mochamonster

K+ of 1.5 yesterday and dropping with boluses. Didn't work today and I'm not back until Thursday.

I pray I have a good CNA, because they have always been the ones to make or break a float for me.

Here's what else I do: Zero the bed, lower it and put all the side rails down Remove blanket, top sheet and extra pillows Take the recliner out of the room (our bathrooms are big enough to put it in there) Ensure there are flushes, IV tubing, etc. Set up glucometer with strips, etc (and make sure it's QCd IV pump and pole And like Bec said, anything specialty once you listen to report (vent, art line/CVP set up, isolation cart, etc) We set up our own rooms, so we usually have the advantage of knowing what kind of patient we are getting.

I am interested in finding out how you all cope with giving post mortem care. It has never really bothered me, but I see, from my coworkers, that it bothers them. When I give post mortem care, I treat the patient as though they are still alive. I try to be gentle and sometimes talk to them. I learned this from my first preceptor. I have seen others who can't do post mortem care alone because of their discomfort with being around the dead. Others have covered their faces so they don't have to think about it I suppose. How do you all handle it?

This made me tear up. I'm glad she had that picture. ETA: in response to the post above this one.

The only thing I could come up with is perhaps they were previously compensating for an acidosis (respiratory depression from the morphine perhaps) which drove up the bicarb (which takes longer) and then started hyperventilating making them alkylotic. Does this make sense to anyone?

This is what I was thinking.

I stayed at school after class and studied there. I also started studying after they went to bed or got up early to study.

Thanks for your input folks. Unfortunately mine do respond to meds and are on the rarer side. I have neurological symptoms, but no pain. I felt like I was letting everyone down by not being able to care for my patients. I am sure I am being harder on myself than I need to be (which is my norm). I guess I'll just pray that these continue to be few and far between. I was caught off guard because previously I only got them when I pregnant or breastfeeding, this was my first with hormones taken out of the equation. I take some comfort that others deal with this and function well given the circumstances.

Hi everyone,So at work today I got an abnormal migraine and was unable to take care of my patients. Other nurses took over their care, but I feel awful because I was sent home by employee health and we were already short staffed. I haven't had one in a year and a half and was surprised by it, and now I'm worried about working in the future. Do any of you have migraines and how does it affect your ability to give patient care? Surely I'm not the only one with this challenge.Thanks.

Usually after, yes. What is prompting me to write this is a patient that has their days and nights so mixed up that they sleep all day and then they are a wild banshee all night. Unfortunately they had to be put back on propofol because they are so agitated. They are hallucinating and clearly have ICU psychosis, but all the psych meds seem to do nothing for them. Add to that they are a hard headed personality per the family. We just keep trying to get them off the propofol, but they seem to keep taking a step back physiologically from their agitation. So, yes, ideally off sedation, but even when they are sedated at times. This patient seems to be having more trouble than most, and I feel they can't help it either.

Hello everyone, It is my understanding that patients still experience sleep/wake cycles while sedated on propofol. However, I am having difficulty finding more information about this. I am curious if measures can be taken when a patient is sedated to prevent/minimize/correct ICU psychosis in patients who have been sedated for long periods of time and aren't receiving the normal cues for the sleep/wake cycle. I've already had patients moved to the east side of the unit to get morning sun, and tried other cues to encourage less sleep during the day, and I know night shift tries to make things as quiet and restful during the night as possible (though I know that is difficult or impossible many times). We also do sedation holidays every shift if stable enough. Your thoughts and info are appreciated! Mochamonster

I'm with ESME12, but like you say we weren't there and who knows what they saw. Mattmrn2013, COPD is not a confirmed diagnosis, just my suspicion from looking at the patient. They just "looked" like a COPDer to me along their decades long smoking history. Also, in any emergency you have to save the patient first. I'm sure they tried other oxygen therapies first and weren't successful with those. Many COPDers end up on BiPAP if needed to maintain their sats, you just have to titrate based on their response to it.

Point taken Altra. It is.

