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PICURN74

PICURN74 ASN, RN

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PICURN74's Latest Activity

  1. PICURN74

    Need help with this vague patient safety question.

    There are "National Patient Safety Goals" that might give you some insight
  2. PICURN74

    Cardioversion Sedation goes Beyond Moderate-Help

    Can't speak for Texas or give legal advice but in my opinion you are right to have some concern. I think you bring up a good point of the level of consciousness being deeper than traditionally considered "moderate" but also concerning is that many of the recommendations for "best practices" related to sedation include having the person responsible for providing sedation be separate from the person performing the procedure. I couldn't tell what the practice at your location is. I agree with you that nurses can often handle situations that arise but make sure that you are supported by your hospital if things go bad. Keep questioning until you get your answers, preferably in writing.
  3. PICURN74

    A stupid question on Sympathetic nerve system

    There are a couple of thoughts I have on the situation, SNS stimulation releases Epinephrine and Norepinephrine as well as cortisol and aldosterone etc. and causes the effects previously mentioned, in doing so it decreases blood flow to the kidneys (need the blood else where) which causes decreased urine production. Your kidneys don't like this and so they deal the best they can (since you still need to fight or flee they can't over ride the sns) and decreasing the pressure in the bladder makes the little blood getting to the kidney easier to pass into the kidneys (still keep some kidney function) also nor/epi cause smooth muscle contraction (hence the vasoconstriction) so you get some contraction of the bladder as it is also a smooth muscle so you feel the need to go. Just my thoughts
  4. PICURN74

    New Nurse...Need advice on dealing with death

    I agree with everyone else your feelings are normal but that doesn't make them easier. I also work in the PICU and pediatric codes are especially hard as a general rule kids are not suppose to die. I don't think you get used to them but rather learn to cope and see them differently. I used to second guess myself and wonder if I were more expierenced if the outcome would have been different but as I have seen more codes I have learned that as much as we want to control things somethings are out of our hands. Some kids recover dispite our mistakes and some sucum despite our most heroic efforts. The serenity prayer/chant helps me "...grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference" Wisdome and serenity came for me later and I can tell you already have the courage part down
  5. PICURN74

    Words of Wisdom?

    Be honest with your desire and your areas you need to improve. I tell my new grad orientees in the PICU that you aren't suppose to know everything on day one or orientation would be pointless. To me the more important quality in a good ICU nurse is desire to learn and genuine motivation/interest in the positon which you sound like you have.
  6. PICURN74

    Cpr???

    you might want to try craigslist for an instructor, I have had some friends who were able to find someone this way to validate skills after doing the online portion. Otherwise try calling the boyscouts/girl scouts they sometimes have classes or know instructors (just besure to find a healthcare provider course) Local YMCAs sometimes are good places too.
  7. PICURN74

    Graduation Gift Ideas for Big Brother?

    The best gift I got was a box of my favorite pens (my personal favorite is Pilot ultrafine point) I never knew how much the quality of your pen can affect the quality of your day until I started in the Unit. Otherwise coffee is always a crowd pleaser.
  8. PICURN74

    scared of being in a code

    FutureNICU- You are suppose to be scared of codes they are one of the few things that are literally a matter of life or death. You will learn to use the fear and it does decrease but they day that a dying kid ( I work in PICU) doesn't scare me a little is the day I will hang up my stethoscope. During a code I am usually fairly calm and then afterwards is when I notice my heartbeat in my throat and how fast I am breathing. I have broken many ribs and those that have survived haven't held it against me.
  9. PICURN74

    I made a huge mistake and ruined my life.. long, sorry

    You made a mistake and you admitted it now you need to forgive yourself for it. It will be something that is with you for quite some time but doesn't have to mean the end of your career let alone your life. While every situation is different, I work in substance abuse where I see people who make mistakes time and time again and eventually put their life back together. We even have some recovering addicts who work in patient care. It will be a long road but stick to it, get thick skin and keep trying and you will be the one who determines your future. Hang in there.
  10. PICURN74

    Atarax IV?

    Check with your institution but, vistaril can be given IV but it is often avoided if possible, however it is on my formulary as IV and I have had some patients recieve IV vistaril.
  11. PICURN74

    Bereavement Committee

    We make plaster hand prints if the family would like, we send them a letter of sympathy from our berevement committee as well as a card signed by the people who took care of the patient (hangs in the lunch room for 2 weeks and then is mailed out by berevement) we have rememberence services twice a year where all the familes who lost children are invited back and we read their names and the staff attends and interacts with the families.
  12. PICURN74

    Non-Clinical Factors that Help Create Positive Outcomes?

    Glad to hear your son pulled through! Where I work we have a general hospital wide orientation followed but nursing specific orientation when we first get hired and then we are given additional instruction throughout our employment. One of the things that I found really helpful when I first started was hearing what it is like to be a parent in the ICU. We have something called patient family advocates, mostly parents of former patients or current long term patients, that are actually on staff and that tell their stories, answer questions and give suggestions to new nurses, doctors and other members of the health care team. They are also available to talk to families that are currently going through it because it is nice to talk to someone who has been in their shoes. I know the families and staff love it.
  13. PICURN74

    Distractions for patients in cervical traction

    TallTraveler- Unfortunately we see many kids like this (motorbikes should be illegal but I digress) Is the patient in traction or in a C-collar? Depending on the reasons for the immobilization, our doctors sometimes will allow us to put the bed in reverse trandelenburg (Pt is still flat and immobile just changes the vantage point) but that is on our crazy expensive ICU beds that have lots of bells and whistles. Depending on how old the pt is we will often put the younger ones in a bubble top crib with a clear plastic top and place things on top of the plastic (DVD players from Childlife or mirrors/toys) but the cribs are designed in such a way that there is no possibility of the object falling on the kid. Sometimes we have light show machines (think planetarium/disco ball) that provide something to look at. Also books on tape/cd can provide some relief and are available at most public libraries (kids seem to be mad if they listen to DVDs while everyone else gets to watch them) Hope something helps
  14. PICURN74

    Help with a GCS question...

    The scale is 3-15 with extremes at both ends. In our facility 10 and below is a sure way to get the million dollar workup http://www.trauma.org/archive/scores/gcs.html
  15. PICURN74

    What should I do?

    I agree, mistakes are just that until you try and cover them up then they become choices be honest. It sounds like you did try and varify the dose after reading it back to the doc and checking with pharm. In my world I sometimes give crazy doses of drugs but I still double check with my neighbors/docs. It could have been the doc forgot what they ordered when they went to read it in the chart. When we take a verbal order we have a big yellow sticker we place in the chart where we write what the doctor says and that we wrote, repeated and varified the order and sign it and the doctor then comes and cosigns the order. Most importantly the patient sounds like they were not harmed and pain was treated.
  16. PICURN74

    almost graduating

    I work in peds and do a lot of lifting, best advice is find a job you will love and figure out a way to deal with the rest. Making friends with the stronger people on the unit is always a good idea (I am 6'4 and have a LOT of friends come time to change/transfer patients) there is strength in numbers (save your back)