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nminodob

nminodob

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  1. nminodob

    Any interview tips for a patient sitter/attendant position?

    I worked as a CNA while I went to school. I can tell you that the interviewer is not looking for someone who is a medical genius - rather, they need someone who will work within their scope of practice SAFELY. They want to know you will defer to someone with more expertise when you see a change in the patient's condition. They may ask you what you will do if you enter the patient's room and find them on the floor - of course, you will call for help, try to see if they are breathing or in distress, bleeding, etc. They will not want you to diagnose illnesses, or take it upon yourself to move an injured patient. Common sense stuff. You will do fine!
  2. nminodob

    Looking for general insights on a few common drips ...

    I work progressive care/ICU stepdown. Outside our expertise to hang vasopressors, but we hang amio (too convoluted a protocol to go into here, let's just say you and at least 1 other nurse will be reading the protocol line by lione as you follow, and the tele nurse will also be involved). We hang insulin as well, but generally q 4 hour fingersticks - most times in progressive care the charge nurse (where I work anyway) will refuse a pt if they require 1 hour ANYTHING - too much manpower involved since we have a 3:1 ratio. But there are times we do 1 hour checks for a short span of time, like DKA in a brittle diabetic. Heparin drips, pretty stright foreward, q 4-6 hour PTTs, just remember to shut off the drip before the lab draw or draw from a site a safe distance from the heparin, or you will get a bogus result. I have never seen a lidocaine drip in progressive care, but I gues anything is possible. And of course, most of these drips (especially insulin and heparin) require 2 nurse signatures. And it doesn't hurt to get another nurse to eyeball any drips you have hanging - just in case!
  3. nminodob

    How long does it take you to calculate the doctor's med/IV order?

    Nowadays between the pharmacy and the "smart" IV pumps, most of the math is already done for you - I'm not talking peds because I don't work in that area, just med surg. Of course it is critical that you be able to verify the math as well - otherwise you will have missed out on the RN check that may be the last opportunity a med error is caught. And sometimes even the pharmacy makes errors! The most difficult math I have come across was a pt on an argatroban drip - the rate was calculated by mcg/kg/min, and the concentration in the bag was 1 mcg per ml I believe, and the rate was titrated according to the latest PTT. Of course, the pump was in ml/hour, not mcg/min. We all had fun checking the math on that one! What I have learned so far is that the most importnat thing is to get someone to double and maybe triple check anything critical, never let that uneasy feeling go unheeded!
  4. nminodob

    Stroke pt with increased weakness and slurring

    All the posts were right on the money, but I would think if this woman was not already NPO then she probably should be at this point.
  5. nminodob

    Just realized, I think I hate ICU, prefer floors

    I work in a busy ICU step down unit and I love it - more challenging than floor nursing and more varied than ICU because we take total care pts as well as walkie-talkies. We see art lines, CVP monitoring, amio, dilt, heparin, insulin drips (to name a few), and respiratory support of all types except vents. Our pts are not on pressors or knocked out on propofol, but they are often on q 2 hour neuro/vital checks, etc. We are ever monitoring for a crashing pt, which happens constantly. Then we have to push to the ICU. Unfortunately, that's when we often have to take another admission! This rapid pt movement is exciting and demanding, and we have to be on our toes and work as a team to stay above water. Are other stepdown units this crazy? I'd love to hear from other ICU stepdown nurses out there. Registry nurses who come to fill in tell me no - that we are unique because we do so much...
  6. nminodob

    CEU's

    Get on one of those websites that offer online CEUs for a few dollars a unit - theres a bunch out there - I have no personal experience, but logic tells me that they would rather see you scramble and get those needed CEUs at the last minute rather than take a perfectly good RN out of the workforce! And the lesson to all of us is, keep good records!
  7. nminodob

    Those at the 1-2 year mark of nursing

    I am also at the 1.5 yr mark. There are still moments of panic and dread, but these are mixed with moments of pride. For example, I just had to re-cert for CPR, and while we were practicing compressions on a dummy the thought popped into my head, "I have done compressions during a code! On a real live person!" Realizing that made me feel so much more at ease while practicing on a dummy, that's for sure. Then there was a time the oncoming shift needed an ABG on a pt with an A-line, and I was the only available nurse in our stepdown unit who knew how to get it (or else the only one brave enough to attempt it with a crowd of residents and family looking on.) We only occasionally see A-lines on our unit. I got the ABG, zeroed the transducer again, and handed it off to the primary nurse. Whew! And no blood spraying anyone in the face!! Then there was the time I was floated to a med-surg floor with lower acuity, and I was given their most difficult patient - a trach, C-collar, jaws wired, who had been vomiting while being supine down in the MRI suite. This was a near disaster for all involved, but I was able to handle it OK and the patient recovered fine with a little O2 and suctioning. The other nurses on the lower acuity unit I had been floated to looked at me with a little more respect than I had been accustomed to, and one of them remarked that it was lucky for the patient that I had come from the ICU stepdown unit to their floor that night! And probably one of the most satisfying aspects of having a little experience under my belt is being able to conference with the residents about our difficult patients, and kind of "getting it" when the lab results show rhabdo, or a troponin leak, or central diabetes insipidus. None of this is meant to be "blowing my own horn" - well, maybe just a little! But these are all things that experienced nurses know, and take for granted to same degree - and these are the things newbies generally don't know, and why experienced nurses (who have forgotten what it means to be inexperienced) may roll their eyes a bit at the inevitable questions a newbie will ask. Someone once said that half the game is just "showing up" - putting in your time. This doesn't mean that the adrenalin stops flowing when you think about your upcoming shift, or that knot in your stomach completely disappears. It just means you kept yourself in the game, even when it looked like you were losing. Because you are not losing, you are becoming a REAL NURSE!
  8. nminodob

    respiratory arrest

    Learned something new today! However the comment by RN-Cardiac that 30 min reserve was possible was a real exaggeration! Thanks, Gila!
  9. nminodob

    respiratory arrest

    I guess that means you couldn"t find any scientific evidence for it either...
  10. nminodob

    respiratory arrest

    A Google search did not yield any information regarding a person's oxygen saturation remaining above 90% after 10 minutes of apnea, Gila. And to RN-Cardiac, nothing that I can find on the AHA website indicates a person may have up to 30 minutes of reserve O2. I would just like to see some scientific evidence of these "facts," since they seem a bit unbelievable.
  11. nminodob

    respiratory arrest

    I just recertified my AHA BLS and, although it is all over the news that the new emphasis is on compressions, the guidelines still included 30:2 compression/ventilation ratio for 1 rescuer and 15:2 ratio for 2 rescuers. And I am still curious to see some data on the 30 minute O2 reserve thing. Thanks
  12. nminodob

    respiratory arrest

    I get that the emphasis is on compressions, but I wonder about the "30 min O2 reserve" part - I can't find this anywhere on the AHA website. Do you have a link? This is new information for me. Thanks
  13. nminodob

    respiratory arrest

    "Assuming I have a healthy patient who is well denitrogenised, I could make them apneic for nearly 10 minutes or so before their saturations even fall below 90%." Sorry, but I have to challenge this statement - how have you verified this "fact"? I would hate to be the experimental subject!
  14. nminodob

    respiratory arrest

    maybe I am overthinking this, but if a person isn't breathing effectively you would want to give them rescue breathing after clearing their airway, and wouldn't this fall under the category of CPR? If not, why do we have to learn about rescue breathing when getting our CPR cert? CPR isn't limited to compressions and defibrillation...
  15. nminodob

    List of most commonly prescibed meds, please

    Let's not forget the always stimulating Senna and Bisacodyl!
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