leosrain

As part of treating the "C" in ABCs, Giving blood/fluids will increase blood pressure, and therefore perfusion to the brain. Without brain perfusion, tissue dies. It's not uncommon for traumatic brain injury patients to have high blood pressure goals--this will make sure blood gets to the injured tissue and prevents further secondary injury. So, treat the blood pressure ASAP. Better yet, give the blood to treat hypovolemia and find out if you can open up the EVD to decrease ICP. With an EVD, there's no reason why you can't treat the hypovolemia and ICP at the same time. Look up CPP (central perfusion pressure) and how it's calculated. CPP is arguably the most importand factor in treating brain injury. It requires a high BP and a low ICP. If you understand CPP and how it can fluctuate and be treated, everything will fall into place.

That was my first thought too! core0 is right....feed through J, decompress through G. It must be sucking out tube feed as it tries to pass through the jejunum. J goes to jejunum G goes to stomach

I don't know if I read your post right, but it sounded like the doctor ordered the heparin to be d/c. Perfect nurses see a d/c order like that and instantly know it's not right and question it--every single time! Nobody's perfect though...Including the doctor in this case! Remember, the doctor ordered it to be discontinued. It's his/her mistake to share. If nurses are going to take 100% responsibility for every single order, we may as well fire all the doctors and put in orders ourself! But, you see, there's a reason we don't do things like order heparin drips, or develop plans to bridge to coumadin: we don't have the same specialized training. Yes, it's a nurse's job to question orders, but this is a very subjective art that takes an entire career to master--and even then, erroneous orders can slip through the cracks. We need to stop taking the whole weight of a doctor's responsibilities on our shoulders. And Doctors need to stop casually putting in orders with the assumption that nurses will catch mistakes. One last point. Why was that nurse calling you at home? a) She should be calling the doctor to clarify the order, not you! You didn't put in the order, the doctor did. It wasn't your order to clarify!!! b) If she wanted to tell you that you made an error (rub it in?), she could have done it on the next shift. I suspect she was just doing it to boost her own ego for catching an error. Anyway, I just wanted to stand up for you a little bit. This mistake was not as big as you are probably thinking. Like everyone has mentioned...you will never make that mistake again. Nurses frequently learn from horrible failures. What an incredible way to learn!!!

Hey there! I'm just orienting to the ICU currently after about 2 years on med-surg. I just wanted to add to the comment above. There is an UNBELIEVABLE amount of information thrown at new ICU employees. I'm noticing that there have been things I have had to ask a couple times before getting a full grasp. There have been a couple times where I asked a question, received the answer, fully understood the answer....and then a couple days later needed to ask the same question again in order to reinforce my learning. Hearing and understanding does not equal memorization. Here's one anecdote: The other day I stood there staring at the monitor at the beginning of my shift. I started laughing out loud. My preceptor asked me what I was laughing at. I told him, "I've printed out an ECG strip at least 20 times...and now I'm sitting here drawing a blank...I can't remember how to do it!!" We had a good laugh, and I felt silly when I was reminded that there's a giant "graph" button on the front of the machine. Good nurses focuses learning resources for information...not on memorizing every last bit of detail. Better nurses than me still have to look up things that are fairly simple just to make sure...

Hey there! I'm just orienting to the ICU currently after about 2 years on med-surg. I just wanted to add to the comment above. There is an UNBELIEVABLE amount of information thrown at new ICU employees. I'm noticing that there have been things I have had to ask a couple times before getting a full grasp. There have been a couple times where I asked a question, received the answer, fully understood the answer....and then a couple days later needed to ask the same question again in order to reinforce my learning. Hearing and understanding does not equal memorization. Here's one anecdote: The other day I stood there staring at the monitor at the beginning of my shift. I started laughing out loud. My preceptor asked me what I was laughing at. I told him, "I've printed out an ECG strip at least 20 times...and now I'm sitting here drawing a blank...I can't remember how to do it!!" We had a good laugh, and I felt silly when I was reminded that there's a giant "graph" button on the front of the machine. Good nurses focuses learning resources for information...not on memorizing every last bit of detail. Better nurses than me still have to look up things that are fairly simple just to make sure...

I was wondering the exact same thing! :)

Here's a secret... Try to find out by word of mouth what your manager's research interests are (usually managers have a Masters or PhD), or perhaps what projects they are working on for the unit. For example, my ICU manager did her research on family care, and she was working on many programs to support families. So, it was easy for me to integrate the idea that I was interested in helping families cope in difficult times, support them, etc. etc. Make sense? Or if their interest is more technical, talk about how you are interested in the technical aspects. Otherwise, truly soul search and see if you can put your desires into words. I know, it's super hard!

