RescueNinjaKy

RescueNinjaKy has 3 years experience and specializes in Cath/EP lab, CCU, Cardiac stepdown.

RescueNinjaKy's Latest Activity

1. 

   AF or AFL or Artifact

   RescueNinjaKy replied to Dsmcmm's topic in Student Assist

   I think it's sinus rhythm with pac/pvc and some compensatory pauses.
2. 

   Patient's "right" to abuse nurses...I need your opinion

   RescueNinjaKy replied to MsNewbee's topic in Nursing

   We've all had that challenging patient and certainly it can be testing, but make no mistake. Patients do not have the right to abuse you. Nobody does. And if any management tells you different then they need a reality check and a visit from HR. I would not tolerate anyone telling me that the patient can abuse me. For me this is how I deal with these patients. I like to be up front and real about things. If they keep calling me for narcotics, I'll tell them that they are not due for it and it doesn't matter how many times they call me, I cannot give it to them earlier than scheduled. If they are appear to genuinely in need of it through my assessment then I will page the doctor and suggest a change in pain management. As far as the neediness, patient satisfaction is not first no matter what. I'll tell any administrator that in their face. Patient safety and care is number 1. So if I'm busy with another patient then the needy one is just gonna have to wait. We didn't go to school and get tested on those painful priority and delegation questions for some suit to tell me that o have to drop everything for my more urgent patient to go cater to someone who is not actually in distress. Another thing is that when you give them the response that they want, they are conditioned to believe that they can do it all the time. If they get upset they get upset. I tell them I was busy with another patient and that they're not my only one. Most patients understand but those that don't, doesn't bother me at all. Also assaulting anyone is not okay and should be reported. Management is at serious liability when they do not prevent that from happening so if the patient is that aggressive then either restraints need to be used or hospital police needs to be present. I also agree with other posters that the assignment needs to be rotated. Spread the hate is what I always say when I used to make assignments.
3. 

   Debate: Nurses attitude,a contributing factor towards low patients turnout in rural areas

   RescueNinjaKy replied to Memepapi's topic in Student Assist

   I need a million dollars, you have two days.
4. 

   Should I work as a CNA prior to Direct Entry NP Program?

   RescueNinjaKy replied to shannon9r's topic in NP Students

   You should be thinking of np education like pa education. Pa students are required to have a certain amount of hours and medical knowledge whether as an emt, paramedic, nurse, or whatever before they can apply to the program. Anyone who is a nurse knows that passing the nclex and going to clinicals doesn't even come close to getting you prepared to hit the floor running. Direct entry nurse practitioner programs are a disgrace to the profession. If it requires a certain amount of direct patient care hours in the capacity of a emt, paramedic, nurse, RT, then I would certainly understand. But for it to be any non medical savvy person to go straight to a practitioner role is just ludicrous. OP, I think it would serve you best to work as a nurse first but if that's a definite no go then working as a cna can beneficial still. It should at least teach you bedside manners, and you can familiarize yourself with some floor activities.
5. 

   Transitioning from Med/Surg to CVICU

   RescueNinjaKy replied to Nurse_bre's topic in CCU

   I second the brain sheet. It helps a lot to get organized. I like to show up a little earlier before work to research my patients. I have it labeled from 7-19. Then I circle each hour that I have meds. If it's something special that requires longer preparation then I will write it out. Then at another section I have the continuous meds/pressors written out with current titration and map goal. That way I know easily and can glance at it whenever. I have labs written in the back and then a to do list. Like if I have abg q4h then I'll write when it's due like 8, 12, 16. Group whatever you can. Typical blood sugar checks q4h for patients without insulin drip so I see which labs I can grab together (like get my abg while I'm at it) Of course you have to prioritize. Make sure you see your patient quickly and assess. As you get more comfortable with your rhythm and assessment things will go faster. If your patient load is heavy ask for help. The critical care setting is all about team work. Ask for help and help others.
6. 

   PVCs on monitor

   RescueNinjaKy replied to Matt8700's topic in CCU

   And I think on the monitors you can select paced and it might be able to read the pacer spikes better. Also if nothing works switch the wave that's being shown.
7. 

