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Neurosciences, cardiac, critical care

Content by jelly221,RN

  1. Waterhouse gives a good explanation in this article: An Audit of Nurses' Conduct and Recording of Observations Using the Glasgow Coma Scale You are correct that central pressure should be used in the GCS-Motor. A central stimulus is applied to the cranial nerves, NOT to the center of the patient's body, and the preferred method is supraorbital ridge pressure. In patients with facial fractures or trauma in whom fractures have not been ruled out, pinching the trapezius (CN XI) is acceptable. Sternal rub is not recommended. Peripheral stimulation is transmitted by primary afferent neurons, which end in the dorsal horn of the spinal cord. These neurons branch into two upon reaching the spinal cord- one branch synapses with a second-order neuron causing a spinal reflex, and the other branch decussates (crosses over) and ascends via the spinothalamic fibers and runs through the brainstem to the thalamus. For the GCS-Eye Opening, if peripheral pain causes the patients eyes to open, this indicates that the spinothalamic fibers are intact. However, for the motor portion, testing a peripheral nerve leaves uncertainty about whether the patient's motor response was due to the spinal reflex, or a purposeful movement motivated by a higher brain center. You were absolutely right in your actions, and your documentation looks good, too. If it were me, I'd print an article about central vs. peripheral stimulation & leave it lying around where the resident will pick it up...
  2. jelly221,RN

    Pupillometer guideline

    Hi! We're looking into using these, did you ever find/develop a policy or protocol that you'd be willing to share? Thanks!
  3. jelly221,RN

    Metairie/New Orleans Jobs

    Hi! I'm considering moving to NOLA, just curious how things worked out for you!
  4. jelly221,RN

    JULY NCLEX-ers!!

    Hey y'all! Just wanted to see who else is scheduled for NCLEX in July so we can maybe keep each other accountable to study goals, share study woes, good prep books, etc. My date is July 11th, can't wait!! I'm doing the NCSBN, Kaplan book, LaCharity, Lippincott and Mosby books, and reviewing ATI books from my school. From what I've read, I think I should get Saunders too... seems like the questions are good.
  5. jelly221,RN

    GPA for USC?

    Hi there! I'm in an MSN program now (it was almost as fast for me to do an MSN as a BSN) and I'm hoping to go to USC's CRNA program. I know it's ridiculously competitive, hence my question. One of my classes right now has discussion boards weekly, and I missed one due to being in the hospital. My teacher is very strict about deadlines, that's her thing. Fine. The post I missed was 7% of my grade, so the best I can get in the class now is an A-. I've had this teacher several times before, and getting the A- is totally doable. As long as I get all A's in the rest of my program (which I've done so far), I'll graduate with a 3.96. I have the option to drop the class and take it later, which would bump my overall program GPA to 3.98. So my question is, will the 3.96 vs 3.98 make any difference in my application for USC's program with all other factors being equal? As far as other things go, I'm working on a cardiac DOU and am transferring to CVICU in a few weeks, I'm working on shadowing a CRNA, and I do well with standardized tests, so I'm not too nervous about the GRE (my MSN program had a bunch of different requirements, so we didn't have to do GRE). I plan on working in CVICU for 2 years before applying, which will give me about 9 months break after finishing my MSN, during which I'm hoping to do some research and (fingers, toes, arms, legs crossed) publish. Am I just being OCD about the GPA?
  6. jelly221,RN

    Wiping off IV ports

    Of course when I used (past tense!!) the flush caps I didn't set them down - I would take it off the syringe, hold it and screw into the end of the tubing. Touching air doesn't make things un-sterile!! If it did, the OR wouldn't be a pleasant place to work!!
  7. jelly221,RN

    How messed up is this?

    Last week, I noticed a poster advertising special activities all week long for "National Hospital Week" in 2 weeks. These activities are things like an ice cream social, a talent show, etc. All events that sound like fun and I would like to participate. However, I heard no mention of Nurse's Week. One of the CNAs on my floor even argued with me that it couldn't be that week because she hadn't heard anything about it. It's pretty insulting, honestly. Administration thinks so little of nurses that they don't even acknowledge a week nationally dedicated to thanking us for choosing our profession. I've considered writing an (anonymous) note to my CEO or CNO or SOMEONE to let them know how saddened I was by the situation. Feedback?
  8. jelly221,RN

    How messed up is this?

    You said it better!!! It is nice to have more than purely a contract- a sense of loyalty makes employment more pleasant. There's an awesome book, "If Disney Ran Your Hospital", that talks about courtesy and going out of your way as an employer to recognize employees. If hospitals are going to attract and retain the best, then they need to show that they actually recognize & value hard workers and good nurses. I realize that this is different than a generic "Nurses Week" celebration, but in my experience, complimenting or thanking someone makes them work harder, at least for a little bit, because they take pride in their work and realize that someone else notices the little things. Little things make all the difference in nursing.
  9. jelly221,RN

    I graduated todayyyyyy!!!!!