Here in Calgary, Alberta, the norm is to work either a day/night or day/evening rotation. I actually like my day/night...I don't think I would want to work all one or the other. I like changing--makes life interesting. Sean

Lack of control! The following people make all the decisions: Doctors, admitting, administration, patients, family. I am only able to say, "I think x would be best, and can we do y?" I'm never actually able to make decisions. I am only on the receiving end of everyone else's decisions. Nursing has a long way to go before it finds itself autonomous. Sean

I think this is a GREAT list! It is a very telling sign that nursing theory DOES trickle down to the bedside. There isn't one thing on that list (except for maternal-infant attachment) that I don't use on a daily basis! As for a previous post. I am a bedside nurse and I use and appreciate nursing theory. I can name many theorists and how I use their ideas in practice (see above list for examples). I have an appreciation for liberal arts and humanities. I love philosophy and sociology. I love complex ways that scholars have interpreted this world. I see these passions as only contributing to my practice; they certainly don't hinder.

I also use Neuman's systems model (I think that's the correct spelling). However, I do use a simplified version. As part of my final Bachelor's of Nursing project, I created my own practice model/theory. There are those of us out there that use/appreciate nursing theory, even at the bedside.

I'm just upstairs from you on 102. General surgery/surgical oncology

I don't know of any schools in the GTA... However, I am currently taking the critical care courses through Mount Royal College here in Calgary. It is a distance education program, so you WOULD be able to enroll. It has been great so far. You should check it out and see if it would work for you. http://www.mtroyal.ab.ca/healthcomm/ashs/accn.shtml

Just a note to an above poster... There's a great show on Discovery Health called "Nursing Diaries." It's great! It's basically like any real life doctor show, but follows nurses with different specialties. Give it a google and see if it's on sometime soon for you. I happen to be watching it as I type :) Sean

Hey there! If you're looking for a Nursing Attendant job at the Foothills still, let me know and I can pass along my manager's email. As someone with nursing experience, I'm sure she'd be happy to see your application come across her desk! Sean

I don't think there is such a thing as associate's degrees in Canada. And to be honest, I don't think there ever has. The debate in this country has always been between diploma (from a college or hospital) vs. a bachelor's degree.

[quote But then I am a card-carrying socialist, so... http://www.ndp.ca You and me both!!! I'm glad I'm not alone! :) Sean

It wouldn't hurt to call the U of C and ask them the status on your application. Good luck! I loved my time at U of C nursing program. You will make some amazing friends! Sean

I'm not sure what the correct answer is...but wow! I would never wait for a doc's orders before giving 02 in an emergency. I'd probably be elevating the bed and administering 02 at the same time. But you're right, I can't immediately recall the correct bed positioning. I now feel the need to research it stat! I do know that if the patient has a PE, the clot has already gone through the heart and to the lungs, so it would be hard to trap it in the heart. Can anyone better describe the correct actions?

Well said Jan! Thanks for writing this! Sean

Phew! I'm so glad I'm not alone! I'll be reading your post ASAP! Sean

It seems to me that over the past few weeks since the surfacing of Michael Moore's movie "Sicko," there have been many myths about Canadian health care floating around. Americans who are particularly against Michael Moore, socialized health care, or both seem to be spouting these myths about Canadian Health Care in order to show that it is a horrific system. These are some rumours that I have heard more than once: I have heard that in Canada there is no choice in health care providers. That the government chooses our doctors for us. We are not allowed to go for second opinions or reject the appointed provider. Myth!!! I have heard that Canadians often have to wait months for emergency surgeries and that people are dying because of this issue. Myth!!! I have been told that health care in Canada is mediocre at best because socialized medicine promotes laziness in its medical professionals. The rationale is that we health care professionals are all treated equal no matter what, thus taking away our motivation to be ambitious and succeed. MYTH!!! Is anyone else getting sick and tired of these false accusations being passed around? Sean

It IS sexual discrimmination, you just feel it is justified. These sexist attitudes need to stop. It's no wonder males are so afraid to be nurses. *sigh* Edit: Removed remarks which I decided were not necessary.

I personally believe that forcing men to have a chaperone is sexist and against the law. Until females are required to have a male chaperone when caring for males, I refuse to accept this practice. The day I have to have a chaperone is the day I quit. I refuse to be seen as a criminal without cause. Sean

P.S. Anyone know if his post is against TOS?