hellonurse36

I can only speak for Datascope (now Maquet) as that is the one I use. If a pt codes you DON'T CHANGE ANYTHING with the machine...focus on the pt. As soon as the machine no longer senses an EGK to use as a trigger for inflation/deflation it will AUTOMATICALLY switch to pressure trigger. Once you start compressions the machine will pick up the pressure changes from the compressions and will time the IABP appropriately. Changing to pressure mode is not wrong, but there is no need as the machine already does it. Key is to focus on the pt....same if you need to defibrillate...ignore the machine.

Our criteria in Eastern NC is a pt presenting to an ED with STEMI (ST elevated MI) should be on the cath lab table with balloon opened in culprit lesion withing 90 min of presentation. If pt presents to facility without ability to do interventional cath, pt is transported to nearest facility (us). If the distance to us is far enough that pt can't reasonably get here and on the table in 90 min, then they get thrombolytics (unless they have a contraindication - ie recent stroke, bleed etc). It's all about time. . . time is muscle. Hope this helps, Terri Greenville, NC

I spoke with our medtronic rep last week about this scenario. This is what he told me. All the newer MEDTRONIC pacemakers have AICD components (he stressed that this was how medtronic devices worked, but he couldn't vouch for other brands). If a pt has this AICD/pacer then we use the magnet to TURN OFF THE DEFIB aspect of the device so it won't shock pt - ie pt with runs of VTach but is being made comfort care (withdrawl/no shock). The magnet will flip a switch so the device can not read/respond to shockable rhythms. Once you remove the magnet the switch flips back and the device can shock. But it WILL CONTINUE to pace. Magnet does not affect pacing ability. In our hospital our policy is to call the device rep and s/he comes in and turns off the pacemaker if that is needed (ie. withdrawing care). Hope this helps. Terri

I have a whole setup that new RNs can "play with" and practice setting up. I also have a display board with the inside of the heart on it that I have glued a swan catheter in the correct position. Below I have a pict of the stages of the swan being floated in. At each stage I show a pict of the balloon and the waveform. It is great for helping people visualize things. Terri

[ How long does the AICD have to be exposed to the magnent before it stops? I am not sure how long the magnent has to be exposed before the AICD stopped.] I believe it stops immediately. "The reason for this is because there is a small magnetically activated switch built into the electronics of pacemakers and implantable defibrillators. This internal switch is designed to close when a magnet of enough strength is placed over it. . . Removing the magnet returns the pacemaker or implantable defibrillator back to its previous, normal programming." (from Medtronic website) Terri

I work in an ICU and we do report at the desk and then go into the room for bedside rounds. I agree that bedside report is not approriate...although I will repeat something to the oncoming RN in front of the pt if it is something I told the pt I would pass on. ie. "I just gave Mrs X a lasix pill and she is concerned about incontinence, I told her when she rings her callbell we'll answer quickly to get her a bedpan." On my bedside rounds I check- dressings, chest tube/drains - both the dressing and the amount/colour of drainage, length of transvenous pacer wires or swans, groin sites if pt has arterial sheath/IABP or had a sheath pulled on that shift, swelling/edema, LOC/responsiveness on a sedated pt or pt with altered LOC. ALWAYS check your pump set up on any infusions. Make sure the pump is set up for what is hanging - ie. Dopamine 400 mg/250 ml bag hanging but pump is set for 800mg/250 bag! Once you assume care of the pt you are responsible for that error too. I also review the MARs so I can ask the day shift RN about any unsigned meds - did they give them and forget to sign them off or did they forget to give them. Also, if family is at the bedside of a very sick pt or one that is comfort care (withdrawing on a DNR pt), I make sure I ease the transition to a new nurse with them as well. ie for a really sick pt: "Mr Z's wife will be sleeping in the waiting room or at hotel ABC and the ph number is in the chart, I told her that we'd let her if anything happened and keep her up to date on things." For a comfort care pt I make sure the family knows that they can stay at the bedside and that we are there for them as well, reinforce to not hesitate to let us know if there is anything we can do for them. I think for many families shift change is a stressful time. If they've built a rapport with the nurse and have gained confidence in the care their loved one is receiving, they worry about who is coming on next and how things will go. Hope this helps, Terri Greenville, NC

Tazzi, I went to a woundvac class and it was great. It was a lecture about skin breakdowns, staging pressure ulcers, treatment for different stages etc. Then there was a hands on part where we go to play with the machines - even practiced putting dressings on each other. It was neat to feel the suction. The WounVac is made by KCI. Here is their website http://www.kci1.com/35.asp lots of stuff. Terri Finney, Greenville, NC

