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catshowlady

catshowlady

ICU
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catshowlady specializes in ICU.

catshowlady's Latest Activity

  1. I agree wholeheartedly that a good sitter is worth his/her weight in gold. That said, just to point out another side, I have had some sitters with pts that really were not terribly helpful. Rather than try to help meet the pt's needs, such as comfort or re-direction, they would just put the call light on. I have also had sitters that allowed the pt to pull out not one, but two (well-taped!) IV's in a shift. It can be frustrating to have a sitter that doesn't really help to lighten the workload or keep the pt safe, including keeping lines and tubes in place. I don't mind if a sitter watches TV or reads or studies while the pt rests, though. No reason not to, if the pt is safe. When I was a PCA during nursing school, if I was assigned to sit, I usually asked my co-workers if they wanted to trade. I just couldn't sit there or I would fall asleep. So I have a lot of respect for the folks that can do this job well, because I struggle with it. Just my . If you do your job well, don't worry about what others think. Pride comes from within. :paw:
  2. catshowlady

    Anti-Intellectualism/Autonomy in nursing

    I didn't mean to suggest that med-surg nurses are not capable of thinking critically. If it came across that way, I apologize. What I was trying to point out was that it seems like med-surg nurses seem to get their hands smacked, so to speak, for exercising their critical thinking judgment, whereas ICU nurses don't. I don't really have an answer as to why, other than unit culture or unit protocol. Personally, I don't understand why. We all receive the same education and training in critical thinking. Why should location make a difference in rescue situations?
  3. catshowlady

    Anti-Intellectualism/Autonomy in nursing

    To my mind, this leaves you open to a lawsuit for failure to rescue.
  4. catshowlady

    Anti-Intellectualism/Autonomy in nursing

    felineRN: I think you would enjoy ICU nursing. We have more latitude to do some of the things you are describing without getting griped at. As you pointed out, it's about what the patient needs in that moment. In fact, I'd be a ****-poor ICU nurse if I didn't react to my pts' needs. If their sats aren't cutting it on NC, they get a Venti-mask or NRB. If their pressure tanks into the 60's, yes, I am going to start a bolus. You can't just let them hang out with a pressure in the 60's or a sat in the 70's and not address it, just because you are waiting for a doc to call you. (At my hospital, it might be 1/2 hour and two more pages before you get a response. By then, it might be too late if you didn't react, or you'd have the ER doc there because you had to call a code. We don't call RRT's, we ARE the RRT.) Granted, I have already paged the doc, and I tell them when they call back, "I took the liberty of doing XYZ, and I'd like to have orders for A, B, & C." And I don't ever give meds or do something like BIPAP without the actual order (unless it becomes an ACLS situation). I will get it ready, though. We wean O2, we advance activity levels, we advance diets after extubation per nursing judgment too. I will say, however, this would not EVER happen on the med-surg floors. They take a very dim view of doing any of the things I just mentioned. But, for us in ICU, it is perfectly acceptable to our docs. I agree with some of what you are saying about autonomy. We are insituting an early-warning scoring system. As the scores increase, it triggers different things (calls to doc, transfers to ICU, etc.) It is supposed to catch deterioration of the pt earlier. To me, this is a rote standardization/automaton version of what a good nurse should be doing anyway - noticing changes in VS, mentation, etc. I don't know if this is a "chicken" or an "egg." In other words, are we doing this because the nurses aren't practicing good critical thinking in the first place, or is this a way to take away the critical thinking element to evaluating our pts? And about anti-intellectualism, I sometimes see this too. I had a pt last week that was dig-toxic and bradying down into the low 30's frequently. According to the literature I was reading, bradycardia from dig toxicity can be refractory to atropine. So, when I reported off to the next nurse, I explained this and said, "So if you need to give something you might want to grab epi, not atropine." He looked at me like I had two heads and six eyeballs. I thought that was important to know, but I guess not. *shrug* Try ICU nursing; I think you would like it, and be really good at it.
  5. catshowlady

    New Grad RN...Why can't I hear lung sounds!!

