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ICUenthusiast

ICUenthusiast

ICU
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ICUenthusiast specializes in ICU.

ICUenthusiast's Latest Activity

  1. ICUenthusiast

    Propofol and drug overdose

    Anyone know why propofol is suggested for drug overdoses over other sedating agents? Tried looking up a good reason, couldn't find one.
  2. ICUenthusiast

    Subtle Changes?

    Even tho you're a new grad, you'll be expected to start picking up on the trends quickly... it's very important in an ICU area. So even if you aren't going to be alone for some time, act like you will be anyways. You'll get the most out of your orientation that way. (Of course the first couple days on the floor might be shadowing and just learning where things are etc, especially if you did not ever work on the unit as a student.. but I think you understand what I meant.)
  3. ICUenthusiast

    Subtle Changes?

    Subtle changes.. Easy example: sign of cushing triad (increasing cranial pressure) is widening pulse pressure. If you do not actually watch the trend, you may not pick up on this sign. This is common in vital signs and labs.. don't just look at most recent, go back and compare the days. If there's a trend (up or down), take note and think of why it might be. Common example of subtle changes & trends: nurses just keep increase the O2 for someone (or FiO2 if ventilated) little by little. After a week, the patient dies from something breathing related. It could've been prevented if the nurses noticed the trend of increasing the O2 every shift. Then, if you have had a pt once before, you can pick up on in subtle changes in personality/demeanor and level of consciousness better.. Though they can be hard to if it's a very slow change and you haven't had a patient before. e.g. a pt of mine last night was very alert and awake (ventilated and weak though, couldn't speak). Tonight I came on shift and found her very very lethargic when I just pass by her room. When I get report, I find out they had been doing breathing trials all day.. From knowing the patient (actually had her going on 7 nights whew), I knew these were interrelated, luckily nothing more serious.
  4. ICUenthusiast

    How does your unit orient new nurses?

    Our hospital gives preceptees a bunch of core competency check off lists, almost like a "care map" for the orientation period, etc. They are told they will have lots of small evals to help bite problems in the butt or identify preceptor/preceptee clashes. They have a lot of classes, but nothing very ICU oriented. Supposedly, they choose a mentor. The preceptor takes one 6 hour class if they wish to precept and can then precept. In theory, it sounds like a good model.. but only if individual units enforce it. With the exception of choosing preceptors... they kind of let anyone and everyone do it regardless.. even if they have shown to be bad preceptors in the past. The model you're saying sounds good, honestly. Some things people can't really seem to decide upon in my hospital: 1 vs more than 1 preceptor. Some people thrive by learning things from different people, as a different preceptor can offer different insight and different ways of thinking. Then there's some that think there should only be one preceptor for a preceptee, and some preceptees really can't adapt to a change in preceptors well (although this may reflect upon their ability in general to adapt..?). As for preceptees feeling part of the team, luckily there's this quiet safety net amongst the individuals in my unit. They don't really stand out at first glance because they don't socialize at the nurse's station, talk loudly, etc. But they also tend to reach out to preceptees and help make them feel competent and wanted by the unit more than others. Otherwise, there's very little done to help preceptees feel part of the unit. The hospital overall gives preceptees a lot of "pep talks" in various classes about how they think every person there is special etc and how much of a difference each one can make. Unfortunately, it's kinda cheesy and I don't know how many people take it w/o lots of salt. For rapid clinical competency, you need the unit as a whole aware of the preceptee. Offering up skills for them to practice is helpful. Another helpful thing is having preceptors that have a good balance between letting the preceptee take over all the work yet enough oversight to make sure it is safe (maybe not the first week, but after x many weeks). Telling preceptees what to do at x time every day will not make them competent nurses, only a nurse that only does what they're told to! Of course this can be solved by frequent meetings with both together, and separate, so issues can be identified and solved. Unfortunately, learn from my unit's mistakes... preceptees are basically left to the wolves. If the preceptor doesn't like them, the preceptee tends to get a very negative eval only at the end of precepting, and often with no constructive criticism. All the paperwork is a good idea, but only when it's enforced .. and in our unit, the preceptees are motivated to do the paperwork... it's the preceptors that aren't doing it. Tends to fall on the preceptee's head though.
  5. ICUenthusiast

    Littman vs. Ultrascope vs. others

    Don't put your stethoscope down?
  6. ICUenthusiast

    Hemodialysis with low BP on pressors?

