ADDnurse

to completely unknown:yes it is a serious question; I don't see anything to joke about.

:heartbeatWhat causes people's bodies to ball up and get contractured; I know I curl up myself when I sleep. What can be done to prevent or reverse this process? I work in a vent/ltc unit and I'm so sick of seeing people all bound up like that;isn't there something that can help them/"restorative " programs seem to be under-funded in general,and not paid much attention to.............

Hi! I'm addnurse,I've been a RN for 13 years,but always scared of working where I always wanted to;the CCU.Can anyone give me some direction;there's a local hospital William Beaumont in Royal Oak,MI that is offering internships in January.I am 52 years old,an ADN with ADHD and a slight physical handicap,but I have finally reached the point where darnit I'm gonna have the guts to do this and be good at it!I'd like a job description,some advice and maybe even encouragement from you pros;I refuse to continue believing that all nurses 'eat their young'.I'd appreciate any help;thank you! addnurse

You have chosen one of the toughest areas to work in and should pat yourself one the back for giving it a try. However, as others have pointed out, we all have areas that we are more suited to and gravitate towards. I have worked with some excellent nurses in my time that couldn't stand ICU/Floor/Peds/ you pick the area, but they all found somewhere where they could make a difference. The fact that you are acknowledging your feelings and asking for advise is also hard to do, and demonstrates your maturity and the high standards that you hold yourself to. From what you have said you sound like a good and caring person, precisely the kind of person we need in nursing. In closing, don't quit, ask your friends and colleagues (that you respect) where they think you qualities are best suited, but as Monkeyman1000 advised, don't rush it, you have along career ahead of you. Thanks Tony

Congratulations, and try to remember in 10 years how it was to be a student. Tony

If you read the post the ICP had stabilized when the drain was pulled and as far as using hypothermia in a Hunt-Hess grade 5, whats the point? The real danger is from cerebral vasospasm, and cooling the patient will not effect that to any significant degree, I'd be more interested in triple H therapy in that case, or cerebral angioplasty at the first sign of vasospasm, with a ventriculostomy to help control the ICP. As to a lot has changed in NSICU in 6 years, actually it's 5, but my friends and wife still work bedside, so I'm not as removed as you assume, and not that much has changed! However I would be interested to know if others are using hypothermia as much as your institution, also I'd be interested in the protocols and standards for the use: are the patients swan'd? obviously vented, what is considered the optimal temp, is there any specialized equipement needed, beds, cooling systems, and are there any particular electrolyte problems that occur? Thanks TNN talk to you later.

sorry tnn but as derelys9 stated, this was after a month and the patient was moved to rehab shortly after. i think we all agree with your comments in the early stages when cerebral perfusion is a serious concern, but not one month out in a patient who's icp is so stable that the ventriculostomy has been clamped. i do however disagree with your comment that in patients with icp's >22mmhg "you try to keep these patients cold". first of all apatient with an icp of 22mmhg means nothing if an adequate cerebral perfusion pressure is maintained and there is good cerebral compliance. secondly since when has hypothermia treatment become the norm for treating elevated icp, the complications associated with this therapy are extremely grave and should not be taken lightly. when i left neurosurgical nursing in 2000, the nhi multicenter hypothermia study (for the treatment of cerebral trauma) had just been stopped due to unacceptably high complications associated with the therapy. i know that the use of hypothermia has been shown to be beneficial in the pediatric population but i am not aware of the treatment being shown to have the same success in adults. the principle investigator for the nih study that i mentioned was dr guy cooper. i'll double check that and see if i can get a reference for you, and please if you have a study to show the benefits of hypothermia i would be grateful for the name. thanks tnn, have to go to bed now, i'm up at 4. tony

I had a similar problem when I move from NY to CA. CA is extremely strict, when it comes to documentation. I was however able to get my CA licence after working and passing the NY state boards. You might want to try another state first that has a reciprocity agreement with CA. Good Luck PS: I'm originally from the UK

Don't they want clinical experience as well? Before I could sit the CGFNS I had to complete an extra 8 weeks of OB. Tony

A cerebral SVO2 monitor (we used pediatric SVO2 swan ganz caths) is placed in the external jugular vein at the jugular bulb and you simply use it to monitor the mixed venous oxygen saturation as it leaves the cerebral circulation thereby giving you a measurement that reflexes cerebral oxygen utilization. When the cerebral SVO2 dropped below 75%(it may have been 70, it's been a while since I left neuro) an intervention was needed to either increase O2 delivery, or decrease O2 consumption. Regarding CSF drainage we would only drain for sustained increases in ICP>25mmHg, except where the ICP waveform showed decreased compliance in which case we would diurese and drain. Hope this helps, as I said it's been a while since I did neuro:)

Fungirl you are right in your treatment when trying to prevent a supratentorial herniation but with a posterior fossa tumor the problem you face is subtentorial herniation, and the HOB should be flat. If you raise the head of the bed you can cause shunting of the CSF which causes the ICP above the blockage to suddenly decrease thereby inducing a subtentorial herniation(the pressure below is not caused by excessive CSF but the mass effect of the tumor and accompanying edema) which because of the sudden nature of the incident does not always present with Cushings triad. The only treatment is surgical decompression of the posterior fossa. Thanks

Tony, you're to be commended for the mature and professional way that you dealt with this problem. Violence is, I agree, never the answer "in a professional setting". Just a few insights from my own experience: in 25+ years in nursing (including 10 years in Greenwich Village, NY) I have never been hit on at work (by men), the behavior of the individual who groped you should not be looked at as "normal homosexual behavior" it is not, it is the behavior of a pervert and should be dealt with accordingly (Which you did). As for reverting to violence against anyone, it is a mistake to assume that because someone is smaller than you that you can take them! My wife is 5' 2", 112lbs, has trained in Martial Arts for 18 years, and has no problem facing people larger than herself. Thanks.

No you didn't confuse me, but thanks for asking. I am however glad that we seem to agree that a decrease in diastolic blood pressure is not a component of cushings triad, but occurs after someone has herniated, be it supra, intra, or subtentorial. I am however confused as to why any patient in a NSICU, with a grade 4-5 SAH, a large hemorrhagic stroke, or for that matter any trauma patient with a GCS Thanks

Cushings triad consists of Hypertension, Bradycardia, and hyperventilation in the presence of increased intracranial pressure. The widening pulse pressure that accompanies the hypertension is as a result of the increasing systolic pressure in an attempt to perfuse the brain, the only decrease in the diastolic that I have seen is after herniation and is not a component of cushings traid.