    Are the earpieces on your stethoscope angled correctly to direct the transmitted sounds towards your eardrums? I find I have to direct mine forward to hear well. (Drives me nuts when I have an isolation pt and I can't get the cheapo isolation stethoscope to do this.) :paw:
  6. catshowlady

    Why do some Medstudents love to belittle nurses?

    Think about what you would accomplish by reporting them to the Dean of their medical school. Could you get them reprimanded, or kicked out of school? Maybe, maybe not. How would you feel later about that? Is that the goal you are trying to accomplish? Is it worth the cost? Your pride is hurt, I understand. (I was the victim of a serial "disruptive physician" this weekend, so I really do understand.) If you are looking to hurt them back, does that make you any better than them? I don't think so. Is there any meanness or anger behind your decision to report them? If so, do you want to act on that emotion, and if you do, how will you feel about yourself afterward? The result (I'm guessing) that you really want is for them to respect the nursing profession, and you personally as a member of the profession. Does reporting them to the Dean accomplish that? More than likely, no. Does it stop them from doing the same to other nurses they will encounter? Probably not. Getting them punished for their actions is a negative consequence, not a positive consequence. I personally think people respond a lot better to positive reinforcement than negative reinforcement. Don't worry so much about what someone else thinks of you. Behave in an appropriate, professional manner, and you will lead by example and show others who in this situation is the person deserving of their respect. Just my . :paw:
  7. catshowlady

    Things you'd LOVE to tell coworkers...and get away with it!

    WARNING: RANT AHEAD... To the tech that bounced me about a property list that wasn't done (which is primarily our techs' responsibility anyway) as I'm staying an hour late after my shift to chart: Yeah, I didn't get the property checklist done. I'm just glad all my pts are ******* still breathing! ABC's, nope, don't see property list in there. Assessments and meds, nope, not there either. Do you understand how far down on my list of priorities a PROPERTY LIST is, when I can't even get my meds passed and I haven't peed for 7 hours? P.S.: Next time YOU don't get something done on your shift, don't expect me to be nice about it, especially since you are one of the laziest workers on this unit. You WILL be staying late to complete whatever it is YOU didn't get done. :flmngmd: Rant over.... :paw:
  8. catshowlady

    Why apologize to doctor when calling?

    I also apologize when I have to call repeatedly, or for "dumb stuff". Example: we have certain lab results that our policy requires we call within 1/2 hour (critical results). Even though the result doesn't need to be treated immediately (like a low calcium level in a pt who also has low albumin levels) or isn't all that much higher for that pt, we still have to call. Plus, the lab will not call all the results at the same time. So you call for the first critical lab, then 30 minutes later they call another one on the same pt, so you have to call again. Sometimes, you have to call again right after you talked to them about something else, such as new symptoms, or the pt just told you they want something else (that they failed to mention to you earlier or to the doc when he was just there, but now all of a sudden it's urgent). Or the pt deteriorates. I just say, "Sorry to have to call you so early (7am), but I have to call you XYZ lab," or, "Sorry to have to call you again, I know we just spoke, but since I last talked you, XYZ has happened." Again, I feel it is just a courtesy to recognize that the MD is as busy (or tired) as we all are. :paw:
  9. catshowlady

    The CRAZIEST "Baseline" You've Ever Heard

    I took care of a Down's syndrome pt once. She was rather long-lived for a Down's pt; she was in her mid-50's. Her O2 sat was always in the upper 60's/low 70's, and she was alert, talking, normal activity, although her skin color was always on the blue side. IIRC, she had Down's-related congenital heart defects, which had never been fixed. Took care of a fresh CABG once with a HR 39-42; that was her baseline for the last six months of her medical record. Not sure why they never did a permanent pacer on her. She, too, was alert, talking, active, and had a normal BP. Had a leukemia pt (CLL or CML I think, can't remember) with a WBC count in the 100's-130's. (I don't see many leukemia pts, so that sticks out in my mind.) That's all I can think of right now. :paw:
  10. catshowlady

    Sedation..Your thoughts?

    I would have left it alone if she was comfortable, could follow commands, and was not grabbing for the ETT. Why snow them? I think it takes them longer to wake up if they are constantly snowed. I do turn the sedation up and snow them during their bath, so they aren't uncomfortable during the linen change, then turn them back down after we're done. As far as how much sedation, each pt is different. I've had LOL's that needed 50mcgs of propofol plus some Versed to keep them comfortable and young folks that only needed 10mcgs to keep them sedated. I think you did fine. :) :paw:
  11. catshowlady

    Song Ideas?

