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AmyCardsNP RN, NP

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AmyCardsNP is a RN, NP and specializes in Cardiology.

I was a cardiology RN for 8 years (CVICU, Cath Lab) before going back to school to get my FNP. I am now a NP in a cardiology office.

AmyCardsNP's Latest Activity

  1. AmyCardsNP

    How Cardiac meds r/t BP and HR

    I think a spreadsheet is a great way to study all of the cardiac meds. Rather than memorizing each drug, learn HOW the class of drugs works in the body.... it will be easier to remember side effects if you can remember the "how" For example, the ACEs/ARBs work through the RAA pathway (kidneys). If you remember the RAA pathway, you'll remember that there's no chronotripic (rate) effect of these drugs. Good luck!
  2. We use velcro straps to secure high risk patients to the cath table for angiograms. Deciding who is "high risk" is at the discretion of the staff in the room. Personally, I consider any patient who is having difficulty following simple instructions to be high risk. This is the type of patient that I most often use the straps on... those who can't seem to remember to keep their arms down, or to lay still, etc. We often use the straps on patients who extend a great deal over the sides of the cath table to assist in keeping the arm boards attached to the table. We also use the straps for all ICDs as it helps keep the patients still for device function testing.
  3. AmyCardsNP

    What to do with your rings when you scrub?

    Thanks for the replies everyone - I don't work in a sterile environment all day (I float back and forth), so I would like to be able to wear my rings for the hours that I am not which is why I was asking if there was a way people secured their rings. I like the hooking it to your bra ideas... I can't imagine leaving my bra somewhere :) (my job is nothing like Grey's Anatomy..haha)
  4. As a nurse with experience in an inpatient area as well as a procedural area (as well as a current NP student), I would say that floor nursing will give you a better background for what your long term goals are. While working in the OR will give you a great background of surgical procedures, you will not have much experience with what happens to patients before and after surgery, which is the time you are wanting to care for your patients as a NP. Procedural (OR) nurses don't often find out what happens to patients when they are done with the surgery nor get experience with treating post-op nausea, hyper/hypotension, or surgical complications such as infection. Working on the floor, you will see these things happen and have a better idea how you, as a NP, will need to care for them. Just my two cents on helping with your NP goals. But, there is something to be said about having passion for the job you're doing, so maybe that would lead you to choose the OR position. To me, it sounds like a decision between short term desires/interests and long term goals. Good luck! Oh, as a side note, in my facility, the PAs who assist with surgery are the ones who round on the patients post-op (in addition to the physicians, of course)
  5. Hey everyone- I was wondering what you do with your rings when you scrub? I don't scrub all day long and I don't like being without my rings all day, so leaving them at home or in my locker isn't ideal. Does anyone have any contraptions set up to hold your rings (maybe in a pocket) while you're scrubbing? The only thing I've heard is people using a large safety pin to hook them to their badge. Any other ideas out there?
  6. AmyCardsNP

    how many calories do you think we burn during a 12 hour shift?

    I wear a pedometer (http://fitbit.com) every day to work and depending on how busy I am in the ICU, I walk anywhere from 2-6 miles in a 12 hour shift. It's great to see how far I've walked during the day, especially after an exhaustingly busy shift.
  7. AmyCardsNP

    Annual Arrhythmia competency testing

    ACLS recertification does not require you to know rhythm interpretation to pass. It only requires that you recognize fatal rhythms (Vtach, Vfib, Asystole). They do cover heart blocks, afib, aflutter, etc during lecture, but they do not adequately test on it. I think arrhythmia interpretation should definitely be required for all RNs (and monitor techs) in an environment where it is a part of your job duties.
  8. AmyCardsNP

    Once Bitten Twice Shy

    Yesterday, I had a new experience as a nurse.... I was bitten by a patient. I was team leading (same as a relief charge nurse) & helping another nurse admit a patient to the ICU from the cath lab. He was in his 50s, had a heart attack, and the lesion was successfully opened and stented by the cardiologist. This patient was spanish-speaking (surprisingly, something we don't see in my area of Phoenix as often as you'd think) and he was waking up from sedation very wildly - thrashing all over the bed and trying to sit up. I was holding one of his arms down, and the other nurse was on his other side, because he still had a sheath (big IV access) in his groin and if he sat up, he would run the risk of severe bleeding. We were attempting to get him to calm down, when he pulled his arm (the one I was holding) up to his face and bit my arm. I pulled away quickly and used my other hand on his forehead to keep it on the pillow. Two more male staff members came into the room to help us physically restrain the patient (now for our safety as well as his own). We then called for security and the house supervisors to come to the room and the patient was placed in restraints and his sedation from the procedure kicked back in. I know that there were many variables that act as excuses for this patient to act how he did (language barriers, confusion from sedatives), but there was a spanish-speaking staff member in the room while the patient was acting out and the patient was fully aware of what was going on. He knew that he was in the hospital and remembered coming to the emergency room with chest pain. If a person is awake enough to realize these things, I think there is no real excuse for actions like that. I'm sure it's hard being in that situation - not knowing what exactly is going on and having people trying to restrain you, but to lash out and bite someone when you willingly came into the hospital for help is inexcusable. Situations like these make me weary of getting as close to patients as we often have to. But, my two options as a nurse are to 1) attempt to restrain him and put myself in danger, or 2) let him do what he wants, which would cause a life-threatening bleed from his artery onto the bed or into his abdomen. What's a nurse to do?
  9. AmyCardsNP

