LoveActually

First of all....6 months orientation, you are lucky, embrace it and make the most of it! I had a little less than 4. Remember that it's hard being new (especially a new grad in the ICU!), and everyone makes mistakes, new and old! You should know your drips at least the most common ones. As far as exactly HOW they are titrated, it depends on your facility. Your continuous med infusion order set should tell you how exactly to titrate, or you may have specific instructions, but it should be on your MAR. You should be able to create a drip table. This is what we used to to until we just got Alaris pumps that calculates it all. You should know all about what is common in your ICU. Levophed, vasopressin, dopamine, dobutamine, nicardipine, nitro, amiodarone (need a filter!!!!!), cardizem, propofol, Versed, fentanyl. Less common in my ICU is epinephrine, Neosynephrine, Esmolol, Primecor and others, but if I can't remember what something is you better believe I'm looking it up. For the most common ones, you should know what they are used for, what the side effects are, what to watch for...You have to keep studying this stuff over and over, but the more you use them, the easier it gets! In the beginning, you are inundated with information and learning how to be a new nurse. Know this is all part of the process. I am still a new nurse, and still have questions every day, but it's so much better than it was a year ago when I was first off of orientation, and you will not always feel like a fish out of water! Don't stop asking questions...Whenever I'm about to ask a question that I feel like I 'should' know the answer to....I preface it with a smile and, "ok not to sound like a total dumbass, but I can't remember what........" A little humor goes a long way, and the only dumb questions are the ones that should have been asked....

For the most part families don't bother me. When I need them to step out so I can do an assessment, procedure, or just plain old need to think without distraction, or if I need to reduce the amount of visitors in the room, I kindly do so. I think about how I would feel if one of my loved ones were in intensive care. I would want to be there as much as possible. If I myself was in intensive care, I would want my loved ones with me. I do however, not tolerate disturbing the patients, or interfering with sleep, hanging in the halls or nurses station, and I tell them to stop watching the monitors, and will even turn the monitors the other direction from where they are sitting. I explain what I'm doing when I go in the room. If I'm hanging an antibiotic, I say so. If I'm giving lovenox or heparin, I say so, and explain it. And I do make it a point to ask how families are holding up, and if they are taking care of themselves, getting sleep, eating etc, and often encourage them to go do so, if they are not already.

why no nitro or cardene?

The only way I'm titrating in mL's is if it's Diltiazem which equals mg's anway. I ALWAYS titrate mcg/min or mcg/kg/min ALWAYS ALWAYS ALWAYS. Titrating by 5 mL's may be way too much or not enough depending on the concentration.

I think a big factor in success or not has to do with your orientation & amount of education (duh). I had 6 weeks orientation on telemetry & 8 weeks in ICU both with amazing preceptors. I went to more classes & had more education in the first few months, than I did in nursing school it felt like. I went to an 8 week critical care academy with classes and simulations while on orientation. I also went to endless classes at my facility...wait I still go to endless classes I have been off of orientation now for about 6 months. I was well-prepared & I never feel alone at work. Oh, and I work nights - that helps too. I don't regret going to straight to ICU - it has felt like the 'right' place for me since I stepped through the door for my first night of orientation . =)

My sister is going for OT. I think it sounds horrendously boooorrrrrrringggg IMHO

Can't Reglan do weird things to some people? From Wikipedia, so you KNOW it has to be the truth! Common adverse drug reactions (ADRs) associated with metoclopramide therapy include: restlessness, drowsiness, dizziness, lassitude, and/or dystonic reactions. Infrequent ADRs include: headache, extrapyramidal effects such as oculogyric crisis, hypertension, hypotension, hyperprolactinaemia leading to galactorrhoea, diarrhoea, constipation, and/or depression. Rare but serious ADRs associated with metoclopramide therapy include: agranulocytosis, supraventricular tachycardia, hyperaldosteronism, neuroleptic malignant syndrome and/or tardive dyskinesia.[6] Dystonic reactions are usually treated with benztropine or procyclidine. The risk of extrapyramidal effects is increased in young adults ([5][6] Tardive dyskinesias may be persistent and irreversible in some patients. In 2009, the U.S. Food and Drug Administration required all manufacturers of metoclopramide to issue a black box warning regarding the risk of tardive dyskinesia with chronic or high-dose use of the drug.[10]

As Nike says, Just Do it! "Go big or go home"

When I feel like I'm going to say something potentially stupid, I start out by saying, "Ok guys don't laugh at me, but...?" OR "This may sound REALLY idiotic...but?" Or "this may sound really dumb, but since I've been a nurse for like 5 minutes I HAVE to ask...." Or "Ok I'm having a brain-fart...but...?" Or "My brain is shutting down...and I know I know the answer to this, but I need you to answer my question...?"

