OleMissRN

Interns and Residents...for anyone at a "teaching" hospital, this is more than understood.

If your chart has been thinned, as per a doctors order (Required), then you should also have an updated Med Reconciliation Form with all of the current medications, checked yes or no, with a doctor's signature. This is a substitute for the original order as an update to the patient's medication list and would keep you from having to find the original order. I can't believe some of the stuff I'm reading here. People not checking charts because some pharmacist checked off on it, as if the pharmacist is responsible for giving a patient a med, original orders taken out of charts and not updated...yeesh.

According to nursing standards, YES, you are supposed to check the chart for medication orders each shift to make sure that the MAR is correct. Does this happen every time, everywhere? Absolutely not. Is it the correct procedure? Absolutely. When you write on the chart that you have done a chart check (whether an entire check or for meds only), you are stating that you have checked the MAR against the entire chart.

I've worked nights and days, and you couldn't pay me enough to go back to nights. I'm in the ICU so it is a little different than on the floor. I like all the night people, but having a regular schedule is so much more convenient for me. Both shifts are busy, just a different type of busy. Day shift is burdened with daily orders, discharges/transfers, feeding, generally more meds (daily stuff), procedures, radiology, etc., but nightshift is often burdened with more admissions (due to vacuum created by dayshift discharges/transfers), baths, etc. Dayshift often is more involved in the "care plan" of the patient (in my opinion) such as LTAC placement, changes in care, family meetings, withdrawal, etc. Just depends on what is important for you. The $7,000 wasn't worth my energy and sanity.

No, CHF is diagnosed via ECHO or PA cath readings. Those are the only two ways that you can reliably diagnose CHF.

Telemetry will probably be more "intensive" patients (due to needing telemetry). It will also teach you more about abnormal EKGs. SCI floor will probably teach you more about trachs, log-rolling, and some other small things like that. Personally, I would do telemetry. But everyone is different, and I hate neuro/trauma anyways.

Levophed....leave 'em dead. (toes and fingers, that is) I know, I know, that's an OLLLLLDDDD quote. For those of you out of neo and/or dopamine as well....YEEEESH! Using epi as a first line? That sucks. Nothing wrong with Vaso...if you want to put your patient on dialysis eventually... Wasn't aware of the recent propofol shortage...we use Versed + Fentanyl mostly...works like a charm, and hangs around FOREVER......

As a student you will learn more in-depth information about patho, pharm, and everything else working in the ICU, especially a MICU. If you want to learn more about systems and how they interact, I'd go with ICU. Of course, I'm partial...

I've been doing this since I started out of school. Its what I was taught as a student during rotations. As iluvivt said, if you back-prime properly, there shouldn't be any issues. There are some medications, as previously mentioned (like insulin) that require their own primary tubing, but backpriming both saves money/utilities and prevents possible infection (related to keeping the end of the unused secondary sterile/not sterile).

I went through something similar...was fired from my first job. Keep your head up, this obviously wasn't where you were meant to be to have an impact. You'll find the right place...I did.

I did....been there, done that. For you floor nurses (especially telemetry) that think that ICU isn't busy, get back to me when you have one patient getting intubated/extubated and/or lined out (TLC, a-line, sometimes shiley) on pressors with tons of meds and probably HIV/AIDS/HepC/TB/C.Diff (please select any combination of this list) while your other patient is on CVVH (aka CRRT, this is continuous dialysis for those unfamiliar) with 4 bags of fluids (that have to be stocked and changed) and an ultrafiltrate (urine) bag with some kind of intervention every 30 minutes (assuming there are no troubleshooting issues, which never happens...), charting, electrolyte replacement for CVVH, on a vent, charting, with 2-4 vasopressors that are being titrated, sedation titration, charting, IVFs, multiple antibiotics, PO meds, charting, arrhythmias, tube feeds, bowel movements, dressing changes, line changes...oh, and did I mention CHARTING. I've worked both the floor (stepdown) and an ICU. Both can be busy at times. But I was never as busy with 5-6 patients as I can be in the ICU.

OP: It depends on the person. Everyone is different and, unfortunately, its really hard to tell if you will get it or you won't. Do you have any experience in an ICU, such as an externship? That would help you to know how well you will handle it. In an ICU there is alot to learn...you're learning all about how patho REALLY works (not just what the book says) and how to recognize things before they get bad, as well as figuring out how to chart, what to chart, when to chart, vital signs, procedures, titrating meds, lines, vents, suctioning, etc etc etc. There is alot to learn about disease processes before you even get into the patient care and prioritization part. I worked on a stepdown before moving to the ICU and I found that time to be invaluable in becoming more capable at managing patients and prioritization of care. But, like I said, some can handle it (some of my friends from school did great in ICU right out of school...some didn't), some can't.

It gets better, but look out if you transfer to a different level of care or a different type of unit (say, to the ER or to an adult floor or ICU). Some of that will start to creep back, but you will get through it. When you think about how much you "don't know," try to remember how much you have learned since you started school and how much you do know...it will surprise you.

CF patients often have colonized pseudomonas (p. aeruginosa [sp?]). If you think about someone getting a transplant, they take loads of immunosuppresants so as to decrease the chance of rejection of the transplanted organ...and this goes for all patients with any type of transplant. The last thing that a person with a transplant needs is to be around someone with colonized pseudomonas in their sputum, much less be in a relationship with them. That's just begging for sespis.

Don't know on the IV, I guess your best option (if you're answering a question) would be to address the patency of the IV and the need for a new one. As for the renal failure, you are probably right that there is some prerenal ARF (aka AKI) going on due to hypovolemia and dehydration. All of your labs as well as vital signs seem to indicate this. The solution is giving fluids or lasix...in this case you'd want to give a bunch of fluids and monitor the UOP for an increase (which would be expected). Hope this helps...