leesespieces

We also have a very in-depth charting system, and our q 2hr charting includes, vitals, phys. assessment, vent settings, skin care/turning etc. We have separate interventions we can chart on as needed for gtt titration, MD calls, critical labs, etc. I chart narratives whenever a procedure was done, when I recieve an admission, any significant change in status.

Titrating by mL/hr is NOT a standard of care, and if you ask me, also quite dangerous. I agree with the other posters, you should always titrate by dose, not rate. At my facilty, our concentration is 4mg/250mL and I always titrate by mcg/min; sometimes by 5's, it all depends on how labile the patients BP is, sometimes I'll titrate by 2's etc. Hope this helps!

I just had a 19 yr old F admitted to ICU 5 days post partum with a Temp of 105.7. Turned out she had sepsis from retained products of conceptions. We acted quickly and aggressively and she did fine in the end. Once saw a really sick pt (not mine) who had mult issues all of which I can't remember. He did have malignant hyperthermia Tmax was 106.7!!! We attempted to Tx with Dantrolene (boy is that fun to give!) He died within the next few days.

Hi everyone! So I work in a 27 bed ICU (CCU/MICU/SICU) at a community hospital. I think we should have more standing orders in our ICU and more protocols to follow for certain types of patients. For example, we have standing orders for severe sepsis/septic shock, intensive insulin gtt therapy, acute CVA, and acute MI. The standing orders for HF, pneumonia, chest pain are ED orders and are not always initiated or used. As a matter of fact, our sepsis protocol is never used! I think we should be using what we have and adding more! I know many ICU's have standing orders for electrolyte replacement and for all their drips etc. So what kind of standing orders do you have in your units?!

I, unfortunately do not work in a unit like this. First of all we don't do open heart anyway (wish we did!). But I think any ICU ought to have standing orders as far as replacing lytes, ordering certain labs, x-rays, ekg's, starting/titrating drips. I think it benefits the pt to be able to do something for them right away vs waiting for a doc to call you to give you orders.

When we have transfer patients we still leave them hooked up to the monitor. Depending on the patient I will continue to do assessments and VS as an ICU pt. With withdrawl of care situations I usually try to talk to the family before if I can to see what they want. Some families like to have the monitors on so they kind of know what's going on. Otherwise I turn the in room monitor off and just monitor from the nurse station so I know when they're really going.

I definitely understand parents wanting to be with a child in the hospital. I think parents should be there. And I agree, I don't see the need for the whole community to show up. Thats the problem we had I referred to in my OP. For this one pt we had at least 40 people in the waiting room day in and day out with quite a few small children running around, it was completely inappropriate. I also agree that educating the family can go a long way to putting the family at ease and ensuring some cooperation. And certainly there are families that just don't get it no matter how many ways you explain something, unfortunately. janfrn: I hope your son is doing better after his stay in the PICU Labcat01: I also hope your father is doing well

I need to know if others out there have the same difficulties with patients family members/visitors in the ICU. In my facility visiting hours are more strict than they are on the floors. Visiting is supposed to be from 12-8 and we close the unit to all visitors during change of shift (for HIPPA reasons). There are only supposed to be 2 visitors at a time and no children under 12 allowed. We even give pamphlets on the ICU to the family at the time of admission to the ICU that outlines all of the above in addtion to things to expect when your loved on is in the ICU. However, more often than not 3-4 or more people will show up and go into a patients room at a time. (Part of this is the fault of security and/or visitor control). When they are reminded of the rules or when the overhead announcement is made when visiting is over for the night or during shift change, visitors simply ignore us. In a few instances they refuse to leave. And once recently we've had to call security and the police dept.!! I am not heartless and I do understand and am willing to make exceptions when I know the pt's spouse or child works until late and wants to come by after hours for a little while or if the pt is actively dying etc. But many times these are patients who are completely stable whose families give us the hardest time. Also, there are times there are 4 visitors in this rm with the patient, a vent, monitors, mult IV poles, IABP etc and they are crowded around the patient and when I come in to do my job to care for THIER family member they don't even back off so I have to do acrobatics to hang a new drip or check a BP! And they act like its such a nuisance to let me do what I need to do when I ask them to please move. We explain to them that ICU pts need more rest than they think with all the tests, procedures, etc they go through. But it doesn't stop them from yelling into their loved one's face (who is vented and on a propofol gtt) "WAKE UP MOM!!!! I KNOW YOU CAN HEAR ME!!! WAKE UP AND LOOK AT ME!!" They use their cell phones in the room after being told it interferes with the monitors connected to their loved ones. They don't wear the appropriate PPE when going into an iso room. If they do wear it, they leave the room and go in the hallway to talk on their cell phones still wearing the gown and gloves. And the nastiest thing of all is when the use the bathrooms that are shared by 2 rms to dump bedpans and urinals!!!! Not sure if I've just lost my patience along the way or if anyones meets this much resistance, and often outright rudeness from family members. I love it when they finally do leave saying so intentionally loud "Sorry I have to leave, the nurse is kicking us out" or "they won't let me stay with you." Just wondering what your visiting restrictions are in your ICU's, if you meet the same resistance, and what you all do in these situations.

i'd say that sounds about right meandragonbrett! and at my hospital, in addition to caring for our own patients, the icu rn's have to respond to all codes throughout the hospital, rapid responses, we do all bioz's on the floor, we are often called to start iv's on the floor. now we also have to respond to c-ports, and acute cva's. don't forget that we also have to deal with family members who can sometimes be more needy than our critically ill patient!

