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zambezi BSN, RN

CCU (Coronary Care); Clinical Research
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zambezi is a BSN, RN and specializes in CCU (Coronary Care); Clinical Research.

RN, BSN

zambezi's Latest Activity

  1. zambezi

    Preceptorship Expectations???

    When I precept a student, I honenstly don't expect much as far as skills go, only because most people haven't had much clinical time. I would expect you to know the basics of assessment, starting IVs, foleys, ngts, bps, etc. What normal values for labs are (or at least where to look them up), general procedures and plans of care for the types of patients in your unit. If there is a skill that you haven't done before, I would expect you to know the general plan...maybe watch me do it once and then try on your own (after telling me your plan). I expect you to be a willing participant, use good common sense, ask a ton of questions when you don't know something. I would also expect a general understanding of meds that you use frequently and to look up meds you don't know. I would encourage you to practice time management skills from day 1. Alot depends on the student...I find out how to learn and go from there.
  2. Southern Oregon is beautiful and also offers smaller towns and lots of outdoorsy things to do. I also like Eugene-
  3. zambezi

    Post Term Babies/Deliveries

    Just wanted to say hi! Thanks for all of your previous responses. Despite not wanting to induce, she decided that she did not want to come on her own. The birth didn't go as I planned (at all really) but I am happy with it. I did go in on the 24 th for the induction. We started with cytotec- when I came in I was having "contractions" (still non painful)- about every 5-7 minutes. I had a second dose of cytotec 4 hours after the first...when it came time for the third dose, my contractions (which were still tolerable) where too close together so they decided just to let me rest for the night. Doctor ordered ms and phenergan to help me sleep (which I ended up taking- so much for my non medicated delivery!) Around 200 that night I had to breathe through all my contractions and started shaking and throwing up with most of them- it was awful...I haven't been so sick in a long time! The plan had been to start pit in the morning around 0600...I took a shower (with painful contractions and throwing up the whole time, it was awful) and hurt so bad that I just stayed in bed. They didn't start the pit at that time (don't really remember why)...my doc came in a checked me and I was effaced but not very dilated (about 2 cms)...they broke my water and it did have mec. in it...Anyway contractions obviously got worse, I did my best trying to breathe through them- I wanted to get up and move but would get sick (literally) at the thought of it, plus I couldn't stop shaking and I don't think that my legs would have held be up...so I opted for the epidural (which I also had wanted to avoid)...in the end, it was the best decision that I made though...it took anesthesia awhile to get there (that and I had to wait to even get to 4 cms)...placement was fast and fairly easy and after a couple of contractions, I felt much better...my doc came and checked on me a few hours later and I was finally complete! The only bad thing about the epidural was that I didn't feel the urge to push very well even though I could still feel my legs and maueuver around in bed. I could feel the contractions too but the coordination of pushing was difficult (even though I felt like I had enough "mucscle" to push). Anyway, I took a nap for a hour or two waiting for the urge to push and then my contractions came on strong again where I could feel them...I pushed for about 2.5 hours...it was soooooooo long and hard. Her head was able to been seen in the birth canal for most of that time, she still just didn't want to come out. I didn't really want an episiotomy either (and my doc wanted to avoid one too) but after pushing so long and not being able to get her out, he gave me a small cut- and I tore too (ended up with a 3rd degree tear- ouch!)... Anyway she was born after a long labor...7 lbs and 15 oz. Apgars were 8 and 9 but sats were a bit on the low side due to mec...after some deep suctioning and positive pressure ventilation she was okay and I got to hold her fairly quickly after delivery. Not exactly the birth I imgained but I came out with a beautifu healthy baby and that is all that matters! I forgot to ask about how the placenta looked due to being post term...She was born 14 days after her due date on the 25th of April. We named her Kassidy Anne- she is so pretty!
  4. zambezi

    Post Term Babies/Deliveries

    So I set up an "appointment" for the induction for monday the 24th- I will actually be 13 days post term at that point...All of my NSTs have looked good...I hope she comes on her own before then but I think she is just too happy where she is! I still don't really want to induce but I also don't want the baby to hang out too long either...I had made no other progress at my last appointment though, I have been 50% effaced and a fingertip dilated since 38 weeks...here's to hoping she decides to come in the next two days on her own!
  5. zambezi

    Hmm...."You don't have to run"...no?

