in2ICU

My main goal is just to know a bit more that ties back to physiology/pathophysiology and how that differs from adults. Sadly, I don't have a mom to ask; my parents died a few years back and my husband's mom had a stroke last year. We (my husband and I) are totally solo in this, so I'm trying to at least have the heavier references available so I can make sense of things.

I'm an adult ICU RN/CCRN (MICU and SICU jobs) but am about to have a baby. What is a good reference for infants? Hoping to find something that is above and beyond the layperson's level. Any input would be greatly appreciated!

I was considering CRNA, yes, but not exclusively. I haven't decided how to proceed just yet - will let things settle into the new year and make a choice to move ahead or stay put for a while longer. The rate for online independent study at BYU was the same for everyone I thought - so non-LDS.

BYU Physics was around $450 OSU Ochem was right around $1,000. Gross, I know. It's hard to believe these are the going rates for education these days. The UNE Ochem course (the one I dropped) was around $1,400 I think.

I am an ICU nurse with 2+ years in the unit. Last year I was looking at going back to school and needed to take Organic Chemistry and Physics. I scoured this site and everywhere else looking for info on a good place to get these courses considering how hard they are and that I needed an A. As of today (12/10/12) I am finished with both and I wanted to pass along my experience so somebody else can be spared the hours I spent trying to find the same info! Physics - BYU I took Applied Physics (PHYS 105) from BYU Independent Study online. The professor was Dr. Joner and it's a self-paced program. There are 4 proctored exams that you can schedule at a school/university that's near you. You are allowed to take an enormous cheat sheet into each exam, which is an outline prepared by the professor that you are allowed to write your notes on. A definite bonus. The moral of the story here is that Physics = HARD WORK. OMG, I did practice problems for hours, and then I did them again. Only at that point would I start to get the hang of what I was doing, so then I'd go back and do them yet another time. Physics isn't like the other stuff we learned in nursing where you just need to understand the physiology of something in order to work through it in your head. Physics should be thought of as a skill that needs practice, and it's a full-time job. I worked my tail off and got an A... barely. Organic Chemistry - OSU Took a course called General Chemistry of Living Systems (CH 130) which covers 1 chapter of general chem (acids/bases), then 5 chapters of organic, then 5 chapters of biochem. The name is misleading and you may want to get the syllabus/content cleared with the graduate school you plan to attend just to be sure there are no misunderstandings. I took this at Oregon State University online and the professor was Gautschi, but another guy named Nafshun teaches using pretty much the same syllabus. This class was good. The weighting of homework and labs, plus an essay, tips the odds in your favor to do well in the course. The midterm is not proctored, but the final exam is. The key to this class is making a good set of note cards with reference molecules and functional groups on them so you can refer to them indefinitely. The homework is done online using a program called Mastering Chemistry. Most people report this to be some really evil software, but I thought it was pretty good. It shows the student, in a very obvious way, what the important concepts are and how to do them (usually through repetition). I got an A in the class and I'd say the Mastering Chemistry homework was really the key to help me focus on the right stuff. The prof puts out practice exams which are really helpful, especially on the final. The labs are a pain and completely not related to the course. I got semi-lame scores on them but still came through with the A-grade at the end. Good luck to all of you looking to get these out of the way. I had tried OChem at UNE and it was awful - it was unreal how difficult it was and I had no idea what I was learning. I had an A but I dropped because it felt like I was staring at Everest. The Ochem at OSU was actually useful and tied to health-related topics so it was much easier to grasp.

