tnt1985

what is your educational background? bsn years of experience? 2+ years drawing blood? 3 years what kind of education did you get for doing blood draws? learned from trial and error on the job or by watching others. what was the most challenging part about drawing blood? trying to find veins in fluid overloaded patients. are there any tip or tricks you have learned throughout the years that you have found useful? yes, we have an ultrasound machine that helps us find veins. the machine is called a sonosite and nurses now must be certified to utilize it. if i use the sonosite machine i can successfully draw blood or obtain an iv in 90% of my patients. we have called phlebotomy in the past but find the sonosite machine to be much more helpful. how often do you have to draw blood on your clients? at least once per day. if the patient is extremely sick, at least every 6 if not more frequent. as nurses we have prn orders for the below listed labs. which labs do you most frequently draw? bmp; mag; phos; ionized calcium; abg's; vbg's; ptt/pt inr; cbc; lactate; hfp are there any particular labs that are difficult to draw? blood cultures or abg's (if the patient doesn't have an arterial line). with blood cultures you need two peripheral sticks and this can be difficult to obtain in fluid overloaded patients or patients who are a difficult stick.

You are definitely thinking in right direction. Most patients who are septic from an infection or bacteremia are vasodilated due to the release of inflammatory mediators (a response to an overwhelming infection). Even with fluid resuscitation these patients still present with perfusion problems and require multiple pressors. Inflammatory mediators also cause capillary leakage which you mentioned in your nursing diagnosis. Some other factors to think about: Does your patient have a temperature, increased respiratory rate, increased WBC, evidence of organ dysfunction (i.e. Acute kidney injury)? These are just a few other things to think about and possibly include in your diagnosis. I will list a few simple nursing diagnoses related to sepsis: * Ineffective tissue perfusion related to decreased vascular tone. * Ineffective tissue perfusion related to hyopvolemia, fluid shifts, and vasopressors. * Interrupted family processes related to sudden critical illness. * Decreased cardiac output related to inadequate volume, inadequate cardiac contractility, inadequate vascular tone, dysrhythmias. * Risk for electrolyte imbalance related to fluid shifts and potential hemolysis. Hope this helps!

You are definitely on the right track! First, remember that cardiomyopathy is a disorder involving the structure and function of the myocardium. There are also different types of cardiomyopathy: dilated, hypertrophic, and restrictive. Clinical presentations can vary depending on the type of cardiomyopathy. It may help you to look back at the patient's past medical history to determine the cause of cardiomyopathy (i.e. idipathic; infection; toxins; pregnancy; etc.). Here are some examples of nursing diagnoses for cardiomyopathy: * Decreased cardiac output related to decreased contractility. (Your patient's EF is 35 to 40% which signifies there is a decrease in contractility). - Dilated * Fluid volume excess related to maladaptive compensatory mechanism resulting from decreased cardiac output. (Does your patient have dependent edema? Your patient will also most likely have decreased cardiac output due to a decrease in EF). * Activity intolerance related to decreased tissue oxygenation. * Deficient knowledge related to disease process, therapy, and recommended lifestyle changes. (Does the patient have a history of smoking or drinking?) * Interrupted family processes related to change in health status and potential life-threatening situation. * Decreased cardiac output related to pump failure. - Hypertrophic * Decreased cardiac output related to inability of the heart to stretch and fill. - Restrictive * Activity intolerance related to pump failure. * Anxiety related to health alteration and recommended lifestyle changes. Hope this helps! When I was in nursing school I found a nursing diagnosis book to be helpful. Keep up the good work!

I work in a Cardiac Surgical ICU and we have walked vented patients, but this is rare. These patients are usually post-lung transplant patients that have a trach in place and are having difficulty being weaned from the vent. These patients usually are failure wean due to problems with their diaphragm post transplant. This patient population has benefited from walking on the vent. Hope this helps.

Most new ICU staff hires have at least an 8 to 12 week orientation (based on previous experience). During orientation most nurses should be able to experience removing arterial lines. On my unit (Cardiac Surgical ICU), pulling arterial lines is necessary for patients to be able to transfer to the telemetry or Cardiac Surgical Step Down Unit. In my institution there is not a competency for removing arterial lines. I believe the most important thing to remember is to hold adequate pressure for at least 5 to 10 minutes depending on the location (i.e. if the patient has a femoral arterial line pressure will be need to held for a longer period of time). This will also depend on the patient's anticoagulation status (i.e. are they on Heparin?). Pulling an arterial line is similar to removing a peripheral IV but pressure needs to be maintained due to the high pressure in the arterial system. Hope this helps!