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JeanOfAllTraits

JeanOfAllTraits

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JeanOfAllTraits has 2 years experience.

JeanOfAllTraits's Latest Activity

  1. JeanOfAllTraits

    RICU experience??

    My guess is you will be seeing a lot of COPD, influenza, pnumonia, interstitial lung disease. RICU sounds like the respiratory half of MICU. I've only ever heard of a RICU twice, both on AN, but never been in one. The might be why you can't find much info on them.
  2. JeanOfAllTraits

    Does your ICU have CNA's?

    Three units, a 25 bed SICU, 18 bed MICU, 16 bed CVICU. MICU and SICU have 2 CNAs on and CVICU has one on. They help with turns, restocking linens, ordering supplies, doing baths, stripping room after a transfer and grabbing floor beds for transfer among so many other things. We'd sink without our CNAs.
  3. JeanOfAllTraits

    Critical Access Hosp to Trauma ICU

    If you want it and they are offering with a good orientation program, I'd say go for it!
  4. JeanOfAllTraits

    MICU vs SICU

    I just had to pop in on the MICU side. I love our MICU. Yes, plenty of chronic geriatrics, but also plenty of younger acute issues. Things can go really wrong, PEs, septic emboli, suicide attempt with acetaminophen OD. Some of my sickest patients have been younger MICU patients. Our SICU and CVICU also have their share of chronic patients, admittedly MICU has more. What are you looking for in your patient population and what are your long term goals?
  5. Forgive me, but I feel a bit confused. What access do you have to a PICU? Aome other things I'd ask wouls be: What is the process for moving a step down pt to a PICU bed? Who an admit to the step down bed?
  6. JeanOfAllTraits

    Could I have done anything else?

    Good for you. You showed strong critical thinking and clear a thorough understanding of pathophysiology. It seems to me that your hospital is squelchin your nursing practice. I think if you get in a facility that supports the nurses, you'll make a wonderful ICU nurse. A side note, if a pt's blood glucose was 70 and you have to ask the MD if you should hold the novolog or even the lantus, and the MD says to give it...that pt could easily become hypoglycemic which can have serious consequences. A hospital's policy of you bending to the whims of the MD does not protect you or your license from legal action.
  7. JeanOfAllTraits

    Step down units: what's your ratio?

    Our intermediate care is 2:1 if there is super heavy or unstable and needing the ICU ASAP before we code otherwise it's 3:1. I've never seen ratio go above that, but my hospital is fantastic about ratios even though we're not union. Our IMC is 100% tele with a handful of stable trachea vents, some new from this admit some old trachs, some on PS/Bipap. They don't wean vent/PS setting but will do switching between vent and trace dome during the day. They take anybody who is needing Bipap apart from at night for OSA. It's a heavy and busy unit, sometimes 2 total cares with another IMC patient, but the team works very well together. The hardest thing is when the ICUs are full and we can't move patients to a higher level of care until we're at a rapid response or code situation.
  8. JeanOfAllTraits

    Mucous aversion, can I overcome

    Gastric residual volumes, the sound of retching/dry heaving and emesis in general and I are not friends. I sometimes get nauseates with my cycle and I have actually had to get another nurse to check residual volumes for me because I was literally gagging.
  9. JeanOfAllTraits

    feeling guilty about blood draw

    If you have an ART line, draw from there. However if you don't have one, then the PICC or your CVC is your only option besides a typical lab draw. I was taught to pause the other drips before drawimg the waste, them draw the lab, flush and start the infusions back up. If the patient isn't able to tolerate their drips being off thay long then they really should have an ART line anyways. All else fails, find a good vein and try a lab draw your self. :)
  10. JeanOfAllTraits

    Nursing shift report--what's your procedure?

    Different nurses have different sheets. Most use one basically blank sheet. I fold mine in half and use one side for each patient. Top half had past medical history amd current hospital course. Sometimes that current is everything that has happened, sometimes its the original reason for coming to the ICU and where they're at now. Bottom of the half sheet is for the current assessment. I like a system report and most of our nurses do too. I write sections for cardiac, respirator, neuro, gi, gu, skin, IV and "needs". I sometimes write allergies, usually code status. At the end of it all, the paper is a brain but the computer is the final back up (as long as my brain doesn't say something in the computer is wrong. ) what I don't write down is always on the computer.
  11. JeanOfAllTraits

    What do you think of this story?

    I'm sure the story leaves out a lot of the information we in the medical community are hungry for. Oh well, we won't get it and will just have to be satisfied knowing that either we don't have all the info, or there is something greater than medical science at work. As a nurse of faith, I'm still gonna go with the former. My concern is that these stories give families false hope and make them feel like parental failure for giving up on a child who might have 'gotten a miracle' if we'd only tortured them a bit longer. The same goes for pediatric and adult ICUing as well.
  12. JeanOfAllTraits

    High Acuity Step Down ICU Nurses vs the MICU

    I habe always said that the hardest unit I have ever worked on is our stepdown unit. Broad range of diagnoses, all the services in the hospital, the need to be hypervigilant and have keen assessment skills. All of this while dealing with the psychosocial aspects of critically ill patients and very concerned families. My deepest respect goes out to you guys who do a lot with a little. Hats off to you!
  13. JeanOfAllTraits

    bi pap?

    Thanks RRT! You've inspired me to tall with one of our RTs this week to better understand the workings of our Bipaps amd the settings. I only mentioned the 'back up rate' because that's what our most recent attending was referring to when discussing our attempts to wean a chronic vent dependant trach patient.
  14. JeanOfAllTraits

    bi pap?

    The thing that I love about our BiPaps, and iI'm not sure if this is how all of them work, is that they can have a back-up rate programed in. So that pt working too hard to maintain a rate that keeps their acid base balance looking nice now won't need to work quite so hard because we're gonna give them a few extra 'breaths' in the form of pressure, they just have to open up.
  15. JeanOfAllTraits

    Berlin's and toddlers

    For the record this is exactly what I meant. :-) I also wish how much we loved the patient or family got them higher on the list. Breaks my heart when the ones who you know would just 'fly' with a new organ die on the list.
  16. JeanOfAllTraits

    Made a drug error and feel sick

    My very last clinical as a student I made a serious med error. I had to talk with my clicial supervisor, class instructor and the dean of the nuraing program. That dean told me something that has shaped my career since, especially since her unexpected and untimely passing just two months ago. She told me, "Jean, every nurse makes mistakes. I've made several. It's the good nurses who take the steps so that the same error never happens again." It sounds like you've thought out those steps, and so, have the makings to be a good nurse. Yes, med errors give you a huge punch in the stomach, but thats what reminds us that we have a high responsibility and calling. May this propell you to keep learning and growing as a nurse, hopefully making your ward a safer place to work.