   Question about Cardiac Caths

   RescueNinjaKy replied to Tneo8385's topic in CCU

   Was it the internal med doc that said that or was it the interventional cardiologist that said that? If it was the IM med then he should've gotten a cardiology consult to determine it. But otherwise, I can't see why it would be contraindicated.
8. 

   TTM Exclusion Criteria

   RescueNinjaKy replied to Catticus11's topic in CCU

   I think the exclusion criteria is if the patient is verbal post rosc. So yeah the patient should've been placed on therapeutic hypothermia.
9. 

   ADN vs BSN : Is getting an ADN a waste of time?

   RescueNinjaKy replied to Nurse Beth's topic in Nurse Beth

   I do not believe that getting your ADN is a waste of time. I worked in a cardiac icu with my associates and got the same pay as bachelors degree nurses. Right now I am on orientation for cardiac cath lab which falls under critical care in my hospital and I still do not have my bachelors yet. Some facilities will require that you work on it though with a time line, but by no means is it a waste of time. I am working as an RN and going to school for my bachelors. If I didn't go for my associates I would not have been able to be working right now.
10. 

    an ICU nursing book please?

    RescueNinjaKy replied to txsky SRNA's topic in Critical

    Have you tried getting the ccrn prep book?
11. 

    Albumin and DKA

    RescueNinjaKy replied to JVerne07's topic in Critical

    off the top of my head the body uses protein as the source of energy which produces ketones, ketoacidosis. Which is why you have that fruity breath and rapid shallow breathing. It's the body's attempt to get rid of and to correct the imbalance.
12. 

    Understanding different gtts for sedation: Propofol vs Precedex vs Versed vs Fentanyl, etc

    RescueNinjaKy replied to Catticus11's topic in Critical

    Fentanyl is a narcotic that is used for pain. It also has a synergistic effect with sedatives. Typically a patient should be on a pain control drip in addition to their sedative. It is inhumane to just sedate a patient that is having pain. Propofol is a powerful drug used for inducting and continuously sedating a patient. It is used for procedures or for keeping vent synchrony. It usually doesn't last too long and the patients will wake up shortly after turning it off, however there are exceptions. In particular, patients who receive high continuous doses of propofol for prolonged periods can wake up slower when finally turning it off. It is recommended to have sedation vacations for patients to help with weaning and to do assessments. With propofol look at their ck and triglycerides to watch out for propofol infusion syndrome. A patient that receives propofol should have an airway(intubated) as they're likely to not breath. In my icu we used rass (Richmond agitation sedation score) from -5(they're completely out and no response) to +4 (they're batshiz cray). Doctors might order titration on propofol for a score of whatever. versed is benzo that is used for calming down patients and as a sedative. It can be pushed or used in a drip. I have seen versed used in replacement of propofol for patients who have elevated triglycerides or ck(think propofol syndrome). Typically I find that it doesn't work as well as propofol for patients who are in ards and bucking the vent. In the case in which they shouldn't get propofol due to propofol syndrome, they might be indicated for a paralytic. it's been a while but I kind of remember that the patient getting a paralytic drip should be getting pain management (fentanyl) and possibly a sedative (versed) as an adjunct, as you don't want your patient to be in pain and paralyzed. Or in pain and awake and anxious. For paralytics it paralyzes the patient like the name suggests. I think it's mainly the ards patient that you will see this on. Especially those that will need an oscillator I believe. Since their lungs will be paralyzed, they will definitely need to be ventilated. There's an induction agent like roc/vec and then a maintainence agent (which I don't remember). For the patient being paralyzed you should be doing a train of 4 with your assessment to ensure that they're not under or over paralyzed. The train of four is basically electric shocks that causes their fingers to twitch per shock. If they don't twitch at all then they're probably too paralyzed. If you're getting 4 twitches then it might be under. There's a specific guideline/titration on it usually. Then there's BiS monitoring which kind of measures activity in the brain. DO NOT USE THIS TO SAY THE PATIENT IS BRAIN DEAD (you don't use this for that) if their BiS is high you might want to go up on the sedative and if it's low then lighten it. Finally precedex, which is used to calm the patient down with a sedative/hypnotic effect. I hardly ever seen it used but it was usually for the agitated delirious patient that we are trying to extubate (like detox/etoh withdrawal). As a disclaimer, all of this is just off the top of my head and I no longer work icu nor do I remember much about it. The information is just a general way of how I saw things in the icu that I worked (5 months) at, and could absolutely be wrong so don't take this as an absolute. Each icu might do things differently. Some docs have a preferred sedative and pain management drip. I do want to go back to the icu one day but I'm going to be working cath lab instead for now.
13. 

