kvsherry

Hi Guys- I work in a Trauma ICU and we frequently have patients who are either full axial or log roll spinal precautions. My question is this, when you turn your patient to the side, how do you prop them up? We have "Macgyvered" a set up by taking a heavy blanket, rolling it and taping it. This works, but is not ideal. Does anyone out there know of a commercial product that is used in Neuro/Trauma units to offload weight and maintain spinal alignment? Thanks! kvsherry

Along the same lines, from the surgeon... "you're not going to save him".

Regardless of the program requirements, it would be a good idea to have real world experience prior to the NP. Your chances of being taken seriously without it are slim.

I like working with other guys, until they start getting all bent out of shape and pissy about being called a 'male nurse'. That is what I am because I am trailblazing in a field in which I'm a minority. By the way, I love my "Rosie the Riveter" lunch box that my friends got me.

i hope this helps!

Do you belong to a union? If so, talk to your rep. Then, since I'm no expert on labor law, I would second the other posters advice about speaking to a lawyer and finding greener pastures right quick. You may not have done anything wrong, you may be the best new grad in the country, but that will be small consolation when this petty organization ruins you. Good luck, you have my best wishes.

First off, let me correct Mr. Singer's 'research'. ICU nurses do, in fact, know the difference between clinically dead/brain dead. Those of us that do talk to our dead patients do so for many of the reasons laid out below. However, the reason that I have seen is habit. We talk to our unresponsive patients all the time, see a body, talk to it. That is what we are trained to do and that is our knee jerk reaction. For what I do? I never talk to my dead patients, and I correct any staff members (tech, RN, RCP etc.) that do. I unfortunately can not find the article, but it reminds nurses that by talking to a brain dead patient, the family can be easily confused. They may already be having trouble reconciling the heart beat on the monitor with dead, and they can be made to wonder, "If he is dead, why is everyone talking to him?" I hope this helps.

With regard to the question about drainage and checking ICP. It depends on your surgeons preference for that particular patient. Some patients, the really sick ones, require having the ICP open to continuous drain at XXcmH2O. On these patients, we close it every hour to get an accurate ICP. On other patients, the surgeon may only order drainage of XmL for an ICP >YYcmH2O. Either way, we never record ICP on an open drain. It's off my about 15mmHg too low. I hope this answers your side question.

my family usually drops the RN bomb. I don't say anything personally unless I am asking for something like lab results. I like the staff to know that they can give me as much information as they are comfortable sharing and not have to worry about me misinterpreting it. Many docs I know treat RN family members more inclusively than non RN family members. I wait and see how the situation is going to shake out before I whip out the RN card, metaphorically speaking of course.

you can accurately predict a patients BAC by his breath.

yeah, sorry about that, I was trying to reply to something in the middle of the conversation.

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smartest thing would to say you misspoke and drop it. anyway, back to your original question...Dickie's scrubs work great for me. They sell Unisex (no flaring obviously woman's pants or plunging neck lines) and have some really nice scrub cargo pants, perfect for keeping those important things on your person. They run about $20/set I think.

I meant if the patient has a chest tube connected to Pleur evac and wall suction and the CXR showed no pneumothorax. The doctor writes and order saying to turn suction off. Do you just turn suction off and leave suction tubing connected to suction source/wall (isn't this the same concept of clamping?) or do you need to disconnect it from the suction source/wall so that air cannot build up (chest tube still connected to Pleur evac)? OK-I think I'm following you a little better now. The order says turn the suction off, then you can d/c the suction from the wall, but keep the chest tube connected to the pleur evac. This is different from clamping because air can still escape into the water. Also, I've found articles saying never to clamp chest tubes, but is this only if the pneumo is not resolved? Because I've also read that clamping is sometimes done for a few hours before taking out the chest tube to ensure that the pneumo will not come back once the chest tube is out???? I know that a tension pneumothorax is a risk, but only if air is still leaking into the pleural cavity? That is correct. You don't clamp a chest tube if the pneumo is not resolved, otherwise the air won't get out. Only clamp if you find an air leak (bubbling in the water chamber). The doc will may test clamp the tube if he thinks the pneumo resolved and wants to make sure. Other docs just leave it in until they are 100% sure that the lung fully re-expanded (good CXR/no fluctuations with resps etc.) and then pull it. I guess it's personal preference.