    I usually jog to codes. I am not in an all out sprint, or even a run for that matter- but if I walked it would take me forever to get there. That said- awhile ago we had an experienced RN and a new grad going to a code and the exp. RN was rounding a corner and his shoe caught on something and he broke his foot- he did make it to the code but wasn't much help. The patient was ok and got transferred to ICU....the exp. RN had to go to the ER and we had to cover for his patients, thankfully there was only about 2 hours before change of shift...he actually ended up needing surgery to fix whatever bone he broke! We got to make fun the of the new grad for trying to trip her preceptor and take him out for weeks! Anyway- the moral of the story is- be careful and wear good shoes!
  6. zambezi

    Post Term Babies/Deliveries

    Thanks for the fast responses. Like I said the first NST was looked good and the second will be tomorrow. We are giving her 11 days post term (I am 8 post term currently) to show up on her own and if she doesn't we will induce on Monday...Like I said, I prefer not to induce but will if she doesn't show up. I am delivering at the biggest hospital around here with an NICU- hopefully I won't need that though! Thanks again for the responses!
  7. zambezi

    Post Term Babies/Deliveries

    Hello! I Just have a quick question and wanted to get some of the experienced OB RNs thoughts. I have done a search on post term deliveries but didn't come up with any hits... Anyway, I am just over 41 weeks pregnant (and I am positive of dates). Healthy pregnancy thus far. Absolutely no issues. Originally my doc wanted to schedule an induction at 41 weeks...which I ended up canceling because I would really prefer not to be induced if possible. However, the 42 week mark is quickly approaching and still nothing so far. I know that I could go into labor at any time (and hopefully that will be the case). My doc has been great about working with me to get me what I want, but he does want to do the induction if I hit 42 weeks. So far I have had one NST which was good and I have another one scheduled before the tenative 42 week induction date. Other than castor oil, which I refuse to try, I have tried lots of thinks to get labor going: pumping, sex, cleaning, walking, resting, working, etc... At your facilites, do you see most docs inducing for post term? How long do the docs usually let women go? I do trust my doc, he is just fantastic and I feel he truly does want what is best for me and the baby. I am just curious to have the opinion of those that work in the field...I know the chances of mec. deliveries goes up with post term babies (I have had lots of discussions with my respiratory therapy coworkers about this) and I have heard that after 42 weeks the placenta can begin to break down. I just want to do what is best for me and the baby... Any thoughts/opinions are appreciated!
  8. zambezi

    Administering IV antibiotic bolus with concurrent IVT

    I typically run everything on a pump. If I have my NS at 125 cc/hr, I just use the secondary port, program in how fast I want the abx to run...it runs in my abx at the specified rate and then switches back to my NS rate when it is complete. It is very handy.
  9. zambezi

    Visitation and staying the night

    We have fairly lax visitation rules in our unit. The unit is closed between 630-800 both morning and night for shift change (unless there is something major going on with the patient- like life support was just turned off). Other than that it is typically up to the RN caring for the patient. We do have a written "rule" that states two family members at the bedside at a time. But if there are three in the waiting room, I let them all come back. Sometimes, if I don't want to go over things 5 times, I just have them all come back for one short visit so I can answer questions and everyone is on the same page. If the patient is not awake, we also usually only let family members back (unless otherwise specified or the have the "code" number). If we are having problems with the family, it gets brought up at change of shift each time so the nurses are more strict with visiting, etc. We don't typically have families stay the night (unless the patient is actively dying or crazy) - everyone is pretty consistent with that rule. I always tell families that just because I let them stay back for x amount of time or if I let them come into the unit without calling in first that the next nurse may not. Typically it works well, we do have those families that we have to be tougher with for one reason or another but it isn't too bad most of the time. In our unit pamphlet that we hand out the visitation rules just basically state the hours that the unit is closed and that visitation is up to the bedside RN. MOst of us encourage families to leave the unit, go take a break, take a shower, eat, etc. and I think that most families are fine with that. If the patient is sleeping, I don't usually let them be woken up, especially if they have had family in there a lot. The patient is there to rest and get well, not to be kept awake by a ton of family. I use my judgement as far as that goes, how well the patient is doing, etc...
  10. zambezi

    Cone biopsy, bad experience

    This is definately one procedure that I am so glad that I don't remeber. I had propofol during my cone...not sure about pain meds, I know I had about 25 mcg fentanyl after I woke up for mild cramping but not sure about intra-op. I don't remeber anything about the procedure though- and thank God for it! But that is my experience- I would not want to remember any part of the procedure! Anytime they take a knife to your cervix it will hurt! As for versed, I use it alot in my workplace- for some it works really well and others don't like it so much. I would say that I have had about 98% positive experiences with it (administering it to others that is) but for what we do, I typically use smaller doses, only 1-2 mg whereas for the cone procedure I would guess that they use a fair amount more. OP- I am sorry for the bad experience...Hopefully you won't have to go through the procedure again...and let your docs know that for future procedures you don't prefer versed.
  11. zambezi

    Cervical Adenocarcinom in situ-> Info??

