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RescueNinja

RescueNinja

ICU, ER
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  1. RescueNinja

    IVP vs IVPB

    I'm really surprised to see people saying you need an order to piggyback something. I have never seen an order for anything other than "IV." You can dilute things as much as you want as long as it meets the minimum as specified in the policy or instructions from pharmacy. For example if policy is to reconstitute a gram of Vanco with 20 ml SW and you only mix with 5 ml, that's where you're going to run in to problems. In my facility, nurses on the floor are not allowed to push anything. They must use syringe pumps or piggyback. Nurses in critical care areas (ED, ICU, PACU) however can push everything that RNs are allowed to push per the BON. Some nurses still use syringe pumps in my department (ED), but I prefer to push almost everything that can be pushed. Of course things like Abx need to go in the syringe pump, but narcotics, lasix, etc all get pushed. You need to be familiar with your facility's policies. For example one place I work says up to 10 mg Morphine needs to be pushed over a minimum of 2 minutes and the other place says 10 mg should take at least 4-5 minutes. If my pt has never had IV narcotics before or if it's an elderly person, I will push the first 1/4-1/2 of the dose extra slow to make sure they're tolerating it ok then will push the rest at the speed suggested by pharmacy/policy.
  2. RescueNinja

    Holy guacamole, this new grad just scored an awesome gig!

    Congratulations!
  3. RescueNinja

    First shift off orientation.

    Wow I'm so jealous of all your orientations! I had 8 shifts before I was thrown to the wolves.
  4. RescueNinja

    What the what??

    Here you go :) Push the little pronunciation button at the top http://www.drugs.com/metoprolol.html
  5. RescueNinja

    What the what??

    So many of these drive me bananas. The worst is O2 Stats. Or the patient is statting at whatever. Those make my skin crawl! Shortly after I started a new job about an hour and a half from where I live (not far, but *very* different culture) I asked another nurse if she had any pts on Diltiazem so I could borrow. She said "dial-tye-a-zam?" I said, yes "dill-tye-a-zem." She didn't. I asked another nurse if she had any. She said "dial-tye-a-zam?" By the end of the shift they had me wondering if I was saying it wrong. I looked it up, I was right. It's "dill-tye-a-zem." The Metoprolol one gets me too. If you look it up, it's supposed to be pronounced Meh-tope-ruh-lol, but I'm guilty of saying Meh-top-ruh-lol. I work in emerg so I give a lot of MeTOProlol and DIALtiazAm
  6. RescueNinja

    low pressure alarm if trach comes out?

    I did not read through all the posts so this may have been posted already, but the very first thing I check when I have a trach patient (okay, second thing after code status) is that I have an extra trach at the bedside so that I can pop that sucker back in in case of emergency. Usually I keep two at the bedside. One that is the size pt has in and one size smaller - you don't want to be fussing with it too much in an emergent situation. Check your policies. One hospital I worked at required all RNs/RTs to be trained and signed off on emergency insertion before you were ok to do so, but at my current facility there is no training, but you are expected to do so.
  7. RescueNinja

    first code

    I have taken part in many codes including a few hours ago and yesterday too. My first was in my third semester of NS. None of them were my patients and none of them survived, unfortunately. Since I work in the ED, most of the codes I see now are people coming in VSA and paramedics have already initiated CPR. The prognosis is usually not the greatest. If they are Asystole when they get to us, chances are pretty slim that we will be able to bring them back. Of course I don't enjoy seeing people lose a loved one, but participating in codes doesn't bother me. I, like someone else posted, enjoy them. I am an andrenaline junkie. However I have never been to a peds code and hope I never have to...
  8. RescueNinja

    Oxygen by mask

    I agree with other posters. I would never wait for an order to put my pt on O2 if I felt it was necessary. You do need to be careful, but you will learn who can tolerate the O2 and who can't. Now I work in Emergency and we have a lot of directives that allow us to do many things independent of the physicians, but even in other departments I've worked in I would never hesitate to give something like Oxygen if my patient needed it. Once, while working on the floor, I got into a little bit of a heated discussion with a nurse who didn't want to go over 2 Lpm of O2 via NC because she was waiting for the doc to answer her page. It was her pt, but I was in charge that night and he was satting in the low 70s obviously very uncomfortable and in severe distress on the 2 Lpm. I popped on a NRB and he came up to the high 80s. He ended up in the unit on BiPAP by the end of our shift.
  9. RescueNinja

    Nursing in Nova Scotia

    It doesn't look that way, but I don't know for sure...here are the websites for the nursing Colleges. Good luck with whatever you choose. http://www.crnns.ca/ RNs & NPs http://www.clpnns.ca/ LPNs A lot of nurses I know have used Athabasca to obtain their BScN and enjoyed it. http://www2.athabascau.ca/programs/bnlpn/
  10. RescueNinja

    What can you run iv tylenol with.

    The only incompatibilities listed on Medscape are diazepam and chlorpromazine.
  11. RescueNinja

    Drugs used on adult critical care unit

    We use Propofol almost exclusively, but if BP is an issue and Levophed is not working well enough or if we are unable to wean pts off the Levophed within a day or two, we tend to ask for the Versed/Fentanyl combo also.
  12. RescueNinja

    critical care texts

    http://www.amazon.com/Critical-Care-Nursing-Made-Incredibly/dp/1609136497/ref=sr_1_2?ie=UTF8&qid=1322615881&sr=8-2 I don't have this book in particular, but I have several others from the series and LOVE them. They make everything so easy to completely understand. They are also great to prepare you for patient teaching as they are laid out in terms that are easy to explain to pts. I have the ECG one and it has really helped me learn the basics of cardiac monitoring and learn about the most common arrhythmias and how to correct/treat them and when to not worry so much. http://www.amazon.com/ECG-Interpretation-Made-Incredibly-Easy/dp/1608312895/ref=sr_1_1?s=books&ie=UTF8&qid=1322616090&sr=1-1
  13. RescueNinja

    am I covered by my facility when transporting?

    Your facility should have a policy on this. Mine does. As long as we follow our facility's P&Ps for our department/specialty we are covered.
  14. RescueNinja

    Scope of practice ?

    We thought this at my facility (LTC) too until one of our local coroners was angry that we hadn't been putting anything in the preliminary cause of death section of our facility's internal paperwork. He told us that it is not a legal diagnosis, but it's important for the nurses who have been caring for the pt to put what they think killed the pt as it helps the MDs get a better view of what was going on. If I am unsure I just put whatever their main diagnosis is. Most of the time it's expected anyway and the doctor has charted or told you what the disease process is at that time. In the hospital I work at we don't do anything like this, just LTC.
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