**LaurelRN

Unfortunately, it seems this is the trend in healthcare. Hospitals don't want to continue to pay experienced nurses- it's cheaper to train nurses. Not safer- just cheaper- at least that's the way I see it

So here's the thing... I have done numerous papers and alot of research about this topic (not tube feeding specifically- but it ties in). If a patient is in the ICU, there is already a reason to do FSBS- sepsis, MI, neuro issues, cancer, infection- whatever. The inflammatory response is the same no matter the diagnosis. Now add into the stress and release of cortisol and on top of that add tube feedings, yep- you bet I'd be doing FSBS. Advocate for the patient. Euglycemia has been proven in numerous studies to decrease morbidity and mortality related to ICU admissions.

annie.rn- I'm like you- I want them all labeled and pretty- so I know what's where and it's not a spaghetti mess

Are you referring the secure to the patient? We use 12 inch Tegaderms and of course the MD sutures to the leg.Then the helium line should run parallel to the patient.

I did the Laura Gasparis DVD's and questions from her book. I did them nonstop for 3 weeks, had been in ICU 1 year and passed. It depends on alot of things. Are you a good test taker? Do you critically think well? The worst you can do is have to take it again...

Our hearts routinely come out with Amicar. DDAVP is kinda a last resort- if bleeding doesn't stop with FFP and Plt's, they'll go to cryo, then DDAVP- if it doesn't stop then- they go back to OR

The funny thing is JACHO found that their own standards inhibit the ability of nurses to care for patients and their own inspections create part of the problem in health care. That's why I have left the bedside. I'm tired of not being able to actually take care of my patients. It's more about charting, HCAPS scores and patient/family satisfaction than anything else.

Poll: Are your induced hypothermia patients kept 1:1 throughout cooling/maintenance and rewarming? Thanks in advance :)

Though what everyone else has said could quite possibly seem feasible. I am more inclined to think (though without labs, trending vitals, and pt history, it's a guess) someone who is in renal failure quite often has electrolyte imbalances. What was the potassium? Mag? Calcium. I have seen more codes from electrolyte imbalances than I would care to. I do agree that the D50 IVP was just coincidence. Don't get too hung up on it- good luck

Nugget...As with everyone else (for the most part)...Inexperience does not mean you screwed up...The Dilaudid...I don't know that I wouldn't have given it...Yes it can cause respiratory depression...however..."below 8, intubate" is not necessarily true..many factors go into whether we intubate someone or not...NARCAN is a wonderful thing (well to reverse narcotics) intubation is for people who cannot maintain adequate oxygenation/co2 exchange and maintain a neutral acid/base balance. translation..if they are breathing 6 times a minute and are pink, good sats, and arousable to verbal stimuli...my book- that's ok.---that said...I may hold it if they are already lethargic- depends on their pain level. As for the hypoglycemia...nope..not on you (well..except the cookies...I mean...real sugar, high carb ones)...as said before...regular insulin is short acting...a late night, early morning hypoglycemia...nothing to do with you unless you gave Lantus or some other long acting insulin. My one problem with your post is that your "preceptor" is barking orders to you. Though she is there to guide you..barking orders is not OK. Hang in there. You've done the hard part...you're a nurse!

Lgood, I don't think it really depends what unit you start out on- I think we all feel that overwhelming sense of OMG!! How am I going to do this and did I make a mistake. Relax, take a deep breath and think. You need to get into a habit of organization. If you don't have a sheet you use to make a list- get one, make one, borrow one..whatever. Get into the habit of writing a "to do list". If your patient has serial H&H's Q 4..write down, 8,12,4 (or whatever time they are..and check them off as you get results) Whatever your facilities charting is make a to do list for that too. Like head to toe (8am..or pm..depending on night or day), Pain 8,12,4...Plan of care- NIC/NOC(or whatever you use there)...you get the point. See what time you have meds due...write them down and check them off when you give them...PS.just a side note here...take it from an ICU nurse who goes to the rapid responses...PLEASE, PLEASE, PLEASE...check BP's before you give meds, Check Potassium levels before you give K+, and make sure there's a decent FSBS and the patient is eating before you give insulin. And always check your labs/xrays at the first of your shift!! Once you get into the habit of things...you'll get to the point where you won't need it. you've done the hard part! You're a nurse!! Just my ....Hope it helps

H_2_0 There are alot of things at play here. 1) as most everyone here has said, the insulin drip is not really to bring down the blood sugar ( I mean it does, but that is not the primary reason). In DKA, A) you have the absence of insulin B) you have acute dehydration C) electrolyte imbalances D) acidosis. so A) give insulin- brings down blood sugar B) Give NS until blood sugar is under 250-300 ( depends on your facility), corrects dehydration- helps correct the acidosis. C)sometimes people with DKA will have K+ levels at 7 (The highest i've seen - well, and the patient is still alive is 7.6) Insulin chases potassium back into the cell. D) This is the biggie- Ph of 7.30, 7.25, 7.2, I even seen 7.0 ( well and he was still breathing)- This is the real reason you're giving insulin and fluids. Correct the acidosis- its metabolic. You just have to do it slowly- because remember, for every tenth ph you go up, you potassium comes down by 0.6. You don't want to cause hypokalemia...most facilities start fluids with K+ added once the blood sugars normalize and the Ph starts to get near normal. (which is why we do labs so often) Eating..well.... that's up to the doc. Some will let them eat- others won't. It makes it a bit difficult, but you're doing Q1 hr FSBS- so it really isn't a big deal. Lantus- again, so do some don't. We have one endo guy that swears by it and one that won't start it until they are off the gtt. You just have to be careful. Correct slowly. And if you have a question- you ask it. As a advocate for your patient- (and your license) you have the right to question any order a MD gives you. Hope we've helped

though there still may be times when no one can get there- my hospital went to cna's coming in 15 minutes earlier (and they get off 15 minutes earlier)..that way report is staggered to free up the cna when nurses are giving report and vice- versa

i took it, no preparation- it was cake. it's a few med compatibilities, acls, rhythms, prioritization, lines, hemodynamics...stuff like that....