    SLED commonly used interchangeably with CRRT by some, altho I think they are technically different .. CRRT slower than SLED iirc. gets confusing when you hear a pt got a SLED from one RN And then CRRT from another.. at my ICUs, dialysis nurse sets up the CRRT, but the ICU nurse will monitor it and be taught how to respond to alarms from the machine etc by the dialysis nurse they'd do the same for SLED probably, since it'd seem inefficient to have a dialysis nurse sitting around for prolonged periods of time
  7. ICUenthusiast

    Are some people just not cut out for ICU?

    I agree with this post a lot. During my orientation period, I had personality clashes with a preceptor. She wanted to tell me what I'd do, at all times, and it was very demoralizing as I felt I couldn't learn well and what knowledge/skills I had were not "good enough" for that one preceptor. Unfortunately, for some ppl, this backfires and they almost regress, because all they are not being allowed to think for themselves, and if they do, they don't receive recognition for it. This is what happened to me! When I had another preceptor, it was completely opposite, and I was independent w/ exception of emergencies. I felt like I was able to show I knew my stuff, and at the end of the day, they'd tell me things like, "You did very well overall. As you progress, try to improve on x points." And if I made a dumb mistake (like why isn't this suctioning--oh it's not hooked up), I appreciated that people could say "Yeah, I make some of those mistakes still," where as the preceptor I didn't get along with attacked me for them. So what that came out looking like was one person only had negative things to say about me while everyone else on the unit I knew and worked directly with me praised me and welcomed me to the unit. That made my first eval hell too. Regardless of that, I still always showed up to work on time, was trying to expand my knowledge base, and could tell someone dig was an inotrope............ I feel those are just basics to showing you even want to be a nurse regardless of specialty!
  8. ICUenthusiast

    What's Your Best Nursing Ghost Story?

    A pt died 2 nights ago suddenly, after a handful of codes. The family finally said no more, and changed him to DNR so he could pass peacefully. 24 hrs passed, no one in that room since him because of low census. It was a very easy going night so many of us were gathered near the code pagers etc. when one pager went off. The paged called a code blue from that patient's room. We all looked at each other, realized no alarms were going off (technically our alarms WILL go off before the pager if a code is on the unit), and proceeded with "what the hell is going on" looks. At that moment, we realized that 24 hrs earlier, exactly, our pt in that room had passed. Queue the whole unit rubbing the goosebumps on their arms.. That's not even the haunted room of the unit!
  9. ICUenthusiast

    CVP through PowerPort?

    You're right, I misread the powerport as a picc. Had just gotten off work when checking forums heh.
  10. ICUenthusiast

    CVP through PowerPort?

    The port is just made so it can handle the injection pressure from imaging dye and doesn't need hep lock flushes. Can run thru them fine, we have been. http://www.bardaccess.com/nurse-powerpiccsolo.php if you wanna double check, even bard says you can!
  11. ICUenthusiast

    Rx Adderall for a nurse

    If a location declines to allow you to work because you take adderall and it shows up on your drug test, because you have a medical reason that can be legitimized by a physician, that can be considered discrimination. fyi
  12. ICUenthusiast

    Stuck in the rumor mill at work...

    I thought most workplaces didn't care anymore who slept with who provided it didn't affect the job you do!
  13. ICUenthusiast

    You know it's going to be a crazy night at work, when

    Previous nurse tells you "Oh, I thought you needed a doctor's order to do ________" replace blank with most basic nursing function you can think of
  14. ICUenthusiast

    The things your teachers say...

    IS and FEV is testing how well your patient can suck and blow
  15. ICUenthusiast

    Question about flushing lines

    Since a central line and clots got brought up, what do you guys do for clotted centrals? In our ICUs, the RN's can order TPA x2 (it's like 3 cc)for each clotted line per protocol.. out on the floor, a MD has to order, and I think a ICU RN has to come give it.. doesn't happen enough for me to know though!
  16. ICUenthusiast

    staffing

    Only 1:3 when they're not ventilated, walkie-talkie telemetry status patients (we d/c open hearts directly, and sometimes tele floors are full and we have to hold onto a tele patient for a shift). Can be a very busy shift, but it's usually low-risk overall. Fresh open hearts are 1:1 for 24 hrs. Sometimes, if they are in just really bad shape, they stay 1:1 for over 24 hrs. IABP are always 1:1. CRRT are always 1:1. And so forth.
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