    What are your NP clinical rotations like?

    RescueNinjaKy replied to Rocknurse's topic in NP

    I too am very curious what clinical rotations are like for nurse practitioners. Keep it coming !
14. 

    How do I pursue nursing with a Health Science undergraduate degree?

    RescueNinjaKy replied to nurse2bglo.'s topic in General Students

    whether you finish your health science degree, you need to get into a nursing program to become a nurse. You can either apply now for the one in school, but you seem opposed to that idea. So your other choices include transferring to another school to get into their nursing program or apply to another school with a nursing program when you graduate. As far as how long it takes to complete the nursing program, it varies depending on the program and the individual. Generally speaking if you have completed all your prerequisites, then 2 years for a standard associates degree nursing program and 4 years for a bachelors program. Of course you can go faster if you take more classes or join an accelerated program. If you are missing prerequisites it will take you longer. For working as a nurse, you can work as a nurse ONLY when you become a licensed nurse. So that means graduating with your nursing degree, and pass the board exam(NCLEX) and receiving your license. A health science major cannot work as a nurse because they aren't one, similarly, a nursing student or even a nursing graduate cannot work as a nurse because they are not licensed. And finally I am unsure what you mean by working random job. If you want to get a job to get some money while you're in school, you can do that, and it certainly is feasible, but certainly not a job as a nurse since you're not a nurse yet.
15. 

    Eating Their Young

    RescueNinjaKy replied to futurelnd's topic in Relations

    I didn't realize that the prerequisite of a nurse is to be a perfect being. Do you honestly think that just because I'm a nurse, I'm expected to be nice to everyone. We are humans not saints. Yes, my calling is to be compassionate to my patients, but that is it. It does not mean I have to be nice to everyone. And speaking of hypocrites, as a nurse, is our job not to advocate for health, then does this mean that we should be in perfect health lest we be hypocrites? This is another common overused generalization next to NETY, "you're a nurse, aren't you supposed to be nice all the time". Nope, nope, nope. Believe me, I am strictly against bullying, but to make such wide generalization is wrong. Once again bullying exists everywhere, to claim and generalize that all experienced nurses do it is wrong, bullying is wrong, expecting a nurse to be nice 24/7 is also wrong for we are only human. Also not everyone jumps to the conclusion that no bullying is present. We go off with what we get from the OP. In fact there are indeed other threads on which posters have called out bullies before. One in particular that I remember is when a nurse kept referring another nurse, who happens to be male, as girl. Multiple posters have told him to report that behavior.
16. 

    Eating Their Young

    RescueNinjaKy replied to futurelnd's topic in Relations

    The primary reason why I have an issue with the phrase "NETY" is because we are led to believe that this phenomenon is localized with nurses. The simple and pure answer is this: there are *******s in every single profession. This generalized statement that nurses like to bully new nurses is just mind boggling. Not all nurses are bullying, heck some of that bullying might be perceived as such but really isn't. If I talk to a new nurse about a mistake it is to make sure that they don't do it again. We are in a profession where mistakes can mean a difference in living or dying. But of course someone is going to think I was bullying. Now in the instance in which we have that one nurse that's mean and nasty for no reason, yes we have a bully. But that's just a bully. Why are we generalizing this behavior with other nurses. I've worked in offices and banks before, and I've experienced more gossip/backstabbing/rude behavior there than I have in the hospital. My point is that there are bullies in every profession, to simply generalize that nurses find the newbies to be oh so appetizing is just an insult to nurses everywhere. Bottom line: bullies suck, but is not limited to nurses. Although I hate the phrase NETY, I do oh so love posting in them.