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Rosie_one's Latest Activity

  1. Rosie_one

    PA catheter and parameters

    PA Catheters are used frequently in our CVICU. You will not see them in use in any other specialty, only cardiothotacics. The alternative option is a PICCO monitor, which I have used in MICU, but in Aus aren't used on a regular basis.
  2. Rosie_one

    Help! How do I deal with frustrating patients

    Oh I forgot to mention. When you start out in ICU, you will be given the stable patients. They are assessing your skills with "simple patients", mind you often mentally draining. If you can handle these patients, your acuity of patients will slowly go up, as they get to learn your skill level and teach you skills to look after more unstable patients. ICU will take the longest to progress so work hard and you can go far. Even experienced ICU nurses to a new unit are given stable patients first. I've been working in ICU long enough now to not care about allocations anymore. I found it helped changing my mindset. Give me whatever patient and I'll look after them the best I can. If their confused/agitated, I try to see if my nursing style/care makes them less so or more agitated than previous shifts as if I'll discover the secret to a calm patient lol.
  3. Rosie_one

    Help! How do I deal with frustrating patients

    I would also make sure the husband isn't making your confused/agitated patient worse. Often family members will talk to and expect conversation and just stress a patient out more than if the family wasn't there. I'd explain to the husband that his wife isn't herself due to nature of frontal lobe, what that actually means for their wife, what to expect. I'd also educate the family on the importance of low stimulus and regular rest periods to aid in their wife's recovery, reduce delirium etc. Some family get distressed how their family member is acting. I find every shift I'm explaining this, even if the patient has been there awhile. These type of patients are common in ICU as wards can't handle with their patient loads. We have lo-lo beds that can go to the floor which are much safer. If a line is deemed unnecessary, ask the drs whether you can remove it. One less thing to pull out. Restrains are often required were I work due to traches, which would be pulled out. Sedating a patient isn't always an option due reduced ability to assess neuros, but if you think it's causing distress to family, get the drs to chat to them about what to expect. A nurse can say it all they like, but families like a dr to say it to them too. Put a positive spin on things. A patient's rolling in the bed. Self pressure area care tick.
  4. Rosie_one

    New Grad in Neuro ICU

    Congratulations! Welcome to the dark side haha. Have a lot of patience. You will be dealing with a lot of confused/delirius/agitated patients. You will sometimes feel, "is there a point to this". I work in a major trauma centre specialising in neurosurg and a neurosurgeon said to me once, that you could get 20 patients with what appear to be the same brain injury, all interventions, some wont make it, some might be severely disabled and one might walk away and live a productive life...they just don't know who. I remember that when I feel works getting to me and we're just torturing people. Don't be blasé about hourly neuro obs, patients deteriorate quickly, just because neuros were stable for 2 days doesn't mean they'll stay that way. Always do a set of neuro obs with nurse that is handing over patient. You'd be surprised how peoples' idea of the GCS scale/assessment varies. If you don't already, get a very good understanding of the Monroe-Kellie Hypothesis and how it relates to the patient you are looking after. It'll make everything make sense. Working to Cerebral Perfusion Pressures (CPPs) and not MAPs. I came from a CVICU background, so different way of thinking. You will get great experience in failed extubations and reintubating as neuro are high-risk patients due to nature of their injury. Families will be difficult and require a lot of care, as often take a lot of time to come to terms with 'brain death'. Most don't get it.
  5. Rosie_one

    Intubation turning into a code blue

    Agree with all previous entries. Just to add. I always think back to the oxygen dissociation curve, once Sp02 is under 90%, it will drop very quickly so no surprise it got down to as low as it did. I doubt their Sp02 was above 90% to begin with. Did you preoxygen the patient with Fi02 100% I preoxygenate on BiPAP for high risk patients Maybe the dr should of had another doc there just in case things went wrong. All high risk deteriorating patients should in my view. Maybe the dr let stressful situation get to him too.
  6. Rosie_one