    Sorry it took so long to reply! I had no symptoms. I went in for my yearly annual pap and it came back abnormal. A few weeks later I had the colposcopy after than which showed CIS (and when it was reread by another pathologist that specializes in womens gyn cancers it showed CIS and AIS). A few weeks after than I had a cone biopsy, which also showed both CIS and AIS. I had not ever had any abnormal paps prior to the that one. So from initial abnormal pap to cone was about a month and a half. Incidentialy, we did see and gyn oncologist who recommended a hysterectomy as well, but since we were interested in having a child she recommended that we try to get pregnant as soon a we could and when our childbearing was complete that we have the hysterectomy. We got pregnant the first month we tried (about two months after the cone) and are due in a little less than two weeks. I will probably have the hysterectomy sometime shortly thereafter. If anyone has any new or good information or sees this alot, I am still interested in opinions!
  12. zambezi

    Common Drips Used in CCU

    Our most common drips are: Dopamine, Epi, Neo, Vasopressin (though this is a fairly new one for us), Nitro, Nipride, Heparin, Amiodarone, Propofol, Fentanyl, Primacor, Dobutamine, Cardizem Obvioulsy, we use others as well, but these are most common for us.
  13. zambezi

    treatment of post-op hyperglycemia

    When the patient first gets back from surgery and is vented or not taking PO we using an insulin drip. We check a BS with our frist labs when they arrive from the OR. We start insulin when the BS is 140 or higher. For diabetic patients, we start it on the frist BS > 140 and for non diabetics we start it for the second BS > 140. Once the patient is taking PO, we change them to a sliding scale. There was a really good article out a couple of years ago regarding tight insulin control and infection (as well as other things, healing times, complications, etc) but I don't have the name of it off the top of my head, I will see if I can find it at work. I posted our protocol a while back, I will see if I can find it and post it here.
  14. zambezi

    back to med surg...can I give meds thru a permacath?

    I double what dinith says. Our docs prefer that we do not use the dialysis lines for IV meds or lab draws (unless a direct order is written to do so). The exception is in the event of a code or near code when immediate access is a necessity- I have use mahurkers for infusion of blood products and pressors when necessary...
  15. zambezi

    Improvising the foley P and P

    I am not even sure what #1 is... I usually place the drape under the patients hips but I don't consider it sterile (nor do I try to make it overly sterile). I just use it as a place to place my betadine swabs without getting my sheets dirty. I will use the drape with the hole in it only for male patients- and only occassionally at that. I find that it gets in the way more than anything. I usually place a bedside table to my right and make a nice sterile field there- easily within reach. My Left hand is my "unsterile" hand that either holds the penis or the labia open. Right hand ovbiously remains sterile for the cath insertion.
  16. zambezi

    swan lines

    We check placement on the xray when the patient returns from the OR. The swan also has little markings on it that tell you how far in the swan is. However, everyones anatomy is different as well, some people also have more friable vessels that are more prone to rupture. We always monitor the pa waveform up on the monitor so we can determine if the swan is in a "wedged" position. After each purposeful wedge, we capture the swan coming out of wedge on paper, which we post for documentation. We usually do this Q4 hours, more if necessary or less if the patient is doing well...On occassion, the swan can spontaneously wedge which can cause ischemia or rupture of the pulmonary artery (which is one of the reasons the pa waveform is monitored). The pulm. artery can also be ruptured while obtaining a wedge measurement- it is one of the known risks of using/having a swan. Some facilities do not wedge the swan and just use the pad...my facility does use the wedge measurements. Each facility is different in how often they wedge, etc... Without knowing more about the situation, it is hard to say whether the RN did something "wrong" (either by using a poor wedging technique or by lack of proper monitoring) or whether it just happened- which sometimes it does. I feel comfortable using a swan, I use them almost daily- that is not to say though, that I am unaware of the risks of having the swan. Like anything, I think that the more you do something, the more comfortable you are doing it. I am sorry about your grandmother...I hope that she is doing okay- a ruptured pulmonary artery can be very serious.