shinynurse

Oh my gosh, forgot to say something Back to the original question. Typically you'd like to see a CVP of 10, but very dependant on the pt and diagnosis. Also, remember that the CVP (aka RVEDP or R. ventricular end diastolic pressure) assesses th R. ventricular function and general fluid status. Soooo, as always, the very first thing you'd want to do with a value that low is to recalibrate your CVP line and make sure it's accurate. Also, take another look at the pts. meds. Any diuretics on board?

Wow, good test question! I don't work with transplants in our hospital. I can work with you from basically the same angle that you're working from, though. When I see a CVP of 2, automatically we know the pt. is intravascularly dry. Why?? How about labs? Does the pt. have hypoalbuminia? Is the pt. 3rd shifting? What's the pts' Na level? Tons of pitting edema? You need to do one of two things. Either you're going to intravascularly rehydrate with fluids to get your CVP up because the pt. is truly dehydrated or you're going to have to figure out a way to get the pt. to shift back into intravascular and give "some" IV fluids without overhydrating the system, especially if the pt is shifting everything out. So, as an acute dialysis nurse this is what I'd do. Regardless of the pts. nutritional status (albumin level) I'd probably give Albumin 50 gms, raise my intravascular sodium level and give small amts. of fluid. Also if your CVP is 2 then your bp is probably going to be in the bucket and your heartrate is going to be elevated. Very slowly rehydrate and give time for your albumin to get to work. If 50gms doesn't do the job, give 75 or 100gms to bring that osmotic pressure up. I would consider this a pretty critical situation but just be careful you don't overload with IV fluids because you don't want to stress out that new kidney. You would definately work from the angle of doing a somewhat slower quick fix then work on the long term issues. What is the pts. output? Any other underlying issues? etc!! Also, post op, of course you want to be careful of the lungs and heart with your fluid status. We just want to get and keep that fluid in the right places. Did this help? Would love to hear!

Repetitive? Routine? Boring? Wow!!! It sounds like many of you are caught up in the wonderful life of the chronic world. Dialysis is for nurses that love to think!!! What job could you possibly work as an RN and work with every organ in the body AND all the way down to an intracellular level? What you do effects EVERY system in the body and it's all very pt. specific. It's not just about pulling fluid, keeping stable vitals, assessing, sticking needles, or putting on and taking off catheters. You are remolding!!!! a body. How much more awesome could your job be???? As always, though, your job will be what you make of it. If you're critical and clinical thinking skills are honed in and your physicians can truly trust and depend on you, the world is yours. The professional respect level is wonderful and you'll be a hero to many! Good luck!

I am so sorry for your situation. Just reading your letter brought back old feelings of frustration that occurred years ago while training in a chronic facility. Please understand that this type of "teammate" struggle occurs in many occupations with nurses, ie. flight nurses; paramadic vs. RN, CCT nurse; paramedic vs. RN, LVN's vs RN's. It's truly very sad and oh my gosh, so very frustrating! It's all about ego trips and shoulder chips. Also, I'd bet big bucks that your FA isn't an RN. If your FA was truly an RN (or maybe a good FA) that was trained in dialysis, she/he would have never made this an issue with you because more than likely it would have been something that he/she had experienced throughout their personal dialysis years. Also, if your FA had participated in any of your training (ie. weekly evals) and would have actually taken just a touch of participation in your training, the FA would have been able to see for his/herself that nasty RN additude you were carrying. However, telling you this isn't going to make your situation any easier. Please just remember your years of RN education and be proud of your title and of who you are. There was another nurse that responded telling you to basically not let them bring you down because that is what they're trying to do. They're trying to just put you in your place before you ever even get out the gate. They're trying to show who's the boss. I've had techs override UF and sodium modeling orders just because they could!???? Setting an SV as high as 150. Then they wonder why the pt. comes back hypervolemic? Do they understand that they were the ones that sent that pt. home thirsty? Exactly how much do techs understand labs and the effects of their highs and lows? What do they understand about the underlying diseases these pts. also have? What do they know and understand about CHF, cardiomegaly, cardiomyopathy, diabetes, etc. and how these diseases can behave during txs.? They know they have to remove fluid and keep those vitals stable. Techs and nurses both can become very number focused and task oriented. Dialysis is very individualized. Believe me, their are some very intelligent dialysis technicians out there that really know their stuff. The techs that do, though, have total and complete respect for an RN's training and their knowledge base. Also, it takes at least a good 3 years of hard chronic time under your belt to be able to pat yourself on the back and to be able to say that you know that you know what you know!!! If a tech wants to rule the roost, then they need to go to school, pay thousands of dollars out of their pocket or in school loans, give up how many years of their lives to be able to take the state boards and obtain their nursing degree. Keep your head up high, a smile on your face and take no abuse!!!! This behavior is based hugely on ignorance. They have no idea what your responsibilities involve. When you get really good at your job, move into acutes and then you can really shine. Then you can really save lives!! It's an awesome feeling:heartbeat! Good luck in your challenges and be strong! Remember you gave up many years to become a professional and that's what you are. Remain just that!!!

Hmmm...this is what I'd do. Look up the Davita job search site for the state and area that you're relocating to and find out what's available to you. Going from chronic to acute I would probably suggest staying with your company and asking them to train you since you've already got contacts. The responsibility level from chronic to acutes can be huge. The chronic pts. that you see in the acute facilities normally have their usual challenges that they have on a day to day basis. Then on top of that, everything is very dependant on their reason for hospitalization and their acuity level, as well. All of my work is one on one and mostly in the intensive care arena. As you know, all renal pts. have tons of challenges including working with their underlying diagnosis, ie. CHF, diabetes, hypoalbumenia, CPD, etc. Those challenges then become your challenges. You are making large intracellular exchanges. You're dealing with pts. that can be very hypervolemic but with blood pressures in the bucket, intubated, septic and on tons of meds that you have to always challenge to have your perfect outcomes. You could be performing treatments on pts. going through drug and ETOH detox, liver failure with extremely high ammonia levels and their confused and sometimes combative. You are working with a multidisciplinary team that is trying to work around you and be successful with their jobs, as well. For myself, I never have any backup so if something goes wrong, it's on me and I better figure it out real fast!!! I could go on for days regarding the difference but if there's anything specific I can help you with, would love to help.

Of course it's going to depend on experience, chroni/acute, etc., but I'm going to shoot for a ball park for you. I'm in northern Calif. and I believe the nurses are starting out in the chronics at approx. $25-28/hr. I work acutes and am currently making $40.00/hr. with years of experience. I have found that So. Calif and No. Calif. can be very different in pay rates. Although it seems that the starting wages are pretty comparable. Good Luck!

Renal nursing, dialysis nursing, nephro nursing....an awesome specialty field! Dialysis nurses, unfortunately, are one of the lower paying specialties and one of the most difficult. Because this specialty is so involved (we're talking every cell in the body), it does take quite a bit of training to really "know that you know what you know"! Now days, most of the training is on the job due to the shortage of dialysis nurses. Basically, it's just selling yourself to the right clinic and they'll get you rolling! Days past, it took us 3-5 years in critical care to even apply for this type of job. Most of my days are still spent in the ICU working acute dialysis and after 10 years I can honestly say that I STILL love it. I have a nurse friend in So. Calif. that wanted to move into dialysis and that's exactly how she did it. She now works acutes in the hospital and is so proud to be in such a fantastic field. Let me know if I can help further!