RN Joe 86

An exchange with a brand new intern after a woman coded and expired. Intern: So, what do I do now? Me: You declare the death. Intern: How? Me: Poke her with a stick and see if she moves. If not, declare the time of death. Intern: You're crazy. Me: I ...

Why not take the PCCN since it is more specific to your specialty? The CCRN isn't a BETTER cert to have. I would assume most of the CCRN would be totally foreign to your specialty and irrelevant.

Great question! Hopefully there is an obturator in the room. If not, most trach stoma sites are well developed anough that with a little surgilube you can place it back in. If all else fails and the RT or whoever isn't there to help, occlude the trac...

"Hello Doc. My patient does not a have a pulse. I need help in here." Yeah, that would probably suffice. :)

I think being a new nurse on nights is particularly difficult. Lack of resources, rounds and other learning opportunities can make you feel alone. Try exercising and reading a book or magazine before you go into work. It definitely helps ease my nerv...

Yes. They always have the best advice.

It actually does not matter if the gtt is y-sited in or not. What ever the gtt rate is set is what the pt. will recieve.

1) Prioritize (Bed bath vs. PEA code) 2) Organize (scatterbrained vs goal oriented) 3) Able to function under pressure (High stress only if you let yourself get stressed) 4) Stay one step ahead of the patient and always anticipate the worst. 5) Eager...

I'm actually on orientation myself. My preceptor and I joke alot with eachother and are quick to laugh at ourselves and eachother. Try to keep it more light hearted. In any way you can, try not to take it to heart. It sounds like they should be more ...

Listen for the burp, initially. And, of course, a CXR.

Hmm, I think it's time to double check your protocol. That sounds ridiculous and painful.

SV is contingent on preload. When a patient is dry, there is obviously less preload. LEss preload means that with each stroke there will be less afterload and altered filling. The altered and inconsistent filling will effect your SV and INCREASE your...

According to the fellow on my unit, the literature shows greater survival using levo for sepsis and SIRS. From what I could find, it does in fact. Dopa, at lower levels, has almost purely beta stim whereas at higher levels has almost purely alpha. Du...

I know exactly what you mean. A month or so ago, me and another nurse decided to turn a DNR, DNI pt of her's and we turned him to his side and BOOM: complete desat. He was dead in 5 min. Fortunately, the family was in the lounge and close enough to c...

Yikes! That sounds like a rough day. However, where were the other nurses? Just two weeks ago I had a new post code with sbp in the 50s and I had another nurse (teamwork!) help me out with her. We wound up maxing her on levo, dopa, neo, vaso, and epi...

I agree with everyone else to NEVER pause your pressors for labs. If all of your cvp lumens are occupied try a piv, as long as it has sufficient blood return. Or, just stick them. In reality, if your patient's BP is tenuous enough to be on pressors t...

Hmmm, that's interesting to hear. I can understand the benefits of recieving report from a nurse in-person. However, leaving your own unit to recieve another patient makes little sense to me since you will likely have other acute patients to tend to....

Basically, have them presentable as if you would expect your own mother or father to look if they were in the unit. PS, speaking of ICU bed change/ wash, as turning a patient with ARDS to the side to clean his bum bum the other day the turn put him i...

That's a real bummer. I know how you feel about the opportunity part and with this change of assignments to less acute patients. you lose some of the more critical experience you could gain from taking on more complex patients. Honestly, I've approac...

If I may continue this discussion, I'd really like some advice from any CRNAs. I'm a second year bsn/msn student and just recently I did a few rotations in the OR. Needless to say, I was impressed by the entire perioperative team. I've been used to a...