SterlingArcher

Thanks Esme. So when replacement fluid is added postfilter, it is essentially the blood flow rate through the filter that is driving convection?

Just started doing CRRT at my hospital and I had a question that has been nagging at me. We mostly do CVVH on out patients and I know when we do that we can either add in the replacement fluid pre filter or post filter. What I do not understand is that if we add replacement fluid post filter then how can the solutes be removed by convection? Correct me if I'm wrong (which I probably am), but I was under the impression that as the replacement fluid is added it drags the solutes out of the filter by convection. Now this makes sense if it is added pre filter, but if the replacement fluid is added post filter then it cannot drag anything out of the filter at all since it is added only after the blood has already passed through the filter. Any help would be greatly appreciated. Thanks.

Pt was on Assist Control and on a Fent drip @ 50 with Ativan pushes PRN. I was just confused since I wouldn't think low tidal volume by itself would be an indication the pt was fighting the vent. I always though there would be other sings like physical signs of agitation and the peak pressure alarm.

Hi I am a new nurse in the ICU and am still getting use to working with vents. The other day I had a fully vented pt whose low tidal volume alarm kept going off. I auscultated for an air leak around his ET and didn't hear one. One of the other nurses came by and told me that low tidal volume alarms usually meant that the pt is fighting the vent and told me just to increase his sedation. Is this true? The pt was not breathing over the vent, the peak pressure alarm was not alarming, and the pt did not seem like he was agitated or anxious at all. In fact he was just laying in bed with his eyes closed and not following any commands or even moving. I felt weird going up on his sedation when he already seemed like he was pretty sedated :/

I'm a new grad on an ICU floor and most of our pts are on vents. I feel like many of my patients cannot seem to tolerate suctioning. As soon as I start using the inline suction they start gagging, desating into the mid to upper 80s, start getting frequent PVCs, RR goes into the 30s etc. After I am done suctioning, they stay like that for a while too which is even more unnerving. The ventilator will keep alarming afterwards with high tidal volume alarms as well as other alarms. I know this is normal since suctioning is very uncomfortable, but every time it still freaks me out. I pre-oxygenate with 100% and I always explain what I am going to do and what they might feel beforehand to minimize their anxiety. Is there anything else I can do to help them tolerate it better or help them return to baseline afterwards?

That is horrible. I feel bad you had to go through all of that. This place has problems and I would not be surprised if they had a high turn over rate. I'm not sure what you would do. I always thought background checks just focused on arrests/convictions/etc so I don't think they would know about this employer? However, just in case I still think you need to put them down on your resume (though not necessarily as a reference) just because honesty is always the best policy. In future interviews you should mention that you and the unit just was not a good fit and that their were issues that compromised your integrity. Good luck!

Thanks KelRN215. Also (correct me if I'm wrong), the PICCS I have seen seem to have their lumens all end at the tip of the catheter whereas Triple Lumen Catheters seem to have their lumens end at various points of the catheter. Thus one lumen is considered proximal and the other distal, etc. So is this another difference between the two?

I can't seem to wrap my head around what is the difference between a triple lumen PICC and a Triple lumen catheter. Are the just two different names for the same thing? And if not, why is one used over the other? Any help would be greatly appreciated!

I just started on a ICU floor and am super overwhelmed with information especially regarding vents. Almost every patient on the floor is on one so I know it is super important to understand them. Can someone explain to me how the Pressure Support mode is different from CPAP/BiPAP? Both modes seem to do the same thing, which is apply positive pressure during patient initiated breaths to decrease the work of breathing.

Do you mind if I ask why you think those questions are goofy? Those are pretty customary questions that I feel are asked in not only most nursing interviews, but any job interview.

Yep, this is a great decision for you! This experience will help you a lot because you will get use to having patient interaction and touching patients. This will definitely look good on a resume once you are done with nursing school. Many of the people I knew in nursing school who had PCA or CNA jobs landed jobs much more quickly. Good Luck!

Hi everyone! I am a new grad who just got hired in the ICU within a large medical facility which I am very excited about, but I am also terrified because during my student clinical rotation there was a lot of hand holding and I never got a super authentic experience as a "nurse". I am really motivated to do well in this position and will put in all my hard work and effort to succeed. I do not start for another month, but I want to start preparing. Any way I have a few question which may seem silly (please don't judge, I'm just a baby nurse!), but if some nurses can help me answer them I will great appreciate it with my whole heart! :) 1. As a student doing care plans, I literally had to read through every single inch of the patient's chart, however, I don't ever recall seeing the nurses I follow do this regularly. My question is what part of the chart do you always make time to read besides obviously the MAR/lab values/new orders part? 2. When I do my first assessment of the shift I usually do this: assess LOC, assess pupils, listen to lung/heart/bowel sounds, assess radial pulse and upper extremity strength, assess pedal pulse and lower extremity strength, and of course do a general visual inspection to see if anything looks out of the ordinary. Should I add anything else to this? 3. When you start your shift, what is your flow of things to do? (Ex: look at the chart first briefly, get report, introduce yourself to pts, etc) I know everyone is different and you just gotta see what works for you, but I just want to know what others do to get some ideas. 4. In school, we learned that before suctioning a pt with an ET or trach tub, you need to hyperventilate them w/ 100% O2. However, I don't think I have ever seen a nurse do this before. Is it usually done? I'll probably think of more questions, but right now these are at the forefront of my mind. Thanks!

Thanks for the advice runningoutoftime :) I do have their cellphone numbers since they gave it to our clinical group during clinical in case we ran into any problems. I feel weird calling their numbers since it was not given to me for the purpose of calling them for anything short of an emergencDy, but I guess in a way this is a professional emergency for me I guess I will try to call them. Also I did work really closely with one preceptor who I have gotten to know very well. However, she works night shift from 7pm-7am. I am afraid the hospital may call her for a reference, but she won't pick up because she is sleeping.

Hi I am a new graduate currently interviewing for a position at a major hospital in my area. Because I am a new graduate the hospital asked me to include my last 3 clinical instructors in my references. I have not really kept in contact with them so I e-mailed them explaining the situation and asked if they felt comfortable giving me a favorable recommendation and if so if I could have their contact info. It's been a week since I e-mailed them and 2/3 have not responded. The interview is in a few days and I don't know what to do. Should I try e-mailing again? Or should I explain to HR that I was not able to reach them? I have other references from professors and other clinical instructors I can use, but it seems like they really want the last 3 clinical instructors I had...