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ventmommy

ventmommy

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  1. ventmommy

    Post-Extubation Policy

    Do you have a respiratory therapy department? There are definitely evidence-based best practices for assessing for extubation readiness, extubation, and post-extubation care. Extubation readiness: able to follow commands, off most sedation, minimal use of vasopressors, PEEP less than 8 cm H2O, FiO2 less than 0.5, a pressure support trial with minimum settings while achieving adequate tidal volumes. PS trial means different things in different facilities. A true PS trial would be a PEEP of 3-5 cm H2O, and a PS of 0-3 cm H2O. The patient needs to have a significant leak when the cuff is deflated, not be producing excessive secretions, and able to manage those secretions. Post extubation depends on the patient's needs. Many patients are fine on room air or 1-4 LPM NC. Some people will extubate to HHFNC, CPAP, or BiPAP. Some patients need a dose or two of racemic epi to manage swelling. And of course, some patients will fail extubation and need to be reintubated which is absolutely not a failure on the part of the RT/RN/MD.
  2. ventmommy

    What does your username mean?

    It's cool to see who is still here. I saw your post on like page 1 or 2 when this thread started! I'm not a nurse. I wasn't an RT when I joined. I am the mom of vent-dependent child (who has since passed away) and I continue to foster trach and trach/vent babies so I am VentMommy.
  3. ventmommy

    When family fails the patient... it breaks my heart

    And this is where our medical system fails patients. When further care is futile, care should be withdrawn and the patient should be placed on comfort measures.
  4. ventmommy

    As seen on TV

    I just watched "Shot" last night. Ironically it starred Noah Wyle (Dr. Carter on ER) as the main character and shooting victim. The message of the movie was phenomenal but every single bit of medical stuff was so horribly wrong from beginning to end.
  5. ventmommy

    Yet another ethical question...

    The V60 isn't necessarily the most comfortable thing in the world but it's very effective at oxygenation and ventilation. So if the patient is disoriented because of hypercapnia or hypoxia, it would be a good way to get them normalized to discuss their short- and long-term plans.
  6. Thanks Blondy....I lost 3 hours of my day falling into a rabbit hole of craziness because I decided to Google this. OMG. Insanity.
  7. ventmommy

    Working on More than One Floor?

    I can't imagine any hospital that would allow this because your PRN work would constantly be pushing you into overtime. More importantly to your wallet, all that OT would push you into a higher tax bracket so all those extra hours yield not so much extra in your paychecks. I have a FT job at one hospital and a PRN job at another. I usually get at least one call shift per week at the FT job and work 1 or 2 days at the PRN job. That is the best way to maximize income.
  8. ventmommy

    Relocating..? So scary!

    I love adventure and moving. I have lived all over this country by choice. Moving is fun and exciting! I moved all the way across the country when I was 18 and never looked back! I realize that kind of life isn't for everyone but it sure can be fun. No, there is absolutely nowhere in the country that has such an extensive mass transit system as NYC. If you are on the subway line, there are cities with good subways like Boston and DC. If you plan it right, you could avoid having to drive in Boston, DC, Chicago, Los Angeles, and San Francisco. Maybe Denver and Atlanta if you really plan well. There are many places between NYC and FL that would be closer to home. CT, MA, NJ, RI, and parts of PA would all be a day trip back home if you wanted to see your family. FL would be a 2-3 day drive or a plane ride. Also consider what kind of weather you want to deal with. FL has hurricanes and tornadoes. My next move will be to get away from the Mid-Atlantic/Southern weather problems.
  9. ventmommy

    Influenza vaccine

    I get a flu shot every year. Every year I get sick with fever, chills, cough, muscle aches approximately 24 hours after the shot and it lasts for 48 hours. I plan for this so I am not scheduled to work. This reminds me of a funny story that happened to me the other day. I was at Walgreen's at the pharmacy counter. The pharmacy techs are asking everyone if they would like a flu shot. They used facts (80,000 people died from the flu last year) and perks (it's free for almost every insurance). The lady in front of me was picking up a ton of medication for herself and her young children including blood pressure medication, diabetes medication, and asthma medication. To the flu shot question, she says "I don't need that. The good lord Jesus Christ will keep me safe." I commended the pharmacy tech on not rolling her eyes and not pointing out that JC wasn't helping her with her weight, diabetes, or asthma.
  10. ventmommy

    Should I, should I not?

    If Brittany Cooper is really your name, I strongly suggest not using it for your screen name. You never who is on this site and might see that.
  11. ventmommy

    Drowning in Skills

    PDN agencies love to send untrained nurses to families. They hire tons of new grads with absolutely no nursing experience. Many of them have only merely seen a trach change done and they are basically thrown to the wolves. There is a lot you can learn from watching videos and asking questions here. Trilogy and LTV have their manuals online. Please learn the difference between a setting and an output because it makes me crazy when health care professionals don't know the difference between them. Trachs can seem complex but they really all have the same fundamental features. Neo/Ped/Adult refers to length (there are also custom lengths for people with really long or short tracheas). The number refers to diameter of the hole. Trachs can be cuffed or uncuffed. If cuffed, they are either water-filled, air-filled, or foam (which are pretty rare). Bivona and Shiley are the two most popular brands. Bivona makes some fancy trachs like a Flextend and Flextend Plus which are for kids with no necks - the adaptor for the trach sticks out instead of being right under the chin. There are plenty of non-crazy families that have really experienced parents that are willing to train an inexperienced but kind and motivated nurse. And you can always ask more specific questions here.
  12. ventmommy

    % infants in Peds? Male RN in Peds?

    I don't think your experience is the norm. I work in a children's hospital. We don't have L&D here. We have NICU, PICU, surgery/PACU, hem/onc, general care, dialysis, transplant, etc. There are male nurses (and RTs and PTs and OTs and CNAs) in all of these units! I honestly can not picture any one I know at my hospital discriminating against a male nurse. Are there times that a male nurse might have to swap a patient? Sure, there might be a female child abuse/rape/gyn patient that is not comfortable with a male nurse but I think that is the exception, not the norm.
  13. ventmommy

    2 full-time jobs?

    Will it be easy? Nope. Is it doable? Yes. I'm a respiratory therapist. I have a FT (12.5 hour shift) job as an RT in a hospital, a PRN (12.5 hour shift) job as an RT in a hospital, and a full-time non-RT job. I wouldn't work more than 6 hospital days in a row because you will be completely exhausted by the end of day 6. I try to never do more than 5 hospital days in a row.
  14. ventmommy

    Parent/camera nearby...can u read?

    Why isn't your agency giving you the household info before you even go to the meet and greet? I had a comprehensive booklet with all of our expectations, requirements, rules, and responsibilities all laid out. It also explained our household composition so that you didn't waste my time if you hated dogs or were deathly allergic to cats. I also included things I was picky about (you needed to bring CLEAN slippers/crocs for use in the house),there was no pork of any kind allowed, and you needed to bring your own flatware if you were eating meat. It also listed the perks (cable TV with all movie channels, occasional fun outings, use of wifi, unlimited cat cuddles). It's not too late to talk to the parents. If the parents are that unapproachable, then talk to your ADON or DON to get this worked out.
  15. ventmommy

    Parent/camera nearby...can u read?

    Can't you just have a nice conversation with the parents? Our nurses had access to our wi-fi and there was a cable television in the bedroom. They could read/study, knit, watch TV/movies (nothing R-rated) as long as everything was done and kiddo was happy. In your case, if the child is in the stander, he/she might need some distractions through singing or reading books. But a sleeping, content child should give you plenty of time to chart, read your own book, whatever.
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