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diprifan's Latest Activity

  1. diprifan

    LVAD Implantation

    I would be slightly concerned that you haven't had post-op LVAD training. There are some unique problems that can arise post-op, such as the ones Szyjarek mentioned, that are less so present in a patient with an LVAD in the community; I'm specifically thinking of tamponade and acute right sided failure... but it sounds like you recover open hearts, so those may be more obvious. Flow alarms are a big one. 2210485 - no, LVADs are for "destination therapy" in addition to bridging for transplant. Destination therapy is for a heart failure patient that has probably tried home inotropy without success and have been on a slow decline. The VAD buys them some time. I understand that you work in the cath lab and probably see your fair share of percutaneous VADs (impella and tandems) which are vastly different than what the OP is talking about. This type of mechanical support is placed under general anesthesia where the CT surgeon cracks the chest, cores out a part of the ventricle, and attaches it to a pump that is implanted into the chest and connected to a continuous power source and then hopefully closes the chest (probably over simplified it). The LVAD is permanent, and the patient goes home with it until they die or get a heart transplant. These patients usually have severe heart failure and already have a dual chamber pacer for resynchronization therapy (not sure why you mentioned pacers). The operation is a big one in terms of hemodynamics compromise and recovery. It usually takes a significant work up with cardiology and cardiothoracic surgery, but can be placed on an emergent basis. Most hospitals have teams that treat these patients both inpatient and outpatient. The patient recovers similarly to other open chest patients in terms of nursing care... which is why the OP was asking about specific training.
  2. diprifan


    Like Juan said, it's just one step. They both get you to get licensed in your state. Being "allowed" to do a procedure or skill is a part of the credentialing and hospital privileging process. Not sure about every state but mine makes mention of seeing the population that you were educated for... so the adult-gerontology acute care population is what I am educated for. There are other posts that mention the differences in the actual exams; but they are generally the same in terms of content.
  3. diprifan

    Anterior vs. Inferior MI

    Anterior MI (left side) LAD ST elevation in the precordial leads V1-V6 but mainly V3-V4 Reciprocal ST depression III/aVF Tachycardia is common to compensate for decreased stroke volume/ cardiac output Low BP May need left sided mechanical support after reperfusion (impella/iabp) Inferior MI (right side) RCA (if ST elevation II ST elevation in leads II, III, aVF ST elevation in the posterior leads (V7-8) can indicate posterior infarct Bradycardia, think conduction delays (Mobitz I, II, 3rd degree), might need transvenous pacer Vomiting due to vagal system stimulation Volume dependent infarct, so saline boluses are your friend before the cath lab May also need mechanical support So anterior are tachy and hypotensive, probably need fluid and pressors. Inferior are brady and need fluid, atropine, potentially pacing, and pressors. Hope this helps
  4. diprifan

    AACN ACNPC-AG boards

    I agree! Most people could pass the AACN version; its more like what people get in school and very similar to the CCRN... Now the ANCC version is absurd... without a prep course I could see how it is difficult. New grads should consider the AACN version over the ANCC and not go off of what their faculty memebers (who are probably item writers for ANCC) tell them... also the practice guidelines come from AACN so...
  5. diprifan

    PASSED - 2017 ANCC AGANCP Comprehensive Exam!!

    First off, congrats! Do you have an NP job lined up? "I chose the ANCC exam over the AANP because it is an established exam and has a moderately better reputation. Also, the pass rate on it is better than the AANP. The research I've done reported overall that the ANCC test was more policy and practice characteristics based while the AANP exam was more clinical question based. I'd say that was likely the case (discussed below). I will say that no one I knew, from prior students, instructors, established NPs had any idea or counsel as to why you would choose one over the other and made it feel like flipping a coin was just as good for choosing, ugh!" -- The AANP doesn't offer the acute care exam... American Nurse Credentialing Center (ANCC) and American Association of Critical-Care Nurses (AACN) do. I took both last month and agree the ANCC exam was focused more on the health care system, delivery of care, and process improvement. The AACN version was definitely more about diagnosis based of signs and symptoms along with evidenced based treatment. The AACN exam was harder, but made me feel like I know what I am doing...
  6. diprifan

    Taking acnp-ag exam from ACCN

    Did you take the test yet?
  7. diprifan

    AACN vs. ANCC

    It is accepted in all 50 states now.
  8. diprifan

    AACN ACNPC-AG boards

    Of the few jobs I have interviewed for, they state that either exam (AACN or ANCC) is acceptable for credentialing. I think the AACN test will be more like what most people are used to.
  9. diprifan

    Acute Care NP Career Options

    Its the same at my hospital, they prefer ACNP over FNP/AGNP but hire either really. I have seen a lot of neurosurgery practices want FNP to see all the patients the neurosurgeon can see, but that is very anecdotal. Our ED is large enough that there is a separate peds ED so they hire ACNPs in the ED.
  10. diprifan

    Are you happier as an NP than you were as an RN?

    I have to agree with WKShadow, if you work somewhere toxic, you aren't going to like it no matter what you do (RN or NP). I'm finishing NP school this summer and I had a moment of internal terror when I realized my dream job may not be where I work... But there are so many factors, especially with advanced practice, that will affect how you feel about your job.
  11. diprifan

    ACNP for intermediate care nurse?

    Brittany, There are plenty of nurses that have become an ACNP without intensive care experience. From what I have seen nurses without really solid clinical experience sometimes struggle with certain clinical topics/situations that don't arise in the intermediate/step-down areas. It really depends on your drive to understand presented information. Email some program directors and get a feel for what type of nursing experience they expect prior to matriculation.
  12. diprifan

    New Class of 2017 CRNA student at Our Lady Of Lourdes

    Thanks for the kind words. One last thing, how long was the whole interview? I have a long drive and was wondering if I could drive after it was over.
  13. diprifan

    New Class of 2017 CRNA student at Our Lady Of Lourdes

    How was the interview? How long did they take to give you an offer for admission? Thanks!!
  14. diprifan

    CCRN Certification

    It can be within one year, 10 months, or 18 months... as long as you have met the hours requirement. The 2 year statement refers to the hours being within the last 2 years, no greater.
  15. diprifan

    What is CEN, or CCRN?

    There is an hours requirement for CCRN, (1,750hrs) not necessarily 2 yrs.
  16. diprifan

    tips on acclimating to ED- seasoned nurse

    I just transferred from ICU to ED, its been challenging. I am running into the same things. I find that the work flow does not make sense and somethings are not logically in place (at least where I work).