Hi, I wanted to add my input as a newly passed CCRN. I looked on this site for lots of tips and hopefully I can add a few as well. I scored 111/125. In school I was a 4.0 student and have experience in MICU and SICU. This is the first exam I've ever taken where I had NO IDEA how I was doing as I was taking the test. There were many questions, approx 30-40 questions that were pretty obvious. Another 30-40 were more the type I had to think about and work through the patho. But the other 75 OMG! I had no idea. It was as if none of the answers were right and I had to choose the least harmful one or the one that looked like it was talking about the right topic. No joke! It was heavy on cardiac drugs, specifically in combination with each other. I'm good with lungs, but there were some not-so-realistic scenarios that made the answer choices tough. Prep: I watched the Laura Gasparis Vonfrolio videos. Although I learned a lot from these, I don't think they really did much for me on the exam. This was a surprise because of so much I'd read about her videos being so spot-on. Perhaps it was just the version of the test I received. That said, I still learned a ton of useful info from these videos that help me on my job every day so I certainly still recommend them. PASS CCRN: Ignored the book mostly - did the CD practice questions for 3 weeks. I think the formatting of the practice questions is a good warm up for the actual exam, but still the content wasn't that well matched to the exam. I would say that reading and understanding the rationales of these questions lead me to learn/look-up more info that was the type which appeared on my test. I think if you work in a critical care setting, actually practice critical thinking, and study your cardiac/neuro/lung basics you will be able to pass this exam. Prep for uncomplicated swan questions, basic ECG stuff, and a lot of questions regarding treatment of visitors, patient priorities, and choosing a policy vs. common sense. I'm not sure how to prepare for those - maybe it's in the book, but I wasn't focused on that at all. Good luck to everyone! It took me 3 weeks of intermittently intense study. I was worried that I should've studied more but in the end - after the exam - I realized that there's nothing I would've studied past that point that would've given me more answers on the exam. OH, the one thing LGV says in her video that is super true - they throw the crazy questions at you first - the ones that no one is going to be able to answer. Don't get discouraged! Just realize that's what's happening and move on!

In response to the above replies: But how do you standardize on "regular lighting"? Day vs night, different light switches (we have about 8 lighting options in each room - it's ridiculous), if pt's eyes were open or closed prior to exam? That's what I'm getting at. If we report the size upon initial inspection that can be incredibly variable based on external factors. Do your units have a standard set for this? I know mine doesn't and the results are all over the place. I don't have any issues with the reactivity and regularity... it's just a specific question of timing that pupil size is measured.

I was a tech before I became a nurse. Duties vary a lot with that title. However, regardless of the requirements, I'd say there are 2 viewpoints you should consider: A) Being a good tech (so you can get experience), and B) just actually doing a really good job. Usually, if you do a really good job then you'll get a lot more help from the nurses with regard to gaining skills/experience. For option A: -ask questions about everything. (What is this? Why is it set up this way? Is this supposed to look like this? ?????????) -never assume -look for opportunities to do basic nursing tasks -assess patients (even though that's not your job - you can at least check 'em over and then look in the charting to see how your results match up to the nurse's findings) -let everyone on the unit know that you want to learn things. I would come in to work and say "hey - we're covering GI right now in school so if anyone has anything interesting let me know!" -look at meds that are hanging and get familiar with those -look at labs in the chart to help you get used to normal/abnormal values -assist with procedures, transfers, and anything that the unit secretary does For option B: -be proactive and stay busy - there is always something that needs to be done -ask nurses if they need help with turns, if they need supplies -let the nurse know to give you a heads up when they are going to bathe a patient so you can gather supplies and help out -if it is your job to bathe the pt, then when you get ready to do it ask the nurse if he/she wants to see the pt's backside -do the blood glucose checks as much as possible (inform nurse of the result) -always advise the nurse if you can't perform a task -go find the nurse if something doesn't look right with the patient -be available (don't be hiding out somewhere) -learn what the unit secretary does (so you can do it if there isn't one there) That should pretty much cover your bases. I was a tech for 2 years on two units (an ICU and its stepdown). I got a job in the ICU out of school and thank goodness I learned so much in advance (while I was a tech). Good luck!

I have worked at two equally well recognized teaching hospitals in an ICU setting. Most everything is the same, but I've noticed a difference in how pupil size is assessed. Hosp#1 - Assess size of pupil as it reacts to pen light so as to eliminate variation in room lighting. Hosp#2 - Assess size of pupil upon initial inspection, regardless of room lighting, etc. (and before using pen light). I do look at the pt's pupils initially, but I make my measurement based on the size to which they constrict. So I am wondering - how does everyone else do it?

