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nursingpower

nursingpower

Cardiac Critical Care
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nursingpower specializes in Cardiac Critical Care.

nursingpower's Latest Activity

  1. nursingpower

    CABG recovery ratios?

    It seems to be dependent on your facility, level of nursing training, availability of staff physicians and policies. I am at a large hospital and the only ones are 1-1 are patients on devices (ECMO, VAD, IABP) and high acuity d/t instability. Sometimes they may do 1-1 if they have extra staffing for road trips and end of life patients (to accommodate family and processes). They also try no to give back to back fresh cases (within 2 hours of each other) despite mechanical ventilation status. Its rare but it can happen. It is possible in one day that I can get 2 patients out and get 2 fresh cases before I leave, again this is rare and we compensate by having a great team. The surgeries we get: valve repairs, aortic aneurysm repairs (ascending, descending w/spinal drains), CABG, congenital defect repairs, myectomies, and combinations of these. 98% of our patients are intubated upon admission and we attempt to extubate ASAP.
  2. nursingpower

    Sliding scale insulin...give or hold?

  3. nursingpower

    Attending physcian talks too much

    I will keep this short as possible. I am in my last semester for my AGNP program. I am with a physician who is 65-75 yrs old. During my rotations the doctor enjoys talking about so many off topic nonclinical subjects its draining to me. His staff, residents and other NP students warned me about this. Many people just redirect him but they don't have to be around him for 8 hours. For us that do we suffer. I just try to learn as much as I can and make the most out of my learning experience but the excessive talking is affecting my motivation and attitude about attending the site. One example... I told the doctor I needed to leave by a certain time which by the way he agreed to do partial days. I work full time. Some days I have class and many days I need to get home and get things done to properly manage my time for studying, sleep, homework, school projects, and household chores. I decided this was my last patient to leave on time and I waited 30 minutes to present to him as he talked about politics and how bad piracy (in the seas) is the worse its ever been. I ended up leaving 45 minutes later than I wanted. During clinical days, I prefer to discuss things like assessment findings, differential diagnosis, disease processes, assessments and plans. For the most part we talk about these things but I feel I have to sit there in between the important stuff and be forced to listen to the election/politics, religion, history (War with Britain, civil wars, rise of the Roman empire), cooking, government conspiracies, just to name a few. I am looking at my Preceptor evaluation form and its asking me for feedback. I would like to say something but not come off mean, disrespectful or unappreciative but I have like a 85 hrs left and I dread going because of this. It is affecting my learning experience and I personally thing I could be having more beneficial medical related discussion that will help me advance. 1. Is there anyway I could tell him without being offensive or just suck up the last 85 hours and get it over with? 2. How can I provide constructive feedback or should I just not mention it?
  4. nursingpower

    ICU RNs floated to floors?

    I don't know. I feel like ICU nurses can pretty much work anywhere if they are oriented to the unit. It just can't happen the other way around though.
  5. nursingpower

    Sliding scale insulin...give or hold?

  6. nursingpower

    Sliding scale insulin...give or hold?

    a lot of people forget the whole glucose metabolism piece. Great point!
  7. nursingpower

    Sliding scale insulin...give or hold?

    Exactly. In this case, some continue to support disregarding physician orders despite knowing that the next BG level was worse. It seems very clear that the patient should have gotten the 2 units.
  8. nursingpower

    Sliding scale insulin...give or hold?

    I think it's more important to treat hyperglycemia as the physician orders state to prevent worsening hyperglycemia. The patient's blood sugar went from and untreated 159 to 228. Don't seem that beneficial to the patient.
  9. nursingpower

    Sliding scale insulin...give or hold?

    Yep, your rationales explain why the patient's next BG level was 228. Go figure. I hardly think getting D5 1/4NS constitutes as as diet. Again...the patient's BG nearly doubled because the patient wasn't treated the first time.
  10. nursingpower

    Sliding scale insulin...give or hold?

    I just seen this after I typed my reply. So this could have been prevented had they treated the first hyperglycemic event. SMH. Poor patient was hyperglycemic all day. Wonder how many days of this is going on.
  11. nursingpower

    Sliding scale insulin...give or hold?