Unless you are saying something good, of course

In addition to helping with the pressures, and recruiting different lung feels, proning with a bed works wonders for mobilizing all that crap in the lungs and sinuses. We don't keep them only prone, they get positioned at 45% angles (or other angles) too, with a rotoprone bed of course...

Ok this is going to sound dumb, but I look at the CVP monitor, after zeroing & flushing it, if the patient has one! No one has ever asked me to calculate it, nor have I learned how to as of yet. lol

I really hate it when the ED brings me a pt. on levo, takes them off the pump, doesn't tell me, and leaves the room, and then I take a pressure and the BP is TANKED, and I'm like CRAP! THE LEVO isn't even hanging! I have been a nurse for like 5 minutes, and this has happened to me 3 TIMES!!!!! Or when the ED chartS they gave Vanco at a certain time, but when I mull it over a little later, when I get my bearings, and I realize that Vanco should have been still hanging when they arrived, and then I call pharmacy, and they tell me Vanco was NEVER dispensed for this patient. I don't want to turn this into an ER gripe session. I'm just venting. Or when fellow nurses who CLEARLY have MUCH easier assigments, or ONE PATIENT sit around and ******** while I run around frantically with a newly admitted, unstable patient. (This doesn't often happen) Snotty doctors. Docs that don't order labs for patients that REALLY need them. And then I have to choose between getting the info we all need to care for the patient properly, and doing things that kinda out of my scope of practice. Someone who had blood transfused the day before & was on K-phos doesn't get a CBC, BMP & phos, or ANY other labs to boot? Really? Docs that aren't on board with protocols, that don't care, and want to do their own thing. Eg: sepsis protocols. Protocol says I use a Vigileo, and I have to report, and chart CVPs, SVV's CO's, CI's, and no one uses those numbers to guide the patients care, or gives a rats a$$? Day shifters that think we don't do anything at night. Our nurse aides which are totally useless. Not nurse aides in general, just the ones on our unit. Paper charting. Orders that take me a half hour to decipher. When the doctors STEAL my bedside charts. Not beginning report until 0715 because people are late. Not getting to go home on time because someone didn't show up, and I have to come back that night. This happened to me twice in the last 2 weeks. Nurses that forget it's 24 hours of care. Super Nurses. Nurses that forget what it's like to be a new grad! ok, I feel better now. And with all of these negatives I just mentioned, I remembered a bunch of positives

all of that is on our 'vasoactive medication' order sets, so unless the doc orders otherwise, we go by what is on the order set. and then I go and make a drip table on the computer, and print it out. of course...I know how to titrate with pen & paper too, but I trust the drip table more. and as far as for cautions...look that up in your drug guide when you hang a new drug. and don't forget compatibility. and know that some drugs don't work so well in with an acidotic pH eg. levophed. and patients needing levo are often acidotic, so pH oftentimes needs to be simultaneously addressed...

FYI, you can't be an RN and work as an aide, unless you give up your license. I have worked as an aide, and am now an RN. They are not two totally different things, but something that's all encompassed under total nursing care. We don't usually have aides, and when we do, I find them useless. I work in ICU, and our aides don't bathe people, turn patients, chart vitals, change boards, clean up messes, or do any of the stuff I used to do as an aide independently. Frankly, I don't really know what the aides in our unit do - that's another topic. Anyway, I give 100% of my patient's care, except for RT, and that makes me the nurse AND the aide, but I don't think of it that way, I just think of it ALL as nursing care from the hands on down and dirty ------> to the technical critical thought part. I love it all. I loved being an aide, and I love being a nurse a million times more, because I feel like I actually use my brain now. (Not that aides don't need a brain, but there was no mental challenge in it) And should you go back to school to become an RN? Of course you should! Go back and grow yourself, and make more money while you are at it!

Don't usually see it, but aw it happen the other day...the nurse they gave the assignment to was agreeable, a very good and very experienced nurse, and the CM had her back...

ahhh clonazepam klonopin prolly helped bring down the BP anyway, especially even if the pt was a wee bit anxious =) just curious how you were able to even *get* the wrong med though...did the patient already have klonopin on their med profile? just thinking about our system....write the order, scan to pharmacy, add order toon preprinted MAR, pharmacy either dispenses to us or enters into the Pyxis depending on what it is. So...if I wrote for clonodine...I wouldn't be able to get klonopin unless it was already on the profile... have had hydroxyzine & hydralazine PRNS on one patient before

I think it's a GREAT idea! You're so young, why not do both? And who knows, maybe you become a nurse, LOVE it, and go on to become an advanced practice nurse! OR you still go to med school, but can pick up shifts as a nurse and make REAL money while your friends are working at Target Best Wishes! With your ideas, and goals, though they may change along the way, you're going to do amazing things!!! =)

