christen13

It is not possible to have a true negative CVP!! You will see a negative reading on the monitor, but that is not the actual cvp....unless you have a MAJOR problem. Negative pressure in the vein....not good. Check the line, look at the waveform, look at the patient, positioning can change the reading.....but it is NOT negative. Do not chart a negative cvp!! Think about it .... all shift you are saying the patient has negative pressure!!! Ouch, you didn't do something about this???? What it may and usually does indicate is that the cvp is low and they are dry.....but not that dry :)

Hi, I am a nurse in a much different specialty, I have a question that seems a bit "morbid" to me, and do need some help with it. I recently had a patient that delivered a stillborn infant at 37 weeks. She was encouraged to visit, hold the baby after she delivered. This was very helpful, emotionally for the mom along with the rest of the family. I believe this is a theraputic practice, I don't have a problem with it at all. But here is where I get confused....... What do you to with the baby's body after the mom and family have had time with the child?? How much time do you allow for them, and when are they encouraged to say goodbye?? hours, days?? If days go by, where does the baby's body stay?? How much is this talked about on your unit?? Does the baby's body go to the morgue or stay on the unit until mom is discharged, where is the body if it stays??? Please let me know what your thoughts are..... Thank you all so much...this is a tough one for me :)

I agre with augigi, completely. By asking this question, you are showing that you "get it", and that is a great place to start!!! Hang in there, be kind to yourself!! I can assure you that you will make mistakes, and thank goodness ....... the key is what do you do then?? Can you admit it and learn from it.....if so you will excel at this!! Good luck........

I have worked in a sicu for several years and have seen the way RN's treat each other and I just don't understand why we are so critical of each other!! We have a tendency to act like "monday morning quarterbacks!"... Looking over the decisions that were made by the rn, things that were completed and (god forbid) not completed. (Remember that there are 3 shifts) Bottom line is, we serve NOBODY when we act this way. We perpetuate nursing's tough reputation...(we eat our young) and put our patients at risk. This behavor seems to be "justified" because we are in "'critical care" and we have a stressful work environment....arent we really just adding more stress! Does this help us or out patients?? Nursing could be a very strong profession, but we don't allow it, because we can't even get along with each other. We are the reason our profession struggles... What do you guys think???

We have no pay differential for a BSN or MSN, no differential for working in the ICU and no differential for CCRN

I need to respond because I think it is NOT ok, to treat someone badly and use the excuse that you work in a stressful environment. Doesn't that make it a bit more stressful!! Nurses sabotoge themselves constantly, and It is my biggest complaint about our profession. We serve no one, not ourselves and certaintly NOT our patients when we have this belief. I see this all the time in the ICU, and will never fully understand it. Being rude to another nurse for WHATEVER reason is NEVER justified because you are "right" or have more expereince...even if you are an ICU nurse.

Thanks everyone...We are looking for a way to develop a Kardex (seperate from the chart) That higlights the specifics for that pt...drip rates, labs, drsg changes....just like the tool described that some of you use. I really believe this would cut down on confusion and help the RN's and the patients I am wondering if anyone would be willing to share their current kardex. I don't have any examples to go by. This is not an official part of the chart, so it wouldnt be a pt confidentialiy issue, and obviously would NOT have any pt info, just a form that you use. would be VERY appreciative!! Thanks guys!! ps, is a hurry please excuse my terrible typing and spelling

I have found that the most effective way to deal with this is to appeal their inflated ego's. "help me understand........ " Is always a good choice. "What do you think about .." "I value your opionon......" We are the pt's advocate...ears, eyes and VOICE. Getting angry and challenging will only put the MD on the defense and will not help your patient. Remember why we are their..........not to inflate our own ego's , or to be "right" in the situation, rather to help our patients. We are responsible for THEM.

Hi everyone... I have a couple questions regarding how your icu's do rn shift reports. I am looking for a way to improve our communication between the Rn's (the md's are a whole different issue :) Communication between all the members is so important, and in my opionion the value of good communication is very underestimated!! ALL of your suggestions would be GREATLY appreciated :) 1. Do you guys use a standardized "kardex"?? How does it work, does this stay with the pt during their stay?? Is this a separte tool for the nursing staff with the up to date pt info, all in one place......gtt's, allergies, etc?? What does it look like?? 2. If you do use a kardex.....I would love to see some examples, anyone willing to send a copy?? 3. How effective is your current technique?? What would you change or think would improve it?? 4. Do you think Rn to Rn interaction improvment would improve pt safety and care? 5. Do you think communication between Rn's is a problem?? Thanks guys.............. I FIRMLY think that the only way to make changes to improve the ICU is to start with the BEDSIDE RN's........we are the one's who know where the problems are and we are the ones who can MAKE the changes.