    159?? Fasting glucose? That is high for a fasting glucose. 1. What does the orders say? If the physician orders state to give 2 units for 159 you should give it. YOU ARE CORRECT! Sliding scales are designed to treat hypoglycemia despite diet. Sliding scales are not to treat for future food intake. It is to bring a person BG back to a normal range. ITs FOR CORRECTION. We will never know how much a person will eat! Think of it like this. Say normal fasting BG range is from 70- 110. Anything above 150 is abnormal. THAT'S A MINIMUM 40 POINT BUFFER RANGE! (150-110=40) 2 units of insulin given at 110 or less may cause hypoglycemia. With that being said, your preceptor and charge nurse are implying that 2 units will make someone with 159 BG hypoglycemic? That means they will drop more than 89 pts to get below 70 (159-70=89). Also many ppl are not symptomatic until their BG level is about 50 (average). My fasting BG was 59 when my PCP checked me. (I was NPO for cholesterol studies) I was hungry and had hunger pains but I was driving, walking conversing just fine. So considering that, it's no way 2 units of regular insulin with drop a BG by 100 pts to cause symptoms where you would have to return and treat. I've work in an CVICU for 6+yrs. We use sliding scales for diabetics and non diabetics who are having stress hyperglycemia. We give 2 units if they are 150-170. I've never seen anyone get hypoglycemic getting 2 units when starting out >150. NEVER. 2. Why do we treat hyperglycemia? It places them at higher risk for infection in addition to increasing the risk of damage to blood vessels end organs. Maybe you should provide some research to your preceptor and charge nurse about treating stress hyperglycemia and the use of sliding scales. Furthermore they are telling you to go against physician orders based off of ignorance and fears. So the patient suffers from hyperglycemia because of it. Did the physician orders state, "Hold if pt has no appetite"? If they want you to hold it, you should have the preceptor/charge nurse call the physician to obtain and order to not give the medication to cover yourself. They have to have a better reason to go against a physician order than a low appetite. That's for holding ANY MEDICATION. Any nurse who feels the need to hold should call the physician and clarify the order or get orders to hold. But I feel your situation. You didn't feel like arguing with them. I know you can't wait to get off of orientation.
  12. nursingpower

    Vitamin D supplementation in prediabetics

    I am an NP student doing a project for my research class. I am a CVICU RN going for Adult/Gero NP. I don't know primary care practice NP's. So I came here for an discussion. My projects is about how vitamin D supplementation can help reduce risk factors that my cause prediabetics to progress to diabetes status. My research has shown that prediabetics with vitamin D supplementation has helped decrease glycemic indices (HbA1c, OGTT and FPG). I'd like to know if any Adult/Gero NP's and/or your primary care practice use vitamin D supplementation/testing to regress diabetes risk factors?
  13. nursingpower

    Saw a nurse yelling at a patient in ICU

    Just what I was thinking. Also InspiredbyNavy, as a nurse you will have to tune in not ignore. Pay attention to detail and gather all the information you can get before you make a decision. In my opinion had you truly felt that "it wasn't your business" you would have never made a post about it. There is just not enough information from your account of the story to even comment on it. When you become a nurse, you will learn that a 5 second snapshot of a nurse/patient interaction means nothing. Especially when you purposely didn't hear the situation. I work in a CVICU and I will yell at my all the time if they are doing something to me or to themselves. Safety first.
  14. nursingpower

    Shocked by facial piercings at work

    After careful consideration I've decided to reply to the OP. I can careless what anyone else think of MY OPINIONS. I work at a very large Magnet/teaching Hospital. Upon my hiring over 4 years ago and in orientation I read the personal appearance/professional policies. I've followed those policies for years and management seemed more focused on infection rates, patient satisfaction scores and staffing. Ya know, things that affect how much money we bring in. I followed the rules consistently. No acrylic, no chipped nail polish, long hair pulled back, No visible tattoos & piercings, white shoes, clean white uniform that I ironed before wear daily. I took it upon myself to be conservative. Light make up, black/white solid undies. Etc. At work I've seen, unnatural hair colors, tattoos everywhere except the face, long acrylic nails, chipped polish, stained uniforms, ear bars, eyebrows loops, facial microdermal piercing (stud removed), microdermal piercing on the forearms, wrinkled uniforms, colored shoes (supposed to wear white per policy) and hair unrestrained and falling all over patients they bend over. I thought so much for policy. Now I see that they are hiring people with the tattoos and piercings. I'm sure people hide these things during the interviews but they continue to work. I don't know what corner of the closet some of you live in but patients of ALL AGES have tattoos and body piercings some offensive. Women come in with nail polish (pulse ox?), wigs (can't remove pre/intra/post op.) Physicians have tribal or other arm/neck tattoos. I've never seen a patient turn away not one tech, RT, RN, MD because of a damn tattoo. We have patients from as far as the middle East at our hospital. People from all across the US. I used to think certain things are unprofessional but since the hospital doesn't care to enforce their policies. Oh well...
  15. nursingpower

    Shocked by facial piercings at work

    I thought the same thing. Then I started liking comments for some reason.
  16. nursingpower

    Shocked by facial piercings at work

    SMH.. Lol. I'd have probably Googled this before asking.