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PJMommy

PJMommy

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PJMommy's Latest Activity

  1. PJMommy

    Use of techs (UAPs) in ICU/CCU

    Working without our techs is terrible. They help bathe, do all the Accuchecks (how are nurses supposed to get all those hourly checks done?), restock, clean equipment, help with code browns, run errands, order supplies, help turn patients, etc. In your appeal to the budget-conscious powers-that-be, suggest that safety is compromised when two nurses are in a room giving a bath or turning a patient -- it leaves not one but three patients unattended...and for how many baths a night? And no, we are never greater than 1:2 ratio even with the techs.
  2. PJMommy

    Order Clarification

    Our docs can transfer with "resume previous orders" to lower acuity units. When transferring from low acuity (i.e. med/surg) to high acuity (ICU), they have to re-write ALL orders. Same goes for post-op pt's -- they can't say "return to ICU, resume previous orders"....they have to re-write everything. As far as verbal orders go -- I take them all the time. However, if doc is just standing at nurses station and gives a verbal order, I say "the chart is right here, write it and I'll do it". I think some of it goes to trust -- there are some docs I absolutely will not take a verbal order from....maybe they are an a**h***, maybe they have tried to burn nurses in the past...whatever. I consider taking verbal orders a courtesy only as the ultimate responsibility for giving/writing orders is the doc's.
  3. PJMommy

    What is the #1 healthcare problem in the USA?

    I was wondering if anyone was going to mention end-of-life issues. At any given time in our ICU, we have 5-6 patients for whom everything we are doing is futile - they will never leave our unit. Yet families say "do everything for gramma" (who is 90 y/o with terminal lung cancer). So people "live" on ventilators and with the support of numerous meds for literally weeks on end before finally transferring to Heaven. Docs do everything - order all the daily labs and x-rays, get the EKGs for every instance of ectopy -- all because they are terrified of being hit with a malpractice suit. High costs lead to high insurance premiums which means many are uninsured -- and don't even think about insurance companies paying for preventative things like smoking cessation programs or Jenny Craig.
  4. PJMommy

    Interventions for constipation

    Ducolax suppository
  5. PJMommy

    Med-Surg Pathophys question

    Ischemia which results in an infarcted area will cause increased lactic acid (did they get a lactate level?). The ABG will reflect this change as metabolic acidosis -- pH decreased, bicarb decreased (as it is used up to buffer the lactic acid), pCO2 might be lowered if pt is compensating respiratory-wise. Is this what you are looking for?
  6. PJMommy

    New to the Night Shift Experience

    Also...don't fall into the trap of trying to be a day person and a night person. When it's time to sleep - turn off the phone, darken your bedroom, eliminate all distractions. Don't try to make appointments or get up and do some yard work during your sleep time. I've met so many people who say nights didn't work for them because they were tired all the time....and then you find out they'd always get up after 3-4 hours sleep so they could get something done. Day people don't wake up at 1 AM so they can get something done so neither should we.
  7. PJMommy

    Med/surg experience for possible change to ICU

    I know you didn't solicit this opinion but...sorry...I'm throwing it out there anyway. When we have someone float to our ICU, that nurse gets two "easy" patients. Floats (unless they are critical care floats from our float pool) do not get vents, Swans, balloon pumps, ICP monitoring, or drips (other than insulin or ativan). I just want to point out that ICU nursing may not be the same as your float experiences. Okay...with that said... :) My pointer is prioritize, prioritize, prioritize. It isn't task oriented nursing so much as it is a constant flux of what's-going-on-now. It's not a game of 'at 8 AM, I'll do vitals...at 9 AM, I'll give meds....at 10 AM, I'm giving a bath' because things change too fast and too often. The biggest issue I see with med/surg nurses coming to ICU is that they are still doing tasks and not dealing with issues. I've seen a nurse go in to spend 15 minutes turning and fluffing one pt while the other pt has a BP in the 60s. I once saw a nurse walk out of the room during a code on their pt so they could go give 2 units of SQ insulin because it was due right now. It seems to constantly be a game of 'what's the most important thing to do right now?' and what you might think you'll be doing in 30 minutes is shot when your pt blows a pupil and you are with him in CT scan instead. A q day IV Pepcid dose may be delayed 2 hours because your other pt suddenly needs a Neo gtt started and then add some Dobutamine and maybe some Levophed....oh, and the doc wants to float a Swan now.... Good luck!! The best news is that you only have one or two patients and can focus all your attention on doing the best nursing care possible. :) Let us know how it goes.
  8. PJMommy

