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Thank you Mis Ashley for your helpfull answer ......... sbruc002 I think according to CDC no need for PPE during transfering any patient if the colonized areas of the patient’s body are contained Thank you all

Daer All, I have a concern regard wearing gown during transfering any patient under contact or droplet precaution. any one has idea about that if it is good practice and if there is any reference for that ? Sincerely

Dobutamine where given almost for CHF :redbeathe patient on lasix (furosemide) IV with dobutamine is Incompatible at y-site IV infusion:down:

"1) Turn stopcock off to patient 2) Remove cap 3) Press "Zero" 4) Replace cap 5) Turn stopcock back to neutral" excellent:redbeathe simple and clear but some types of caps contain a hole in side it, so no need to remove it :idea:remember: if arterial line the pressure in cuff to be 300 mmHg the flush is very important and some times if you interface a problem reinsure there is no air bubbles inside tube to give accurate reading.

We use mostly Ultiva (remifentanyle) for sedation despite its analgesic, and recently we start using Precedex (dexmedetomidine) with some patients. In rare cases may need extra morphine or Dormicum (midazolam).

dear dnpstudent, i worked in icu 1.5 year and in ccu 1.5 year i hope my reply is helpful for you pico question: in critically ill mechanically ventilated adults receiving temporary enteral feedings, does the implementation of a nurse driven enteral nutritional therapy assessment protocol reduce the risk of hypocaloric intake compared with current practice? survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): select all that apply rn__yes______ np_________ pa_________ other (please specify)_____________________________ 1.) does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults? a. yes and it is clear, concise, and easy to understand b. yes, but i don't quite understand it c. no d. not sure 2.) in your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient? a. always nasal b. always oral gastric c. whichever is easier d. the purpose of the tube drives my decision (for the purposes of draining or feeding) e. other_________________________________________ 3.) in your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated? a. salem sump (gastric) b. other gastric__(ryle's tube - stomach tube)___ c. post pyloric (nasojejunal : nj tube) d. not sure e. other___________________________________________ 4.) after enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated? a) bowel sounds auscultated in all four quadrants b) lack of abdominal distention c) patient has been intubated for more than 72 hours d) the therapy has been ordered so there is no other criteria necessary e) other_________________________________________ 5.) what rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient? a. 10 milliliters an hour and advance to goal as tolerated b. 20 milliliters an hour and advance to goal as tolerated c. bolus feedings d. i start my feedings at the goal rate e. other (please describe)___________________________ 6.) what monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy? a. gastric residual volumes b. promotility agents c. patient positioning d. all of the above e. other_____________________________________________ __ 7.) what assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy a. bowel sounds auscultated in all four quadrants b. lack of nausea and or vomiting c. lack of diarrhea d. gastric residual volumes e. other______________________________ 8.) after initiation of enteral nutritional therapy, how often do you assess gastric residual volumes? a. every hour if residuals remain high b. every four hours c. every eight hours d. once a shift e. other_____________________________________ 9.) what amount of gastric residual volumes would you consider acceptable to advance your feeding rate? a. there should be no gastric residual volume b. 10% of amount of feeding instilled c. 20% of amount of feeding instilled d. i do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy e. other____________________________________________ 10.) when assessing gastric residual volumes, what amount would you consider "high volumes" which would cause you to "hold" the patient's feedings. a. greater than 50% of the amount of feeding instilled b. greater than 250 cc in a four hour period regardless of the rate c. greater than 500 cc in a four hour period regardless of the rate d. greater than 100 cc in an hour regardless of the rate e. other _______________________________ 11.) when assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient? a. i discard all gastric contents b. i return all gastric contents c. i return only 250 cc of gastric contents d. i return only 500 cc of gastric contents e. other____________________________________________ 12.) how often do you flush your feeding tubes? a. 60 cc every 2 hours b. 60 cc every 4 hours c. 60 cc every 6 hours d. after administering medications e. other_____________________________________________ ___

Regard me I prefer and work in ICU where alot of nursing procedures done and working with critcal cases. It perhaps need alot of effort but I am happy there.

In regard my school we learn the method in lab then try it on dolls under teacher supervision in ideal steps, after that in other courses we practice injection in hospital with our teacher, and by time take expert.

thank you Mr SandieO for reply

Hi, Im newly graduated. I assigned to give my uncle a course of vit B12 inj. but he express pain at time of inj, is it from vit B12 it self or my little experience ? and how can I master this problem? My wishes replies = views

it is elusive qustion, but I think a. respiratory as base line data because the pt will recieve sedative.