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Step-down, cardiac

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  1. queenjulie

    Reno/Sparks RN salary?

    My husband and I are considering relocating to Sparks to be near family who moved there, and because my husband is retired Navy and interested in working for Tesla. I'm an RN with five years' experience primarily in telemetry and Step Down with some ICU and house supervisor work. I've got BLS and ACLS. Does anyone know about how much a day-shift RN makes at NNMC? Do they pay PRN nurses more in exchange for not getting benefits? (I'm currently PRN at my hospital, and I get a big hourly increase because I don't get insurance.) Do the Reno hospitals have a higher pay scale than Sparks (i.e., would commuting into Reno be worth it)? Any info about working in the area would be awesome!
  2. queenjulie

    Orders from hell...

    I got a new admission one time of a CHF patient, and the family was furious when they asked what diet he had ordered, and I told them it was our low-sodium cardiac diet. They insisted, "He doesn't eat ANY salt! He has heart disease! He is on a NO SALT AT ALL diet!" I tried to explain as gently as possible that eating no salt at all would lead to death fairly quickly, and they were absolutely enraged. I have no idea what they actually fed the guy at home.
  3. queenjulie

    Is this real? Vein light

    Yep, it's real, and I've used it a bunch of times. Whether it's helpful is a mixed bag. It can give you a good view of the location of veins in someone with very dark skin, which is the best benefit as far as I'm concerned. However, it doesn't help you get in the veins if they're flat, dehydrated, rolling, etc. Also, they aren't much help if the patient is very swollen--the veins get hidden under all the fluid (which also makes them hard to feel manually, so you just have to do your best!). I think of it as giving you a head start, but it won't get the job done for you.
  4. queenjulie

    Avoid Kids at ALL Costs! Ch 8

    "Don't worry, none of this is breaking my HIPAA laws – photos of her are all over the news." Wowza. That statement was probably meant to be funny, but for any new nurses on here who might be unclear on privacy laws, just because your patient is famous or on the news does not mean you can talk about their medical issues!
  5. queenjulie

    Magnesium for oxygen absorption?

    I got an ER admit today who has COPD exacerbation. The ER nurse reported that she was given 2 g of magnesium IV to help with her oxygenation. I'd never heard of such a thing, and neither had the most senior nurse on my unit. I Googled and found one somewhat sketchy article that says that magnesium can increase oxygen binding to heme: http://drsircus.com/medicine/magnesium/hemoglobin%e2%80%99s-oxygen-carrying-capacity-magnesium/. Does anyone else do this or know if it's true? --Julie
  6. queenjulie

    Bleedind at PIV insertion site

    SummitRN is quite right--it's incredibly common to have a little blood leaking around a heparin or Integrilin drip, because they are anticoagulants. Now, if it's bleeding a lot, or the IV won't flush or the arm is swollen or something like that, that's a whole differen thting, and yes, you should pull out that IV and start a new one.
  7. queenjulie

    Coumadin therapy

    I'm on a primarily cardiac, high acuity step-down unit. Our Coumadin patients generally get a PT/INR every day or every other day, and if they're new to Coumadin, we refer them to our local Coumadin clinic, where there is a specific protocol. I think it's every day for three days or a week, then every other day, then weekly, etc.
  8. queenjulie

    Lexiscan vs. stress echo

    I'm on a Step-Down tele unit, primarily cardiac, and I just realized that I don't know the difference between a Lexiscan and a stress echocardiogram. Can anyone explain? It seems to be the difference checking for blood flow versus structural abnormalities--is that correct?
  9. queenjulie

    Pushing a Cardizem bolus

    Thank you! I thought I was going crazy when she said that!! I'm wondering if maybe she was thinking of Primacore. That makes me feel so much better!
  10. queenjulie

    Pushing a Cardizem bolus

    How slowly do you push a 20 mg Cardizem bolus on a person with afib with RVR? My patient was an elderly woman with stable BP but HR up to 150 BPM. I pushed her Cardizem bolus over four minutes and her BP stayed stable, but within ten minutes, her fragile little vein turned bright red and was extremely painful. She had crappy access to begin with and we couldn't get anything but a 22 gauge in a tiny vein. Lots of saline flushing alleviated her symptoms, and we started her drip at ten ml/hr. I looked it up, and most references say to push over two minutes, but my charge nurse said she takes 20 to 25 minutes for a 20 mg bolus! Is that crazy, or did I do it way too fast?
  11. queenjulie

    PCCN--is it worth it?

    Is getting a Progressive Care certification worth it? If you have one, did it help your career at all? I'm a relatively new nurse on a Step Down unit; I've been an RN for a year, so I'm just now qualified to get certified. My hospital just had a round of layoffs, and then our unit had a huge number of nurses leave due to the layoffs and management craziness, so there's room for new charge nurses, but I'd have to pay for the test myself. Until a few months ago, they paid for it, but now that our budget has been slashed, we have to pay for it ourselves if we take the test. Should I bother?
  12. queenjulie

    petechia/purpura during dying

    I had a patient recently who was actively dying, and during her last few days, she developed petechiae and purpura essentially all over her entire body. It was more than usual, but I know that petechia is very common in the elderly. Her family asked me why it was happening, and I realized that I didn't have a really good answer for them (I'm a relatively new nurse, and I rarely work with hospice or palliative patients). It's because of weakened capillary walls that allow blood to seep through, right? Or am I totally off base?
  13. queenjulie

    Any ADN-BSN programs without ridiculous papers?

    Why would a college *not* require you to write papers? Learning to do research and write critical papers is a vital part of a college education--one of the most fundamental parts, in my opinion.
  14. queenjulie

    Med/Surg Experience

    Honestly, our local psych facility is so understaffed that they definitely don't require anything but an RN after your name to work there. I'm sure they prefer med/surg experience or other psych experience, but it's not mandatory. But it's not a great facility and it's in a poor area, so there are good reasons why they have a hard time finding people--your local psych place may be different. You might call them and ask! Maybe ask you talk to the charge nurse and tell her you're interested in working there after graduation, and how does she feel about new grads? HR people often have very different expectations than the actual floor staff.
  15. queenjulie

    Accuracy of Automatic BP machines?

    We used to have that kind of BP cuff, but our hospital got rid of them because of concerns about infection, so now we have disposable cuffs that come sealed, and we give each patient one on admission and throw it away when they go home. Apparently the ones we had built into the wall were not disposable, and they obviously weren't going to throw away a permanent cuff with each patient! :) I actually thought the disposable cuffs were becoming a JCAHO standard, but maybe not--the change to disposables happened before I started working here.