Pheebz777

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I am working a travel assignment with Kaiser Fremont CA and applied with HealthTrust Workforce solutions as registry for a couple of HCA facilities here. The average take home pay is a little over $750 per shift. I will be only having a 6hr facility orientation then another 6 hrs on the unit before I start my own shifts.

The only thing I would be concerned about is did he use a new suction tubing to stuff down the ETT? Or was it one that has been in use for a few days? Usually the in-line suction catheter connected to the ETT is a closed circuit to reduce possibility of introducing foreign bacteria. A 14fr suction catheter would have been more appropriate as it can access the airway better than a wide ended suction tubing.

It will help transport the glucose into the cell for energy.

Are you planning to take both just for the bonuses? Awesome! Go for it! I work with a nurse that has both PCCN/CCRN on his badge.

Peak pressure is basically pressure in the airway circuit. Increased secretions, fluid filled bronchioli, patient biting the ETT for example will directly affect peak pressure. Now once you've taken away all variables affecting peak pressure, what you have left is Plateau pressure which is essentially lung compliance or the ability of the lungs to expand and relax in response to respiration. And yes you are right that whatever is the PEEP, you add that to the pressure support. In your above example, PEEP 5 + 10 of PS = 15

Yes, they alter the action potential thus delaying conduction.

Totally agree. I would also suggest watching several YouTube Videos and understand the concept, the basics, preparation and such. Then if you have a facility that checks you off for the US guided PIV class, sign up and there's nothing to it.

Regarding giving report, always develop a routine/system and get used to it so you minimize forgetting something when giving report. As what was said above, use a workflow sheet or "brain" as we call it. I usually start with: Name, age, male/female, full code/DNR status, allergies. Then.. 1. Presentation to ER (ex. Chest pain w/ SOB, etc. ) 2. Diagnosis - ex. NSTEMI - include pertinent supporting data ex. negative EKG, elevated troponin+, etc. 3. History - ex. CAD,CABG,HTN, 4. Consults. Reason for consult and plan of care for each consult. Then I go head to toe: 1. Head - ex. pt is alert, awake, confused, etc. 2. Lungs - ex. pt on 2L/min NC, BiPAP, Vent, Breathing even and non labored, wheezing, chest tube, etc. 3. GI - Cardiac diet, PEG tube w/ Glucerna at cc/hr, takes pills whole/crushed, NPO, puree, etc. 4. GU- PT is on HD MWF, foley, urinal, ambulates to Bathroom, etc. 5. Legs (LOL!) - PT ambulates, uses walker, prosthesis, bedrest, etc. 6. Skin - intact, wound care, etc Then: 1. IVF - fluids, TPN, etc. 2. Pending: Labs, procedures, etc. Then all the other little chit chat. Rude family, patient requests, etc. Even without a "brain" or workflow sheet, you can give and receive a solid report once you integrate some kind of personal workflow so as to avoid jumping from one topic to another and then forgetting to report or forget to ask questions about the patient when getting report. For me it also works when getting report when floated to other floors.

I am about to leave my full time job and I love the insurance that it provides under AETNA. I would like to speak with HR if I can continue coverage and pay for it out of pocket. Is that an option that can be offered.?

Here is the best write up for sedation agents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227310/ You would also benefit from watching the numerous YouTube videos on this subject.

The QRS complex will always be narrow in a heart with a normal functioning conduction system and a supraventricular pacemaker. The QRS will be prolonged in a BBB or from a ventricular source (PVC) since both signals will be conducted from muscle to muscle tissue in the myocardium outside of the normal conduction system pathways. So to answer your question, a prolonged QT interval does not necessarily prolong the QRS. A prolonged QRS is always originating from a conduction issue. (BBB, Ventricular pacemaker, elevated K+)

55-65/hour is just your base pay for the first 8 hours, beyond 8 hours it's x1.5 for each 12 hour shift you do. Beyond 40hrs per week you will be paid x2 of your base pay for each extra hour beyond 40hrs/week. You also have to factor in your housing stipend, travel allowance, etc, which are non-tax deductible. I am also looking into travel nursing in California and the 2 most lucrative offers I got was for $2800/week in Kaiser L.A. and Adventist in Tehachapi CA. But I wanted to work near my relatives in Fresno and San Jose since they have huge houses, swimming pools, vacant rooms, so I'm still waiting for an offer from a couple travel agents I'm working with to see if they can fetch me anything else above $2 grand/week.

Even though PA measurements are not routinely utilized, it is a great concept to grasp and understand. Many symptoms from various disease conditions reflect what is happening to your patient and understanding the pathophysiology behind these conditions make for better nurse anticipation and better patient outcomes. For example: patient with existing COPD, stable BP (101/62), placed on BiPAP, has a drop on blood pressure after 30 mins, 88/45. If you understand what the BiPAP does to the pulmonary vasculature, you can understand why there's a drop in BP. Or, what sepsis does to your SVR with subsequent drop in BP and compensatory response of your HR. Just think of the cardiovascular system as a system of pipes and valves, just like the plumbing system in your house. Key things you need to keep in mind: 1. Direction of flow (IVC/SVC --->RA--->TV--->RV--->PV... etc) 2. What systems and/or chamber lies before and after each valve 3. The normal pressure values before and after each valve. (before=closed, after=open) I would put a lot of effort into understanding these normal values, what they mean, and the effect of disease processes have on these parameters. To me, this is a very exciting concept to grasp. But it doesn't end there. Once you've collectively put together your understanding of the RAAS, sympathetic/parasympathetic response, catecholamines, as well as your understanding of mechanism of actions of antiarrythmics, pressors, vasodilators, ventilator management, etc, everything just falls into place.

You can still have a pulse while in VT. Not adequate perfusion but you still have a pulse. And there's pulseless VT. To the OP, Are you a Tele Monitor Tech? Without a 12 Lead EKG and only looking at 1-2 leads on your monitor, if you recall VT's impulses are generated from the ventricles so you will always see wide mono morphic complexes. In BBB, there is still conduction from the SA node to the AV node and down the Bundle of His thus generating a better distinguishable QRS complex. Now you have the aberrancy. Since one side of the bundle is blocked, the signal will bypass the Left or Right Bundle of His causing the signal to travel down the ventricular septum cell-to-cell instead of thru the normal pathway thus the widened QRS. On slower rhythms this is easy to see. However when you have a tachycardic patient (or SVT) with a Left or Right BBB it almost always looks like VT, but remember there should be a discernible QRS, Rwave, or S wave that you might be able to identify as opposed to VT which will have none.