SCNuttyMeg

Hey There! I'm PCCN certified and have been for over three years now. When I studied, i actually used the ACCN CCRN Dvd'd (because It was cheaper to borrow than buy PCCN), I went to a two day class PCCN review, and used the PCCN Certification Book by Brorsen (great book, worth it to purchase). I studied for a good six months before taking the exam. I personally felt the exam was harder than the NCLEX which I had taken! Good Luck!

Hi, A little over a year ago we started doing insulin gtts on our telemetry units for our post open hearts. We were told a 3:1 ratio for those nurses with the gtts but lets just say it was 4:1 days 5:1 nights. Unfortunaly if you were short that night you would have 6:1 (which was a problem). I moved to an all medical telemetry floor in January and we do preop open hearts, pre/post pacemaker and ICD's on insulin gtts(depending if they are diabetic, and the doctor) I have a 5:1 ratio. I had a gtt the other night with 5 patients. It keeps me constantly busy but luckily I work with great staff who usually take the fingersticks for me until I can get all my assessments, meds, etc taken care of for my other four patients. The gtts are time consuming and will keep you on your toes all night. I think a lower ratio would be nice but I also know where I work....its an impossible request. Good Luck!!!

This week I had my first PD patient. I have never had any clincal training on these machines when I was in college or nor in the hosptial setting. This was the first time I had seen the machine etc. This patient had been on our floor since october so some of the other nurses had learned how to work the machine etc. Luckily the patient was young and able to work us through the hooking and unhooking process. She actually had the same machine we used at home. I was up front and honest in making her aware I had never done this and she was mroe than happy to work me through the steps. We have a floor dedicated to renal but of course when they have open heart surgery they get places on a cardiac unit. It actually wasnt that hard except filling out the sheet. If they come to us we the nurses take care of the PD.

Within the last month we began using insulin gtts pre and post op on our surgery patients. When we were inserviced on this gtt we were informed our pt ratio would be 3:1 and the floor would only have one gtt at a time. Well we are only taking one pt on insulin gtt which is most often the post of patient because we only take post open hearts. The issue at hand is the ratio 3:1 is not being used. I had a pt last night with an insulin gtt and started out with 3 pt's. I still managed to get behind because I was constantly having to go back to my gtt since my pt was still being monitored anywhere from q30 min to q1hr. At 2300 I then picked up my fourth pt. I was then informed that if our beds were full I could take up to five pts including a gtt. I'm interested in hearing anyone elses ratios or if you have any research that your aware of on these gtts. Thanks for your help

We use reopro occasionally for our post intervention cath patients. Most of the time we use integrillin. We have a 5:1 or 6:1 ratio on nights. We do the frequent vitals and observation with pts on reopro as we do with our pts who have not had an intervention. Of course if pt is bleeding from site and on any of the above drugs they will recieve closer monitoring.

I have the master cardiology III and I absolutely love mine. I have no problems picking up murmurs,rubs, and lung sounds. I must say I havent even heard of the ultrascope, I might have to check into it. Most of the nurses on the floor have a master cardiology and seem pleased with the results.

On our standard post op orders it states to continue previous orders. We do not rewrite the previous orders as written before we just continue what was already written. Pharmacy continues all meds ordered before procedure, continuous labs remain ongoing. The previous diet is changed back from NPO status. We have also started doing this with transfers to different floors. If they are moving from a non-monitored bed we just get an order to continue previous orders and meds. We do not transcribe all the medications, activity, diets etc over. The only time we get orders rewritten is from transfer from Unit to floor but thats obvious. So far it seems to work out well. I have noticed where meds were not written exactly the same when transcribed for the second time, easily to correct if caught in time.

Hey, I graduated almost 2yrs ago and I started on a cardiology floor. We take post open heart pt's once off the vent, post cath, MI's, Strokes, CHF, plus anything else the cardiac surgerons operate on. I have no regrets at all going straight to a cardiology floor. You get med/surg plus cardiac. If I had the chance to do it all over again, I would not change a thing. We have a lot of new grads that start on our floor and they do very well. Good Luck in your decision. I say go for it!!!

This is a stupid question but what is NSTEMI??? I could tell you my guesses but I think Ill pass. Okay I will....Non ST Elevated MI???

I had a pt last night who was +for decreased BP and HR according to the tilt table test. The doctor wrote he had vaso depressive syncope and started him on clonidine. I asked very experienced nurses what was vaso depressive syncope and why would he be started on clonidine...seeing clonidine lowers HR,BP and can cause orthostatic hypotension. I have not been able to find any helpful websites online to answer my questions. Can anyone help me understand what is actually going on with this dx and why clonidine was the drug of choice. Thanks :)

I'm a new grad and I wanted to work nights. I had worked two year of nights while as a tech and Its an adjustment to your body. When I work I try to stay up late the night before my first shift so ill sleep through the day. Wake up around 3 if I have errands to run...4 if not. When i get off work I go to bed between 9-10 and wake up at 4 for another night. The bad part is when you get off work and you dont have to work the next night. Dont sleep all day!!. Get 4hours or so and get your butt out of the bed and get moving or you will be up like me :) AS a new grad I have more time on night shift to look things up, learn the ropes at a slower pace and try to comprhend whats going on. Until i feel more comfortable and more independent Ill stay on nights. I love it. And yes you can catch a few workers catching sleepy eye here and there. Good Luck