    For the lighting of the lamp, we did "Light Your Candle" by Kathy Troccoli (sp?), which has been sung by Chris Rice. It talks about giving our light to those in need. It does have one stanza which is overtly religious in nature. I still tear up every time I hear it, thinking about my pinning. :paw:
  12. catshowlady

    How much Versed/Fentanyl is too much????

    I'm ICU, not PACU or OR. We use Versed & Fentanyl gtts to maintain sedation in intubated pts. That said, I have given up to 300mcg/hr of Fentanyl and, oh, around 33mg/hr of Versed. We dose Versed in mg/kg/hr, and we max out at 0.12mg/kg/hr. So a larger pt will get more Versed than a smaller one. I have hung both concurrently, at the max rate on the fentanyl and near max on the Versed. I have also hung max rate of Versed concurrently with max rate on Propofol, which for us is 50mcg/kg. This was on a large pt, and we were hanging new bags of Versed about q3h and new bottles of Propofol about once an hour (this was during the propofol shortage, and all we had were 50mL bottles). As far as side effects of higher doses, I think the folks who are on Versed for a couple of weeks for a prolonged intubation, esp at higher doses, seem to take longer to wake up when we turn it off. JMO. :paw:
  13. catshowlady

    Gift ideas for my stepfather, the soon-to-be LPN

    What about a really nice pair of trauma shears? Even if he isn't going to be doing trauma, they work to cut just about anything. They have a blunt tip so you can use them to cut off dressings, too. I always carry a pair. :paw:
  14. catshowlady

    Unhappy and Depressed

    If you are working and going to school, you may be experiencing some burnout. I worked full-time as a PCT on a busy intermediate unit and went to NS full-time, and I burned out doing it. I was cranky and I hated my job. Now that I am out of school, I am much less stressed, and I like nursing again. It helps that I have found a good unit to work on. There is still some back-biting and gossip, but not to a toxic level. Also, I haven't worked in a field or workplace yet that didn't have its share of drama and complaining. I think it is just human nature. We have to work to live, but most folks don't have the luxury of being independently wealthy or making a living at a job that they would work for free, just because they like it so much. So people aren't always happy to be at work. Just my . :paw:
  15. catshowlady

    How soon we forget.

    I would like to point out a legal distinction, just as an FYI. The FEDERAL government is (theoretically) limited in its powers to govern only the situations laid out for it in the Constitution. They've really expanded their powers in more recent history under the "interstate commerce" clause. Many "strict constitutionists" believe that the federal government has far exceeded the powers that the original framers of the constitution intended for it to have. The STATE governments, however, can govern just about anything they want, under "police power," unless it is given to the federal government by the constitution, i.e. making treaties. The federal government does manipulate the states into passing the laws it wants by threatening to withhold funds. One example of this happened in the 1980's when the feds threatened to withhold federal highway monies from the states unless the states passed laws raising the legal drinking age from 18 to 21. It worked, too. The key difference in the case of car insurance is that mandatory insurance is demanded by the individual state governments, not the federal government. Had every one of the fifty states mandated health insurance (as Massachusetts has done), the laws would not be unconstitutional, since mandating health insurance is a matter of "police power" and state law. The strict constitutionists are using this bill to forward their interests in keeping the federal goverment from getting bigger. The folks who are against more universal health coverage are using it too. It's not a popular bill , so it makes a nice target. :paw:
  16. catshowlady

    Scrubs: MOBB, Dickies, other favourites??

    I actually really like my Koi pants. They have held up really well for me, much better than Landau or Urbane. The most popular one has a drawstring waist, and they come in petites. Some of the tops are thin (which helps give them their pretty, delicate styling), but I have not found this to be true of all the tops, especially the Katelyn, which comes in the most colors/prints. The other pant I love is the White Swan pant. They run around $13 a pair, and they last forever. They are a simple straight-leg drawstring waist pant. They come in petite and tall. Their sizing tends to run a little big, though. :paw: