mspringer

I have had a case on the medical floor for the last couple of days and am wondering if any of you could give me some insight into the problem the patient was having. Clinical Course Male approx. 65 y/o Day 1&2: Admitted with pneumonia and subsequently tx in normal fashion- ATB, 02, MNebs. Pt. started on 5000 Units of Heparin SQ/qd. I am unsure of why he needed this. I am guessing he was not moving around enough for the MD to be comfortable enough, so DVT proph. initiated. Day3: Dx: with a cardiac tamponade and trans. for CCU where a pericardial window is preformed and 1.7L fluid removed. Cytology of fluid reveals CA (adenocarcinoma). MRI(I think) reveals mass in R lung. Day 5: Pt. develops GI bleed with hypotension. Transferred to ICU 2U PRBCS transfused. Heparin Stopped. Day 7: Pt. transferred to medical unit. Stable H/H holding around 28/9.5. Day 8: Pt. becomes disoriented to place/time. Intermittently drowsy to lethargic for extended periods with intermittent R facial droop (literally comes and goes), grips equal/strong, no other deficits noted. No bloody stools noted, but pt experienced epistaxis of 30-45 min for me to control. H/H drops over last 24 hrs. to 25.4/8.7. Platelets go in 8 hrs from 57 to 46. They platelet numbers has been in the 80s to 120s over the last 5 days or so. I think they started the most precipitous drop on day 6-7. Wish I could remember more. Could this be -Heparing induced thrombocytopenia? If the CA had spread to the bones I don't think it would cause such a precipitous drop in platelets. Did not see any reports about his spleen condition. Pt. also had cardiac stents placed in July. Could angiomax, or aggrastat cause a delayed rxn. like this? BTW-I called the hospitalist at 0100 to report the hemogram numbers, etc. and she didn't want to know his hx or anything. He had been a hospitalist pt all along. She also didn't give me any new orders. She just said follow existing orders, which was to transfuse 2U PRBCs if H/H drops below 8.5. Is my logic ok on the possibilites with this pt.? I am fairly new to nursing and just want to make sure I am thinking correctly. Any ideas?

Can anyone send me a weblink or name of a waist/fanny pack they use while working on the floor? I have been looking for one for a while and cannot find one that has some spots for pens, etc. I have a nurses waist belt, but it just doesn't hold enought stuff for me. I work on a tele/oncology floor and like to hold extra items for central lines, etc and the basic waist belt just isn't cutting it anymore. Thanks in advance, Marc

Our hospital is going to go to barcoding of meds real soon. I am wondering if some of you have experience with this. I would like to know some of the ups and downs about this type of a system and how to avoid common pitfalls with it. I am wondering if I will be hung out to dry for giving a 2100 med at 2015 or so. How tight is this big brother system? Thanks, M

2u PRBCs, hitting/attempted biting, restraints, 8 IV's running at min of 125hr, missed dayshift orders, Haldol with peridoxical rxns., Ativan, disraught family, nickled and dimed, IV infiltrate

The book is called Intravenous Infusion Therapy for Nurses by Dianne Josephson, 1999. For reference the page numbers are 271-272, 289, 292, 302, and 387. I hope this helps because I really want to get to the bottom of this. :) Cheers, Marc

This is strange because the method is decribed in an IV therapy book I have that is about 2 years old. Maybe the method is really that new. Surely, I am not the only one who has read something on this.

Has anyone ever heard of the POP method in declotting central lines. If so, can you please tell me a little about it. I have read some on it, but cannot find any internet articles explaining it. Keep coming up with POP music groups in the search! :) Thanks, M

Sorry, I know of no competency tool for that. Just working side by side with another nurse until you are observed to be competant, safe, and comfortable with taking those patients. Sorry for being no help.

Yea, I would like to end up in ICU/CCU as a floart between the two someday, but I feel there is some experience to gain on the floor so I am going to go there for a bit. Maybe just a year or less, who knows, but when I fell ready I think I will know. For now, that's the plan. CCU was a lot of fun and I learned tonnes of stuff. I used to work in the computer field so I loved the monitors and getting to use my hand at the same time. I really liked taking the Swan-Ganz numbers and trying to interpret tele rhythms. Cheers, Marc

Like how s/p? Immediately after they come back from the OR or day 1/2? Marc

I recently finished my final preceptorship in the CCU and will be graduating on June 10. Yippee. During my rotation I had a lot of nurses asking me if I would be coming to work in the unit after I graduated. The nurse manager of CCU/ICU asked me three times if I would consider coming there after graduation. I told her I wanted to do some medical floor time first before I can the units to work. She seemed to be respectful of that decision although I later found out she called one of my professors and wanted to know how they could change my mind. I think I made a good impression on them :-) or else they just wanted another warm body to fill the void. My question is this.....Did I make the right decision be passing up this opportunity? This particular CCU is very busy with open hearts and seems like it might be a bit tough for a new nurse. I know one other student who has done it, but my gut tells me not to jump into something so tough. My plan for the last several years has been to get some time on a medical floor so I could become a well grounded nurse and then move onto critical care. I really want to stick to my plan. What do you of my decision? Would you have done such a thing straight out of school? Thanks for you advice and time! :-) Marc

Thanks surfer girl! I like the analogy. Makes it easy to understand.

Can someone explain pulmonary shunting to me. I am reading a couple of articles on ARDS and they talk about pulmonary shunting, but without explanation. Is this just blood being shunted away from the areas of alveoli collapse to other areas of the lungs? If so, can that cause flash pulmonary edema or right-sided heart failure? Thanks, M

I know there is! We posted it. We are reposting to get more replies to our poll. Thanks.

This is for a class project. We need more data! TAKE OUR POLL, PLEASE!! TIA, Marc