Rookie12

Rookie12 specializes in PICU.

Rookie12's Latest Activity

1. 

   Nursing then NP or CRNA as a second Job.

   Rookie12 replied to jobjohnson's topic in NP Students

   Look into PA school. Would probably be the quickest route to a decent paycheck in the medical field for your situation
2. 

   Intralipid (20%) infusion administration

   Rookie12 replied to harryalexx's topic in PICU

   We pretty much always run TPN and Lipids together and it's pretty much always central (can go peripherally with the proper dextrose concentration) I've seen drips run with TPN/IL when access is an issue though its not ideal. When compatibility and access is an issue we may have to put the lipids and/or TPN on hold to give meds/antibiotics. If running drips, the biggest pain is having to change out all the lines for the drips Q24hrs if its with the TPN/IL! We also mix a lot of our drips ourselves...pharmacy will make them but they usually take too long and we get impatient...when you need an epi drip you need it 5 min ago not in an hour!!
3. 

   Question about zeroing lines

   Rookie12 replied to meluvsquki's topic in PICU

   Yes!! Thank you
4. 

   Question about zeroing lines

   Rookie12 replied to meluvsquki's topic in PICU

   janfrn, your explanation makes a lot of sense, it was never explained to me that way. So once you've zeroed your line initially you don't need to do it again, but you do need to relevel when you change the patients position, is that correct? Our policy is to zero our lines once a shift does anyone else do that?
5. 

   daily weights in your unit?

   Rookie12 replied to picurn10's topic in PICU

   Usually the most we would weight a patient is 3Xweek. All our beds weigh and some of our cribs. For the beds people ususally zero the bed and attach a sticker at the bottom of the bed stating what the bed was zeroed with. Everyone tends to make their beds the same way but the sticker helps avoid confusion, although honestly if they're not a chronic or really sick kid who we expect to stay awhile we usually just stick with the admission weight
6. 

   Sedation Woes...

   Rookie12 replied to MegNeoNurse's topic in PICU

   Jan I would be interested to hear if you learn anything from the rep. I have seen both, some kids awake and calm on the max dose of precedex, and also awake and agitated. I've also given it as a PRN to one particular chronic patient and it would knock him out for 12 hrs sometimes and other times not even have the slightest effect...So all in all i'm unsure how I feel about precedex but it is still relatively new so i guess we'll see!
7. 

   Sedation Woes...

   Rookie12 replied to MegNeoNurse's topic in PICU

   DO you guys like precedex? We've been using it more and more lately but I seem to find that we have kids on the max dose and they are still wide awake and require the versed anyway...We used to only be able to use it for 24 hrs but now its up to the MD's discretion...we've been using it a lot on our ENT patients
8. 

   Magnesium Sulfate for Bronchospasm

   Rookie12 replied to AnnieOaklyRN's topic in PICU

   We also still use mag regularly in our asthma pathway. I haven't seen the use of ketamine for status asthmaticus at our facility yet, though I am still new :) we use terbutaline IV if continuous nebs aren't effective.
9. 

   probably a dumb question about PIVs and drawing blood...

   Rookie12 replied to rach_nc_03's topic in Pediatric

   i work on a PICU and we will draw labs from a PIV if we can get them. We don't return waste on a PIV however, only on PICC lines or CVL's. Why is drawing labs off a PIV with MIVF running so different than drawing labs of a PICC with MIVF running?? I'm curious that this practice seems so different everywhere! What does the research say is wrong with blood from running PIV's?
10. 

    Does anyone have info on IV potassium in their clinic?

