JustKeepSmiling ADN, BSN, RN

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All Content by JustKeepSmiling

  1. JustKeepSmiling

    Titrating

    JustKeepSmiling posted a topic in MICU, SICU

    I've been in ICU for about 2 months now and love it. As I come close to my last phase of orientation (taking my own patients & preceptor has their own too) I'm still wondering about titrating...
  2. JustKeepSmiling

    Titrating

    JustKeepSmiling replied to JustKeepSmiling's topic in MICU, SICU

    Love the feedback! Levo nonweight based kinda makes me antsy. I've gotten a much better feel for levo over the past few weeks. Now if I could just get some other vasoactive gtts and get acquainted...
  3. JustKeepSmiling

    Would this be considered a med error?

    JustKeepSmiling replied to Theone40's topic in Nursing Student Assistance

    I would question the entire dose! HOLY
  4. JustKeepSmiling

    Heparin

    JustKeepSmiling replied to bear14's topic in Medical-Surgical

    Great thread! Hot topic too with focus on core measures. I always fear HIT with a platelet trend down. As far as I know LMWH is not as big of a threat in that
  5. JustKeepSmiling

    Diluting IV meds

    JustKeepSmiling replied to wanderlustnurse88's topic in Patient Medications

    That could happen. Same thing with giving half a pill. When I was induced they used cytotec to ripen, the L&D nurse warned me that since it was a piece of a pill I may or may not get the entire...
  6. JustKeepSmiling

    COPDer de-satting? What do you do?

    JustKeepSmiling replied to Krazziekid78's topic in General Nursing

    What were you disagreeing with me on? Some patients need to get to at least 85 and others 90, depends on a lot of factors and what the MD wants. I never said WAIT for those
  7. JustKeepSmiling

    COPDer de-satting? What do you do?

    JustKeepSmiling replied to Krazziekid78's topic in General Nursing

    Small rehab with no RT - I'd call EMS and stat page the MD. Focus on ABCs. Is there an order to maintain sat greater than %? Even if patient is a retainer, that sat plus accompanied symptoms and...
  8. JustKeepSmiling

    Desperate to leave the bedside, possibly even nursing entirely

    JustKeepSmiling replied to GenericUnicorn's topic in General Nursing

    What areas of nursing have you worked in? What are the top 3 things you like in your current job and the top 3 things you hate? Why did you go into
  9. JustKeepSmiling

    Defibrillators that charged to 400 J

    JustKeepSmiling replied to ECMO's topic in General Nursing

    Holy shites, that's got to
  10. JustKeepSmiling

    Clinical Field Specialist or Medical Product Sales

    JustKeepSmiling replied to jhayroe's topic in Nurse Entrepreneurs, Innovators

    Do you have a specific device in mind? These jobs are HARD to come by. I'm friends with several device reps, some in sales and some in specialist positions. Some nurses before, some not. They make a...
  11. JustKeepSmiling

    Physical Restraint in Intensive care unit

    JustKeepSmiling replied to samer2014's topic in Patient Safety Issues

    Music, reassuring, try to maintain day & night patterns. Tell patient frequently where they are, who you are, what you are doing/plan of care, date & time. I have been able keep patients out...
  12. JustKeepSmiling

    I'm ready to start a paper trail.

    JustKeepSmiling replied to VAC's topic in Patient, Colleague Relations

    What kind of unit? Need to know the type of environment you're working in, type of patients. Team nursing? Is this a
  13. JustKeepSmiling

    Medical Surgical Medications

    JustKeepSmiling replied to bradycardic's topic in General Students

    Know you insulins - onset, action, peak, duration. You'll see a ton of diabetics in medsurg. Familiarize yourself with antibiotic/anti infective classifications and what microbes they are used for....
  14. JustKeepSmiling

    IV push failure - how I am failing

    JustKeepSmiling replied to Brandazzle1's topic in Patient Medications

    You misunderstood me. I deal with a very difficult population involving IVDA, dialysis, etc that have crap for access. When you only have one TLC and have trifused it to the max, sometimes the only...
  15. JustKeepSmiling

    Anyone do a boxing workout for stress management?

    JustKeepSmiling replied to pugmom79's topic in Health, Stress Management

    Hmmm maybe this would be good for
  16. JustKeepSmiling

    Question about ICD/pacemaker

    JustKeepSmiling replied to AnnieOaklyRN's topic in CCU, Coronary, Cardiac

    Excellent question and excellent answers!! I wish more nurses wanted to understand pacer/ICD mechanisms. ATP pacing can be very beneficial. The manufacturers have awesome free clinical resources on...
  17. JustKeepSmiling

    Cardiac Stepdown unit 5:1 patient ratio...is this normal???

    JustKeepSmiling replied to jaznia15's topic in CCU, Coronary, Cardiac

    IMHO a stepdown unit should be 3:1 if high acuity and no more than 4:1. That fifth patient can send a nurse over and jeopardize patient care. Much like the 6-8th patient in M/S can send you overboard....
  18. JustKeepSmiling

    Titrating

    JustKeepSmiling replied to JustKeepSmiling's topic in MICU, SICU

    "Protocols are fine when they work...and can be very dangerous when the pt's body hasn't read them." LOVE this answer. Thank you so much! Will pass that tidbit onto new nurses
  19. JustKeepSmiling

    IV push failure - how I am failing

    JustKeepSmiling replied to Brandazzle1's topic in Patient Medications

    Or you could aspirate the high risk drug out to avoid a bolus, give your push, flush then restart the line. Avoid fooling with high risk infusions for pushes if you can avoid it though. OP - what if...
  20. JustKeepSmiling

    Titrating

    JustKeepSmiling replied to JustKeepSmiling's topic in MICU, SICU

    The guidelines I'm refering to is a piece of paper copied too many times passed on through nurses, it's not something I was given officially. Like for propofol it says go up 5mcg q5m and down 0.01...
  21. JustKeepSmiling

    Time Management Tips for New Critical Care Nurses

    JustKeepSmiling replied to nursey246's topic in Critical Care

    Crazy as it may seem I stick a big ole piece of paper tape on my forearm and jot things down. I know I won't lose it! This works especially well for jotting down swan #'s etc in a hurry to chart...
  22. JustKeepSmiling

    SA Node (decreasing)

    JustKeepSmiling replied to Crew2Nursing's topic in Cardiac

    I have never heard of that but you've peaked my curiosity. What
  23. JustKeepSmiling

    suspended for doing the right thing...

    JustKeepSmiling replied to farmernurse26's topic in Patient, Colleague Relations

    Maybe those parents need a field trip to the local dialysis clinic to see what hyperglycemia does to the kidneys, lifestyle, eyesight, amputations,
  24. JustKeepSmiling

    Brand name of cute headbands?

    JustKeepSmiling replied to 757RN's topic in Scrubs, Uniforms, Gear

    Thanks! I've been looking for something like this
  25. JustKeepSmiling

    Student Nurse with a poop problem

    JustKeepSmiling replied to Grrrse's topic in Men in Nursing

    You can totally get past this. I hate hate hate checking peg residuals. The smell, the warmth, the color. YUCK. I put on small gloves then medium. I do the residual thing, give my meds, then take off...