If your studying for the nclex....Kaplan RN study book had a whole section on how to determine if a certain thing can be delegated. I used it for when i took the nclex in june and it helped me. Good Luck

I work on a cardiac floor and hand out amiodarone like its candy. He really needs to take it, it usually converts the rhythm back to SR. The main effect ive seen is extreme nausea if not taken with food. I read that someone said it can cause a stroke this is true but where i work they do a TEE to see if there are any clots before a cardioversion is done so a stroke can be prevented. Is your husband having one of those done? It is good that he is on coumadin to try to preven clots. Even after cardioversion ive seen patients convert back to the abnormal rhythm. Hope everything goes well :)

Hi TwinRn, I saw that you were interested in the columbia area and specialty in pediatrics. Palmetto Richland Memorial Hosptial has a Childrens Hospital within it. They have the pediatric floor and also a Pediatric Intensive Care Unit. The other hosptials in the Columbia are do not focus on children as much as Richland. It is also a very large hospital compared with the surrounding hospitals with approximately 700+ beds. http://www.palmettohealth.com Good Luck!!!

Of course the doctor was called, vasoline guaze applied, 4x4s and spongefoam tape applied. The patient was sitting up in the chair when this happened and his chest tubes and wires were pulled the day before. The patient had received a resp. tx which caused him to cough and then the sucking noise began. No resp distress. What im trying to ask is what are the patients limitation while this wound is awaiting to be addressed in 12+ hours in the OR? He was going for a sternal wound reclosure that morning. Thanks again for the help :)

I am a cardiac nurse and I was taking care of a post CABG. During the day shift the pt developed a sucking chest wound on the lower part of the inscion. It was pressure dressed but continued to drain moderate amounts of blood. This was the first time Ive had a patient with this type of wound. Could anyone help me with the precautions that should have been taken. I wouldnt allow the patient to get out of bed, stop resp treatments because the coughing increased the bleeding etc. What else should I have done???? Thanks for the Input

Congrats on Graduating in DEC. Before I graduated I took a review course by sylvia rayfield. She goes all over the US teaching a 3 day review course and once you pay you can attend again for free. I also purchased her Insanely easy books (2) which helped me tremendously since im more of a visual person. Saunders also publishes a good question and answer book with a cd-rom that I used. Kaplan didnt help me much nor did the princeton review books. I took a month to study and focus on my weaknesses between the day I grad to the Day i took the nclex. Passed 1st time. Hope things work out well for you!!! Have a good thanksgiving too. Meg

We had an issue over the weekend and I was curious to what type of patients do other telemetry floors accept on the floor. Do you accept patients with positive cardiac enzymes?? What is the highest amount of NTG drip will you allow a patient to be on?? Thanks for your input :)

This Topic has raised questions in my head!!!! Im a new grad and really never gave this much thought till now. We send our patients to xray, ctscan, mri, for caths, to surgery WITHOUT a monitor on. Their is a nurse present when the patients is taken to cath or surgery. The transporter is the only one that is with the patient while going for a test. To be honest Im not sure if these transporters have any special training...Id like to hope so. Great topic ill have to figure out the reasons why we dont monitor or send RN's.

I went to work on a cardiology unit in july after i passed my boards. As more and more I work I realize hosptial isnt for me. I have a passion to work in the community and work with prevention efforts. I figured having a few years under my belt in critical care would be beneficial in the long run. I tolderate my job and enjoy the type of patients but this isnt for me. I know where your coming from.

Usually Family Memebers who sue dont go after the nurse, they go after the hosptial. Who can they get more out of?? A hosptial. We had a case where Im from when a Nurse gave blood to a patient with Dr. Orders to a Jeovah Witness who didnt want blood. He is sueing the hosptial not the doctor or the nurse who gave or intiated the orders. Hope everything works out well for your friend.

I was taking sarafem for a year straight every single day for PMS. It seemed to work better than just doing it before my period. After a year I began to have periods 24/7. Instead of just changing my birth control he also changed me from sarafem to zoloft saying this would help. Oh boy he was wrong. The mood swings are back, irritability, aches and pains are back but not as extreme as what they are without anything. Sarafem did the trick with me and I hope to be put back on it again soon.

To Become an OR nurse you still have to go through an accredited nursing program. My friend just graduated in May and went directly into the OR with no exp. She was required to take a surgical tech class at the community college to become familiar with the instruments but otherwise it was on the job training. When you graduate find a good intership who will provide you with classes related to your interest. I went into cardiology and just finished an internship with tons and tons of classes related to the heart. Good Luck

Hey SC, Just wanted to say hello to all the fellow nurses and future nurses. I'm a new nurse. I just graduated with a BSN in May. I see that most of yall are from the charleston area, any one in the columbia area? I also wanted to say that Lander University has a RN-BSN online, Its been a very successful program. Good Luck to Everyone Meg