    Rookie12 replied to Vampgirl143's topic in Ambulatory

    Patient Type Type of Infusion Maximum Rate Site of Infusion Maximum Concentration (a) Monitoring Guidelines Adult Maintenance (non-urgent replenishment) 10 mEq per hour Peripheral 60 mEq / liter serum K+ at least daily; monitor for signs of hyperkalemia(1) 20 mEq per hour Central 100 mEq / liter serum K+ at least daily; ECG monitor; signs and symptoms of hyperkalemia(1) Acute Replacement 10 mEq per hour for serum K+ >3 but = 40 mEq infused; monitor for signs of hyperkalemia(1) 20 mEq per hour for serum K+ 20 mEq / 100 mL most commonly seen serum K+ after 40 mEq per hour infused; ECG monitor for rates >=20 mEq per hour; monitor for signs of hyperkalemia(1) 40 mEq per hour for serum K+ 20 mEq / 100 mL most commonly seen serum K+ after 40 mEq per hour infused; ECG monitor for rates >=20 mEq per hour; monitor for signs of hyperkalemia(1) 40 mEq per hour Central 40 mEq / 100 mL as above: ECG for rates >=20 mEq per hour or concentration >=40 mEq per 100 mL Pediatric Maintenance (non-urgent replenishment) 0.3 mEq//kg/hr to a maximum of 10 mEq per hour Peripheral 60 mEq per liter serum K+ at least daily; monitor for signs of hyperkalemia(1) Acute Replacement 0.5 mEq/kg/ dose over 1 hour to a maximum of 20 mEq/hr. 1 mEq/kg/hr may be given to symptomatic pts at discretion of an ATT MD (max 40 mEq/hr) Peripheral 80 mEq per liter serum K+ prior to administration and within 1 hour after infusion completed; ECG monitor for all patients ; monitor for signs of hyperkalemia(1) 1 mEq/kg/hr Central 40 mEq / 100 mL serum K+ prior to administration and within 1 hour after infusion completed; ECG monitor for all patients ; monitor for signs of hyperkalemia(1)
11. 

    Preceptorship: Peds Med-Surg or Peds Onc

    Rookie12 replied to mfrancisco's topic in Pediatric

    this was a very hot topic in my nursing program: should i request a preceptorship in the area i want or in med surg for a "well rounded experience?" in my opinion, you mind as well go for what you want if you can get it! any experience is good experience, plus you mostly want to focus on your assessment skills which can be accomplished on any floor. Sounds like you have a really good connection to the med surg floor so taking your preceptorship elsewhere shouldn't hurt your chances of applying for a job on the med surg floor later on. Plus who knows, maybe you'll love the peds onc floor and maybe they'll have a position available after graduation! Best of luck with whatever you decide!!
12. 

    Bathing Policies

    Rookie12 replied to umcRN's topic in PICU

    chlorhex wipes on anyone 2 months or older daily, if under 2 months soap and water daily. Might not happen on fresh post-ops mostly because people dont get to it as opposed to the surgeons saying no. Our CLABSI rates are also climbing...hmmmm
13. 

    Test your PEDS critical care knowledge

    Rookie12 replied to NotReady4PrimeTime's topic in PICU

    did decreasing the dwell time work or did the patient end up needing hemodialysis?
14. 

    Test your PEDS critical care knowledge

    Rookie12 replied to NotReady4PrimeTime's topic in PICU

    would you want to decrease dwell time to say 30 minutes? i think the amount of waste products diffuse more quickly at the beginning of the dwell when the concentration gradient is steepest. Isn't it rare to have hyperkalemia with PD? I had a very similar patient with diarrhea on PD who had hypokalemia. I'm a newbie so i'm just going out an a limb here...
15. 

    iv calculation question. help!

    Rookie12 replied to ading's topic in General Students

    the gtt's/mL don't matter. Think about it, if the fluid runs at 125 mL's and hour and there are 1000 mL's.... 1000 divided by 125 = 8 So it will take 8 hours for the 1000mL's to run out. If you start at 7 AM add 8 hours to that and that's when the bag will run out Remember to read to questions all the way through, sometimes there is extra information thrown in thats just there to try and confuse you!
16. 

    stony brook 2 year and work part time?

    Rookie12 replied to kimber8's topic in New York

    You can do it! As long as you are focused and organized I think you'll be fine! Realistically most people have to work these days to make it through school, I know I did! I'm not saying it will be easy, and a social life def. takes a backseat, but it will be over before you know it and worth it in the end! Best of luck :) PS I found having a dog to be really great during school as he was a great comfort and forced me to take some mandatory time outs for doggie play time!