Jump to content
valsalvamanuever2

valsalvamanuever2

Member Member
  • Joined:
  • Last Visited:
  • 38

    Content

  • 0

    Articles

  • 1,933

    Visitors

  • 0

    Followers

  • 0

    Points

valsalvamanuever2's Latest Activity

  1. valsalvamanuever2

    blood transfusion and first 15 minutes

    Thank you all for entertaining such a thorough discussion on the topic. When I originally posted the question, I was new in my setting, but questioning what isn't necessarily in line with what I have been taught is the standard of care. I thought of printing this out and leaving it subtly in our breakroom. But, that seems passive-aggressive. Statements like 1. "It doesn't matter, they are intubated..." 2. "They just had a transfusion and had no reaction..." (Which, as one poster pointed out, that could increase the likelihood of a reaction). Annoy me. Especially when others look at me like I am doing the wrong thing for staying... So, I practice as I feel I should. Others at work do as they feel they should. Some seem oblivious, some have said "Better nurse than I am..." if I stay in place. As to rates...I work in a surgical/trauma icu. Rate depends on how fast it is coming out/or how much they have already lost...
  2. valsalvamanuever2

    Best resources/advice/education for a new MICU nurse w/ m/s expirence?

    Hello, I just completed my second shift off orientation, with about a year of tele experience, so my advice is framed from that perspective. For factual stuff, the ICU book by Merino, as well as CCRN review materials are often suggested. Most hospitals have fairly extensive education programs, my surgical/trauma icu actually hands out a 4 inch binder on day one of things to know/learn. For actually getting through your day, it seems to help to communicate how much respect you have for your co-workers and their abilities. This seems to play largely as they take time to explain/show/do things for you. For example, now that a preceptor is no longer paid to be with me if I have to have someone draw blood on one of my patients I attempt it a couple times, then assemble all of the supplies a coworker needs and have them ready so the coworker can come in, do it, and go on their way. (they often encourage me that with practice I will get better before they leave my room). From what I can see of my co-workers so far, being a "good" ICU nurse is a 50/50 mix of factual/experiential knowledge and socialization/communication. If someone has told you something (how to do a procedure, a factoid) and someone else tells you the same thing, if you tell the second person that you already know how to do something, it can be received not so well. This can be an awkward balance of not having someone waste their breath vs. attempting to be grateful for them taking time out of their day to teach vs. communicating what you do really know. Overall try to study hard facts when you are able, ask pertinent questions, and be genuinely grateful for the help of others. If by chance you have spare time at work, ask people if they have anything cool or sick going on. Most people like to take on a teaching role. If by chance you have free time at work go around and see if you can help someone who looks really busy (even vitals/turns etc.) You probably wont feel completely ready to come of orientation, no matter how long it is. At least this is from my personal experience as I was about to ask one of my managers for additional orientation and she informed me that she would be scared if someone felt completely ready to be autonomous. But, like I said, I just got done with day two... Good luck.
  3. valsalvamanuever2

    difficulties in transitioning to ICU

    Thank you all for sharing your feelings. I thought that I probably wasn't the first to feel this way. It does feel good to have this outlet. My unit was nice enough to provided us with a giant binder of things to know/learn/tips. I agree that a factual background can help when lacking experience as I do. Thanks again all.
  4. valsalvamanuever2

    blood transfusion and first 15 minutes

    Thanks for the responses. Our policy states to stay for 15 minutes. (ICU). There is a clause regarding emergent/unit patients (which most of ours are) and changing assessment based on pt. condition, but I find that a hard way to say: "see, you don't have to stay..." If anything, I would think it would lead to more assessment, not less.
  5. valsalvamanuever2

    blood transfusion and first 15 minutes

    Anyone work on a unit where the predominant attitude is one of it being ok to leave a pt. during the first 15 minutes of a blood transfusion due to the monitors attached to the pt.?
  6. valsalvamanuever2

    difficulties in transitioning to ICU

    1 year RN experience on telemetry. Switched to trauma/surgical icu at different facility (dream job). Nearing end of 12 week orientation. Still feeling inefficient/slow. Limited experience with actual sick people over last few months as most have been floor/step down pts. (People aren't shooting/stabbing/crashing(?)). Concerns shared with preceptor and manager re: time management/lack of sick people and pending end of preceptorship. Assurances of satisfactory progress. Majority of nurses on the unit start there out of school, and appear more comfortable after their 6 month orientation than I do with my 12 week orientation +1 year experience. How did the transition go for slightly experienced nurses? Trying to forget one hospital's policies, memorize another, more in-depth set, and wipe noses of non-icu pts. seems too much some days. My preceptor did share a concern that my frustration with perceived inefficiency/task mastery could lead me to shut down and actually be inefficient... Thanks for any pearls of wisdom.
  7. valsalvamanuever2

    Happy Pittsburgh area nurses...

    Hello, Looking for any Pittsburgh area nurses satisfied with employment in the cardiac/critical care areas of local hospitals. Any where that treats employees well? TIA.
  8. valsalvamanuever2

    rapid a fib with high blood pressure?

    I meant if her heart did this again and was either symptomatic (i.e. dizzy and takes an unplanned meeting with the ground) or asymptomatic (until her heart can't do this anymore and takes an unplanned break). Thanks everyone for the responses as I start to see actual clinical presentations of the things I have read about. Normally after the ride home I come up with questions about the bigger picture that I don't put together while I am running around trying to complete my tasks. I did not discharge her myself as it was change of shift soon after she converted.
  9. valsalvamanuever2

    rapid a fib with high blood pressure?