This thread is just what I was looking for, thanks ........... I have also been in critical care for 2 years, along with 10 years of nursing experience but am looking for a change. The old saying, "find your passion and do what you love!" is very true for me in the area. I have however, found it very hard to learn more about this area of nursing. It is a new area, hard for me to research. At this point I am looking for a job with a medispa/plastic surgery office, under the direction of a medical director. I have some questions ...... 1. What is the general salary?? I know this is tough to answer...just general. 2. What is "a typical" day like? 3. Do I need to attend a school ...Aesthetic, etc. to practice, or is this more of an "on the job" training? 4. Any websites that may be helpful?? Thanks so much for reading, ANY advice would be very appreciated!! Thanks!!!!!!!!!!

thanks for the info on dilantin. We give it to ALL patients with a head injury....I have never seen a pt a seizure...but is this because it's working or they never needed it?? Guess we will never know... christen

HI rocknurse... I tried to PM you, guess you have too many messages?? let me know... christen

I am a STRONG advocate for my patients. I believe this is one of our primary responsibilies!! As far as putting my pt's at risk, I disagree with you. I have learned through exp that this is not putting them at risk....there are many situations that I would not give them meds drawn up by other RN's but in some I would and do.

I agree with MLSO. There is a high level of trust in our facility between the RNs....there has NEVER been a sitation where a pt was given the wrong med when another RN drew it up. I think it is very wasteful and unrealistic to waste 75mcg of fentanyl when you are only giving 25. Not to mention the PT is the one that pays for this........do you think they should pay for 4 ampules as opposed to 1?? Not me. I would NEVER put a pt at risk and I have gone 8 years without a med error....I am very conciencios and am proud of my practice. The REALITY is that this occurs...it is sooooo unrealistic to assume that RN's should not trust the pharmacy to draw meds up. We are part of a healthcare team...........we are not alone out there.......if you can't trust your pharmacy or coworkers....go somewhere you can

The only instance I can think of where this would occur in my setting is Fentanyl or another med in a vial that has to be broken open - obviously the entire contents will be drawn up and if 50mcg is given I can see a situation with a syringe with the remaining 50mcg being passed on to another nurse. Fentanyl is one of the meds that I am talking about. Should we waste it, if you only use 25mcg?? Even when we know they will require another dose in one hour.....thats not practical and wastes time and money.

OK guys....I think you are going a little to far with not giving meds the pharmacy drew up. As far as the example of the pharmacy sending up the wrong med..of course this happens!! The pharmacist are people like the rest of us!!! I think that was great that you caught the error, it is our job to double check, this is why they drill it in our heads. Where do you "draw" the line on what you "draw" up (no pun intended :) How can you be sure that bags of d545 c 20 k...really have 2o of k?? Would you only feel safe if you put it in the bag?? If so...what if the manufacturer of k made an error and labeled it incorrectly?? Are you going to manufacturer your own k to put in all of you IV?? Of course not, but you get my point. Lets be realistic about this...we are all human beings so of course mistakes happen..by Md's, pharmacists, manager and even Rn's. I don't intend to be sarcastic but I really think this is a bit extreme :)

I agree with all of you, I am just telling you that this is customary in our unit. We do label all syringes and I would not administer if it was not labeled by the prior RN. I will think about your comments :)

Hey all, I do give injections that others have drawn. I know this is a no-no, they drilled it in our heads never to do this in nursing school. But as you all know ... nursing school typically does not show us the "real world". I think in nursing school that they have an oblegation to teach students the, textbook way. However we have all learned that a lot of it certainly is not reality. I am very concience regarding med admin, and have never had a problem with this. This is not to say that I always do it...depends on the med, who drew it up. I feel that I can safely trust about 90% of my coworkers....we are fortunate to have exeptional RN's in our unit :) Just wanted to be honest and tell you what I do......... I would not advise it, as you certainly can run into troube. Thanks...christen

Thanks so much roxanrn2003.... I would love to check them out Thanks again, christen.

Hi everyone...Thanks for taking a look ? I am looking for a flow or as some nurses call it a "Brain sheet". Basically what I need is a worksheet to follow throughout my shift. We don't have a Kardex (well we do but it is never updated so we all use it as scrap paper). So I am wondering what do you guys use to organize your shift?? I need something to work off of, which would include times to give meds, lab draws, vent settings, ivf's etc. I want to design my own so I am looking for any good ideas out there. Ps. I am extremely anal so the more info the better and I work in a SICU. Any examples would be greatly appreciated....... Please post or email them to me. Thanks so much.

You are correct...phenytoin may only be pushed with NS...you will get a precipate....trust me on this one, I learned the hard way :) In addition, it can be given as a slow inital bolus but is called phosphenytion (not sure about the spelling) via IV piggyback, once that is in you can push dilantion (once again, in NS only) We give this to pretty much all of our head injuries, to prevent seizure.......in my experice it has always worked. christen h