Thanks for your responses everyone. Patient was not a good historian. All the patient could tell was that they had a "lung disease" (suspect COPD, but ABGs were good on BiPAP) and history of heart fibrillation from the patient's adult child (a-fib perhaps?). Docs think CHF likely. Patient was afebrile and blood cultures were not back yet. I'm sure the patient will turn out to have positive cultures. ED was unaware of low urine output at the time. Pressures went up to 160s/110s and back down to 140s/90s-100s. Luckily lung sounds remained clear and patient seemed to be okay with the fluid, but I sure was trying to figure out why they would run in so much fluid. Usually our docs are a little more conservative with fluid, but I was not in the ED, so I'm not going to judge. Just trying to make sense of it. Thanks for your insights! I'm a new nurse and I try to learn as much as I can. :-)

Hello wise nurses, Perhaps you can help me understand this. Patient comes up to the unit with pneumonia, rules in for sepsis. Pressures in 140s/100s during time in the ED even higher in the unit but also tachycardic. Desaturated in upper 60s upon arrival to ED, on BiPAP saturating well now. Lactate under 2.5 but elevated, BNP over 5,500, BUN elevated (I realize in the ED they didn't have this info immediately). Patient given 2L fluid bolus wide open in ED. Urine output decreased. I cannot for the life of me figure out why the fluid bolus and my resources didn't see anything obvious either. The best I can figure is that the almighty protocol was followed. Am I missing something? Thanks for your input. Mochamonster

That is beautiful, thanks for sharing. Hopefully she dies with some dignity with her loving (and well-informed) family with her. Bless you!

Also, often times the person who knows the patient's health history best is not the physician running the code, but the nurse (at least where I work, ICU). A wise physician would ask if anyone else has any ideas before ending the resuscitation effort. Most, if not all, our docs do this.

Hello everyone, I am a new nurse in the ICU. Lately I have been dreaming about death a lot lately. Of course I know where this is coming from and I'm sure it's just my psyche's way of trying to reconcile what I see at work now. I am not upset by the dreams, since I know their purpose, but it is just about every night I dream about it. Has anyone else had the same thing? Should I worry, or will I "grow out of it"? Thanks, Mochamonster

Thanks for your response tonet. I appreciate hearing what it is like for an APRN who does work at the bedside. It seems like this arrangement works really well for you and your patients benefit from your added knowledge. I know I want to continue my education, but I want to expand my options in doing so, not limit them.

This is the exact thing I was concerned about. Since they are treating you as an NP and not an RN by asking your opinion and making decisions based on that NP opinion, are you not "practicing" as an NP when you are working as an RN? Also, conversely if something were to happen to your patient as an RN that you could resolve as an NP and you did not act, legally wouldn't you be held to that standard even if your employer requires that you only act as an RN? I've heard opinions from both sides, on here and in person. I suppose it just comes down to how much professional risk you are willing to take when working as an RN. Thanks for your input. I find this scenario to be quite interesting.

Because I have an inquiring mind and wanted to know, I've taken a 10cc syringe and filled it sucking up left over fluid from our IV tubing including the cassette. That was not counting the drip chamber.

This is what I was afraid of. It's a shame because I'm sure I'm not the only one who is interested in more than one area. It's one of the reasons I was drawn to nursing. I haven't gotten my MSN, so I guess I may just put that off a little to enjoy working at the bedside for a while since it seems I will not be able to return to it. Thanks for your response.

Hello all, I am curious if any advanced practice registered nurses also work at the bedside? I wonder if this is possible since, at least in my state, you retain your RN license in addition to your APRN license. Or does scope of practice become an issue? I realize you would be working in the capacity as an RN when working at the bedside. Mochamonster

There are many things that you will be taught in nursing school that is not practical in the real world. The key is to realize that nursing school is the ideal way to do things (ie. no budget or time constraints, no staffing shortages) and the real world is, um, real. I'm not saying one is right and the other is wrong, just different for different focuses. To answer your question, yes, this is how I was taught to take a BP in school too.