressor responsive distributive shock. Yes definitely we get patients all the time that have both septic and cardiogenic shock (eg: really really sick endocarditis patients). These patients are often very tricky to get their fluid/volume status correct.
  3. Sometimes it's a mixture of things (first day observing/nervousness/excitement/overheated/new smells/low blood sugar/dehydrated) that makes people pass out. It happens to SO many people in healthcare. Take big slow deep breaths and slow your heart rate down. Wear a mask if smells bug you. Focus on something else in the room eg count the tiles on the floor, count backwards in your head, etc...something to force your brain to focus. Keep your peripheral vision open so you don't get the tunnel vision. As the feeling starts to go away then slowly direct your eyes back to the task at hand/whatever was bugging you in the beginning. It does get better as you get more used to the hospital environment. Also I've found that when it is your patient and you are having to focus on keeping them safe your adrenaline will kick in and you won't feel faint at all. Hang in there!
  4. Charge200J

    Dilated Cardiomyopathy

    Whew, that's a lot to go through all at once. That's good that you know some staff on the unit that he will be on. Heart failure is not a linear path, there are twists and turns and baby steps forward and back. The staff there will be able to help explain each step of the way to you and guide you through it. Sometimes it is so hard being the family support/caregiver and having a medical background. Some tips/tricks I've learned: 1) Rally your troops. Put those well meaning family/friends to work. Make them a list of things they can do to help. Delegate what you can so you can focus on being at the bedside. 2) Pick your battles. To avoid being "that RN family member"...sometimes you'll need to bite your tongue, and sometimes you'll need to advocate for your spouse. At the end of the day it's patient safety that matters the most, don't worry about stepping on toes - no one should ever fault you for identifying safety concerns. 3) It's ok to take a break. Step away from the hospital, go home and shower. Exercise, get outside for some fresh air. Caregiver fatigue is even more insidious when the caregiver is in the healthcare profession. Wishing you the best. Hang in there.
  5. Charge200J

    Open visitation in the ICU

    Adult CVICU...2 visitors at a time. 24hr visiting. Only 1 family member can stay the night at the bedside. We make exceptions during end of life/withdrawal of care - then we allow larger groups/whole families to come back at a time but they cannot be blocking the halls/exits or disrupting other patients/families. No kids under 14. No animals, food/drink, or flowers. No sick visitors. I really wish that we'd enforce a "siesta time/quiet time" in the late afternoon - would help the overall stress level of the patients/visitors/and staff.
  6. Charge200J

    Dirt bike camp

    Sounds like fun! Definitely organize med pass times for campers. As for first aid: I'd make sure to have lots of ice packs and simple bandaging for abrasions. Encourage counselors to frequently remind their campers about staying hydrated and taking breaks. Lastly, just in case, consider learning how to properly size and apply a cervical collar and provide c-spine/spinal precautions - hopefully you'll never have to use it...but depending on how rural this camp is it could take EMS a bit of time to arrive for a really bad dirt bike accident.
  7. Charge200J

    Per diem cardiac nursing ideas?

    Another Cardiac ICU nurse here voting for cardiac rehab...it's a great side job/totally different feel from the ICU grind/fun to see your patients get stronger/lots of educating patients on heart healthy habits.
  8. Charge200J

    Best stethoscope for an ER Nurse?

    Once you buy a stethoscope I highly recommend buying the "BatClip" stethoscope holder on Amazon. For me I don't like carrying my stethoscope around my neck as it irritates my skin/is an easy target for confused elderly little old ladies to grab. The "BatClip" clips it to your waistband/pocket and has worked great for me...easy to clean/easy to access stethoscope quickly. The plastic holders are cheaper but do not work nearly as well.
  9. Charge200J

    from CCL to CCU ?

    Yes! You will be great at the frequent moderate sedation/procedural components of CVICU and will learn the ICU work flow and daily management of the invasive devices in a good orientation. Go for it!
  10. Charge200J

    Access pressure Pod on NxStage

    Wow, that sounds so frustrating! I've never had that much issue with the access pressure pod. Once in a blue moon I'll have to reset the access pressure pod but that's pretty rare. One trick that our reps always remind us to do when setting up the circuit is turn the access pressure monitoring line counter clockwise as you connect it and then clockwise to lock it (See 2min 40sec on NxStage youtube video "pressure pod resetting module." Also I definitely agree with the above comment...it all comes down to your line...the bigger the better.
  11. Charge200J

    Student - ICU central line access frequency

    Great question. So we do try to limit how many times we access the central line to decrease the risk of a CLABSI. We *try* to access it no more than x3/24 hours. However as you said, often the need to more frequently access an invasive line increases as a patient's acuity changes/increases...eg q4hr labs results in x6 times/day. Trying to "cluster" your lab draws/invasive line interventions helps to cut down on the number of times you access the line. We also utilize green Curos disinfecting caps, daily CHG baths, and meticulous dressing changes/line care to try to cut down on CLABSI rates. A key issue is that often we have multiple types of invasive lines & devices in one patient eg: trialysis, double lumen CVC, MAC or venous sheath with swan ganz, arterial lines, arterial-sheaths with a balloon pump/Impella/etc, PICC's, IO, ports, permacaths, etc...so infection concern applies when accessing all of the invasive lines in a patient.
  12. Charge200J

    Calling out sick on orientation

    If they give you any crap (pun intended) about it just throw around the words: "projectile vomiting, explosive diarrhea, contagious, and patient safety" around a little and that will shut them up real quick. Hope you feel better.
  13. Charge200J

    Feeling incompetent in nursing school

    At the end of the day you know what your patient calls the person with a stellar GPA who came from a well-known program...nurse. You know what they call the person with the average GPA from a small program...nurse. It's who you are as a person and who you become as a nurse that matters a whole lot more than what school or program you came from. You just focus on graduating and passing the NCLEX and getting your first job. The rest will all smooth itself out in the end.
  14. Charge200J

    ICU Float Nurse

    We are grateful for the ICU float pool RN's and try to give them good assignments. We usually don't give them any cardiac devices (IABP, Impella, LVAD, Swans,etc) unless they are comfortable and trained on taking those patients. Some of the ICU float pool used to work full time on our unit so if we know who is coming then we know that we can assign them to patients with cardiac devices. If the float pool RN is comfortable with CRRT then we will definitely give them those patients. Usually they get a 2 patient assignment: one intubated pt ready to do a breathing trial/extubate and the other patient ready to get up in the chair, take out lines, and eventually transfer to the step down unit. We try to prevent them from having to admit, however if needed to admit we try to set them up with a good admission.
  15. Charge200J

    Do I have critical care experience?

    That's a great question. Sounds like a well run, fast paced, high acuity awesome progressive care unit. You have acquired an incredible amount of experience and sound like a strong nurse caring for multiple sick patients from what you describe. Tricky question regarding the job application. You could probably answer either yes or no and be totally ok either way. Because your unit can up-triage sick patients to an ICU (unstable hemodynamics, requiring vasopressors, mass transfusion, ventilator management, etc) I would answer that question on the job application that no, I probably wouldn't call it critical care. However, you will have such a strong interview with so many fantastic examples of prioritization/critical thinking and a wealth of cardiac experience from a high acuity progressive care unit. Wishing you the best - the peds cardiology job will be lucky to have you!
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