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sunnybabe

sunnybabe

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sunnybabe's Latest Activity

  1. sunnybabe

    PEEP and blood pressure/other hemodynamics

    Thank you all! You guys are awesome.
  2. sunnybabe

    PEEP and blood pressure/other hemodynamics

    So if CVP is not an indicator of preload, then how do we determine preload. I've been asked over and over again, "What's the patient's CVP" to see if they are dry or wet (whenever the number was too high, they wanted to give lasix or low, some fluid...) but if CVP isn't an indicator of fluid status then... what is?
  3. Hey all, I had a patient who cardiac arrested and they thought he was in ARDS given his Pa02 compared to his FiO2 and we were increasing his PEEP upwards to around 14 until he finally started oxygenating in the 90's (he was in the 80's before on 100% FiO2). I heard the RT discussing that his blood pressure would probably be affected. I have three questions: 1. How can adding PEEP drop a patient's blood pressure? He was already acidotic (so on a bicarb gtt) and on multiple pressors but vary labile with his blood pressures. The RT assumed that him being on this additional PEEP could make this situation worse. I've been reading and I read that adding PEEP decreases the venous return to the heart, but if that is so, then why is the CVP elevated (isn't CVP an indicator of the venous return to the heart-aka preload)? 2. I don't quite understand the relationship between PEEP and urine output. When I've called providers about a patient's low UO and their intubated, they ask me how much PEEP they are on. Does the extra pressure compress blood flow to the kidneys??? 3. Also a side question, why the patient was dropping his O2 sat, the provider also wanted to know his peak inspiratory pressure. Once she knew that, she went up on the PEEP, so does that mean the PIP was low or high to make such a decision.
  4. sunnybabe

    The Day Nursing Student Apathy Got to Me

    I would love to shadow in the ER. They didn't know what they were missing. Thanks for being so committed to your work!
  5. sunnybabe

    ATI 2013

    For ATI, I was able to use the review manuals for each class. I am in OB-Peds, Mental Health right now. I read these books practically front to back and it was really much more helpful than taking practice exams.
  6. sunnybabe

    Need help with cardiac!

    Hi, I am in Pediatrics class right now and I love learning about cardiac. In my notes and lecture recording, it says that increased pulmonary blood flow (which in children are usually caused by congenital defects like VSD or ASD) will cause impaired myocardial functioning. As a result of this impairment, the heart has to work harder and the patient will be tachycardic, weak, and tired. My rationale for all of this is that since the blood keeps going to the lungs, the body is unable to get enough O2 into the lungs since the lungs are filled with blood/fluid. Is this correct? Also I was thinking that the heart keeps doing the left to right shunting that it can't keep enough blood to send out to the organs so it keeps working hard to get and keep blood from the lungs to send elsewhere. I was also thinking that the continuous left to right shunt increases pressure in the pulmonary artery and the heart is working hard to overcome this pressure and eventually begins to fail ( backup of blood occurs as a result of this as well--> heart failure). I also have in my notes that left ventricular hypertrophy occurs as a result of increased pulmonary blood flow. Is it because of that large amount of blood going from the lungs into the left atria and then left ventricle? I was wondering if anyone could let me know if I am on the right track. If you could put in terms that would apply to both children and adults, that would be helpful. I want to make sure I understand how blood filling up in the lungs makes the heart "work harder". I know it should be common sense but I want to understand the patho part of it. Thanks!
  7. sunnybabe

    How can I prepare myself for Med-Surge

    1. Brush up on your A/P, thenit will be much easier for you to understand disease processes because you know how the actual body system is supposed to work. So definitely know your functions. I found Endocrine and Respiratory to be the hardest. 2. A NCLEX book would be helpful for you. I never bought one but my friend used Saunder's Comprehensive RN and I would always look at it before my tests. Alot of med surg questions are related to 1. Do you understand the signs and symptoms of this disease (Ex. pneumonia vs. COPD) 2. What are the key complications and things to watch out for (Ex. If someone is a diabetic, what's the worst that can happen) 3. What can the nurse do to help the patient with his disease? What can the patient do (goal)? Try not to memorize, but instead understand why the patient has this disease, how he looks with this disease and the treatment that is supposed to be used for it. I got an A in the class. I also think I got an A not only because I studied, but I also work on a med-surg floor and I saw nearly every disease that I learned about in class. When learning, think about a patient ( real or imaginery) so that the situation makes more sense to you and you can answer the question properly. GOOD LUCK!
  8. sunnybabe

    WellStar employees

    I am in KSU's nursing program. I have several classmates who have gotten externships with Wellstar. I believe they prefer actual nursing students. I really wouldn't rush trying to get in Wellstar right now until you are actually in the program. Trust me, once you are actually in the program you increase your chances of actually meeting one of the WellStar recruiters ( they come to our school to speak all the time). Try applying elsewhere, maybe a nursing home or as a sitter, if you need to work as a CNA (for money purposes). That will put something on your resume until you are ready to apply as an actual nursing student. Good luck.
  9. sunnybabe

    Male Nurses on the Rise and They Make More Money

    I notice more males working overtime( i mean like every day!) and working nights.
  10. sunnybabe

    Why are some aides so disrespectful?

