candyndel

still doesnt make sense because if he can not gain access with the site marked, he has to use another site (which contradicts the purpose of laterality). its not like the surgery is going to be done on the wrong side....

that is silly...the heart is unilateral....

It sounds like u have a silly case scenario (non-realistic). But u are correct. ST elevations meet diagnostic criteria for a STEMI if they are >1mm in TWO OR MORE CONTINGUOUS LEADS. Why would they give u STE in just one lead? TWI are non-specific. The lateral (I, avl) ST depressions are reciprocal changes from your inferior infarct. i hate unrealistic case studies!

U do not need to do anything with the pacemaker...like we say in the ED...u cant pace meatloaf! What will happen is u will have a flat line with pacer spikes. Not a big deal. Dead is dead and the pt will be pronounced. If u place a magnet over a pacemaker, that turns the pacemaker into asynchronous mode, which will actually make the pacemaker work (there will be no difference for you since she is pacer dependent). Different models of pacemakers have different 'magnet' rates. (They all used to pace at 75bpm with a magnet, but newer models have changed that old rule of thumb....). It also is not considered PEA because for something to be considered PEA, it has to be an electrical rhythm that should be producing a pulse. Electrical activity in and of itself isnt necessarily PEA. (Just like u wouldnt call an agonal rhythm PEA bc that is not expected to produce a pulse.) I hope this helps!!

I have noticed the many differences amongst various cath labs and am surveying... Please let me know what your institutional policy is re: ambulation/DC time in hours after a manual hold vs closure devices. THANKS IN ADVANCE!!! If anyone has a policy they would like to share, I would greatly appreciate that as well!

dont forget about the effects NSAIDs have on prostaglandins... ps this DOES NOT INCLUDE ASA. They should still take ASA....The AP benefits far outweigh the risks....

I am an ACNP and work as a hospitalist....its the perfect position for an ACNP.

WOW- That must be some book if you have a policy on every task a nurse does! Here's the JCAHO reg on nursing policies... Elements of Performance for NR.3.10 1. The nurse executive, registered nurses, and other designated nursing staff members write nursing policies and procedures; nursing standards of patient care, treatment, and services; standards of nursing practice; a nurse staffing plan(s)‡; and standards to measure, assess, and improve patient outcomes. 2. The nurse executive is responsible for ensuring that nursing policies, procedures, and standards describe and guide how the nursing staff provides the nursing care, treatment, and services required by all patients and patient populations served by the hospital and as defined in the hospital's plan(s) for providing nursing care, treatment, and services. 3. All nursing policies, procedures, and standards are defined, documented, and accessible to the nursing staff in written or electronic format. 4. The nurse executive or a designee(s) exercises final authority over those associated with providing nursing care, treatment, and services.

Very well seasoned nurses also share your opinions and frustrations about charting, too- so know you are not alone. If it was so easy, there wouldnt be lectures, conferences and books on it, right?? I actually began ED nursing when our charting was done on a plain sheet of paper, too. It was actually much easier!! Switching over to EMRs was difficult! I cant stress how important 'good' charting is...having known many nurses subpoenaed and having a med/mal attorney for a sister biases me slightly, though... I think with experience comes knowing what is important and what isnt. And you are def on the right track!! This is really good advice, and I try to do this, but I just don't have time to document it all. In my ED we don't have EKG techs, we don't have nurse's aides or ED techs the majority of the time. We don't have IV start kits. We often don't have working BP cuffs/monitors. We don't have computerized documentation. I feel like I just don't have time to document everything I should, so that's why I just do a more fucused assessment. Of course, the sicker the pt. the more I will try to document. Documentation, to me, is perhaps the hardest part of nursing. There is a constant fear of omission, yet I don't have time for inclusion.

Always, always, always do a head-toe at the beginning of your shift (and I dont mean on the new ankle that just got here an hour ago...) then prn. Especially if you have the 'hold' problem that we do (usually about 20 every morning with over half for ICU or CCU)! You'll be surprised at what you might find that's different than in the report you got...but you also might see a red herring or two!! Remember (among other things) you are getting paid to assess/monitor the patient and report changes in assessment. You arent charting to verify how your day was spent....I can not believe my eyes when I have to review a chart that looks like this: 700a Rec'd report 715a ECG done 720a NTG 1/150 given SL. 725a #18g to Left AC. labs sent. 730a ASA 325mg po given. 740a PCXR done. 750a ECG repeated 755a Plavix 300mg po given. Cardiology fellow at bedside. AHHHHHHHHHHHHH!!!!!!!!!!!! Those activitites all have their place in the record, but a scribe could do this! I also suggest reading the notes of the shift(s) before you. That always helped me to learn what to look for and how to say it. Good luck- once you have it down- your probably go to EMRs anyway :)

Generalized nursing tasks...like bed baths? Why would one even need a policy for generalized nursing tasks? That's what our generic nursing programs were for! If I am administering the MEDICATIONS then I am deciding (and I say that collectively) the best way to monitor their effectiveness. A medication policy such as this one doesnt bestow prescriptive privileges upon the staff nurse, but provides him/her with the tools needed to safely perform the high risk task once ordered. It also protects the patient from inappropriate orders/useage and serious potential harm (examples: insulin, potassium, "old" propofol useage, nesiritide, ibutilide,etc etc etc ...I cant even get started on SGC's!). Like I have already said, it is a nurse driven collaborative effort. And if you were my patient, you'd thank me for how much weight I place on patient advocacy in our myriad of nursing roles.

Gotcha. I like 'Acute Care NP' anyway....

Does hospitalist carry a negative connotation I didnt know about? "Hospitalist" is a term generally regarded as doctor that works exclusively in the hospital. I myself only work in the hospital. No clinic office. I work in a small ER and also admit and round on patients in the hospital. I also cover our small ICU. I don't know that I would take the title of hospitalist even though it is part of the same job as a the "hospitalist" term is now becoming a phsician specialty. But in the same manner I only work in the hospital environment. My certification is FNP I was also a paramedic before I was a nurse so I am comfortable in the critical care environment. In the same manner I have also "trained" up. I took extra training classes, emergency conferences and did alot of time with physicians learning the aspects of inpatient medicine.

Any NPs out there working as a hospitalist?? What can you tell me about it? Thanks!!

I cant even believe what I am hearing (seeing?) on this post. Do some of you really believe that a Nursing Policy shouldnt be written by a nurse? This is a nurse-driven, collaborative effort and she seems to have the right team together.