FirstLadyRN

Hello, I am on a unit that is very acute. This is an ICU with ECMO, MCS devices, and transplants. We take the sickest patients in our region. We were short-staff but have on-boarded 20 nurses. Our problem is how to navigate "the lack of experience".

Can your department force you to precept? It's not that I don't feel qualified. It's more of a mental health thing. Right now I don't feel positive. I really don't want to precept or charge. I just want to hyper focus on my patients for 12 hours. I sent an email to management a week ago. No response. And I'm still on the schedule to charge and precept. I'm exhausted. I don't think I can do that

This was not my patient and when I questioned the nurse I could not get a complete story due to time restraints. I have listed the scenario details Car vs tree accident. Pt was post laminectomy for surgical intervention for injury at thoracic site. Pt arrives to ICU with accordian drain and neck brace. No spinal precautions. Orders recieved to keep map greater than 85. Utilize levophed if required. I don't understand the permissive "hypertension". Why? Is this for perfusion of the injury site? ThAnks

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She seemed fine. No lethargy, dizziness or weakness.

I agree. It was standby assist every time. Despite the orders saying up ad lib. Thank you

Sorry, I forgot to mention she has a diagnosis of TTP. The platelet before that was 9. So I trust the result.

Quick question. I received a 30 something year old patient with a diagnosis of TTP. Her hemoglobin was within normal limits but her platelets was 3. She was agile and mobile. I would label her a standby assist due to the wires in ICU. As I was giving report to the receiving nurse, she asked me how she voided. I told her on a bedside commode. She scolded me and was upset that I hadn't placed her on strict bedrest. I understand that a fall in this particular case would be very bad. But she is no more a fall risk than a patient with chest tubes and drains. I mean we are getting patients into chairs who are on ventilators and ECMO. In addition, she had "up ad lib" orders. I wanted to hear others opinions. What would you do?

For the January/Feburary or August/September cohort?

Hello Forum. I am applying for the January cohort. My stats are overall GPA is 3.2 and BSN is 3.5. I have almost 5 years experience in ICU. But a total of 8 years in nursing. I have not taken my GRE yet. What are my chances?

Recently patient was delivered to me in SVT 180 with blood pressure 75/45. Telephone order received for adenosine. Administered 6mg than 12mg to convert to sinus rhythm. Pushed hard; fast and flushed well. Watched the monitor. Later Charge RN said I shouldn't have done this without MD at bedside. No protocol states I couldn't or outlined any details outside of ACLS. In review; I acknowledge recommendations of pacer pads, nearby crash cart, additional nurse RT in room. I see the benefits in regards to a possible asystole pause. But I do not see where I was wrong in administration with doctors order. Side notes: clinical setting ICU; acls provider (so I was familiar and comfortable with the drug). Again, no outlined protocol defining adenosine use and no restrictions in the Florida's nurse practice act. Thoughts and opinions welcomed

I don't understand. Was the patient desaturated? Wouldn't it show on monitor? Or were there other signs like elevated respirations and shortness of breath?

Thank you so much for your reply. I am sure you are correct. The next day the discontinued the propofol and precedex drip. Left the fentanyl drip on with ranges of 50 to 75mcg/kg/hr. Pt had continued transient asymptomatic bradycardia. I suspect, in this situation, her heart rate had nothing to do with the drips. Everyone was telling me that it was the fentanyl but didn't understand it. I learn and remember things better Fentanyl is preferred because of its ability to attentuate hemodynamic stability but it can stimulate a vasovagal response. Could fentanyl effect the heart rate with no changes to the blood pressure?

New to ICU. Quick question. Pt comes in with aspiration pneumonia and narcotic overdose. Respiratory failure requiring intubation. Maxed out on Dipravan (concentration 10mg/ml and max is 50mcg/kg/hr). Fentanyl is at 15mcg/hr. Pt later on during the day became transient symptomatic bradycardia with heart rate 45 to 50. No drop in blood pressure. Pt alert and awake. Was the heart rate a side effect of fentanyl. I would assume fentanyl would drop the blood pressure before the heart rate. Than you in advance

The Situation: Patient requesting dilaud 2mg dose every four hours for a pain ranging 7 or greater. Pain is described as a headache with visual disturbances. Shes been cleared by neuroligist. Opthamology has been consulted. She has phenergran q6hours for complaints of nausea. She is drowsy, often sleeps, but respirations are never under 16. Husband becomes concerned with her affect and accuses staff of overmedicating her. Question: Was it staff"s fault? If so; in particular was it the nurse who followed the MDs order at fault? Or the MD who ordered it? Or the patient who requests it? How could i have made this situation better?

Sittuation: Patient requesting dilaud 2mg dose every four hours for a pain ranging 7 or greater. Pain is described as a headache with visual disturbances. Shes been cleared by neuroligist. Opthamology has been consulted. She has phenergran q6hours for complaints of nausea. She is drowsy, often sleeps, but respirations are never under 16. Husband becomes concerned with her affect and accuses staff of overmedicating her. Question: Was it staff"s fault? If so; in particular was it the nurse who followed the MDs order at fault? Or the MD who ordered it? Or the patient who requests it? How could i have made this situation better?

When a MD says to wean cardizem; at what increment do you do so?