    Well, after reading your story, I agree that the aide was disrespectful to not only you but the patient. It's still not too late to approach her and have a talk with her. Perhaps, you could start it off the conversation like, "The other day we obviously had some tension between each other..." and then the two of you can come to a common understanding, hopefully. Best wishes!
  11. sunnybabe

    Why are some aides so disrespectful?

    You haven't even tried to discuss this with your management, even the charge nurse? Aides are just like the many other healthcare professionals who can disrespect you. You have to stand your ground and either have a one on one discussion with the aide or take it to management. I'm an aide and a nursing student and have seen the disrepect from both sides of the table, but it's nothing that a small talk can't fix. If a small talk doesn't work, then take it management and see where it goes. I could make a thread," Why are nurses so disrepectful?" but the simple answer is because they are human beings with bad or good attitudes that can affect the way I work depending on how I choose to deal with them. You can either ignore the disrespect or do something about it.
  12. sunnybabe

    Yelling at my patients!!!! HELP!

    I've been told my voice is too soft.
  13. Every nurse is different when it comes to how/when they like certain info to be reported. For example, many nurses would rather have all the blood sugars you took at once than you calling with each sugar as you take them. Some nurses want to be alerted of every blood sugar you took while others want to know the abnormal numbers. It helps asking the nurse who you are concerned about how they would prefer things done. After all, you'll be working them on an almost daily basis. You and your nurse are a team so you have to be assertive with them so you're both on the same page about the patient. If there is anything that your nurse asks of you(like putting in a foley) and you feel unconfortable doing it, speak up! I've been told that I have a soft voice, but I try my best to avoid sounding timid on the phone when I'm speaking to other nurses, physical therapists, dietary, etc.., because my message needs to come across the best way possible to make sure my patient is being taken care of. I'm still working on the soft voice too. But I think having a soft voice helps to calm patients. When overcoming shyness, I'm trying to focus on what I'm saying so that I can come of as assertive. On another note, whenever I notice that the nurse is talking to someone else and I have something to them(maybe a patient's BP is 204/99), I wait until the conversation is finished. They may be in the middle of giving report while I'm taking vitals so in that case, I might mention the BP and tell them I'll enter the rest in the computer for their reference when they finish report. Some nurses don't like being bothered at all during report, maybe because they have a lot of information going on all at once. However, I would rather let them know before something happens and someone asks me why I didn't let the nurse know ASAP. I think you should use your best judgement and observe who you are working with. With time, you will get there. The only people I still feel kind of intimidated by are doctors, only because even nurses seem to dislike them. I don't know how to deal with them myself when I become a nurse. Good luck!
  14. Well, whenever I work sometimes my compassion is received with rudeness. However, I just remember that the patient may be in pain(for example, sickle cell patients tend to be in a lot of pain) or maybe they're in a bad mood. After all, they are in the hospital hurting emotionally or physically. Some patients don't want to be bothered. It's ok because they have the right to refuse medication, service, and my compassion. Also, delivery is important. You don't want to come off as insensitive or fake in your compassion. Sometimes, you just can't help what you do. I was told by a patient that I talked to him like a child because my voice was soft.
  15. sunnybabe

    Slapped across the face by male patient

    Wow at some of these responses. Sorry OP that this happened to you. One of my biggest fears in nursing is assault but it's always a possibility in this career. For the posters complaining about the OP not using the language line, the patient was slumped down in the bed! It was honestly a freak accident on her part.
  16. sunnybabe

    How clean is a "bathed" patient?

    You might want to speak to your charge nurse or even the nursing manager about it so that it could be mentioned in daily meetings(we call them huddles where I work). You might not have to mention the person's name who you think is not doing their job correctly, but eventually the patient or their family may complain and the problem will fall on you. I would bring it up though because it's slowing your work down. I work days and I'm responsible for everyone to get a bath while night shift only has to give 2-3 baths, and sometimes they might not give any on my assignment. To answer your question in the OP, in my opinion, a bathed patient is someone is bathed from top to bottom. Unless they are a new admission that came near shift change and they really smell or look horrible, they're getting a full bath because they deserve it since I have 12 hours to spare in my shift. If I don't have time(like near shift change), I would give them a partial bath, making sure I cleanse the spots that tend to smell the most.