cabgrn2

Various forms of discipline can be used without firing this nurse -

There is a well studied "cheat" sheet call the "SBAR" - follows is short version S=situation - your name, pt name & room #, problem calling about B=background - date of adm, adm. dx. pertinent medical hx, brief synopsis of the tx to date A=assessment- most recent VS, O2, pulse ox, changes in assessment R= recommendation - if the dr isn't ordering what you think the pt needs let him know, our DR.'s tell us they want to know our recommendations even if they don't always choose to follow them (tests you think need done - xray, ABG ---meds needed ----higher level of care --- dr needs to see patient, etc)

Afraid - You will not always be afraid unless this has always been your nature. If it hasn't - Time will help Talk to the doctors like they were real people - they are you know - even though some of them don't know it. Ask them how their day is going. Let them know your name. Talk about unthreatening things when the opportunity presents itself. Most of the cardiac doctors know my genie story. "There were 3 doctors walking on the beach & one found a lamp - rubbed it and a genie came out and offered him 3 wishes. He asked if he could share them with his two friends and it was granted. 1st doctor: I'm a general practitioner and I want to be 25% smarter - think of the people I could help. genie: (poof) it's granted 2nd dr: well, I'm a neurologist and I want to be 50% smarter think of the difference I could make in peoples lives. Genie: fine (poof) your 50% smarter 3rd dr: I'm a cardiologist and know pretty much everything but I want to be 100% smarter. genie: I must caution you - once I grant you wish it can't be taken back. 3rd dr: I told you what I want and I want it now! Genie: Fine, (poof) you're a nurse!. It will get easier, just be as prepared as you can when you call the doc. If you don't know the answer - admit so - but say you'll find out. review what you want to tell the doc and what you expect from the doc when you call with an experienced nurse or charge nurse. hang in there.

If you are taking the courses on line you don't need to have the school based in FLorida. Walden University offers a BSN to Masters and was offering a limited number of 50% off tuition to those starting this summer (over with) and this fall. lk

Vicky, Demerol will break down the same way whether it is IV or IM. Demerol is not the drug of choice for the reasons you mentioned as well as - why inflict pain (IM injection:madface: ) to relieve pain when there are so many other choices. We still have some MD's that order it and if we can't get them to change the order to a different pain med the patient gets it. LK

We try to "special" (1:1) our open heart patients for 8 hours. They are certainly always 1:1 for at least 4 hours. Unless you have some time with the patient as he is waking up how do you know if the patient will be stable? Our opens come to us straight from the OR table and stay with us overnight (usuall).

After CABG a patient has 2 medialstinal cehst tubes and one blake tube laying along the pleural space. The doctors or their PA's remove the chest tubes the morning after surgery and attach the Blake to a J-P blulb for another 1-2 days. The doctors have asked that the staff remove the Blake tube because "it's not a chest tube" it is just a drain. What happens where you work? What are your thoughts? Should we or shouldn't we remove the Blake tube?:uhoh21: [email protected]:imbar

We had a post open patient with multiple dysrhythmias including numerous runs of VT. I believe he was shoked about 40 times during his stay before they decided he was doing well enough otherwise to warrant an automatic defibrilator. In one 24 hour period I think the nurse's count was 23 times. He walked out of the hospital. He was only in his 40's and had good cardiac function (per echo).

Our care map has the patient recieve D5W @ 50ml/hr and D5W (250ml) w/40mEq KCL @ 25ml/hr. Some doctors give even less fluid. Patients only recieve between 750ml and 1500ml of fluid before their IV is stopped. It is stopped after they are taking fluids orally.

:rotfl: All 3 CT's are removed at once by the PA or MD. They are removed at the same time becuase the amount of pain is not associated with the # of tubes removed but the actual removal. So if they were removed separately the patient would have the same amt of pain 3 times. We give pain med immediately prior to removal. We have a couple of Dr's who in addition to pain med give 1-2mg of Versed. The patients that recieve the versed do not usually even remember having their tubes pulled.

:rotfl: All 3 CT's are removed at once by the PA or MD. They are removed at the same time becuase the amount of pain is not associated with the # of tubes removed but the actual removal. So if they were removed separately the patient would have the same amt of pain 3 times. We give pain med immediately prior to removal. We have a couple of Dr's who in addition to pain med give 1-2mg of Versed. The patients that recieve the versed do not usually even remember having their tubes pulled.