ibnathan

I would like to see advanced nursing education changed. The first year would be devoted to clinical sciences such as bio, genetics, gross anatomy, and pharm. During the later part of first year start going through the ten systems and clinical application. Then the last 2 years full time clinical residency. Or instead of requiring a BSN make the requirement a BS in biology or biochemistry. I agree nursing does need to have more science in it's curriculum.

I am not 100% sure but the cardiothoracic surgeons use it on almost all of their open heart patients. It's usual concentration is 2 grams of (2 amps) epinephrine and 2 grams of calcium chloride in 250 mls of NS. Just look at the positive effects and actions and uses of both drugs and then combine them. It's funny though that particular drug is mixed either by anesthesia or ICU nurses, pharmacy won't mix it.

In our facility our max dose for Levophed is 30mcg/min. Just like the other posters have stated once you start to go beyond the max dose it is pointless. I once had a patient on Levo, Neo, Vaso, Epical, and Dopamine and within hours there extremities were modeled all over and expired shortly thereafter.

Epical is usually used by our cardiac surgeons after a cabg. The mixture is 2 grams of Epi and 2 to 4 grams of calcium chloride. Vasopressin is a good drug to use as well. Generally once you hit two vasopressor your prognosis is poor.

When I worked the ICU we used Levophed as our first line in the septic patient along with boluses of Albumin. Neosynephrine was usually used as a second line agent. Remeber levophed works on beta and alpha receptors. Actually it only mildly stimulates beta receptors. It stimulates alpha receptors much more. Neo on the other hand is a purely alpha-agonist drug. This is my opinion clinically levophed was much more potent than neo. I always though neo was a rather weak vasopressor. Actually in one of the doc's pharm book I was looking stated that neo should be used first then levo, because levo was deemed more potent. Epical and vasopressin are good vasopressor too.

I was making 26.50 when I left the ICU. I now make and this is starting wage 42.02 an hour. I think one reason is the perceived danger and enviroment that we work in. Really though it isn't as dangerous as the outside. I have my own personal alarm so if I hit the office and guards will know exactly where I am at. If I work on one of the yards I have at least one or two guards at all times in the office. To answer your question the state of California has a pretty big pocket book compared to any of the hospitals. Also they came under federal receivership which rose the wages to attract and retain good nurses.

Sweet 10+K a month. We start at 7285 and top out around 8400 a month.

I worked in one of the local hospitals in Bakersfield CA. It's funny in Kern County (Bakersfield is largest city in Kern County) we have the greatest shortage of nurses in Cali. ,but we are the lowest paid in the state. Our cost of living isn't as high as other parts of Cali but it is getting close to southern cal. One of the reasons why I left ICU was because I felt that out licenses were on the line to much. I loved it but the hospital would not back its nurses. So my friend who started in the ICU with me went to the CDCR he loved it and told me to come out and take a look at it. Since the CDCR raised there wages condsiderably there is a 3000+ waiting list.

I just got hired on at the California Department of Corrections and Rehabilitation. My starting pay is 42.02 an hour. I just left the ICU were I was only getting paid 26.50 an hour plus shift differential.

It may be a inferior wall MI with RV infarct. But all in all we need a pressure, the patient needs perfusing pressure. A. Start Levophed or Dopamine as well a a 250cc bolus of albumin or NS B. Watch patients pressure and heart rate and any funky arrythmias C. Call Cath Lab team Stat! B. Insert IABP stat and I qoute, " The goal of the IAB in such a disease stat (such as cardiogenic shock) is to decrease or "optimize" preload by ensuring a filling pressure high enough to obtain the highest CO on the Starling curve but not so high as to cause pulmonary congestion." (Counterpulsation Applied, An introduction to Intra-Aortic Balloon Pumping). Again the importance is to agressively treat BP and HR stabilize patient for cath lab. The patient also needs an A-line, and a Swan-Ganz for hemodynamics. Oh I forgot he needs to pray.

Well it definitely sounds like a cardiac output issue. The patient is going into cardiogenic shock/ Heart failure. I agree with everyone that Dopamine should not be used at all you would have a real chance of causing arrythmias. I actually seen levophed used in this type of situation, yes it does have some beta 1 effects but it is very mild compared to dopamine plus it will start giving you a pressure that will start to perfuse. It is a catch 22 though. On one hand levophed will clamp you down and start giving u a pressure, and on the other it is going to increase the workload/ afterload that the heart has to do. It will also increase myocardial oxygen demand. What they should have done immediately is start to TCP until Cath lab is ready. Maybe when the patient goes to the cath lab if he is still hemodynamically compromised they would insert a IABP.

Hell NO! New grads should be paid at a min. of $25-30 an hour. An experience nurse with 10-20 years of hospital experience 45-60 an hour PERIOD. This is why nursing is behind in pay, we self sacrafice ourselves for our patients, and in doing so we sometimes lower the standard and let hospitals determine what were worth. I love what I do but nurses should not stand for any kind of pay that is demeaning. No offense but I believe the pay is low because the majority of nurses are women. As more men come into this profession I hope and I believe that the standard of pay will rise. Don't settle for less.

Congrats!

Yeah I had OB, Peds, Meds that I have never heard of, Priority and Delegation, and Pysch. How many questions did you have tabymac.

Wow! I just took mine today and I got 107 questions then it just shut off. The board just got out transcripts two weeks ago and every who took the test after the board got our transcripts new within 3 days whether they passed or failed. The was one person in our class who took there boards in early Jan. and it took a month to find out because they did not have out transcripts. Hopefully we all passed.