AmyCardsNP

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!

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.

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)

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)

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?

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.

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.

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?

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?

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

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

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

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).

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.

The CCRN has a lot of questions on swans, ABG interpretations, titrating mutliple vasoactive drips at one time, and ventilator weaning. I think the PCCN would be a great test for you to take with your current experience (and getting that certification shows your dedication and will show the ICU managers your commitment to your patient care when you are ready to apply to that area). Good luck! :)

I have copies of all the cards in my wallet, but not the original

I had a patient that reported to be allergic to potassium... and another patient who reported to be allergic to insulin. How do their bodies work?!?!? :)

Agreed. Our managers only make a few dollars an hour more than the staff RNs

When deciding to hold BP meds, in a situation like you are describing, there are so many different factors, as I'm sure you're aware of. Of course, you want to look at your physician order... did he/she write "hold if SBP I also will look at the history of the med. Did the patient get the previously ordered dose of this drug? If the previous dose was held, and the patient's systolic is still 90, I would probably rethink giving the med. Also, we have to look at the patient's medical history/current illness. I've seen many heart failure patients who benefit from the lowered heart rate and are able to tolerate systolic blood pressures in the 80s on a daily basis.

I have seen many more positive outcomes based on swan readings than negative outcomes from having a swan in place during my years in CVICU. So often we look at our PA pressures, CVP, and CI to let us know that a patient is in need of fluids despite an adequate blood pressure. I have also used it several times as an early indicator that a patient is starting to tamponade.

Our CVICU has one tech, he works 4 days a week from 4am-2pm. He has no patient care responsibilities (does no accuchecks or call-light answering) but is responsible for our supply room and equipment, such as cables, IABPs, aquaphoresis machines, etc. He helps us with turns, getting patients out of bed, road trips to CT, and transfers to the telemetry floor. I love our set-up with our tech and I wouldnt want it any differently. The fact that he's available to help us when we really need him (and not doing simple accuchecks) makes things so much easier for us nurses. But, on the other hand, when he has a day off, we all notice how much we miss having him on the unit :) He's amazing

Could you explain your rationale for taking a cuff pressure every hour? I'm curious to the benefit for the patient if your Aline is correlating.

I said that for ULTRAFILTRATION alone, (aka aquaphoresis) the patients are not 1:1. Using the aquadex system, there is only 33ml of blood in the circuit and the manufacturers website states that 1:1 care is not required. Heck, it even says that ICU care is not required (http://www.chfsolutions.com/ourtherapy_howitcompares.html). I was not talking about SLED with my comment about 1:1 care not being used... just wanted to be very clear here. Ultrafiltration, Hemodialysis, and SLED are all different.

Looks like jobs in ICUs for new grads are becoming harder and harder to come by in this economy. You may want to start looking (if you haven't started already) for a job on another unit, assuming you've exhausted your resources looking for job openings in ICUs in your area. Since you have been out of nursing school for a year now with no nursing experience, time is against you... hurry up and get a job somewhere. Nurse managers know that you will lose more of the skills you learned in school the longer you are left out of the game. Hurry and get some applications in to get some experience in the nursing world

CVVHD is ultrafiltration, which is not the same as hemodialysis. Ultrafiltration is the part of the hemodialysis process where fluid is removed from the bloodstream and is often done with the sole purpose of taking fluid off when diuretics aren't doing the trick, or the kidneys have taken a hit and need relief from fluid overload. SLED is hemodialysis at a slower rate. A "normal" hemodialysis run is about 3-4 hours, while a normal SLED run is about 8 hours. The blood moves more slowly through the system with a slower ultrafiltration rate, which allows us to do dialysis on our more unstable patients who will not tolerate the fluid shifts of traditional hemodialysis. On my unit, we run ultrafiltration through the machine by Aquadex. It's fairly simple and the ICU nurse initiates and sees the patient through the process- the patient's don't even need 1:1 care. We have several patients who come in for an overnight stay just for a run of ultrafiltration, and are discharged the following morning.