raskol

My unit takes hearts post op day 2. We rely on percocet 5 or 7.5 q4 (1 tablet) or q6 (2 tablet). If that is not adquate, we get IV morphine, dilaudid, toradol, or talwin depending on the surgeon. We get our patients to the chair on day of transfer and walking by day 3, ideally. The RNs pull our own chest tubes usually when they put out less than 100cc in 8 hours when not walking or surgeon preference.

I had a vascular resident ask me what VICU was. I must have made a look because he went, "It's vascular icu isn't it?"

Just came home from another shift. Nurses who are already scheduled overtime this week will be mandated to stay past their eight hour shift because we have TWO NURSES for 28 beds. Because we were only scheduled three (due to severe staffing issues) and one called in. You bet, I love overtime but not forced and not in the 50 hour range every single week on shifts with only four nurses when we are suppose to have 6-7

On average I work 48-52 hours a week. My status is full time 40 hours, however my unit is at mandated overtime and has been since January.

I've been in health care for about 5 years both EMS/hospital. Up until last summer, all the places I worked had nitrile gloves. However, since the summer I've been using non-powdered latex. Well, now I am awaiting my blood work for a suspected latex allergy. (I think it might be contact irritant dermatitis from my internet investigations). The alternative at my facility are vinyl gloves. Since looking up allergies, I'd learned that vinyl gloves have an increased failure and transmission rate. When I asked employee health, I was told nitrile are way too expensive. But now I'm getting mad that I'll be stuck were substandard gloves. What gloves are used at your facility? Any recent changes to nitrile and how did it happen. I'm the floor representative for the research council and I'm thinking about proposing this as a topic and using it as my clinical packet.

I was getting a telephone order to test for possible HIT. The surgeon said to order HIPA.. well, I was tired and said, "HIPAA? Test for privacY?" He just laughed and told me I needed a day off.

I find it helps to know why they are on each medication. Is the EF low? Am I trying to increase cardiac output or coronary perfusion? How have they tolerated the meds in the past? Am I trying to keep them in sinus rhythm?

You asked what you could do differently. And now you know where to find stupid buried old labs. no big deal.

my floor gets a lot of post-op CABG patients.. they often come with a cordis...that I love for selfish reasons.. mainly I have great access and I don't have to worry about nurse collect draws in the AM.

Yeah, we don't have L&D. The hospital had different campus and mother&baby is on the other side of town. We did try the ED, waited half hour to borrow their doppler...they won't loan it for whatever reason. When I took report from the ED, the nurse stated she got heart tones but not a rate, because she would lose it before she finished counting. They also had abdominal/pelvic ultrasound ordered. AGAIN my hospital, for whatever reason, won't do pelvis u/s on pregnant women... and by the time I got that cancelled, her abdominal u/s got moved to the morning. The mother kept stating she could feel the baby kick.. so I pretty much went on that.

I had a question regarding fetal heart tones. I work on a cardiac step-down floor (our population is most commonly cardiovascular surgical patients) however the other day I had a 30 y/o female patient admitted with chest pain. However, she was 22 weeks pregnant. The only real treatment I was giving (all her cardiac workup was negative) was dilaudid 0.5mg IV q4. I called the resident.. as I was concerned at this choice of pain medication, as well as the fact her OBGYN had not been consulted and I could not monitor heart tones. (I have a vascular doppler. but it stated not for fetal heart tones.. and I think I only picked up mother's heart rate (100s)). After jumping the ladder, I finally got them to switch to stadol and they said it wasn't a big deal if I don't get heart tones. The attending the next morning said at 22 weeks monitoring heart tones is unnecessary since the fetus is non-viable at this time.. ANYWAYS.. my question is, as the experts in maternity,.. is it appropriate to not monitor heart tones, and was I right to be concerned about the dilaudid? I just want some guidance since at my dedicated heart hospital none of us nurses have experience with this population and we were at a loss at what to do with this patient. Thanks.

The order you call the physicians is dependent on your hospital and shift. You'll learn it on the job.

Hello fellow nurses, I'm a cardiac step-down nurse and my floor has all their nurses observe a CAGB due to the large amount of open-heart patients we get. I'm scheduled to go in the morning, and I'm wondering if anyone had any last-minute online resources so I can brush up on the actual procedure (like what a med student would study). I work a major academic teaching hospital, so the surgeons are used to quizzing the med students and I want to have a little bit better knowledge if I get asked (and the CV surgeons I know will). Thanks!

I'm mostly bummed because that wasn't even a good story.

Thanks guys you have been so helpful