MunoRN RN

Critical Care

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All Content by MunoRN

  1. MunoRN

    Step down ratios

    MunoRN replied to Meeshie's topic in General Nursing

    The term "step down" is used for a wide variety of patients, oncology units are typically considered a specialty unit, which is a bit different than a true step down which is usually 1:3. A specialty...
  2. MunoRN

    Extreme brady with strange rhythm

    MunoRN replied to kataraang's topic in CCU, Coronary, Cardiac

    I was speaking generally about whether or not we would externally pace a patient overnight in the ICU for completely asymptomatic bradycardia, regardless of the cause, but actually atropine can still...
  3. MunoRN

    Patient brings own urine sample for preoperative pregnancy testing

    MunoRN replied to DineenC's topic in General Nursing

    Oddly this is true for the "pee-stick" you'll find at the grocery story which have gotten to be very sensitive, but those used in hospitals and clinics are subject to a more extensive process to get...
  4. MunoRN

    Patient brings own urine sample for preoperative pregnancy testing

    MunoRN replied to DineenC's topic in General Nursing

    Proper urine hCG testing is performed on the first sample after waking and the sample remains stable for a while, so unless the person can hold that first morning pee until they get to the clinic it's...
  5. MunoRN

    IV Push med– do you always have to pull back for blood return?

    MunoRN replied to missjune's topic in Patient Medications

    As part of my particular job role I am familiar with what a legal standard of care is, which is typically one of the first things a hospital lawyer will make sure you're aware of when prepping for a...
  6. MunoRN

    IV Push med– do you always have to pull back for blood return?

    MunoRN replied to missjune's topic in Patient Medications

    I am familiar with Lynne's various attempts to justify her recommendation, which it should be noted have never included any supporting evidence and she doesn't appear to make any claims that relevant...
  7. MunoRN

    IV Push med– do you always have to pull back for blood return?

    MunoRN replied to missjune's topic in Patient Medications

    Lynn actually only argues that blood return is a requirement for infusing vesicants, not other
  8. MunoRN

    IV Push med– do you always have to pull back for blood return?

    MunoRN replied to missjune's topic in Patient Medications

    Lack of blood return in a peripheral IV is not an indicator that the IV should not be used, it's actually a fairly normal finding in an otherwise well functioning peripheral IV. As an assessment...
  9. MunoRN

    Extreme brady with strange rhythm

    MunoRN replied to kataraang's topic in CCU, Coronary, Cardiac

    The atrial rhythm you've posted appears to be a coorifice atrial flutter, which could have been the underlying atrial rhythm you observed in a patient in complete heart block. Keep in mind a patient...
  10. MunoRN

    Re-arrest during Hypothermia induction

    MunoRN replied to nurserobinson281988's topic in CCU, Coronary, Cardiac

    It should be less of any issue now that the recommendations for the cooling target have changed to keeping the patient closer to 36 degrees C, so really we're maintaining normothermia more than...
  11. MunoRN

    Hover Mat

    MunoRN replied to mateo1972's topic in Patient Safety Issues

    I've never seen a facility policy specific to the use of hovermats and I'm not sure why you would need one. Aside from the manufacturers instructions for use, what is it that you would like clarified...
  12. MunoRN

    Should we change the needleless hub after drawing blood from a central catheter?

    MunoRN replied to Probably's topic in MICU, SICU

    Changing the cap after blood draws isn't supported by evidence or by recommendations, both the INS and CDC recommend changing caps every seven days. There are reports of organizations that have...
  13. MunoRN

    Chloraprep reuse for IV insertion

    MunoRN replied to TXAZRNED2017's topic in Infectious Disease

    Using it for an IV insertion, putting it back into the package and sticking it in a drawer in case the patient needs an IV later would be multi-use, using it on another patient would be multi-use,...
  14. MunoRN

    Witnessing Consent

    MunoRN replied to Apples&Oranges's topic in General Nursing

    As an RN you also have a professional duty to advocate for the patient, this would include confirming they understand the procedure and have no further questions and wish to
  15. MunoRN

    COPD 96% on RA hypoxic?

    MunoRN replied to NorthernNurse BSN,RN's topic in General Nursing

    A lot of people mistakenly believe that dyspnea is driven by hypoxia, which isn't typically the case. Hypercapnea is actually a more likely cause of increased respiratory effort, and particularly in...
  16. MunoRN

    Questioning a doctors order

    MunoRN replied to MrsJt's topic in Patient, Colleague Relations

    By "infected" I assume you're referring to an infection that would legitimately indicate the need for isolation (VRE in the urine for
  17. MunoRN

    Chloraprep reuse for IV insertion

    MunoRN replied to TXAZRNED2017's topic in Infectious Disease

    Whether it's acceptable practice would be based on the rationale being presented for saying it's not. If the argument is that once it touches skin it should be considered 'dirty' and no longer be...
  18. MunoRN

    Positive drug screen

    MunoRN replied to Ashley9077's topic in General Nursing

    Phentermine not only can but typically does show positive for amphetamines on an initial screen, which makes sense since phentermine is structurally very similar to amphetamines is essentially a close...
  19. MunoRN

    Questioning a doctors order

    MunoRN replied to MrsJt's topic in Patient, Colleague Relations

    I'm wondering if you misunderstood your supervisor since I find it hard to believe that any licensed nurses wouldn't be aware that it's our legal responsibility to question MD orders when
  20. MunoRN

    To suction or not?

    MunoRN replied to romantic's topic in Critical Care

    It's possible for tracheal suctioning to be indicated without a rattle, such as when the mucous is so thick and tenacious that it simply doesn't move when air is moving through the trachea, therefore...
  21. MunoRN

    Witnessing Consent

    MunoRN replied to Apples&Oranges's topic in General Nursing

    The expectation of every BON I've been licensed by is that a nurse's professional responsibility when "witnessing" consent is to confirm that consent has actually occurred (that the patient...
  22. MunoRN

    To suction or not?

    MunoRN replied to romantic's topic in Critical Care

    I don't see a clear indication to suction the patient, or even a vague one for that matter. The patient is tachypneic, which could certainly be a reason to suction but only when combined with other...
  23. MunoRN

    Manipulating Glucometer?

    MunoRN replied to lreddick's topic in General Nursing

    I'm not really sure why a diabetic would need to 'manipulate' their glucometer in order to get an evening snack since diabetics should not only be allowed, but should be encouraged to have an evening...
  24. MunoRN

    Unreasonable requests

    MunoRN replied to emmafrancis's topic in General Nursing

    Regarding the "comfort" of ICU beds, they are actually notoriously uncomfortable for those with bad backs, as a general rule if it gets to the point where I'm having to medicate a patient just to...
  25. MunoRN

    Graduating soon, feeling unprepared

    MunoRN replied to GL191211's topic in General Nursing

    As a general rule, nursing students start nursing school not having any idea what it is they don't know and mainly what you learn is how much you don't know, which is actually really important. I...