Thanks for all your replies! I think I'll hold off until I get my IN license...always better off to have it than to not as most of you said... thanks!

So I currently live in Indiana but I work in and hold an Illinois RN license. I am wanting to start a program in my church (also in Indiana) just doing monthly BP checks and blood glucose checks and simple health assessments for the elderly. Do I need to have a license in Indiana to do this? Any insight would be appreciated, thanks!

Thanks for all of your replies, I'm going to try to find an article explaining the physiolgy and if I find one I'll post it for everyone!

I'm just wondering if anyone knows they physiology behind the "fatal turn" It's commonly heard that often times when someone is actively dying and you turn them, they often die soon after. I recently saw it for myself the other day. I had a pt where the family withdrew life support so we had the pt on supplemental oxygen and a Morphine gtt. He maintained stable vitals for about 3 1/2 hours after extubation. Then I finally decided to turn him and get him cleaned up (he had a lg BM) As soon as I was done his pulse started droppping and he lost palpable pulses and his BP. Within 15 min he was gone. Anyone know the physiological sequence of events that causes this???

i'm 2 weeks into my job (rn) in the ccu at a community hospital right outside a major city. i love it because everyone is so nice, something that's been rare to me in past work/clinical experience! the nurses have welcomed me with open arms and are so encouraging and really treat me as they do all the other staff that have been there 20+ years. i like icu because i like the critical care setting and all the changes that can happen so quickly. i also like that i get to provide complete care for my patients and that it's actually getting done. i know that if i had 7 med/surg patients it would not be possible to meet all of their needs and i couldn't handle that. it's so rewarding to see a patient go from s/p arrest on a vent and multiple drips etc to getting stable and being able to leave the icu. it's rough when it goes the other way but i like being a part of the code team as well.

thanks for all the input everyone! i ended up going with a $40 littmann, the se ii i think. it's served me well so far, but i am only on my 2nd day of orientation on the floor so i've really only been using it for bp's. seems to me most of the nurses use those newer ultrascopes, i've never tried one so i don't know what they're like.

oh.... and good luck on boards mycatmax!!!!:balloons::biggringi:monkeydance::smilecoffeeilovecof:smilecoffeecup::typing:yelclap:

thanks for your reply! it does help. i know i will be totally overwhelmed and i'm trying not to expect too much from myself. i'm tryingto get myself mentally healthy to i can take it a day at a time, an hour at a time if i need to. it's totally nerveracking but i will make it through. [color=#483d8b]anyone else want to share their orientation stories or voice concerns?! [color=#483d8b]still looking to how the orientation actually progresses!!

hello all! [color=#483d8b] i will be starting my 1st rn job on monday! i was hired to work icu on evening shift. i know week 1 of orientation will be classroom stuff covering benefits, infection control, pharmacology, computer charting etc. then the rest of my 3 month orientation on days will begin. how does orientation on the unit usually progress for most of you? [color=#483d8b] i assume i will be observing, then caring for patient's under supervision and eventually on my own but how long does each stage usually last. [color=#483d8b] can you tell i'm getting nervous?!! plus in the midst i have to study for boards which i'll be taking on aug 11th.:rotfl::doh::smackingf:yelclap::icon_roll

hello [color=#483d8b] i am a new grad starting my very 1st rn position in the icu next week. our icu is actually divided into ccu, micu, and sicu and i'll be crosstrained in all 3. just wondering what the best stethoscope would be to use in this unit. i know littman's are great but don't know which one is the best. thanks!

hello! [color=#483d8b] i graduated in may and i'll be taking my boards august 11th and i start my new job in an icu in a nearby hospital a week from tomorrow.... getting nervous and excited!! nice to meet all of you and congratulations to everyone!!!

Thanks everyone for the congrats! And congratulations to all of you too!!!!!

I always bring a 2x2 in with me. I clean the finger with alcohol and do the fingerstick. I wipe away the first drop of blood with the 2x2 and then obtain the sample. I agree handwashing would eliminate a false low result, but many patients in the hospital are bedbound, unable to wash their hands. It would be nice if we had the time to wash their hands for them before each accucheck!!

thanks for all the congrats everyone:) this is really the best week i ever had.... in addition to me landing a great job my boyfriend of 3 years proposed last night!!!!! i've been up since 4:15am because i'm so excited....hahaha. :monkeydance:

thanks!

i am so excited!!! i just interviewed with a really great hospital for an icu position and got hired on the spot!!!!!!!!!!!!!!!!!!!!!!!!!!! i'll be starting in june after i graduate, i am so excited!! had to share the news!!!:balloons: :biggringi :wink2: :roll :biere: :smiley_aa :mortarboard: :yelclap: :caduceus: :cheers: :w00t: :thankya: