meepmeep

I guess it depends on your hospital's policies. I've only ever worked in one PACU. The PACU I work at doesn't do any neuro surgery but we do document PERRLA, vision, and oculomotor check for all sinus surgery patients since a loss of vision/abnormality could indicate a complication like an orbital hematoma or injury to optic nerve requiring immediate attention by the surgeon. We will also document PERRLA and neuro asessment for any patients who had surgery on their carotid arteries to watch for complications like stroke or hyperperfusion syndrome.

In the last couple of years, our medicine wards only used them for bathing MRSA pts and they are used for the pre-operative wash before OR for surgical patients. Otherwise all med-surg wards just use the no rinse spray cleanser. But all our critical care units use only CHG wipes for bathing with the barrier cream cloths for peri-care.

I'm from British Columbia. We have 12 bays in our PACU, 4 step down unit beds near by (which sometimes admits patients directly from OR if the other 12 bays are full) with 11 ORs running. We have no call bells. We have to give our patients those silly table bells you find at hotels if they are staying overnight. We don't get the cardiothoracic surgeries as they go directly to CSICU. I would say 90% of our patients come out extubated. We only get intubated patients that will probably be extubated within 24 hours or if ICU is full. It's not common for us to get preop patients since we don't have the space or staff. It only happens about once or twice a month for specific reasons that I'm not aware of. Our preop patients generally stay in ER or on the ward until they are called to the OR.

I'm still new to the recovery room after working in an ortho/general surgery ward for 6 years. PACU can be just as demanding and stressful as ward nursing as PACU is considered a critical care area and patients can be unstable. We even get ICU overflow patients when ICU is full. I'm still constantly stressed and overwhelmed but this is a new position for me, so I'm still learning to adjust to a new environment. There are some bonuses. I only get 2 patients max and I'm only an arm's away from both patients. The patients are on monitors so we know immediately if something is wrong. On the ward I could only check my patients hourly and was in and out of different rooms in a long hallway. I was definitely on my feet a lot more on the ward. However, if the patient is on a ventilator or unstable it's 1:1 nursing. We generally only do focused assessments, manage patient's pain/nausea, watch for immediate complications and once patients meet discharge criteria we can send them off. I like how patients don't generally stay long term in PACU and there is usually somewhere we can send them off to: phase 2 for discharge home, the ward, or ICU if extremely unstable. It's great when we have a delirious/aggressive/annoying patient we can't wait to transfer out. However, it gets really hectic when complications occur or we can't discharge patients because there aren't any beds available. Sometimes our ORs are on hold because we don't have space in recovery to recover them. I like how patients are usually sleepy so I just let them sleep. I don't like to make conversation. I don't have to wash patients as often compared to the ward or deal with family as much. My PACU has float nurses who help cover breaks, help with admitting patients, and do anything you need. Whereas on the ward, we didn't have float nurses or care aides and had to cover each others breaks. Obviously each PACU unit runs differently, so I can only tell you what I like about mine.

Thanks for the tips. The calipers did make identifying the distance between P waves easier and I managed to get the same atrial rate as the book for the mobitz I blocks. However, for the mobitz II blocks, the book seems to give weird numbers that would require math with decimals which I find odd and is too much trouble for me to bother with. Wonder why there is this inconsistency.

Hi there, I need help. I'm working through the "ECG Workout" book by Jane Huff in preparation for going back to school in September. I'm in the chapter that discusses junctional arrhythmias and AV blocks and for the life of me, I can't seem to understand how the book calculates the atrial rates for second (mobitz I/Wenckebach) and third degree AV (mobitz II) blocks. I tried to Google how to do it, but I still don't understand and most sites just describe the typical heart rate calculations. I know I'm dumb. I assume you count the small squares between each P wave and divide that number by 1500 which is what I do for the ventricular rate. But the number the book arrives with don't match for all the examples and some rates like 123 for atrial rate aren't possible according to the conversion table for heart rate in the back. (i.e. 1500/12 squares = 125, 1500/12.5 squares = 120, 1500/13 squares = 115) So how'd they get 123??? Then I wondered if it was some weird average, but still that doesn't make sense. I don't see anywhere in the book that mentions how to calculate it. So I'm missing something here and must be using the wrong method to figure out atrial rate? Any help is greatly appreciated.

Wow, I can't believe you guys have a way better orientation. Sadly, none of the health authorities here offer an orientation longer than a month. I'm only able to request an extra week or two of orientation at most. My situation is actually pretty bad. They gave me a choice of either staying another month on cardiac surgery or try 3 more months on a med/surg unit. I opted to choose 3 months on medicine. I don't really like medicine, but at this point I have no choice and my license is at stake if I don't progress in those 3 months...

I'm so scared and don't know what to do or what is actually going to happen to me. I just finished nursing school in Dec 2008 and started my first job as a RN on a cardiac surgical floor in Feb 09. I don't even know why I applied for cardiac nursing, except that I thought it was interesting and the staff was nice. Now I completely regret that decision. The ward is incredibly busy, we get 4 pts on days and 5 pts on nights and the patients are quite acute. I've been having problems with everything and making so many horrible mistakes that now my practice is considered unsafe. I'm so tired, stressed out, and depressed. The manager and the educators have spoken to me about my problems and I told them I felt that maybe I should try a less busy and less acute area. I know the educators and manager want to help me, but I feel it's hopeless for me. My coworker told me to try to tough it out on cardiac surgery as I've already been there for 3 months and starting to get to know the people and how things are done, but with my practice so unsafe, I'm really really scared of hurting someone. I feel like I'm doing worse as time goes by instead of improving. It sounds bad that I want to runaway from that unit, but I don't think I can handle it. But to be honest, I don't even know where I can go as I know all wards are busy and with my practice this bad, who would even want to hire me? Everyone is just wondering how I even managed to pass nursing school. I'm not assertive or strong enough to find references to back me up if I were to try to find another job. Actually I'm probably the shyest, timid person you'd ever meet. I feel so stupid. I'm so scared of losing my license. I feel like I'm a crappy nurse/person. I don't want to give up nursing completely since I only just started and I just need to get the experience and find something that suits me. My manager is trying to arrange a meeting for me with the nurses union on Monday. I honestly don't know what they would say to me, maybe I will lose my job/license. I have no idea how they would help me, as I don't know exactly what I want myself. I'm sorry, I just wanted to get my feelings out there. I'm so lonely and sad right now. It's just that I would like some advice as I don't know what I should do. I'm from BC, Canada by the way.

I passed! Now one less thing to worry about. lol. I'm from BC. Congrats to everyone else and goodluck!

Yikes... I'm scared. I'm writing the CRNE in feb too. I've been trying to get through the Mosby's comprehensive review book, and I'm only half way. My average scores from Mosby has only been 64%-68% so I'm feeling kind of hopeless. Mosby's is so technical, the CRNE isn't as detailed as the questions from Mosby's right? I have the CNA book as well, but I plan to do that after I finish Mosby.