To the OP, I would stick to addiction support, and not look for it here necessarily. You flat out said "addiction" in your first sentence, and did not get appropriate responses to that, but you got a whole lot of other dieting advice and "just do it's". We who suffer addiction know that is just not possible. My solution was a Spiritual one. I just lost my sister the other day, and I have no desire to drink, or overeat. I would have really liked a few xanax for my flight home, because I have horrible anxiety to flying, and usually get my doc to prescribe me few for those instances but...I have never abused benzos. I'm going off on a tangent. Stick to the Spiritual solution. It works! Much Love Nurses should understand more about the disease of addiction

You must be joking? What's a good use for xanax if flight/anxiety coupled with the death of a loved one is not a good enough excuse?! Like I mentioned, I asked for a few xanax, not a whole collection. Caring & advocacy have EVERYTHING to do with it. It's OUR job as nurses to advocate, NOT side with the doc's opinion, as you just did. Unfortunately I didn't get a nurse to talk to. I should have gone to my own ER where I work, and would have gotten whatever I needed. Had I thought of it, and had time before my flight, I would have. This all happened so fast. And my original doctor would have prescribed be a few xanax in a heartbeat, because I have taken them to fly before. And drug seeker? I am their patient for crying out loud!!!!!!!! I have had SIX appointments with them in 2009, and am helping to pay their salaries!!!!! Oh, and yeah...I'm sure it would have been safe for me to DRIVE 2500 miles from AZ to PA? It took me FOUR DAYS and FORTY hours of driving to get here. I would still be driving and the funeral is tomorrow! I hope you are NEVER my nurse, or any of my loved one's nurses, and I hope you re-evaluate your outlook. Maybe you are old and burned out, and it's time for you to move on. To everyone else, thank you SO much for your kind, kind words, and suggestions. I got my hands on some klonopin, and my flight was bearable, no panic attacks. Was actually able to speak, and sat next to a very kind man, and even managed to dose off for a little while once I was up in the air.

I had the intra-nasal flu-mist months ago. No side effects. I had a seasonal flu vaccine too & got an ENORMOUS, painful hemotoma from that.

No I lost weight. I've been working nights for 5 months and I'm a new nurse. I bring healthy things to eat at night. I know how many calories I'm consuming in the 14 hours I am gone. When I get home I'm too tired for more than a bowl of cereal or occasional egg mcmuffin which is only 300 calories. And sometimes at night I'm too busy to eat (I work ICU, and many times it's non-stop all night). When I get up in the afternoon, I'm too tired to eat. In general, I care more about sleeping than eating. Then again, I've always been one to lose my appetite when going through any kind of stress, rather than stress-eat.

We prone all the time with rotoprone beds. Seen a few miracles happen after their use.

Have you ever tried a 12-step program? I did/do it for alcoholism. And when I drank, I didn't care about what I ate. I have been sober 2 1/2 years now, with no desire to drink, and weigh 25 pounds less because I'm able to make healthier choices these days... You can message me if you want to know more. Best Wishes.

My sister died unexpectedly yesterday. I am flying a red eye home tonight. I am so hysterical & I HATE flying. Like hate it to the point where I have diarrhea, throw up, feel like I'm going to pass out. I sweat the whole flight. Nevermind the fact that I just mentioned MY SISTER DIED, and I am alternating between being numb, and hurting beyond belief right now So I call my the doctor on call at my office. I tell the answering service my problem in a nutshell. I tell them my sister just died, I have to fly tonight, and I would like a few xanax. The ***** at the answering services goes, "yeah he's not going to do that for you." I say, "why don't you let ME speak with the doctor?" So...the answering service calls back, NOT the doctor and says, "So and so can help you out on Monday." Monday?! I just told you my sister died, I have to fly and I need xanax!!! I was asking for a couple - not 60!!!! And how passive-aggressive that the god damn doctor doesn't call back himself. I am SO done with that office. So I've only lived in the city I've lived for a few months, so I call my old doctor, who doesn't even know I moved, b/c I never transferred records etc. I saw her in Spring of 2009. She is amazing and miss her so much. Unfortunately she is not on call, and I get one of her associates. I calmly try to tell him the situation and what I need. He asks how I know what xanax is. I tell him I'm a nurse, and I've taken it to fly before. He asks me what airline I'm flying, what time I'm leaving. I tell him I'm flying US Airways and flying red eye. He the proceeds to tell me that he can't do that over the phone, it's a dangerous med, and I need to find another way to calm myself down. I stop him and say, "That's fine if you won't prescribe it for me." He keeps talking to me like I am a drug seeker, and I say, "LOOK. I APPRECIATE YOUR CALL BACK I JUST SAID I UNDERSTAND. HAVE A GREAT NEW YEAR!" and hung up on him. He just wanted to hear himself talk! I'm always there for my patients... Where's help when I need it? Are we the only ones that care?