Nursingbride12

I was a new grad on my CCU unit as well and now that I am a preceptor as well I have learned two very important things from the wiser nurses I have worked with: 1) ASK QUESTIONs. It's how you learn! People will not think less of you if you ask questions and will, in fact, respect you more. I have actually learned that if you don't ask questions, people will be more suspicious and have concerns about your practice. 2) Buddy up to the older nurses on your unit. They have more store than you can imagine and odds are, if its on the unit, they have seen it before and have learned from the situation. I cannot tell you how many times I have called in another nurse simply for the fact that something doesn't look "right." If you have a question or are concerned about something, or even if it's a clear case of CYA... call in another set of eyes. Oh. And it's absolutely normal to go home sometimes feeling completely overwhelmed and that you don't know a single gosh darn thing :) That will lessen and you will feel more confident as you increase your experience. Congratulations! You will do great!

While I am not sure of the different models, I have worked with IABP for years and have discovered that they are absolutely fascinating machines. The biggest thing with them is PERFUSION. PERFUSION PERFUSION PERFUSION. The thing with balloon pumps is they are temporary. They are a temporary fix to a heart that is not being perfused. If the interventionist switched the patient to a 1:2 it is a move in a positive direction. Sounds like your patient needs a more permanent VAD considering the pressers the patient is on.

I'm also a new Grad on my unit. Been here about a year and Im still asking questions and learning because at the end of the day, I would like to know the information and get the eye roll rather than "faking it" and possibly hurt my patient. I asked a vet nurse one day about it and she said something that will stick with me for life "All nurses need to ask questions. Technology is changing all the time and new bugs are being born out of the ashes of the latest and greatest antibiotic. If we can't rely on the wisdom of each other, we are all doomed. The day I stop asking questions or stop learning new things is the day I need to get out of nursing!"

While I have also read these articles, I was concerned about the family members disrupting the code itself and making the code less effective. Before you make assumptioms about my personal practice, why not ask more information so that you better understand my question. I understand your position but the way you phrased this is abrasive and not helpful. My care and advocacy for my patients are my practice.

Hi All, I had a pt who came back from coding in Cath lab. The pt was over 80 yrs old, complaining of chest pain, requiring initropes and vasopressors and the family chose to send the pt down for a left heart cath. After being successfully brought back from asystole in the cath lab, the pt again went asystole. The family was outside the room while fresh interns performed CPR for 30 minutes before a family member started crying and calling out to the pt to "Come back" etc. That is when the charge nurse brought a chair for the PTs family member to come into the room to watch the code. However the family member continued to get louder and louder, literally crying out to our MD running the code to save the pt. I understand the premise of having a family member see that the health care team did "Everything" but would you have kept the family member in the room when the family member began calling out to everyone in the room? I honestly can't say that the last memory I want to have of my loved one is an ET tube down the throat and some fresh young doctor doing compressions on a frail chest. Thoughts?

He actually just self-extubated today so hopefully he will "fly"! Thank you for all the advice!

So the group of doctors working with my patient prefer not to use haldol but he was started on Seroquil!

Well on 35% his CO2 is 65 and his PO2 is 85... That makes me nervous to extubate quite yet. I haven't tried the haldol though! I'll bring that up next time I see ICU :)

HI All! I have a puzzle for you all. My patient is a male with cardiomyopathy and an EF of 30%. He came in to the ED with shortness of breath and was intubated and has been for about a week now. My patient's labs that came back indicated marijuana with cocaine mixed with some benzos. The patient has been on volume control for 7 days with no success of attempting to extubate. He is normally on Fentanyl, Ativan, and Precedex for sedation due to the fact that when he is "awake", he pulls at every single line he can grab onto. His vital signs are stable, his labs signs are normal. When we have attempted to extubate him in the past, we weaned down the drips (or just turned them off) and put him on the CPAP setting. Unfortunately, he can't stay calm enough to actually breath on his own so that we can extubate. When we take him off sedation, he becomes tachycardic, hypertensive, and tachypnic. My hunch is this is patient is going through withdrawal. If the patient is going through withdrawal, what are some suggestions you have with weaning off the drips so wake him up, yet keeping him calm enough to breath on his own during the CPAP trial? Or does anyone else have any other suggestions? Thanks :)

Hi All, I have a question for you. I have a personal problem that I would love help with. I am a young woman, eat an extremely healthy diet, exercise 3 days out of the 4 I have off, and am a critic care nurse on my feet constantly. I have been trying to lose weight for over 3 years. I can't seem to get a good shape in and am so unbelievably frustrated. I went to see a gastrologist and he told me it was stress related. Can stress actually prevent me from losing weight?? Even with everything else I'm doing? Any advice would be helpful

I work on a Cardiac Transplant/ Cardiac Surgery unit and we have pacemakers come back from the OR all the time. What our surgeons say is that if you completely pause the pacemaker, it is almost a shock to the heart and doesn't allow the heart to will itself back to it's intrinsic rate. So when you pause the pacemaker all together, the heart will 90% of the time have either a junctional rate or asystole. According to them, this is the best way to assess for an intrinsic rhythm.

Thanks for all the replies!!! I really appreciate all the stories. :) Love learning this way!

Thanks for the site!

That site is great!! I'm doing the same!!

I personally have never gone up that high. If we were up that high Im sure the pt would be on plenty other drips. Really I was just using this as an example of titrating....