2mochas

Calling a code is quite different than calling the MET or Rapid Response Team. You would not call a code on a DNR patient but you would call the RRT. As others have written, you are not calling for CPR or intubation when you call for Rapid Response. It may well be that the distress this patient is experiencing can be reversed with meds, O2, etc. You are calling in a team will help you analyze the situation and go from there. Remember to communicate using SBAR--situation, background, (assessment) and recommendations. If you are caring for a lot of patients, it's hard to remember specifics, so it's a good idea to have the chart handy. And, remember, you only have to have a gut feeling that something is wrong to call the RRT. At our hospital, even family members are informed they can call the RRT (hasn't happened yet, though).

I am an ICU nurse and just cared for a patient last night who had comfort measures only. We did not have any lines in him. We stopped taking vital signs,. dc'd all lab draws, etc. because death was imminent and it was the family's wishes. The family wanted him to stay in ICU until he passed. We basically performed oral care, administered pain meds/sedatives prn and repositioned him. Much of our time was spent giving family support.

This does occur. The term "comfort measures only" in and of itself implies impending death. The key is to keep in close communication with the family (and physician); you'll find most family members prefer that their loved one dies a peaceful death with as little discomfort as possible. Let them have an active role, teach them about the meds available and the actions of the medications. I have come across very little resistance. In fact, the family often will come to me asking for more pain medication/sedation knowing not only the benefits but also the possibility of depressed respirations/respiratory arrest.

Got it, thanks!

Thank you. I think I"d have an easier time finding procedural NPO status information if I went up to med/surg floor and snooped through their P/Ps. One more question, what is EPB? Again, thank you for all the information. Kudos to you!

Very helpful, thank you!

Thank you!

Sorry to get back to you so late, but thank you!

My question is with regard to having patients signing consents prior to procedures. It used to be, back in the day, all we had to think about were surgical procedures. Now (and for good reason) we are having patients sign prior to receiving blood transfusions. However, there are so many new procedures and it seems I am coming across some that do and some that don't require written consent. I would think anything invasive or anything requiring sedation/analgesia requires written consent; is that the best way to know? Also, so many times, I am told to hurry and get the patient to sign a consent BEFORE the surgeon has discussed the procedure, let alone the risks and benefits, to the patient. We are told, "Oh, that will be gone over in the holding area or just before surgery". Needless to say, I am not comfortable with this. Also, our ICU unit has no set written policies (that I can find) regarding which procedures require patients to be NPO prior to procedures and for how many hours, which procedures allow for a clear liquid breakfast, etc. Anybody out there well versed on this? I sure would appreciate any input.

I know a tension pneumothorax is caused by air getting into the pleural space that cannot escape, usually caused by blunt or penetrating trauma, positive pressure, large TVs, and/or PEEP (also clamped water seal). Caridac tamponade is fluid or blood in the pericardial space, usually also caused by blunt or penetrating injury. I am looking for the differences in symptoms. Both can cause a shift in the mediastinum and both can cause JVD. The differences I came up with are that a tension pneumo causes assymetrical chest excursion, tachypnea and diminished or absent breath sounds on the affected side. Cardiac tamponade can cause a narrowed pulse pressure, a friction rubs, muffled heart sounds and Beck's triad. I think what sets it most apart from a tension pneumo is that there are increased both right and left heart pressures (RAP , PaOp). This is all I could come up with maybe that's all there is...

A speaker for a CCRN review class told us it was a good idea to be able to tell the difference between cardiac tamponade and tension pneumothorax. I am finding conflicting information....anyone know?

Thank you!!~

Thank you so much for this useful information. If you don't mind, I just have one more question: Should I do the square wave test in conjunction with zeroing? Does one interfere with the other? Which one should be done first? I undrstand how often the zeroing should be done; does that apply to the square wave test also?

I know zeroing the art line and flushing it are done together but I am unsure which is done first. Or, does it matter? Thanks in advance..