The risk of the chest tube being off of suction is that what ever is causing the pneumo won't get sucked out. If it's an empyema, blood or something else, it needs to come out, and the suction helps that. As far as your second question, I don't know if you misspoke or if you are confused. The chest tube should never be open to air. This is how air gets sucked into the pleural space causing a tensions pneumo. The chest tube can be off suction however. The MD may write to put the suction to water seal. This means it is hooked to a closed system but not hooked to suction. The water seal allows the lung to re-expand, air to escape, but no air to come in. Remember, if you see bubbling in the chamber, you have a leak and the tube is open to air somewhere. Clamp it immediately and find the source of the leak and fix it. I hope this helps.

First off, I would come right out and ask...something to the effect of, "I can't help but notice the scrubs, are you a nurse?" If so, engage her on a professional level. It's obvious that whatever capacity, this person is not ICU. Either way, she is worried about her father and you have to remember that and keep it in mind when she turns into a royal pain. These types of families can be a burden, but with a little politics and salesmanship, you can work them pretty easily and successfully. As far as asking for blankets when your busy etc...ask someone who's not busy to grab a blanket, I know your still new so asking for 'favors' may seem hard at first, but trust me, it will make your life tons easier. When it comes to priorities, you did great with explaining that you have a sick patient. I often excuse myself in mid sentence or cut someone off because I have to check an alarm or something, most families do understand. Also, regardless of this woman's educational level, limits must be set. Say that you appreciate her trying to help, but you need to measure the residuals etc., and you really can't have her emptying equipment. As far as the suctioning is concerned, unless the patient should not have been suctioned, I've always been happy to let the family do something simple like that. It makes my job easier, and gives them a task to focus on. It puts them at ease and lets them feel useful in an otherwise powerless situation.

jmunrs2010- My advice to you would be to speak to the nurse manager and see if you can leave the float pool and go into ICU full time. If not, the two month preceptorship/capstone would be a huge help. I would recommend doing that regardless of where you are working as a tech.

The hospital that I externed in had a combined med/surg ICU. So no rivalry. However, the Neuro ICU one floor up...big time rivalry (same manager). The Neuro ICU nurses hated floating down to ICU and the ICU nurses felt like the Neuro nurses thought their sh*t didn't stink. The manager tried to make it one big happy...but the neurosurgeons definitely preferred Neuro ICU and everyone new it.

Maybe it's just me, but I don't take reimbursements into consideration when I'm caring for my patients. If they can't handle a turn or bath, they don't get one. However, I do document as such and pass on in report so no one thinks I'm being lazy or forgot. I would think that if the facility adequately documents it, maybe MD orders like the one poster had, insurance can't refuse to pay.

I had the same feeling after I completed my orientation in the ICU. I was shocked because I had always had a high level of self confidence but as soon as I was 'on my own' I was terrified. I talked it over with a few of my collegues and one of the more senior nurses told me that being scared, as long as it's not paralyzing, is the hallmark of a good nurse. It shows you care and underestand just how important this job is.

I can not stress enough the importance of prior experience. A job as a nurse tech is almost always an in and a successful externship goes miles to impress. As for CRNA school, I know others said "no" to that, but I think that managers are realistic nowadays that people don't set up camp for decades. If you mention CRNA school, it shows that you are motivated to advance your practice and can be an asset to them while you are there. But maybe just being generic and saying "grad school" would be better.

I don't know if this helps, but everyone (MDs, RNs, Resp. therapy) told me when I first started, some patients know better than us when they need to be extubated. Apparently, it happens alot and I have been told that many times, they don't need to be reintubated. Also, these mistakes (and I don't count the extubation) are things that you will learn from. We all make them at some time and we all feel bad. If you are a good nurse, you will remember what happened, and then it won't happen again. A mistake is only bad if you learned nothing from it.

UAPs are not allowed to give anything. UAPs are not even allowed to touch IV pumps or change an existing Normal Saline bag (its considered a med). For the externs out there, I don't know if its just New Jersey or others, but when I externed I was told that by state law, we could not give meds because we had to be under the supervision of a Master's prepared nurse (our instructor).

You have my sympathy, I am also a new grad in ICU and would not like to be in your shoes. The only thing i can say, from another noobs pov would be to go over it with your preceptor, that is what she is there for. If she says there was nothing you could do, believe her, if she is as great as you say she will tell you the truth no matter what. Hope this helps, from your narrative I can't think of anything you could have done differently, BTW kudos on quickly calling the code.

MPH is not a bad idea, but if he wants, perhaps he should look into CRNA, i have been told that is the highest paying nursing job one can have and limited patient interaction because they are all asleep. btw: to any CRNAs out there, i hope i did not misrepresent with that last statement, please accept my apology and correct me if i did.