angle71054

That is my life every 3 months or so. But then again I'm an Agency nurse.

So my first crazy nursing dream was also a "co-dream" with my husband. So I started my nursing career and found my husband at the same time. And well sleeping (literally) with some one was new too. In my nightmare I was in my patient's room and heard the code alarm go off. I went to the patient's door and couldn't open it. In my husband's dream he was stocking shelves at Walmart (his job at the time), and I was knocking everything off the shelves. In reality I had got my arm stuck underneath my husband. So when I attempted to pull my arm out from underneath him-in my dream I was pulling on the patient's door. And when I would attempt to get my arm out-in my husband's dream I was knocking things down. He woke me up by shaking me and telling me to stop knocking things down and I shouted "Well let me out of the room first". LOL. Oh the wonders of dreams.

So I started off as a Surg/Telmetry RN spent 2.5yrs and then switched to ICU nursing. I loved the switch. I have attempted to go back to med/surg but my heart is in the ICU. I now am a Agency RN and am willing to do what ever where ever. I do not think that going to a smaller hospital would be a huge change from the larger level 1 trauma hospital. Maybe you won't get the big GSW's or the MVA's, but you will still get the sicker than a dog/hovering on deaths door patient's. I am excited for you. I love ICU nursing. Yes you can run harder, critically think more, and get your behind handed to you on ICU as much as you do in med/surg, but you can see your efforts more. I have run my butt off on med/surg and look back at my shift and go "what in the world have I been doing all night that I am so tired" but did not feel like I got anything done, but in the ICU you can actually see what "YOUR" actions have done. You get to be more involved with family and patient. You can bring some one back from death. It can be a high stress, high emotion, high intensity, high reward job. If you are an adrenaline junky ICU can be for you. You have the responsibility of taking care of a patient that you can heal or break. I would not change my med/surg experience for anything. When I went to the ICU I could out assess (because in med/surg you can see everything, cardiac, ortho, pneumonia, renal, neuro and so I had experience with so that I could pull from past experience. Never had to stop and ask myself is this a normal lung sound), out chart (cause you know you have had the 5 patient's you started with sent 3 home and got 3 more)and out organize other nurse walking in from nursing school. You have a lot more tools in you basket of goodies to pull from. I am excited for you. You will have fun.

So I am not an ER nurse, I am a ICU nurse. I had a scary experience with a patient the other day and I am a little freaked out. I know Heat stroke is dangerous. That it has the capacity to shut down your kidneys and other damage, but I have never seen anything like it. I am not wanting to break HIPPA. I am an agency RN that does not work in the city I live in. But forgive my attempt at being geniric as possible. A man walked into this hospital stating he did not feel well. He stated he got over heated working outside, then episodes of diarrhea. He was purple. Like really purple from head to toe. He seemed to be a Caucasian that was very tan. But he was like really purple. The skin looked like swirls of jaundice yellow and purple. They ended up intubating the man and transfering him to ICU where he later coded and died. His labs indicated he was going into DIC. Is it really possible for heat stroke to do this. I've not worked in hot enviroments, so it was new to me. I mean I am an experienced RN for 13yrs, and never have seen anything like this. It really freaked me out. Any info would be great. I hate not understanding things that can happen to my patients.

Thank you for the post. It was very moving. It is a situation that we hope we never incounter but as a nurse with 7 years of expericence I have delt with it several times. It can be heart breaking. I make it a point that with every pt that I admit that we discuss end of life requests. I do it in front of the family and am very specific in the converstation. I believe it doesn't do anyone any good to beat around the bush. I make a point of saying that I don't expect to need to use the information but it is very helpful to know that way we all (patient, family, and staff caring for that pt) understand exactly what are their wishes. I have had several newer nurses overhear my conversations and have questioned my frankness about the subject, and I explain that it is a hard thing to think about but it saves so much heart ache, regret, and sometimes fighting when we are upfront and direct. On a more personal note I have a father that wishes to be a DNR. And being the upfront nurse/daughter we have had long discussions about it. As soon as we were done I immediately told him to get in writing that that he needed to have the same discussion with my other siblings so that I'm not the mean child that wants to kill daddy. That he needed to be the one to discuss it with them and he needed to be as upfront and frank about it with them as he had been with me. End of life situations are hard, but lets face it with digity and grace and God forbid a smile that we can let our loved one meet our maker on their terms not ours.

Speaking from as CCU nurse with 5yrs under my belt here. You can never have "too much over kill". We can do all the tests in the world CK,CPK,CKMB,trop I,EKG, stress tests everything and you still don't know the whole picture. Just because we haven't seen any signs of changes doesn't mean there isn't something going on. I have even seen pt that come back from a clean cath and have chest pain after. The pt could be having spasms or have developed a lot that has lodged in one of the cornary arteries. The moral of the story is if in doubt "CYA"(cover your a**). I would rather be safe than sorry and I'm sure the pt would agree.

