aCRNAhopeful

aCRNAhopeful

CVICU

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All Content by aCRNAhopeful

  1. Nitrates to Patient with Aortic Stenosis

    aCRNAhopeful replied to leahvm's topic in CCU, Coronary, Cardiac

    He could be right you must be very careful. Patients with severe AS have a hard time getting blood out of the LV to begin with and often have very hypertrophic left ventricles. If you suddenly drop...

  2. What do you consider a positive troponin?

    aCRNAhopeful replied to jax22's topic in CCU, Coronary, Cardiac

    I think hospitals with a CCU usually take medical cardiac and then the CVICU will take the cardiac surgical patients. My hospital is smaller so we do both in one unit + will often take more step-down...

  3. Does this follow ACLS guidelines?

    aCRNAhopeful replied to aCRNAhopeful's topic in CCU, Coronary, Cardiac

    Since I've posted this I've been in a situation where I considered giving 1 of atropine first. Had a patient after a heart cath who moved the leg with the sheath in it and vasovagal'd his HR down to...

  4. PRN fluid boluses post open heart?

    aCRNAhopeful posted a topic in CCU, Coronary, Cardiac

    Just wanted to know how other units do things. When we have a post op open heart they come back with all kindsa orders to manage them hemodynamically (as probably all open heart patients across the...

  5. Can I bolus this patient? A legal / practice question about sedatives and narcotics

    aCRNAhopeful replied to simvee's topic in MICU, SICU

    And yes I realize the seriousness of the situation and that there is the potential for some severe consequences in regards to poorly documented narcotic administration. All the more reason to give...

  6. Can I bolus this patient? A legal / practice question about sedatives and narcotics

    aCRNAhopeful replied to simvee's topic in MICU, SICU

    I understand where the OP is coming from. I find "holes" in the system all the time in which I doubt nursing is completely covered by physician orders. The thing about this situation is that I think...

  7. OSA in the ICU

    aCRNAhopeful replied to TemperStripe's topic in MICU, SICU

    Our hospital does non-invasive end tidal CO2 monitoring on the floors. It is nothing more than a little monitor on an IV pole and a nasal cannula with a funny thing hanging down to "catch" and measure...

  8. PRN fluid boluses post open heart?

    aCRNAhopeful replied to aCRNAhopeful's topic in CCU, Coronary, Cardiac

    I've heard of places like this and I do understand the appeal, but didn't you ever worry? You're basically doing the CT surgeons job for him and if you do it wrong all he has to do is say, "I never...

  9. SICU New Grad Preceptor Problems

    aCRNAhopeful replied to kimpatrtan's topic in MICU, SICU

    Obviously I don't mean play stupid to the point where they think you ARE stupid. But if your preceptor tells you something that you know is wrong or based on a misunderstanding then take a second...

  10. SICU New Grad Preceptor Problems

    aCRNAhopeful replied to kimpatrtan's topic in MICU, SICU

    Just play stupid for awhile. Nothing is more awkward than knowing more than your preceptor about a topic. I've had similar experiences in the past. It's like you know that they are a 10x better nurse...

  11. ICU/CCU fast paced??

    aCRNAhopeful replied to Abishag's topic in CCU, Coronary, Cardiac

    Well the not charting part of your experience is what gave you so much downtime. Yes, there CAN be downtime with a low census/low acuity day or something but otherwise you stay pretty busy. One...

  12. SVR too low!!

    aCRNAhopeful replied to HeartRN80's topic in CCU, Coronary, Cardiac

    I believe adding volume does increase your SVR. While it doesn't constrict your vessels like you typically think of an increased SVR it does add volume and pressure to those vessels and therefore...

  13. SVR too low!!

    aCRNAhopeful replied to HeartRN80's topic in CCU, Coronary, Cardiac

    I agree that CO and CI would be much lower. A sick cardiogenic-shocked heart wont produce a hyperdynamic circulatory state IMO. To answer the question about the low SVR: Was there a long CPB time? It...

  14. bolus and GI bleed

    aCRNAhopeful replied to fiveofpeep's topic in MICU, SICU

    I didn't know that it was ever appropriate to give lasix to a severely hypotensive patient? Was there an echo done or something that really made this doc think there was a cardiogenic aspect to this...

  15. bolus and GI bleed

    aCRNAhopeful replied to fiveofpeep's topic in MICU, SICU

    Giving fluids WILL absolutely help oxygen delivery. You need adequate volume to have an adequate cardiac output. Of course they also need

  16. bolus and GI bleed

    aCRNAhopeful replied to fiveofpeep's topic in MICU, SICU

    Yeah that sounds stupid to me as well. When the nature of your problem is so obvious and the risk of being wrong so small why would you initiate a treatment that merely changes a number on the screen...

  17. Question re. applying a tourniquet post flu shot anaphylaxis

    aCRNAhopeful replied to laurasc's topic in General Nursing

    I agree that it would do no good. It's already systemic like you said. Time would be better spent maintaining the airway and

  18. Do you stop vasopressors(/inotropes) during a code?

    aCRNAhopeful replied to Sedate&intubate's topic in CCU, Coronary, Cardiac

    There are many who don't really believe in a "max" dose. Sure, if you have time, then stop at the "max" and start another gtt. But if you don't have time, then don't stop at the max dose and just let...

  19. CRNA- is a strong science background really relevant towards being a CRNA

    aCRNAhopeful replied to jessicanursing101's topic in Certified Registered Nurse Anesthetist, CRNA

  20. Drips

    aCRNAhopeful replied to A_Simp's topic in CCU, Coronary, Cardiac

    You'll have to be more specific about what you would want on this spreadsheet. It could end up being a pretty lengthy document. Just find a good drug reference that sums up what you need to know about...

  21. Wrong label on drip..suggestions?

    aCRNAhopeful replied to Da_Milk_of_Amnesia's topic in MICU, SICU

    Wow both of those situations suck (the amiodarone and the potassium mix-up). Now I seem to remember something from school regarding this. Its my understanding that nurses are NOT responsible for...

  22. ICU Ratios in the US

    aCRNAhopeful replied to ShaunES's topic in MICU, SICU

    Vents really are never an excuse for 1:1 in my unit. It does happen that they will be 1:1 if staffing allows but if thats the most invasive thing they have they are 1:2. Patient like open hearts,...

  23. Turning Patients

    aCRNAhopeful replied to Sg0223RN's topic in MICU, SICU

    Well first off I would never think about attempting it myself or with two people. Probably need at least 3. It can be hard to have empathy for these people since it seems like often times they are...

  24. communicating w/ pts on ventilators

    aCRNAhopeful replied to turnforthenurse's topic in MICU, SICU

    I tell them not to try to mouth things since lip reading is nearly impossible when you have a plastic tube stuck between your teeth. Ask them if they are in pain, uncomfortable, need suctioned, need...

  25. Critical Pt and More stable Pt

    aCRNAhopeful replied to BellaInBlueScrubsRN's topic in MICU, SICU

    Oh my! How do you ever keep your Press Ganey scores