    Sheesh I understand about your situation as a tech- good luck! I worked as a tech through NS, had awesome performance reviews, aced my interview with my facility for Versant, but didn't get it because I'm ADN. Good plan to just go to the hospitals. Try to go to individual floors and talk to managers/directors- HR is the roadblock you want to bypass, especially as a new grad. Just let your personality and passion for nursing shine - they want someone who's going to benefit their team. Good luck!!!
  10. jelly221,RN

    Wiping off IV ports

    Makes sense. I guess where I'm confused is that I fail to see the difference in the cap from the flush and the little white plastics caps. They're both sterile, and they're both covering the threads & tip of the tubing that connects to the IV site. Unless I contaminate either cap, they don't automatically become "unsterile". Goodness, if the flush caps aren't sterile, then I've been risking a lot of phlebitises (not sure the correct plural?) every time I flush an IV. Not arguing about the "one-time use", just trying to think through it logically.
  11. jelly221,RN

    Abolishing the Pinning Ceremony

  12. jelly221,RN

    What is the answer to this question!?

    Yes - all the docs at my work use 1 ml/kg (body weight)/hr now.
  13. jelly221,RN

    a question about cardiac arrest w/asystole!

    I haven't had it with a patient, but I have a friend who flat-lined 3 times in one day. He was mid 20s when it happened (10 or so years ago), a professional athlete, and has had an AICD ever since. They've never figured out why he had the sudden cardiac death, but he's a spokesperson now for some heart health program at Cedars-Sinai. Pretty interesting.
  14. jelly221,RN

    Wiping off IV ports

    Thanks for the info! I'm on my way to class (MSN program) and I'm gonna ask my friends what they do & if they've ever checked, out of curiosity.
  15. jelly221,RN

    Major Drug Shortages Looming

    Could you share what you find? I've seen Zofran work on countless patients, not to mention myself! Reglan & Compazine give me dystonia, but good ol' Zofran has yet to let me down.
  16. jelly221,RN

    Wiping off IV ports

    Huh I'll definitely check out their website, I used it as a resource for a poster presentation I did for our Skills Fair this year, and they had some great resources. Do you have any specific links to info re: saline flush caps?
  17. jelly221,RN

    Wiping off IV ports

    I was taught that the rubber stopper is sterile under the cap, which makes sense considering how hard it is to pop some of those suckers off. Now that I think about it though, I've never checked manufacturer packing to see if it is actually sterile under there- does anyone know? I'll be reading some vials at work on Thursday :)
  18. jelly221,RN

    How messed up is this?

    I guess I should've been more clear- I'm not taking this personally, as I am quite confident in my skills and passion for nursing. The fact that my hospital didn't have an ice cream party for Nurses' Week doesn't make me question my work or even be dissatisfied at my workplace. My post was more of an observation about the culture of my hospital.
  19. jelly221,RN

    Name a stupid policy/idea your facility thought would fly

    I moved to the other coast! Stories from my friends that are nurses in FL are scary.
  20. jelly221,RN

    How messed up is this?

    LOL most of the nurses on my floor would be THRILLED to get a new copier for Nurses' Week - we've been all but begging for a year. :uhoh21:
  21. jelly221,RN

    How messed up is this?

    See my previous response about MD Day at my place. I definitely do agree with your 2nd paragraph, but please don't think that I'm the kind of person that needs a "Thanks" in order to be proud of my work. My post was more of an observation of the culture at my workplace, but I see how it could've come across differently.
  22. jelly221,RN

    How messed up is this?

    Great post. I do consider myself a professional, and I work very hard at furthering my education as well as work experiences. A little perspective on my hospital though - they put up a banner for Doctor's Day and made multiple announcements over the PA throughout the day about the free lunch/dinner for MDs in the cafeteria. Of course this would be FAR more costly (and probably impractical) for nurses since we are greater in number. Really, it would've just been nice to not feel like my hospital was ignoring the fact that it was Nurse' Week.
  23. jelly221,RN

    How messed up is this?

    I totally agree with this, and I'm 100% fine personally with not getting recognition from my workplace - knowing I did all I could do to the best of my ability for my patients on my shift is MORE than enough. When patients thank me, that's the icing on the cake. My comment was more just aimed at identifying a sad trend of not recognizing nurses. Recognition is positively linked with job satisfaction, and while I LOVE being a nurse and by no means need the recognition to feel satisfied with my work, a simple "Thank you to our nurses" would have given me the "warm fuzzies" about my workplace. Just a small, passing disappointment. Now that "Hospital week" is over though, I do have to say that it was a lot of fun! They had carnival games and a BBQ and a talent show. It did a lot for morale.
  24. jelly221,RN

    proper orientation for CTICU

    Sorry to go off-topic, but I'm moving to CVICU this summer and this post made me SO excited!!! Can't wait to join y'all...
  25. jelly221,RN

    Wiping off IV ports

    Ugh makes me cringe... like not washing your hands in a public bathroom. WHAT?!?!