Thank you so much for explaining. No one that I talked knew what was needed and the chaplin that showed up at the code just stated that he didn't think he was wanted and was going to leave. He stated he didn't know what he needed to do to help except to respect what he thought their wishes were and to back off. That is all fine and dandy for him but I have of course bounded with the family and did not want to upset them by doing something they would consider disrespectful. I appreciate you responding so quickly. I will share the infromation with my co-workers that way next time we will be more prepared.

I was caring for a pt that was a buddhist and he passed away. I have never experienced nor learned about all of the different rituals and requirements they need to have met. For instance we were kind of in a bed crunch and the pt had passed and 3hrs before and they stated they needed to not move him for 8hrs and finally settled on 4 after discussing it with the priest/monks that had come up to pray with them. They daughter stated that if we moved the body to soon the pt soul could be lost and confused. Well I can't argue about that. We were not trying to rush them, but did know what was required. Also they wanted everything quiet, no one was supposed to cry. I don't know. I try and not offend people especially in such a delicate state of just loosing a loved on, but I felt so inept to take care of their needs, because I did not understand what they needed. Is there anyone out there that can explain what is needed/expected after a buddhist pt passes. I would be devistated if I caused someone's loved on to loose their soul or not be able to find his/her way. If anyone could help me I would be very grateful.

A Q-wave develops several days after a pt has a severe enough MI that it causes cell death. The Q-wave must be at least 1/3 of the height of a QRS to be clinically significant to say that the pt has had an old MI. It usually does not go way. You must see the Q-wave on a 12-lead EKG not just a monitor strip (monitor strips can be deceving). It just means that there has been an old MI. It can help us as health providers better understand when the pt had an MI.

Never take bp in same arm as a-line and picc. I have in rare occasions taken bp in same arm as picc if it is lower than the picc line, but only in cases in which you have no other place. Like a pt with a shunt in one arm and can't get a good reading from a leg.

I work in CCU. My manager wanted me to start thinking about a collection of information that we could had a newly diagosed pt with CHF. Something that is easy to understand. To help the patient understand the new life altering situation but not to overwhelm them. If any one has any ideas I would greatly appreciate it.

:no:In our hospital (I work in CCU) we replace K+ both po and iv depending on what the dr orders, but iv K+ is never to be stronger than 10meq over an hour. If the pt has a central line we can give in 50cc of fluid for pt in CHF, but still to be ran over an hour. I guess if pt has a such a critical low K+ that it is causing a lethal arrhythmias it could be given faster but not ever seen it if the 5 yrs I have been a nurse.

You are correct in thinking that an IABP as it inflates it provides an increase in perfusion, it almost gives it a second stoke of oxygen rich blood so to speak. Also as it inflates it gives just a little more pressure in to the arteries to help push by a narrowed area allowing more of the heart to be better perfused (especially when the IABP is being used a bridge to surgery). As it deflates it almost creates a neg space aorta allowing the heart to not have to work so hard to open up the aortic valve to perfuse the body. Basically decreasing the svr. I hope that helps I am not the best at explaining things. Wanted to help and its been a while since you posted felt it needed a response. If i didn't explain well enough be sure to ask those nurses around you, or hell you can even call your IABP rep and ask them if you don't the answers you need.

Well I have been a nurse for almost 5 yrs now, and like you I wanted to start in and ICU, but did not think that I would be quailfied to start there. I intially started in a med/surg floor that was surgical/telemetry. I was able to see everything from 18yrs old to 100yrs old, heart, neuro, GI,..you name I was able to see it. In my hospital not every floor was able to do telemetry so you got everything from everywhere. As a med/surg nurse I learn how to do a complete head-to-toe assessment, learned to be very organized (have to be or you won't make it as a med/surg nurse). I believed;) that I became the most well-rounded nurse I could. After 2 1/2yrs I switched to a CCU nurse. It is a whole different enviroment. On the floor you are not allowed to think as much. If something is abnormal ie.urine out put low (200 in 8hrs), pot 3.4, anything you call the doctor. You don't necessarily fix the problem then call. In the ICU you are allowed a little more freedom and with that freedom responsiblity. The biggest problems I faced switching was whether or not to call the doc and to trust my instincts. I think that if ICU is where your heart is, then grab it. Be pro-active in your learning/education. Never be afraid to say I don't know and be proud that you have enough guts to say it. I think if you are brave enough and self-motivated enough to start in an ICU-with the right experienced nurses around you, you can start in an ICU and thrive. You just have to want it enough and be willing to work at it. I personally would not trade my med/surg experience for anything. I think that even though I have only been a nurse for 5yrs, my assessment skills and organization skills are as sharp as those around me. In fact I find the more experienced RN's coming up to me asking questions about things that we don't normally see in CCU because of my diverse experience on the floor. No matter where you start, you determine how successful you will become. You have to want it and be willing to be aggressive to get the knowledge that you need to be the best nurse for your pt's.

Hey everyone I need some information. I am a cardiac nurse so I don't know that much information related to cancer. My mother just had a needle biopsy and the results stated she has Ductal Carcinoma in Situ. I have done some research on it, but it would be nice to have a nurses view of things not a text book view. So any information you could give me would be helpful. I would like to reasure my mother that things are going to be okay, but until I know what I am talking about I can't be very convincing. Thank you for your help.