    What to see in a SICU

    I'd ask to be put with chest trauma, always interesting as great for resp assessment, surgical chest drains (ICCs). They're complex from a ventilation stand point and as such require quite a bit of sedation/analgesia and paralysis if extremely difficult to ventilate. They can deteriorate quite quickly, so you never know what kind of shift you're in for. I work in level 1 ICU, our traumas are mixed with surgical, but if separate then: Trache patient is always great experience as most new nurses find them very daunting. Expecially great experience when doing trache weans from vent to highflow. Major Abdominal and or oesophageal surgeries as they can be quite high acuity. If they do oesophagectomies and a patient in the unit, they are always high acuity. You'll get lots of experience in general drains, maybe VACs, often complications such as bleeding, anastomotic leaks, loads IV/NGT med experience. Electrolyte derailment, and often interesting ABGs. If not 100% sure, maybe ask for what you need for practice in such as IV administration experience, interested in a certain type of surgery. Asking for a high acuity pt. is always a good one. Anything you're scared of looking after haha. Best way to learn.
  7. Rosie_one

    First med error/mistakes

    First of all you made it through the night!!! Some shifts I just want to crawl into a ball haha.The problem with nurses we strive to offer the best patient care to our knowledge and ability, but soon come to realise that with staffing shortages and/or patient load just can't. If workload is too high, always tell your nurse incharge and state reasons why and document in notes before getting caught up. It may not always change your shift, but you've put it on the record if anything happens and, if nothing can be done that night, improved staffing for the morning might be arranged. You are one person, you can only do what you can do! I work methodically through my workload. Don't try to get distracted (easy said than done) especially when doing medications. I find when you get flusted it takes longer to do things, than if just make a plan of what's highest priority and work down the list. Assessment of patients and obs, medications, personal care (as best as possible in that order). Like what was said previously, a standard infusion line takes about 20mls to prime, so then dialling up minus 20ml from the volume of fluids you are giving. Also with piggybacked IVs onto fluids put the volume of your maintenance fluids as 1mL, so when your infusion of IVABs is finished, it will beep without putting air in the line and is ready for you to flush. I tend to also put a timer on my heparin go off after 4hrs, but if you can't get to it quickly to just press continue, then I'd recommend not doing this. Shifts like this, we all have to come to terms with the fact that we can't do everything and next shift will have to pick up what couldn't be done. It's a 24hr job after all! As long as you work safely and to the best of our ability. It gets easier with experience, but some shifts are just plain horrible.
  8. Rosie_one

    Post-Extubation Policy

    Ventilation requirements are that pt. needs to be on Spont mode (no brainer really). Grade of airway should be noted in case of reintubation. PS 10 or less, PEEP 10 or less, Fi02 30% or less. Assess airway, has spont cough (strong) and gag. Has a audible cuff leak. Able to follow commands, strong enough to lift head off the pillow and able to take large Vt when instructed. Also have a decent pre extubation ABG. Extubate onto varying oxygen np, HM, HighFlow (my unit is quite varied in pts). Do a post extubation ABG 30mins after and obviously closely monitor. That's what we have a general rule. Obviously dependingon your unit there maybe exceptions. We have major neuro cases which don't always go completely to protocol prior to extubation, but the intensivist has clearly documented
  9. Rosie_one

    Med error . I’m devastated

    Glad your patient was ok and be glad that this error was not fatal. We have all been there. Looking into most mistakes, a lot of the time it's not just the nurse, but the environment that leads to medication errors. Systems in place in that unit, constant interruptions from drs and family members, the list goes on. Is it possible to change to preparing each patient's medication in front of them and not everyone's all at once. To me this is just an error waiting to happen. I'm sure you're not the first nurse in tgat situation to make a mistake, but honest enough to admit it. The worst mistake I made when I started nursing was not checking blood results before giving out meds. Patient was in renal failure and gave them potassium. Felt terrible and they had to get dialysed they ended up ok, but was mortified. It's made me a better nurse as I check absolutely everything before giving meds etc.
  10. Rosie_one

    How do I transition specialities?

