walkingthecow

Stripping chest tubes!!!

In my unit, they use pressure bags in the OR and we put the transduced line on a pump when they roll out. Problem solved--then we know exactly how much volume they are getting :) I work peds, though, so 3mL/hr adds up faster than it does with adults, and we run it slower based on weight.

I think the family members at the adult ICU I used to work at were worse to deal with than the parents at the peds cardiac ICU I work at now!

Hospice often doesn't require BLS certification, for what it's worth.

I work in a CVICU in a children's hospital. Yes, most of our patients are babies, but we follow our patients for life--I often have toddler, teenaged, or adult pts. Then again we are a major transplant center, all CVICUs aren't necessarily. CV is VERY specialized, and I often don't realize that until I'm floated. We don't have the fast paced traumas and revolving door of PICU, but on average I would say our patients are sicker. CV kids ride a very very fine line between compensating and not compensating. I have not not floated to NICU yet so I can't speak to that, but keep in mind a lot of NICU is feeding, growing, and crying--even a level IV. Also keep in mind that CV is very intense. Your assessment skills have to be top notch, and you have to be able to make sense of complicated pathophys and what that means for your patient. It is also a very humbling experience--it takes a long time to really know your stuff and feel confident. It is a place with a lot of good outcomes and a lot of hope, but there are also chronic patients who will not survive to discharge.

Cincinatti Children's Hospital has one--their website has a lot of information about all the different heart defects.

OP, you might also look into a pediatric CVICU if you like babies but are looking for a more critical area. Even the level IV NICU at my hospital is mostly feeder/growers. Most of the CV kids are infants, although we do see all ages up to even a few adults. Anyway, when our census is low we all get pulled to NICU anyway, hah.

At the LTAC I used to work at, I was able to tell who was going to need to start dialysis because of the wet Cheerios smell their skin gave off.

The standard at my facility is to transfuse for hgb

I actually had a pt this year who was on a lidocaine drip because amio didn't work.

There are a lot of tricks for positioning/moving patients yourself...when I was new, I followed around the best tech I work with for a shift and turned/positioned all the patients with her, and asked her the best way to do things. Give me a well-positioned draw sheet and a pt 200lbs or under and I can usually reposition and turn them myself now. however. I only have one back. I will not do anything by myself that I know I can't do or might hurt me (or the pt!!), and sometimes they just have to wait.

What is the rationale for TPN having a designated line? I have had a pt with a CVL that had one lumen for sedation, one for pressors, and the third for TPN. I called pharmacy to ask about compatibility for abx and they always say just run it with the TPN.

The max for neo at my facility is 360.

I am a new nurse--I have been working at my first job (LTAC ICU) for about 7-8 months now. I made a minor (?) mistake at work and it is weighing on me. The last shift I worked I was caring for a patient that had high gastric residuals--pt vomited on previous shift and tube feed was turned off. On my shift I pulled off 200mL, next check residual was only 30mL so I decided to try starting tube feed again. I passed this on in report. Well, when I woke up (I work nights) I had a voice mail from that nurse saying that the GI doctor was irritated because I didn't chart the residuals or when I restarted the tube feed, and she was just calling to remind me it is important to chart things like that etc...Now this nurse was my preceptor when I was on orientation, so I don't think there was anything wrong with her calling me about it, nor do I think she was trying to be ugly. I know I charted when I started the tube feed, and yes I did forget to chart the residual (part of this is because how we chart residuals is weird in our EMR and I will be looking up policy the next time I work). But it has just been on my mind. I feel like I will never be good enough. And I am tired of this culture of "the doctor is mad at you" or "doctor so and so will chew you out so you have to be careful"...I don't know if this is just my facility or if it is like that everywhere, but can't we just all treat each other like professionals?? I also am wondering when my coworkers will start to trust my knowledge...it seems like it still frequently happens that a coworker will help me turn a pt or something, and feel like they have to make a comment like "with all this weeping edema you need to be sure to put chux under the pt's arms" (when chux are already under their arms...) "oh be sure to do oral care on that orally intubated pt"...I am trying hard to just say "ok" instead of "I know that!!!" I know I still have a lot to learn but I'm not brand new! When I was in school I was in the top of my class, did leadership stuff, etc. And it has been the same in previous jobs I've had... I am typically good at what I do and have been a well-trusted employee. I know it will take time, but dang... I would have posted this in first year as a nurse but I wanted to get perspectives from nurses with more experience too. Any wisdom would be appreciated...how long did it take for your coworkers to stop treating you like the new guy? Do I have to look forward to May/June when we hire another crop of new grads?

LTACs are NOT low acuity. The LTAC I work in has an ICU, and the only things we don't do are CRRT and balloon pumps.