    Pt. converted spontaneously. Bolus and GTT were about to be started when she went SR 60's/70's. The cardiologist who follows her as an inpatient felt that she could be seen outpatient for f/u. Typically when we convert people via drips we do the drip to po route for maintenance as others pointed out. The doc following her felt drip unnecessary and felt comfortable following her in the office. With the obvious next question of: But what if she does it again with different outcomes?
  10. valsalvamanuever2

    rapid a fib with high blood pressure?

    Pt was told to come to hospital after observed bp/hr at pcp's office. Yeah I have not been oriented/asked out loud how/why exactly some pt.s of this type are allowed to come over unsupervised if they warrant inpatient status. 1. In an old copy of "the ICU book" that I picked up it says that hypotension due to loss of atrial kick occurs above heart rates of 180. How empirically studied this is I do not know. I would have to assume this is in healthy hearts as I have seen old tired hearts hypotensive at fast rates that are south of 180. But, these pt.s often have the typical comorbidities. 2. BP was double checked manual at rest. I do like the idea that kidney malfunction and the RAAS system could have some input on pressures that lack of filling/pumping time of the heart at that rate may not have. I did not think of that. 3. This pt. was about to receive a cardizem bolus followed by gtt when she converted on her own to NSR in the 70s. At that point she told us that this was the third or so time that this has happened. (Thanks for the info ) She's asymptomatic when she does this. 4. D/cd an hour later. F/u with cardiologist. I would think an EP study should be in their future? I would have been hesitant to go out the door...
  11. valsalvamanuever2

    rapid a fib with high blood pressure?

    Hello, New nurse almost off orientation on telemetry. Pt. was direct admit from MD, walked onto the floor and into my room with no information to moi. When put on monitor hr a fib 160's- 180's, apical the same (if I could really count three irregular beats a second). BP during this time 160/100, pt. reports self to be asymptomatic. I did not really worry about a pulse defecit to see how many beats were perfusing peripherally as I was more worried about rate control at the time. Question: Why is BP so high when heart should not be having time to fill and pump? Thanks for attempts at answering with little information.
  12. valsalvamanuever2

    bradycardia with nitro drip?

    Hello all. Thanks for the responses. I do not know the full story, aside from the fact the pt. remained on the floor for another week with dx of endocarditis. Did run into family member of pt. who said that she was there as pt. was being transferred back to smaller hospital in a more stable condition. Did not get into nitty-gritty as orientation has been leaving me with a feeling of having my butt kicked. Still plan to follow up with a cns/cardio np re: original question. On a side note, got my first hug from a family member and it made some of a rough week better.
  13. valsalvamanuever2

    bradycardia with nitro drip?

    Thank you all for the input. Assigned to same pt. today. Pt. is 1. septic. 2. EF of Thanks all as I start to learn what I need to learn.
  14. valsalvamanuever2

    bradycardia with nitro drip?

    Nurse of 2 weeks experience on telemetry floor. Pt. transferred from smaller hospital with decompensated hf, scant information provided. Upon admission orders written for nitro drip and lasix drip. Stable bp's/hr's ( slightly over 100 sbp/hr 60-70) on nitro drip while titrating up for two hours, then no change for two hours as desired sbp achieved. Lasix drip without titration. Output not increased. Four hours in, pressure suddenly 70's systolic, hr 50's. Drop happens as titrating off nitro gtt as provider now thinks pt. septic and wants it d/c'd. No other cardiac meds (beta/ace/arb/etc.) on board due to nonadminister prior to transfer, pharmacy issues, and now blood pressure issues. Why would heart rate go down as blood pressure does? Without a whole host of additional information I understand that no conclusions can be drawn, but my undeveloped gut would say hr should attempt to compensate. Thanks for any input as I learn all day at work and when my head clears at home come up with more questions.
  15. valsalvamanuever2

    rochester area hospital nurse to patient ratios

    The title is pretty self-explanatory. The "search" feature did not yield anything too fruitful. Please include floor type and whether or not you have aides. Thank you.
  16. valsalvamanuever2

    moving..what's a nice area to live in Rochester?

    Hello, My wife and I lived around the area for 6 years for school and still at times miss it. Depending on what type of living you like (i.e. complex vs. apartment in a house), there are a great many choices. Originally we lived at Elmwood manor as suggested by a different poster as we were afraid to live in the city. It is a nice complex located close enough to thoroughfares to commute. It seems to have a more "yuppyish" crowd. Brighton/Pittsford are considered some of the "nicer" (read higher rent) areas. Webster/Fairport/Penfiled are considered safe, slightly lower cost east side suburbs, but you will have to commute, as much as it is, with the flow of people. About three miles from Elmwood Manor you can live within city limits in apartments in older homes in the city (read student, as well as young urbanite areas). We absolutley loved our time in this area (areas referred to as Swillburg, South Wedge, Meigs-Monroe neighborhoods.) Rents are typically lower, and we personally love older houses. If you have ever lived in a city, you should be fine in these eastern city neighborhoods. If, like us, you were from out in the country, you may want to live in the Brighton/Pittsford areas before finding out which neighborhoods/streets are better than others. In Rochester it really can be street to street and time of day dependent on how safe you may feel in a particular area; I wouldn't get lost in the city at night at first. We found craigslist to really helpful in apartment hunting. Make sure you check out the Public Market, one of the best open air farmer's/produce markets we've seen, as well as the famous garbage plate. There are also lots of outdoor recreation opportunities if that's up your ally. If you have any other questions in addition to my long-windedness, feel free to message me.