We did a bronch on a guy who came in with "resp distress"...found a $1 and cocaine residue...had a post op a few days ago...a VERY large sweet potato stuck in the rectum...smh...as said before...we couldn't make this stuff up!!!!

ok- so here's the low down.... some picc lines are cut to the length for the specific patients- thought not all. here's are clue...if it is a power picc (mostly used in acute care) they are not cut. if it is not a power picc (and they will say right on the picc if it is) then it could be cut. it depends on the manufacturer. when a patient comes to your facility with a picc line- it should say on it how far in it is. most uncut picc's are 45-55 cm- and will have some of the catheter looped under the dressing. if it is something less less 45cm and nothing is hanging out- it is one that is cut. as for the lumens- there are 1,2,3 and soon to be 4 lumen picc lines. every lumen has it's own hole that it comes out of (distal,proximal, etc) which is why they can be used with drugs that are incompatible. hope that helps! ?

it sounds to me like you are well prepared. i didn't do half of what you have and i passed. don't fret...it is actually played up as a much harder test than it really is. i'm sure you'll do great!!

i agree...an md order is an md order and if that's what they write, then that's what they get and let admin fight it out with the md...however...etoh of 398 would be something that would dictate the need for icu...however.... something say- tox positive for mj and barb's with a completely aao x3, no resp issues, no cardiac issues and asking for a meal tray...ummmm....nope- you need a m/s bed with a sitter......

i honestly think this is an unfortunate result of alot of different sources. what isn't in that article is 1) how many patients that rn was assigned 2) were there any uap's (was this rn the secretary, tech, phleb and ekg tech too...i know many times on my unit- that's me) 3) how many other rn's were there?? 4) what was the response of the eicu? 5) if none...why? alarm fatigue is real...i am guilty of it..i really try not to ignore them..but after the 1000th time of going into granny's room because she keeps picking at hings...it does get tiresome. we don't have an eicu- but i understand the basics of it- so if this alarm was going off for an hour and the rn did not respond....why didn't the eicu?? bottom line is both the primary rn and the eicu md are ultimately responsible- tho we as nurses see all the variables- the law does not...imho

all i have to say is wow!!! i do believe it says interview...yes, that does imply face to face- yet as a student who worked fulltime, managed school, and had children- i understand the possibility that you don't have time to "schedule with your pcp" or the neighborhood clinic. just my , so please no one take offense. ethical?? there are so many. as a nurse, i deal with issues daily. a big one. dnr. our facility does not recognize a signed state dnr once the patient is past the emergency room. so, this mid 80's gentleman comes in- sob, in chf exacerbation...admit to icu...duh! what??? hello...dnr- signed by him!!! nope- policy says md must sign a dnr order and have a consulting md agree...ugh!!!! no!!! that is not how a signed dnr is handled. this went back and forth for like 30 minutes...of course, while we put this poor guy on bi-pap, lasix gtt, foley, aline- levophed- whole works...he ends up needing to be tubed- and of course no active signed dnr by 2 md's in place...you guessed it- he gets put on a vent. i tried to have ethics come and intervene to no avail. family got there and kept him on the vent for 10 days. he gets pegged and trached...very sad...he ended up dying 3 days after the peg and trach.... i did what i could do. i stood up for my patient and told the docs this was worng...no one listened. i called house sup...no one listened... i called ethics...they didn't get there in time... there are times as nurses- we stand up to an ethical dilemma and no matter what you do, it is not going to change the course of action. however, knowing in your heart that you did the right this does matter!

Agreed...had one like this last week- MD refused to D/C insulin gtt, pt had FSBS on 40....pushing d50 all day until doc finally decides.."oh, well maybe thats a little low"....UGH:banghead: Gave him D5 1/2 NS and started him eating/drinking with zofran q6...fixed....

understand that an is a site for nurses to talk to other nurses who can understand what the situation/problem/anger/joy/fear is...no one can understand the responsibility and high stress that comes with the nursing profession...except nurses. so though what you read may scare you...it is in fact the daily life of nurses. i have posted multiple times- and in those times- there were some really angry/scary situations- but all of those times helped me to accept the situation and move on with the help of my colleagues on an- maybe reading some of these posts could help you avoid the problems/situations. as for not coming back- an has alot of info that can help students- don't ask us to do your homework for you- but if there's something you just can't understand, or you saw something that you don't get...by all means; come ask us! but quite honestly... nursing school takes up virtually all your time..i don't know that you'll have a whole lot of free time to be on an. good luck!

i should have clarified- this came up at work this weekend. i got an admit from er- and od "polysubstance abuse". no gtt, no vent, pt on room air..... so i am at a for profit hospital and if patients don't seem to meet criteria- we are suppose to ask why they are coming to us- because the hospital will not get paid icu rate of they don't meet criteria ( as i previously posted- vent, gtt's, dka..etc)

it is ironic that you bring this up- i work in icu and apparently hospitals cannot get reimbursed "icu" charges by insurance if a patient does not meet icu criteria. i.e. titrating gtts, bipap, vented, dka, unstable, symptomatic bradycardia, afib rvr, stemi, alines- etc...something that is out of the scope of practice of a m/s rn or pcu rn. being that md wants "closer monitoring" is not criteria for icu...(lol, if it was- boy would we be busy!!!) icu rn's now have to ask how it is that these patients "meet criteria"...all politics...

i feel your pain almost on a daily basis....i just hope you documented very well- imho, this will be a legal case