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.

Most new grads are quick to pick up and have the energy to learn many new skills and concepts. In my experience, the new grads that did fairly OK or not that great, became NPs. While the new grads that excelled are still working. One guy was even asked by our ICU director not to be assigned any complex ICU patient or be transferred to the stepdown unit. Now he's an NP

I'm planning the same thing. Working in California, and down here in Texas. Tomorrow I'll be calling a travel agent that 2 of my colleagues have used. I would be like to work 6 days straight from Thursday-Friday-Sat-Sun-Monday-Tues in California, and have 8 days off to work Part time Agency maybe 1-3 shifts.

So would it be safe to say any CE's, for example, that pertain to ex. heart failure, Afib, antiarrythmics, etc can count towards the CEN, and topics such as Impellas, balloon pumps, LVADs, post CABG managements, etc, cannot? I just don't want to fall short when the time comes to renew my CEN, and I also do not want to "over do it" so to speak.

I obtained my CEN last July of this year and looked over the BCEN website for requirements for maintaining the CEN certificate. Here's a copy paste directly from the site: "CEs should have a clear and direct application to the practice of emergency, pediatric emergency, flight/transport, or trauma nursing. 100 completed contact hours earned within your 4-year recertification period must be submitted: 75 of the 100 contact hours must be of CLINICAL content in your specialty area or practice, and up to 25 may be of Non-clinical content. It is acceptable to have more than 75 contact hours of clinical content. 50 of the 100 contact hours must be from accredited sources. CEs earned through national accrediting agencies are accepted for your recertification. These include, but are not limited to, American Association of Critical Care Nurses (AACN), American Nurses Credentialing Center (ANCC), Emergency Nurses Association (ENA), and State Nurses Associations/State Boards of Nursing (SNA/SBN)." My question is: Are the CE's I obtain from AACN for my CCRN/CMC/CSC acceptable for renewal of my CEN?

Here's a little story I'd like to share with you. One time I was assigned in the CTICU and took care of a suicide male in his late 30's who gashed open his wrists, bilateral carotids, stabbed himself in the abdomen several times. He was in the ICU for several weeks for post-op recovery. When I had him, he had 3 chest tubes, trache and on ventilator but minimal sedation, awake, alert, and responsive. Several wounds on his wrists and neck were gigantic. Plastics was involved as well. I had him for 2 nights in a row. On my 2nd night I was with him he was watching an old western movie which I watched with him briefly while I was in his room and we both shared a few comments about the movie. After my shift was over, I never saw him again. (I work as an agency RN at this hospital.) Fast forward a year later, I was working at my current Freestanding ED. A 10 year old girl had been signed up for abdominal pain. While she was being triaged, I heard my name called out from a gentleman in triage with this little girl. He waved at me, called out my name and asked how I was doing. Perplexed at who this gentleman could be, I just waved back and answered "I'm doing fine." He waves at me to come meet his daughter so I approached him. I guess he notices that I don't seem to recognize him so he shows me his neck and wrists scars as well as his abdominal scars on his abdomen. Only then do I recall this person. He recounts everything about our interaction during his stay in the ICU, he also mentions about the old western movie I was watching with him and the trache care I provided him, etc. I was so amazed at his recovery. As I was discharging his daughter after feeling better, she thanked me for taking care of her. I told her I once also cared for her dad, at which she looked at her dad and smiled. I could only imagine what he went through during his arrival in the ED a year prior. I guess that ONE life that's saved can make a difference. It did for me.

Yes, wedging the swan is rarely even performed due to the risks which out weight its use in the clinical setting. That's why when the interventional cardiologist floats the SWAN, he/she notes both the wedge pressure and PAP to establish a baseline relationship. Once that is established, they would no longer need to perform any further wedge pressures and just rely on the PAP pressures to give an accurate "rough" estimate of your end diastolic pressures or wedge pressure. The numbers don't mean anything unless they first establish a relationship between the PAP and Wedge pressures in cathlab.

Does extensive experience (and a plethora of certifications) increase your chances of being hired per diem after transitioning from being a travel nurse?

After passing the CCRN back in 2009, I immediately signed up for both the CMC and CSC 3 weeks later while my memory was still fresh. Took the CMC first on a Monday, passed it, then took the CSC the following Monday and passed it as well. I remember passing the CMC by only 3 points, while the CSC I passed by 11 points. CCRN I scored 111 on it, I think the passing was 91 at the time. In my experience, I would suggest taking either the CMC and/or the CSC right after passing the CCRN to keep things fresh. I'm currently working at a level II trauma ED and plan to get my CPEN and CTRN within 2019.

I took the CMC literally 3 weeks after I passed the CCRN with no extra books or reading material other than the ones I was already using. Passed the CCRN with a score of 111 (passing I think was 91), but my CMC I passed it only by 2 points and just shook my head in disbelief.

When I'm in retiring age, that's probably a job I would want.