nmsumurse

Yes that was my argument as well muno. It looks like our neurosurg residents are not going anywhere though when it comes to these drains though, and they're not willing to listen to the bedside rn nor our educators in the surgical icu.

How do you recommend practicing spinals. I've heard of poking a watermelon to simulate it. During your schooling did you use landmarks for central lines or all ultrasound? Did you learn emergent airway techniques in school i.e retrograde intubation, has an airway disaster reared its ugly head in your practice?

These vein "finders" are not the godsend they are made out to be. ultrasound is a more reliable option that is a mix of using your current iv skills for larger deep veins. That can also be used when you have edematous or fluffy pts that you need to get those impossible blood cultures on or to get an abg.

there are also no receptors for vasopressin in the pulmonary vasculature, there are for levo, epi. When you have cardiac pt that are fluid optimized increasing pressors will effect your pa pressures.

Ever since we've started performing these surgeries at my shop, the spinal drains have been extremely problematic. Anesthesia places them in OR, but then neurosurg gets involved because of the spinal drain and claims all spinal drains in the ICU's are theirs. So because of this leveling has been extremely problematic. Our protocol for the TAAA surguries has them at the 4th ICS mid axillallary line. Neurosurg wants them and attempts to bully nurses into changing it to foramen of monro. How is this handled at your facility, hoping to accumulate evidence and other protocols to get neurosurg to butt out of the process.

Unless your staff is really strained in the ED due to in being on the smaller side outside assistance isn't ideal having outsiders come in can do more harm than good. If there is a surgeon, an ER doc or two, blood bank, xray, plus nursing staff there should be enough hands to get a job done. Is your hospital a teaching facility or is it private? Having 1 trauma surgeon establish control and going through atls protocol with people having a defined role is the best way to get things done quickly and not miss anything. In private hospitals that are trauma things can get tricky when multiple procedures are going on say the surgeon is performing a thoracotomy, he is no longer in a position to run the trauma. The Er doc must step up. Or both of them may be placing lines, chest tubes ect, and there are no hands left for medical procedures this is really the only time when you want outsiders coming in like anesthesia or picu attending. In traumas at my shop ed doc resident at head of bed with ed attending intubating, surgical residents placing alines, sublavians, chest tubes, senior resident running code with attending waiting to fill if things start to go haywire or needs to step in and dictate things. I've worked ed and ICU. The only tasks on me as the icu RN coming downstairs was to alert the nursing sup of bed situation upstairs, unless there was multiple trauma victims then you asked where you were needed.

If you are in an extremely bad situation where your mediastinals are clotted off you can also remove the chest tube from the atrium and advance a suction catheter into them if the surgeon is far away/driving in and you don't want the pt to tamponade. set up sterile field and have either 14 or 12 f suction catheter to 20 mm/hg suction. Either assist the physician if available with this or depending on the institution do it yourself. 20 mm/hg of direction suction will not damage grafts as opposed to the hundred or so you will create by actually stripping a tube.

So our protocol attempts the parkland fluid resus for two hours. If urine output is not being met during this process after two hours of increasing fluids, then albumin drip is added of 200 ml hr up to 400 per hr. If this fails ffp is added to the mix each unit of ffp is ran over 2 hours. If the burn started off 30% or more a vit c drip would have been started on a pt from the onset. if all these measures had failed fluid, albumin, ffp for something complicated like an electrical burn then a vit c drip would be added even if under 30% burn.

Yes there's a ton of variation. My unit we have a shower table, where mechanical debridment occurs with scrubbing, sometimes surgical with the bovie. 2% chlorahex soap is used during the process. We can take vented pt in the "tub room". Tub room procedure is very structured with timeouts and whatnot as the pt is very vulnerable during this time. End tidal is used on all pt, ekg monitor is attempted but mostly fails with water going everywhere. All vitals are taken q3 minutes, sedation nurse job is separated from the actual burn nurse dressing duties.

Do you have to get a dea number as we'll? How long does that take

I'm going to be in El Paso for clinicals as well looking forward to January. For those thAt didn't get in, keep your hopes up. I interviewed at 3 schools last year and got into 0/3.

I have the opposite of your problem all passion, bad grades (well only in principles of all things:banghead:). Obviously your an extremely driven and self motivated person if you can get through nursing school(with good grades) without seeing the light at the end of the tunnel in terms of achieving a nursing career.

I would say it's dependent on your other options as well as if you want to go to grad school. If you have any inclinations to go and get a master's don't go here! If you're in a C's get degree's mindset, then its an ok place to go. Every semester you will have a class where 20 or so people out of 40 are teetering on the brink of failing, where 5 or so people in your semester get left behind to take that one class again. Its a poor system, its impossible to get a 4.0; on your clinical paperwork your 1st semester in the program your instructor isnt allowed to give you a score better then an 88. To a friend I wouldn't advise them to go, unless it was their only feasible option to get a BSN.

A lot of people in the program are frustrated by the classes that have NCLEX style questions. The teachers want you to study the book, and they lecture really generally over the same topics covered in the book. Then when the test comes the most common statement is "where the heck did those questions come from?". The questions don't cover the content that was studied at all. Those who study the most really don't get their just dues in terms of a grade, and those who have a feel for the style(and don't study), get good grades!! Its really difficult to attain a grasp for NCLEX style when they don't practice it in class. The Kaplan, Saunders , ect, review books don't help because they are intended for the final nclex not he beginning nursing student. NMSU could be set up so much better, the method to the madness hasn't been seen yet.

I really do agree with the first post that the organization of the program needs work. First the way the classes are scheduled is bad. You have 4 classes plus the labs, and you go once a week too each class for 3 hrs and 50 min. It would be a whole lot better if they just heaped pathway, trads, RRunners, all in one lecture hall so the teaching resources wern'et diverted all over the place on different days of the week. The classes should be daily 1 hour each, everybody would learn alot more, yet we take brakes, get let out early (which is great at the time but in retrospect is a bad thing) and teachers themselves get tired. Secondly we are supposed to read ahead of time and the teachers go over really general information in the chapters they cover because they see us once or twice then its time to take the next test, then expect us to remeber really in depth stuff on the test. Thirdly I trust that all of are professors are really good nurses, but all of them are atrocious at lecturing, they often read directly off the power points which we already had access to ahead of time and already read. The wednesday labs were always insanely stupid, we can't do any procedures on one another (injections, or ng tubes), so the first time we do them will be on a poor sick patient; you will become very well acquanted with all the teaching dummies. You will also be getting alot of emails about course changes in hw and tests the night before often at 9 (which works great for me because I don't have a computer at home). Our semester is really bad at grouping up to study, I talked to a seventh semester the other day and they were really supprised and dismayed that we wern't helping one another to study saying it was what they attributed to their success and ability to get through (divided we will fall i guess). I am a very angry figth semester so I might not be the best source of info. Oh and for the incoming students you dont need a vast majority of the "required" books.