cardiacmadeline

That's so sad! It amazes me how many nurses, including seasoned ones, don't understand how medications work and why their patients are receiving them. I see this too many times with beta blockers (I've administered these to patients with heart rates in the 50's) and insulin, especially lantus (I've adminstered to a patient with a blood sugar of 68 per the endo). If you want to hold a med, you call the md. You could be harming the patient by holding it per nursing judgement.

Bedrest time can also vary based on the type of closure device used--Angioseal, Perclose (?), manual pressure, etc. I've seen a patient bleed a week after his procedure.

I agree with psu, one of my biggest pet peeves is when nurses hold Coreg based on BP and HR and not seeing the big picture. I see his baseline HR was in the 50's and that he had been on it for awhile. I don't know your patients story or clinical picture, but I believe you did the right thing. Your preceptor and other staff nurses on your floor need some education on Coreg! If this was the sole reason you were terminated, I think you were wrongfully terminated. This is a post I posted a couple of years ago regarding Coreg and why you just don't hold it based on BP and HR alone: Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.

What was the patient's baseline heart rate? Was the coreg a new medication or had the patient been on it previously?

I have seen a nebulizer med given iv. It wasnt a common drug, I can't remember what it was. I don't recall anything happening to the patient.

I have tried to have a positive attitude about bedside report, but I hate it! I waste time looking for the offgoing nurse, and then I am told what I already know because I just read the chart! Now, if something is going on with the patient like an oozing groin site, I have no problem bringing the oncoming nurse in the room and showing them the site. I did that before bs report came along. Otherwise I really dislike it, but I am really trying not to have a negative attitude about it.

What if the patient coded? We have allowed a couple of people to sleep over and bring a cot in the room, but I tell them we need to have enough room in case something does happen like a code. I once had a family member bring a cot in and she was setting it up in a semi private room between the beds, told her she couldn't do that, we need room to intervene if something happened. We called a rapid response the next day on the patient.

It was my first semester of nursing school. 9/11 was the first day my clinical group was to meet. I was home studying and had no idea what was going on. My husband came home because they had canceled his classes for the day and he told me what happened. We turned on the TV and watched until I had to go to school later because my classes were not canceled.

If I was a doctor and received a phone call from a nurse asking to give a second norco to a patient still in pain after receiving one pill and there is an order that says you can give 2 pills, I would not be very happy and I would question the critical thinking skill of the nurses taking care of my patients. You have an order Norco 1-2 tabs every 4 hours prn The patient wants to start with one Norco and see if that works. That is administered at 0800. One hour later, he is still in pain so you administer the second one, AS the order states. After that he wants to take two norco every four hours. Since you administered the last one at 0900, he can start taking two pills at 1300. So 1 tab at 0800, 1 tab at 0900, 2 tabs at 1300, 1700, 2100, 0100, 0500 = 12 tabs in a 24 hour period. It is a simple order, shouldn't be that hard to follow. If I am ever in the hospital and need pain meds, I hope I have a nurse who can understand my orders and medicate me appropriately.

You are logging on so much into EPIC throughout the shift, you will have many chances to see that you have new orders. The icon telling you there are new orders should pop up on the first screen.

Love: 1) My cardiac and thoracic surgery patients 2) My coworkers (99% of them) 3) My pay and benefits, able to live comfortably 4) My elderly patients 5) The fact that I am not sitting behind a computer all day. I like the fast paced environment. Hate: 1) Press Ganey 2) Hovering, overbearing, know-it-all family members 3) Having to call people alot to see if they want to work extra and then having to leave the next shift short because everyone is tired of getting called and there is no help in the hospital 4) Patients who don't take care of themselves. Ex: continue to smoke with no intention of quitting even though there is a real possibility of losing their leg, ordering out pizza 2 days out from a CABG, etc. 5) When people outside of work ask me what the rash is on their leg. I don't know, I am a cardiac nurse!

2.4-patient totally asymptomatic

Pretty much everything can be scanned in, including tele strips and 12 leads, making it very easy for a doc to interpret when they are elsewhere in the hospital. As far as new orders, an icon will pop up letting you know there are new orders.

I live 45 minutes from work and drive a small car, nothing fancy. I have never had to call in for snow in the last 7 years. I stay up to date with the weather and road conditions. We shovel ourselves out, even shoveling part of the street once so we could get out. I leave early and drive 20 mph if I have to and I have never been in the ditch. The way I feel about it, I chose to live farther away and I feel I have a responsibility to my coworkers and my patients to be at work. Now I know there are going to be situations where people can't come in, and I don't get upset when people call in because they have tried and can't make it. But it is the people that don't even try or the people that live in town 10 minutes away from the hospital that irritate me. I worry more about dying at the hands of a drunk driver and some of those maniac, tailgating semi drivers than dying in a snow related accident.

I agree with you on this one. If my patient is taking prn pain meds every 4 hours, I will keep track of their next dose and bring it to their room so they don't have to call and ask for it. It's prn, as needed, they need it every four hours.