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  1. anonymurse

    Question about Cardizem Drip...

    One thing that's a common procedural error is paying attention to the HR number on the monitor. At our place, that's the HR of a sliding 6-second window. But when a MD asks for a HR, he's asking for BPM (beats per minute), and that's the standard, measuring HR over a 60-second period. Now if you will look for the HR graph in the pt's details, you will see the HR for a sliding 60-second window. Yeah, your tech just called you in a panic because he saw 160 for a moment on the screen, but look at the true HR--might be 110, 90, 130, whatever. So rule #1 is: don't panic. And don't tell the MD the pt's in the 160s if you want appropriate orders. If there's any way to measure BP too and have it sent to the screen, do it, especially in the first hour of initiation. Second, when you catch a new pt from the ER, always check the med admin record. Always. Sometimes you'll find they've been given a beta blocker just before they came up, and here you have a stat order for a cardizem push and drip. Again, check the HR over 60 seconds. Not too bad, say 130 or less? Wait a while to assess the effect of that beta blocker on HR/BP, especially if they're naive to cardiac meds. But really it's not a good practice to give a pt a PO beta blocker, then put them on a cardizem push/drip. Google it. If their HR is high enough to begin with, start with the cardizem and hold the blocker. Cardizem has a short half-life compared to PO beta blockers, which might hang in there 12 hours with no way to reverse the effect. Third, communicate with the MD. Compare notes. Suggest. Negotiate. Don't guess. When they wrote the orders, they didn't have as much information as you now do. Help 'em out. Sometimes, even if they aren't willing to forgo the drip, they'll d/c the push and let you start at a lower rate. And, um--we ARE talking about afib and svt, and not sinus tach, right? Saw that twice last week, cardizem drip/push for mild sinus tach. We got 'em d/c'd.
  2. anonymurse

    Nurses, how do you feel about raw food diet?

    I can only speak for myself: I like cooked food, if for no other reason than that heat kills lots of nasty micro-critters that would otherwise eat me.
  3. anonymurse

    D5W 1/2 NS in pulmonary embolism

    According to emedicine: "Fluid loading should be avoided unless the patient's hemodynamic condition is deteriorating rapidly, because IV fluids may worsen the patient's condition."
  4. anonymurse

    D5W 1/2 NS in pulmonary embolism

    D5 1/2 is hypertonic in the bag, but because the body metabolizes the dextrose, it is isotonic in action. There is a very good article on Tonicity and IVFs that is well worth reading. The clear explanations of special warnings makes them easy to remember.
  5. anonymurse

    Tums makes GERD worse?

    Right, that's why they sell those mega-bottles of Tums. It makes its own market. Don't get me started on Afrin.
  6. anonymurse

    Family just wants Grandma to die

    Has she formally been found incompetent to make her own decisions?
  7. anonymurse

    How fast to push IV meds

    Easiest to find push rates in the IV drug book--there ought to be one in every med room! A few IV drugs aren't recommended for dilution by NS; Solu-Medrol is one. Another IV issue is filtration to block potential precipitants; e.g., amiodarone has to be filtered at certain concentrations but not others.
  8. anonymurse

    Does anyone have a GOOD manager

    The best, and that's far more important than what kind of unit I work on. I'll search for a good manager at other hospitals when she retires, because there's no manager near as good as she is elsewhere in this hospital (there are some who'll be great managers if they ever get picked, but they don't count).
  9. anonymurse

    Favorite "Lay Terms" for diagnoses.

    It pays to tell pts they're going down for an x-ray of the neck rather than a 'cervical x-ray.'
  10. I bought lots of books, but the most relevant info was given to me by fellow nurses, because whereas the books will give you useful facts, your coworkers will give you patterns of facts to watch out for, and will teach you how to think your way through multifactorial problems. Also, learning facts as parts of larger pictures will make the facts much easier to remember than trying to memorize a bucketful of unrelated facts. Better to keep your head up and your gaze broad than bury your nose in a book.
  11. anonymurse

    would you work for free

    Hey, if you're working with a flock of Flos, clock out, go home, and let 'em at it!
  12. anonymurse

    Nurses don't save lives....WHAT?

    Sounds like this is gonna be a self-fulfilling prophecy--for him.
  13. anonymurse

    What are the top 5 medications YOU administer daily?

    NS, proton pump inhibitors, statins, insulins, beta blockers.
  14. anonymurse

    How do I have more confident talking/calling doctors?

    Before calling a doc, read the progress notes end to end. Also talk things over with others on your shift, particularly your charge nurse. You may find you were thinking of calling the wrong doc. You may find someone who knows the MD is already aware. Your charge nurse may want to look at the pt herself or call the nursing supervisor for more input. Not only do you need her experience, but it's vital to have your charge backing you up, especially when the final decision is to NOT call the doc.
  15. anonymurse

    Floated to the Tele, forgot how hard it was!

    That is the way to do it. I've met BSN graduates who only had 2 max. Scary.