tknoob

When sticking for an IV, once you get the flash, just go a tiny bit further, and then advance the catheter off the needle into the vein. I see experienced nurses advance the whole needle into the vein and end up blowing it, especially small veins. Tape NG tubes to the shoulder/neck and route them up under the pillow to prevent the patient from easily pulling it out.

Our cardiac ICU is 1:1 on nearly everyone. Post open hearts mostly though. Plenty of bypasses as well. Most of the time when we saw open a chest, you get a 1:1. We also do 1:1 on brain death patients or behavioral issue patients in the ICU.

Working the ICU the other night I had the open bed for codes in the hospital. Sure enough, someone coded at 0400. First time getting someone post code. Went out to the floor to see the code and get the general situation. Patient was post heart cath. Nurse checked on him, changed his femoral dressing and he bradyed down to 30 and went unresponsive. He was blue when i saw him and intubated on the floor. Brought him down to the ICU. No orders, nothing from the ER doc. I assessed him quickly and called the physician. Unresponsive, his pupils were about 4 cm and unresponsive to light, bp 65/30, sinus tach. About 20 minutes later, he is coming out of the bed and we restrain him and give him 1 of ativan which takes him back down. I get routine vent orders and get some propofol ready. Team from cath lab shows up and whisks him away. I assessed him at least 3 times, and his pupils never went responsive. I didnt think paralytics affect pupillary response. Sure if you have a tube down your throat, id be keyed up too, but he never made eye contact with us or made any kind of response. Did the paralytics or something he got in the code affect his pupillary response? Do you think he was conscious was it just a reflex that he was fighting with us? I learned quite a bit with this, but any general advice for your post code patients?

When inserting a catheter into a male patient, dont just lubricate the tip of the catheter. Take the syringe with lubricant in it and squeeze it directly into the urethra (its sterile, you're sterile). Males have a much longer path, and you need the lubricant BEFORE the catheter. Most of it is gone before you even get to where it counts! The pain is significantly reduced.

When giving an injection, tap your finger 3 times on the skin about 1.5-2 inches away from where you are giving the injection. On "3" dart the needle in at the same time as your finger tap.

I got a job out of nursing school on the ICU that I had precepted in during nursing school. I am the only male on the unit in the daytime. Good unit, a good mix of people that I get along with well. My preceptor for school was a female and was direct when talking. The preceptor that I received when I started work was quite a bit different. She is the charge, and has 18 years of experience in critical care and always has the 2 most ill or difficult patients. This is fine for her with plenty of experience, but I am still learning. Yesterday she and I had a meeting with the critical care manager to end my precptorship with her and select a new preceptor. Many of the difficulties that I have faced are typical for new nurses, namely prioritizing and working efficiently, something that comes with experience. She offered little to no guidance other than a passing comment to me to "check my K levels" which was her way of saying that it needed done now. She was offended that I dismissed her comments by responding with a "yes" instead of hopping right to it. She doesn't like confrontation, she refuses to call me out on things that i may do incorrectly until the end of the shift or the next day. Sometimes in the form of a post-it note. Lastly, she directly questioned my integrity in front of the manager. I have a bachelors and masters in psychology, and was a therapist for 5 years. I know that it is not related to nursing, but i do have a good sense of my knowledge base and how to ask questions. She was offended that I would not ask her how to do things when I had no knowledge deficit on the issue. We sat down with some expired swan caths and she explained them to me. I listened attentively and did additional research when i went home. But because I wouldn't communicate in a more "female" fashion out of respect for her feelings when she was trying to teach me something, have to get a new preceptor.