takeittotheicu

First....I am sorry for your feelings of anxiety and confusion. But you just pretty well decribed me in nursing school! I have an ASN and I honestly think the first year we were made to "sink or swim". And please don't think that what you are experiencing will leave you being anything less than wonderful at your choosen profession. I passed it all the first time around.... but not nearly with the grades that I had expected myself to have. I was your standard "overachiever". You are aware that you are having problems, you are seeking out other avenues to further yourself and you are not taking the "just deal with it" attitude lying down. Believe it or not....you are doing what the rest of us do during a shift. You are getting a good education, it just may not all stick the first time around. You will learn a lot more once you graduate, I promise. Just keep your chin up! And your Xanax in hand! You can do this.....and you will be great at it!

Propofol is a global central nervous system depressant. It directly activates GABA(A) receptors. In addition, propofol inhibits the NMDA receptor and modulates calcium influx through slow calcium ion channels. Propofol has a rapid onset of action with a dose-related hypnotic effect. Recovery is rapid even after prolonged use. Propofol decreases cerebral oxygen consumption, reduces intracranial pressure and has potent anti-convulsant properties. It is a potent antioxidant, has anti-inflammatory properties and is a bronchodilator. As a consequence of these properties propofol is being increasingly used in the management of traumatic head injury, status epilepticus, delirium tremens, status asthmaticus and in critically ill septic patients. Propofol has a remarkable safety profile. Dose dependent hypotension is the commonest complication; particularly in volume depleted patients. Hypertriglyceridemia and pancreatitis are uncommon complications. Allergic complications, which may include bronchospasm, have been reported with the formulation containing metabisulfite. In addition, this formulation has been demonstrated to result in the generation of oxygen free radicals. High dose propofol infusions have been associated with the "propofol syndrome"; this is a potentially fatal complication characterized by severe metabolic acidosis and circulatory collapse. This is a rare complication first reported in pediatric patients and believed to be due to decreased transmembrane electrical potential and alteration of electron transport across the inner mitochondrial membrane. Otherwise, I've had patients complain of burning/discomfort at infusion site. Switching to a central line or PICC for infusion is optimal, if possible. And it can (in large enough doses) tint urine in a foley bag green...freaked me out the first time I saw it. That god for humorus preceptors! I hope this information helps. Hopefully, the other fine folks on this time can fill in any gaps I didn't think of....it's late and I've been studying.

All aboard the crazy train....now headed for looney ville and hysteria junction. And who says you can't tell a patient they are being inappropriate? lol. I've told people that before. You're in pain? I will do my best to treat it. You're scared? I will do my best to support you. You don't understand why? I will do my best to teach you. Something is making you uncomfy? I will try my best to fix it too. Sometimes.....you can't fix bananas. I stop just shy of letting people scream bloody murder and throwing temper tantrums. I can be one of the most tolerant nurses in the place....you have dementia? I understand that no rational speech will curb your behavior and I will keep you safe. Just about the point where she started screaming about her va-jay-jay itching...I would have cracked up and started snorting. I understand that it's not theraputic to laugh at your patient, but sometimes that's all you can do. I get that comfort is individualized...but come freakin on!!! It sounds like you did an awesome job at caring for her. But that's prob all you got to do....was take care of her. That always infuriates me. (Like the other poster....red faced and temples throbbing) And it never fails that the one who is super needy, isn't all that critical. I won't go into details now, but the last two nights were difficult for me.....on patient was a witnessed home arrest (Vfib) and prob has profound anoxic injury. (18 min without a pulse will do that to most) he was the one I NEEDED to manage. He can't hardly autoregulate anything right now. But my other guy was a big lumbar surgery that was POD 2.....and was mean/crotchety, demanding, and consistantly in pain. I don't doubt that he was in a good amount of pain....but he also had a morphine PCA 1mg demand q 5 min and oxy ir q 4. (Average hourly demand on the PCA do you ask??? 67 times per hour)He was using that thing like an atari joystick. He also had totaled up enough drugs to have knocked out a small mule. (Despite HOURS of teaching and re-enforcement about it) I seriously couldn't get 12 feet away without this man screaming out for me. I even got him a soft touch call light so he would be able to hit it. Sheesh. After more than a few hours of that behavior I simply told him that I was doing the best I could to manage his pain (everything we're taught to do intervention wise) I finally looked him in the face and told him "I am not going to be able to make you pain free. You had back pain before and you just had a big back surgery. And the only was to get you pain free would be to tube you or a large act of God." He settle down for about a minute....but that was all. You can't do it for everyone. Just thank your lucky stars it's only work, and you don't have to go home with her!

There are a few that I like..... If at first you don't succeed...then maybe skydiving just isn't your thing. You can't fix stupid. Stupid is Fo-ev-a.- Ron White "At the end of the day, the fact that we have the courage to still be standing is reason enough to celebrate."- Grey's Anatomy

I had a patient on a PCA of Dilaudid....at a VERY high rate. At 3:15am I went into draw her blood. She was talking....I asked who she was talking to. She had the phone up to her ear. She pointed at the tv, and stated "They get me everytime".....Wait....what? She was ordering an Orek vaccume cleaner. I had to tell the phone operator that the patient would have to call her back once she was discharged! LMAO.

I'm not sure what area of nursing you are in, but in the ICU there is a great tool. It's called a Levalign. It's a telescoping level to zero transducers to the patients phlebostatic axis. It's a neat little tool for CVP's, ICP's,etc. Jess