    looking for examples of self scheduling guidelines

    First, you need to know how many weekend shifts you'll require and how many nurses you need for core staffing on a shift. We sign up in 4 week increments. Then a draft comes out with our schedules and how many nurses are on each shift. With this draft, we'll get a list of shifts where someone needs to move off of or onto the shift because we are either long or short on staffing. This might be "move 4 off of Sat 13th night shift" and/or "move 2 on to Fri 12th night shift". Those who do NOT voluntarily move their schedule around to help balance will be the first ones forced to move on the final schedule in order to fill the gaps -- therefore, we try to move to help balance so we at least have control over the change. Final draft is then final -- no change or moves unless trading a shift with someone.
  9. :rotfl: I hear ya'! I agree with all the previous posts but would add one thing.... I once heard that hospice nurses experience the most job satisfaction. It stuck in my head because it would seem this field of nurses would be the most burnt-out group there is and I doubt I could be happy doing hospice. I don't know the source for that tidbit...so take it as you will.
  10. PJMommy

    carotid dissection

    Heparin will inhibit thrombogenesis since one of the problems with dissection is an embolus traveling to the brain and causing a stroke. From emedicine.com: "Intracranial internal carotid artery dissection is associated with a 75% mortality rate."
  11. PJMommy

    The Pre-crash hint

    Your timing on this post is ironic. I just had one of these on my last two shifts. We all just *knew* things weren't right. He looked like crap, his gases sucked, his labs were way out of wack, he was becoming less responsive. On my fifth phone call to the doc, he started again to brush up my concerns and I stopped him and said "you need to come down here NOW". (He was sleeping in the call room.) I swear he didn't recall any of my previous calls to him that night...."ohmigosh, his calcium is really low" -- uh, yeah, I think I stressed that when I called you with a critical value THREE HOURS AGO! The pt died several hours after my shift ended. Yeah, I did document, document, document. But honestly, it still breaks my heart that, as a nurse, I can do everything right and I'll still have to hope that a clueless, bonehead doc doesn't drop the ball. And then, of course, I play the was-there-something-else-I-could-have-done? game. It's a tough game.
  12. PJMommy

    New job jitters, have you had them?

    Best advice? Use your ears and eyes more than your mouth. :) It's hard to be a target when you listen & learn. I know the very few who have been targets at my facility are those who walk in and act like they know more than everyone around them...and won't shut up with their constant opinions, commentary, and criticisms. They refuse to think they might actually learn something from the staff they work with.
  13. PJMommy

    Asthma Attack ?

    Not sure if this is correct but here's a guess as to the hypokalemia (not sure on the mag though): Body's release of catecholamines causes stimulation of Na/K pump and K uptake by cells is increased (basically a cellular shift). Similar transient hypokalemia can happen with any acute insult like an MI or head injury. I think (?) the beta-2 agonists we throw at acute asthma are particularly good (bad?) for stimulating the Na/K pump. Now...I'll be curious to see what your other responses are like and whether or not I'm even close to the correct answer. By the way, I also have PASS CCRN and love the book. When are you testing?
  14. PJMommy

    Verbal abuse by physicians in ICU

    This is absolutely excellent advice. :)
  15. PJMommy

    Sedation Minimalization....Opinions Needed

    Are these pt's vented? All of the vented patients get sedation...although there has recently been a push to not use as much Diprivan and instead use more Versed. Once extubated, none have sedation but many of our patients receive Seroquel as the drug of choice. It seems to really help with that ICU psychosis they develop. I've only seen Ativan drips used for ETOH withdrawal. I will get the occasional Ativan or Versed prn order for agitation. Haldol is rare -- only with the patients where nothing else works.
  16. PJMommy

    New Graduates In The Icu?

    I have to weigh in on this one.... First, I was a new grad in the ICU. Yes, there were a few times everything was totally overwhelming. But I love critical care and would not have started in med/surg in order to "do time". With that said, as a now more experienced nurse, I believe the ability of a new grad (or any nurse) to succeed in ICU depends totally on that person. I have seen new grad, 22 y/o nurses become excellent ICU nurses...but I've also seen those who have no clue how to organize and prioritize. But I've seen experienced med/surg nurses come to work in ICU and absolutely struggle...and those who hit the ground running. I guess I don't believe success as an ICU nurse can necessarily be learned by working in med/surg. I tend to think success in critical care comes more from a nurse's learning style and personality. Just my two cents worth....