My hardest week ever was 5 on, 1 off then 4 on! Night shift! Not fun. Great paycheck! Terri

Yup. I am sitting at home today enjoying call pay due to low census. Not sure what's going on, but here (Eastern North Carolina) we have had several beds closed for over a month now when usually we are pushing to move pt's to an intermediate bed so we can take new ICU admissions. Terri in Greenville, NC

Our protocol states that a pt with 2 consecutive FSBS > 140 be started on an insulin gtt managed by the glucommander. "The Glucommander is a computer based system for controlling blood glucose by directing an intravenous infusion of insulin in response to the measurement of glucose at the patient's bedside". Basically the computer chirps (audible beep that sounds like a cricket) when you need to take a FSBS, you take it, enter it in the computer and it tells you what to program your insulin gtt at based on how the FSBS is trending. Pt's that are on the glucommander and NPO are on D10 @ 80 ml/hr. I asked one day about this as I thought it was strange that we were giving a DM pt D10, I learned that since the pt was NPO we need to provide some glucose source so the pt doesn't go into ketoacidosis. If the pt is eating or has tube feedings, we don't do the D10. Hope this helps. Terri Finney Greenville, NC

What kind of complications are you looking for? Do you mean how can things go wrong? What are bad outcomes? Are you speaking about in hospital or in general public CPR? -broken ribs/sternum are just about a given if CPR is done correctly. -pt's heart beat returns but there is brain injury from decreased oxygen, anything from mild injury to complete brain death -I suppose you could get some minor mouth diseases (ie herpes) from someone doing mouth to mouth on you without a protective shield....but if I was the person, I'd take the herpes over being dead. - and of course - death. The way I see it, if a pt is needing CPR they are already dead, so, any complications are worth the risk. Terri Finney

Beth, These goals look good, I can't think of anything better. I forgot how the "Nursing School Instructor's mind works!!" Boy am I glad those days are over...sounds like you are pretty close to being through with it all to!! YEAH!!! Good luck. Terri

Hmmmm. Not sure I agree with your instructor. The time spent in clinicals INTRODUCES a student to all of these things, but one can always continue to improve them - in fact....that is what most new nurses are working on during their orientation! What unit will you be doing your independent experience on? Maybe if I knew what area you will be in I could think of some better examples. Terri

Not sure what you are looking for or what type of unit you will be on, but I'll give it a try. 1. Learn how to program and run pumps, including (if they have this), using programable features for different medicines. 2. Learn how to do an effective head to toe assessment in a timely manner. 3. Work on communicating goals of care and plans for the day with pt/family. 4. If you are on a monitored unit, learn how to read basic rhythm strips. 5. Improve or do x # of specific skills - IV sticks, lab draws, NG tubes, Foleys. 6. Improve communications with other health care professionals (care partners/aids, MDs, OT, PT etc) 7. If you are on a critical care unit or happen to work with an RN caring the code blue pager....go to a code, help with post mortum care, if trained- do CPR. Learn about the paperwork that needs to be done after someone dies - do they have an organ donation program? 8. Learn to read ABGs. 9. Improve understanding of different vent settings/modes. 10. Have someone show you how to use the defibrillator, pacer, look through a code cart. 11. Observe placement of an arterial line, central line, swan line etc. Hope this helps get the brain started! Terri

Here is a simple explanation (sounds like you have it all figured out now, but thought I'd add my 2 cents). To help you understand what is the systolic vs diastolic it helps to know how a BP cuff works and understand WHAT you are hearing and WHY you are hearing it. As you inflate the cuff you are exerting pressure against the artery, the number the needle points to indicates the pressure being applied. When you inflate the BP cuff beyond the pt's systolic (highest pressure in arteries - occurs during systole or when the heart is contracting) it occludes blood flow and you do not hear a pulse. You slowly let the air out and once the pressure of the cuff EQUALS the systolic pressure, blood flow is no longer occluded and it rushes past your stethoscope, hence you hear the sound. The number on the gauge at this point is your systolic or top number. As you continue to let air out of the cuff, eventually the pressure in the cuff will be lower than the pressure in the artery during diastole (when the heart is at rest) and you won't be able to hear the blood flowing by....this is your diastolic or bottom number. I think most nursing students have problems learning how to take a manual pressure. Keep practising - it's the only way you really get confident. Terri