    Not sure how it works in the US, but I'll tell you how it works in Aus, as I'm sure there can't be that much difference in landing a position. Easier to get your first gig in a large teaching hospital. Here we have positions available for nurses new to icu. They don't come up regularly, but if you speak to the educators of the icu you're interested in, then they should be able to put you on the list of nurses getting into icu. Here it's called, Into to ICU or something similar. Once you complete that course, anywhere from 3 months to a year you can then apply for a permanent position. If that fails, get acute care experience that will be looked at more desirablely such as ED and cardiology, also if you haven't done so get advanced life support certificate. All these show you have a desire to work in an acute setting and will help you when you do get that icu position. Show you're proactive. Speak to educators of several icus to get a feel for what is desirable criteria and steps to get into icu. Hope this helps
  11. Rosie_one

    Delirium & neuro patients

    I work in a neurotrauma unit and unfortunately hourly neuros are part of it. I would ask the neueo surgeons if it's safe to change frequency of neuro obs. It depends on what's the problem, but they won't risk changing to even second hourly if there is still a slight risk of deterioration. There are some really good Danish research articles into icu delirium. You've named a few things, also if you can reduced sedation(may not be able to depending on reason for admission). Several articles recommended reducing propofol by half, if can tolerate then leave at halved rate. If can't, go back up and try again a bit later and work to a RASS scale aim instead. We often oversedate our patients for our own and families comfort. Difficult to not have delirium in neuro sadly.
  12. Rosie_one

    Blood products

    Hang separately as what everyone else has said regarding possible reactions. Easy to remember is stop signs, amber before red so I'd give FFP first, then blood. Your country should have a blood administration protocol in acute care, massive bleed etc. You could always use noradrenaline if has central access or metaraminol if only peripheral access if blood pressure was that labile until blood products were in.
  13. Rosie_one

    Please help me with central line education

    Maybe when dressings and lumen changes are due routinely and when dressing soiled, coming off. How long to wipe with alcohol wipe before accessing, approx 15 secs then allow to dry to reduce infections including clabsi. Maybe a reasoning behind why some sites are chosen over others and highest risk for pnuemothorax also. How to assess if in artery or in vein by mistake. Checking placement on cxr etc. Also what to do when suspect an infected line and sending tip for culture and how to do that. Maybe even correct removal.
  14. Rosie_one

    First code blue, hard not to blame myself.

    Don't blame yourself. Good to look back on performance and spot whay could have been improved on, but you have to remember they were sick and despite medical/nursing care people still die. I had a very traumatic death my first year out and a nursesaid to me one, "some people are going to die, but you give them a chance at living". Patient should have been treated with suspected PEs anyway till more stable to transport. Unsure about why this patient wasn't taken on a bed as risk of deterioration was on the cards.
  15. Rosie_one

    What do you do with families who think badly of you?

    Sorry you were put in a very difficult situation and it's completely normal to take this to heart when you're doing the best you can to care for their loved one. It generally haopens when you're busting your butt to do all you can. It's a different situation in Australia to the US m, as we don't have respirstory techs so do ventilation as well. Tidal volume alarms will go off for several reasons. *pt. not getting satisfactory volumes for several reasons. Could sputum load, which another nurse mentioned earlier which requires suctioning. A pt. biting the ETT would also cause a low tidal volume alarm, which is disrupting ventilation is usually fixed by boluses sedation to stop biting and/or a bite block. *Tidal volumes are large, which could mean that the pressure support that set on can be reduced as satisfactory volumes are being made. *Minute volume alarms couldbe triggered, as they are increasing their respiratory rate. Minute volume is RR × Vt= Mv *Also mentioned earlier, the alarms could be too tight, or patient's situation has changed and requires alarms to be altered. *They could just be coughing or starting to breath up, about the set alarm limits, so vent often alarms it's a machine and doesn't like humans breathing haha...in certain respiratory modes. It's not uncommon for family members to get distressed when alarms are constantly going off despite you letting them know. You did the appropriate thing to go to team leader etc. I actually find it quite poor that a manager of an ICU not have an understanding of ventilation, even at a basic level would allow to trouble shoot. Surely a resp tech from another pt. Could have helped fix the issue. Not safe to keep vent alarming I agree.
  16. Rosie_one

    Tips for nurses in their first year of nursing

    Nursie69, your forms at your place of work sound terrible lol. They have these stupid forms at my work that you have to fill in with the idea that it will help you pick up problems with your patients, it's quite funny, one is about whether they are conscious/unconscious, as if i needed a form to tell me somethings wrong haha, everyone hates them lol.

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