I am doing the Gasparis DVD and PASS CCRN regimen as well. My question is about the cardiac portion of the CCRN - specifically 12-lead ECGs. Did anyone see a lot of this on the exam? I am very strong in pulmonary, renal, endocrine and moderate in neuro and cards. I just don't do the 12-leads that often and have to really work to pull it all together in that area. It'd be nice to know if I need to spend a ton of extra time on that subject or if my time would be better spent on general review. ANY input would be greatly appreciated. Thanks!

I should also add that the facility that considers mittens to be restraints is reporting them as part of restraints use in comparison to other Magnet hospitals (their numbers are considerably higher than the national average). I think the results are skewed because the other hospitals may not be counting the mittens in their audits and there is no way to tell which ones do or don't!

Hi All, Are mittens, used alone, considered a restraint at your facility? I have worked at a couple of major magnet-designated medical centers and they have opposing views on classifying the use of mittens as a restraint. One says they are, and the other calls them a restraint alternative. Just to be clear, I mean the boxing glove looking mittens that have velcro at the wrist to hold them on the patient's hands. These are NOT tied down in any way shape or form and the patient can still move his/her arms. Specifically, I use these in the ICU to keep patients who are sedated from pulling their ET tube or central line because obviously they are not thinking clearly! Please let me know what your hospital's stance is... thanks!

I look at the teacher's PPT to see what topics are covered. Then I go to the book and look at those topics specifically. The key is to understand those specific topics inside and out in relation to the general content in a chapter - even if you have to look in other books, dictionaries, wikipedia... whatever. Just make sure you "get it" and that's half the battle. Ultimately I highlighted a lot. I would skim a section to see what the big picture was, then I'd go back and read it carefully (that's when I highlighted), and then I copied the important passages into my notebook. After doing all that, I usually remembered the information pretty well. Then I'd just skim over it the day of the exam. I left nursing school with a 4.0 GPA. The best shortcut advice I could ever give you is that there aren't any shortcuts. If only I could take back all the time I looked for a better, quicker way to study. Just do the work; if you truly understand a topic then you don't have to memorize it and you'll be able to build on that in later classes. Good luck! PS - caffeine (like a soda) helps with brainpower... I always drank mine 1/2 hour before the exams

I remember the first time I just SAW a pt die (I was a tech) and it still sticks with me to this day. It was somewhat dramatic (a chatting lady who had a massive PE and was dead in 30 mins). I thought about it every time I went to the hospital for a good 1-2 months. The big take-away for you is the experience. You can feel good that you NOTICED - you saw a change in the pt. Although it was the beginning of a downward slide for that person, catching things early is the BEST thing you can do as a nurse. I'd say you probably have some pretty good assessment skills. Keep that in mind - you'll learn to trust those things because you'll always know "what could happen." I'm now an ICU nurse and my biggest worry is that I won't notice if something is going wrong when everything is already wrong with my patient! One last thought is that it's probably hard for you to get closure because you weren't there when the patient died. Often, being there and seeing/helping the family is what helps me cope with the death - the families are so thankful for caring nurses when their loved one is in that position. It takes some truly rough and sad times and turns them into moments where you know you made a difference.

-A G-tube is the same as PEG tube (Percutaneous Endoscopic Gastronomy). -If the liquid is clear it could also be stomach acid, and the greenish color is a common finding too (in small quantities, i.e. -The nature of the G-tube is that a dome or balloon holds the stomach wall right up against the abdomen wall. -A G-tube should be in the right place unless the tube has migrated INTO the patient (and would be a lot shorter on the outside of the pt's abdomen). I've only heard of a G-tube coming OUT of the pt one time - and that was because he pulled it out... ouch! -Whenever I see brown (not tan, but brown) I do a guaiac to check if there is bleeding. -Bad colors that should make you take notice: brown, red, pink, black, coffee-grounds, or like stool. Clear, dark green or TF color are usually OK, and be mindful some odd colors like orange can come from various meds. -As for large amounts of residual, I either use a graduated cylinder or a suction canister but it's never as neat as I'd like it to be. Always have a washcloth handy! So these are some general guidelines - I hope this helps!