PetERNurse

PetERNurse

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All Content by PetERNurse

  1. this did not make sense to me.

    PetERNurse replied to turnforthenurse's topic in Cardiac

    Even though your platelets are 65 or 50, they are still capable of forming a thrombus. This is why the doc ordered the hep drip. Heparin is not a "blood thinner", and does not decrease the viscosity...

  2. Anyone have any good critical care questions to quiz me on?

    PetERNurse replied to nurse678's topic in Critical Care

    CVP, PAP, and wedge will all be

  3. Anyone have any good critical care questions to quiz me on?

    PetERNurse replied to nurse678's topic in Critical Care

    The answer to these depends on what the current vent settings are and full assessment of ABG taking disease process into

  4. metabolic acidosis and tachypnea

    PetERNurse replied to vic_rn's topic in MICU, SICU

    It's not as simple as saying the pH is X and the PCO2 is Y, therefore the disorder is N. It's not like a hemoglobin, where if it is low the disorder is anemia. You need a complete ABG to evaluate...

  5. Ketamine during an emergent intubation

    PetERNurse replied to BelgianRN's topic in MICU, SICU

    Ketamine causes increased HR and myocardial oxygen demand, while decreasing ventricular filling time. Don't fall into the trap of thinking it doesn't "stress out hemodynamics". Given that the patient...

  6. Best one sentence handoff report

    PetERNurse replied to emtb2rn's topic in Emergency

    "521 is a babysit. When he goes to bite you just toss the pill in the back of his

  7. Ketamine during an emergent intubation

    PetERNurse replied to BelgianRN's topic in MICU, SICU

    I think we can all agree that it increases morbidity and hemodynamic sequalae as it increases the likelihood of vasopressor dependence in the PO period. Yes jury is still out on if it increases...

  8. Ketamine during an emergent intubation

    PetERNurse replied to BelgianRN's topic in MICU, SICU

    Controversies surrounding the use o... [Ann Pharmacother. 2010 Jul-Aug] - PubMed - NCBI Etomidate versus ketamine for rapid sequence intubati... [Lancet. 2009] - PubMed - NCBI Acute adrenal...

  9. Ketamine during an emergent intubation

    PetERNurse replied to BelgianRN's topic in MICU, SICU

    People used to think the etomidate did not increase m+m, but that is not the consensus now. Even a single dose has been shown to cause prolonged adrenal supression that increases m+m, especially in...

  10. Self extubation

    PetERNurse replied to Jdalt10's topic in Neuro Intensive Care, ICU

    Dipravan causes significant myocardial depression and decreased CO. Definitely can effect BP especially in a CV compromised patient. I agree you may need to up your sedation/look to other meds...

  11. Nitro vs Morphine

    PetERNurse replied to moidla's topic in CCU, Coronary, Cardiac

    Morphine is also more vasodilatory than fentanyl and will provide more of an increase in myocardial oxygen delivery. Additionally the increase in mortality with morphine demonstrated by the CRUSADE...

  12. Respiratory acidosis/failure s/s

    PetERNurse replied to Aurora77's topic in CCU, Coronary, Cardiac

    Your body wants to blow off the excess carbon dioxide so tachypnea is an early sign. Along with tachycardia as the heart tries to increase it's output to meet an inadequately supplied metabolic...

  13. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    the problem here is that your answer to the op "original simple question" contains fundamentally incorrect material (see post 39 above). i'd be interested to see the clinician's reaction when you...

  14. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    It's not so much that the kidneys separate Na, Cl, and H2O, but that it is an aqueous solution. NaCl does dissociate when in solution. It's just basic

  15. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    Right, 140, because that measurement is a measurement of CONCENTRATION, not a count of the absolute number of sodium molecules. Got that? If not, work on it, because you have to "get" it. If you have...

  16. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    The OP was referencing this comment when they said that. I guess I just read the OP comment as hyPOvolemic. OP- Just to clarify, was the patient hypervolemic or

  17. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    Not an appreciable difference. Again, remember that the underlying disease process is still occurring, which means continued fluid retention. Yes if the patient is hypervolemic due to CHF, liver...

  18. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    It sounds like what she meant was that even though there is sodium in the solution, there is enough water in the solution to dilute serum sodium levels even further. I'm not sure that is...

  19. How bolus infusions of NaCl may affect low sodium levels...?

    PetERNurse replied to Xsited2baNurse's topic in General Nursing

    There are a few different types of hyponatremia: 1- Hyponatremia w normal plasma osmolality (aka "pseudohyponatremia"). Usually due to hyperlipidemia/hyperproteinemia, which interferes with sodium...

  20. Refued to give pain meds due to brady

    PetERNurse replied to kindnotstupidRN's topic in Medical-Surgical

    Why is the patient

  21. infection and normal WBC

    PetERNurse replied to clearblue3's topic in General Nursing

    If there was bacteremia you would expect changes in the diff (bands at the very least, but frequently if WBC on way back down, P would be neutropenic/low normal neuts and you would see metamyelocytes...

  22. infection and normal WBC

    PetERNurse replied to clearblue3's topic in General Nursing

    I would suspect the patient has inflammatory cellulitis secondary to the lymphedema. Abx are Rx because of the decreased barrier integrity and likelihood of infection. Like another poster said, the...

  23. infection and normal WBC

    PetERNurse replied to clearblue3's topic in General Nursing

    Again I would say that there may not be an infection present. Just because you get a positive culture doesn't mean there is an infection. If we swabbed your hand we might grow strep, but that...

  24. infection and normal WBC

    PetERNurse replied to clearblue3's topic in General Nursing

    Some patients just don't read the same books we

  25. infection and normal WBC

    PetERNurse replied to clearblue3's topic in General Nursing

    Might not be an infection. Was a culture