    Patients' Perceptions of Nurses' Skill

    Every once in awhile an article comes along that I love. Heck, I've even been known to rip out an article and put it in the nurses' lounge at the hospital a time or two. In September 2009, they published an article titled "Patients' Perceptions of Nurses' Skill" which I read and loved. The article discusses the factors that our patients use to assess our skill level. How do the factors that they use differ from the factors you use to look at your own nursing skill, or the skill of your coworkers? Nursing practice has three domains that make up skill: interpersonal, critical thinking, and technical. Which of these can our patients most easily pick up on? Interpersonal, of course. Our patients have very little insight into our critical thinking skills. As they lay in bed trying to breathe post-extubation with stridor, they don't know that you're the one calling the doctor for racemic epi, IV steroids, and heliox because you know the cause of the stridor. The same is true with our technical skills. Sure, they see us removing their central line, but they don't know correct steps to tell if you're performing the procedure in conjunction with best practice standards. All that our patients can see is our attitude about these things. When you call the physician on your patient with respiratory stridor, they see that you are doing this quickly and with confidence. You are in the room reassuring them that things will be okay and educating them on what is happening. When you are pulling the central line, you are explaining each step to the patient to reduce their stress level about the procedure and possibly chatting about another topic to get their mind off of it and show interest in them as a person. I highly suggest reading the article (I've attached the PDF below), but the big take-aways for me were: Patients describe the attributes of skilled nurses as: friendly, caring, compassionate, kind, good listener, confident, enjoyed his/her job, well-organized, and followed through with tasks he/she said they would do Patients describe the attributes of a non-skilled nurse as: Lack of confidence, timidity, rudeness, abrupt answers to questions, indecisiveness, frustration, and a negative attitude So, I look at these terms that our patients use to decipher our nursing skill and I can see the affect on our unit. There are a certain group of nurses who often get thank you cards or small tokens of appreciation from patients and family members and they display off of the attributes of skilled nurses - seems that this article is telling the truth 🙂 This article helps me remind myself when my day is going horribly, to take a breath. You're getting paid to be at work and these patients/families are going through a hard time right now. Relax and do your job, they don't need to know that you just got chewed out by a jerk physician or that the patient next door is confused, crawling out of bed, and on your last nerve. When you go in the room to do something, do it with a smile and take the extra time to try and make a connection with each one of your patients. You will stand out as they remember their hospital stay and you will personally feel better for having a relaxed attitude.
  10. AmyCardsNP

    Discontinued/held current medsor never started home meds

    It doesn't sound like you use electronic charting yet at your facility, and when you transition, it gets a lot easier to keep track of medications that your patient is on. Instead of having to flip through a thick paper chart, you can just click a button to see what medications the patient takes at home and cross reference with what medications are currently ordered. Unfortunately, I don't have a good short term solution for you. Maybe you guys want to keep a copy of the patient's home meds under a tab of the chart that could be easily referenced each shift?
  11. AmyCardsNP

    Are swans going "out of style?"

    It seems to me that the use of Swans depends on the physicians in the unit. I primarily work in a CVICU and all of our patients come back with swans in place s/p open heart surgery. Although, when we have patients with huge MIs (that could benefit from the knowledge behind a swan) who were in the cath lab, the cardiologists often prefer not to place a swan (comfort level possibly?). We ask the physicians if we can use the vigileo, which hooks up to a radial arterial line to measure cardiac output and most physicians will agree. When I float to the medical ICU, they never use swans... ever. We actually had one of the MICU nurses call to the CVICU when they needed to remove a swan a couple years back because no one on the unit felt comfortable with the skill set. (which I think is a good thing to call for assistance if you're unsure, for the record) http://nursinginfluence.com
  12. AmyCardsNP

    Care of the VAT patient post operatively

    Unfortunately, I don't have any great online resources, but as a preceptor in a unit that does many lung surgeries, I do have some suggestions of topics to cover with your staff: Why these patients need these surgeries in the first place? What would cause someone to need a decortication, lobectomy, resection, etc? What is the anatomy and physiology behind the surgery? Why are chest tubes required? What are signs/symptoms of common problems s/p thoracotomy? Just my 2 cents. Hope it helps a bit http://nursinginfluence.com
  13. AmyCardsNP

    Creatinine levels and need for dialysis

    I definitely agree with traumaRUs's reply - there are a number of factors that go into deciding if a patient needs dialysis. In my unit, we recently started new dialysis on someone whose Crt was only 2.9, but they were not making urine, fluid overloaded, and not responding to IV diuretics and were becoming clinically unstable. http://nursinginfluence.com
  14. AmyCardsNP

    NCLEX in different state than graduation state??

    I graduated in Illinois and took the NCLEX (and am practicing) in Arizona. I didnt have any issues with the process.
  15. AmyCardsNP

    Uniforms and dress codes

    We rolled out the same thing about 2 years ago... all of the nurses wear red tops, techs wear navy blue, unit clerks wear teal, etc, etc. When we all learned we were going to have to start wearing uniforms, no one was very pleased- we were happy with what we had picked out on our own. But, after just a few months, it became "the norm" and now no one thinks twice about it. I actually enjoy it when I'm floated to other units, I can tell who the nurses and/or techs are so I'm asking appropriate questions to the right people. So, I can imagine that the doctors/patients feel the same way. I know you mentioned that they are more than welcome to ask you if you are an RN, but I think that's just as big of an inconvenience for them as it is for us when we can't see a doctor's name tag... it'd be nice just to KNOW rather than have to ask. Try and go into it with an open mind... you'll find that it's not that big of a deal afterall (as we did at my facility).
  16. AmyCardsNP

    Heat/cool w/ CVC?

    We induce hypothermia on patients post witnessed cardiac arrest using external blankets. The way I've often seen patients "go to crap" during the rewarming phase is resultant from electrolyte shifts. We don't replace potassium during the 8 hours prior to rewarming for this exact reason. You can expect to see many arrhythmias.