openheartmom3

Forearm BP's are inaccurate.... We had an incident where a 207kg pt had been monitored with forearm BP's ... the readings were consistantly showing SBP's greater than 200's and DBPs 80-90s. PRN medications had been given all night long with SBP cont to read > 200's. Surgeon unable to place arterial line....Surgeon consulted Medicine to manage BP and a Labetalol drip was ordered... Prior to starting the drip forearm BP was 234/44.... Noted drop in DBP cause me concern not to start the drip till MD arrived on unit... Thigh cuff (as described previously) showed a reading of 130/60 and a doppler pressure with the thigh cuff read 110. Thinking of the harm that could have been done to this p/op patient is alarming. So my hospital is now trying to educate physicians/nurses and find an accurate way to treat bariatric patients

Appreciate the response... but the thigh cuff we used just BARELY went around the arm and took over 100 pumps each time to pump it up.....What do we use if the thigh cuffs won't fit?

Alot of literature out there supporting the inaccuracy of forearm BP's. I am looking for information and suggestions of what BP product is available to use on Bariatric patients to achieve accurate NIBP (non invasive) readings using the upper arm. Anyone had any dealings with "Technicuff" (the purple cuff)?

Thank you ... I do have that practice alert......still going to look for research on the accuracy of forearm BP's.

Recently I had a 207kg pt that our staff had been using a NBP (proper size for arm) around her forearm..They were obtaining SBP pressures >200's and DBP's 70 - 90's. Physicians were going to start a vasoactive drip on her until I noticed a BP of 237/44.... the significant drop in her DBP made me question the accuracy of the pressure... A physician and myself found a thigh cuff that we could just barely get on her upper arm and manually with stethoscope ( and verified by doppler) we obtained SBP of 130. Does anyone have know of literature supporting the accuracy of forearm cuffs. (multiple attempts to start an arterial line were unsuccessful)

We have 2 nurses at my facility that are starting to do a research project on the paranormal in nursing... They would love to hear your your stories.....

Thanks for the ideas... I am a nurse and use CM & F but my daughter just graduated and needed to find out what the current thoughts were...

What is the best way to get comparisons of malpractice insurance for nurses. Or the how to find the most reputable companies..... Any suggestions?

Hey yall (southern for hi everyone) I am a 22 year veteran of Critical Care Nursing..... The past 18 years I have worked in the Pinehurst area. Live in Rockingham. I am 2 hours from the beach and 4 hours from the mountains. Best of both worlds. My unit is a CVTSU. We recover open hearts as well as surgical, vascular, trauma, and occ medical overflow. I am a CCRN and one of the senior nurses in my unit... My specialty lies in Hemodynamics, which I love to teach :) My daughter just graduated nursing school and my son will graduate nursing school next May.

Does anyone know if there are any schools with specific pathways designed for Critical Care Nurses to go from ADN to BSN. I have been in Critical Care for 22 years and would like to investigate getting my BSN.. but want to do it with a critical care track. I have heard that there are some .. but don't know who offers them? Help

Thanks so much..........will keep ya posted

Thanks for the info..... I have just purchased the AACN CSC review CD... Haven't looked at it yet .. but will soon........... How big a test is it? #questions? Thanks again for the input

There is no question that the Littmans are the best...but remember the stethoscopes are only as good as the user. Take any chance you can to learn heart sounds and the abnormalities.... Oh and NEVER NEVER EVER leave your littman lying around.... as they tend to grow legs and walk away very quickly!

AACN's newest certifications: CMC - Cardiac Medicine Certification CSC - Cardiac Surgery Certification

I am currently working in a unit that has a nurse educator liason. She is a staff nurse that has been assigned to help with credentialling and set up new employees with orientation. My problem is that she has be setting up new employees, new staff, new grads , anyone... with multiple preceptors. For all my years of nursing and helping with education .. I have ALWAYS found it better to keep one person with one or two at the most preceptors. I need to find some data to support that this is the best way to facilitate their learning needs...

1. A 2. A 3. B

quick drug calculations: first find out the concentration of the bag/bottle of rx you are hanging: mcg per cc = mg /cc x 1000 = concentration *if the drug is delivered in mg then don't multiply by 1000 then to calc dosage for pt..follow this easy formula: a) if you know the rate set on the pump but not the dose the pt is recieving use this formula: rate x concentration/60 = mcg per min (mcg/cc) rate x concentration / 60 / kg = mcg per kg per min (mcg/cc) b) if you have an order to start a drip on a certain dose but don't know the rate then just turn the formulas around: dose ordered x 60 / concentration = rate to set pump in mcg per min (mcg/cc) dose ordered x kg x 60 / concentration = rate in mcg per kg per min example: dopamine ordered at 5mcg/kg/min..... bag comes with 400mg/250 pts weight is 75kg find the concentration first by taking 400 / 250 x 1000 = 1600mcg/cc now plug in the rest of the numbers: 5 (dose ordered) x 75 (kg) x 60 / 1600 = 14cc ( the rate to set the pump) or you walk into your shift, see the pump set at 23cc......(still using the same concentration of dopamine and same pt wt @ 75) 23 x 1600 / 60 / 75 = 8.17 mcg/kg/min hope this helps

One other certification that many of our ED nurses obtain is the TNCC. Hope this helps

AACN has developed 3 new certification exams Has anyone taken the Cardiac Surgery Certification test? Can you share how difficult this test is. What tools did you use to study for the test.