andi.w

A patient recently told me that she was scheduled for a stress test and an autopsy the following day.

I think that a lot of RNs have or will make a med error at some point, whether big or small. I've made med errors before; it feels TERRIBLE. And as terrible as it feels, at the same time, it feels so much better to fess up and get it off your chest. The patient is always the priority. Immediately reporting the incident to your supervisor also says a great deal to them about your character and professionalism. Many facilities also have a way of reporting the error to the patient without the nurse directly having to be involved. In my state, a lot of offices and urgent care centers allow CMAs to deliver injections after a clinician or licensed provider has drawn the medication up. This has always made me a little uneasy. As an RN, it had always been drilled into my brain that you never administer a medication that has already been opened or that someone else has drawn up, unless you witness them doing it and are able to check the 5 rights yourself. When drawing up injections from a multi-dose vial, I will sometimes even have another RN witness with me just for my own peace of mind, even if the med doesn't require a double check of a second RN.

Good resources! Thank you all! One thing that I think I may be confused about is CMV vs. SIMV. It's my understanding that in CMV, the ventilator gives a fixed number of breaths with a fixed Vt and ignores any spontaneous breaths from the patient. Whereas in SIMV, the ventilator will support spontaneous breaths and ensure that they achieve the set Vt. Is this correct? Also, would this mean that in CMV a patient may be taking more breaths than the set rate, just not necessarily with the same Vt? And lastly, can you give pressure support in CMV mode? Thanks again!

Hello, all. I've been looking for a good resource that explains the different vent modes/settings. Does anyone have any favorites? Thanks!

Unfortunately, this sounds familiar to me. I have worked with a couple of physicians that have been ordered anger management classes for their behavior. In my experience, it didn't make a difference. Aside from the fact that no one should have to work in that type if environment, this behavior and treatment of nursing staff could also be detrimental to patients. Nurses don't want to reach out to these physicians for help when they constantly fear being belittled and verbally abused, or in your experience, threatened. They will avoid contact with a particular physician for as long as possible, possibly delaying patient care. I feel that hospitals should give offending physicians more than just a slap on the wrist.

Try this: http://fastfactsforcriticalcare.com/ I bought this mini binder as a new grad and still use it as a reference. It's not only cardiac, but has several sections for neuro, drugs, respiratory, etc. I also bought the additional sections for IABP and cardiac surgery. I believe they now have it available as a smartphone app, and it's quite a bit cheaper than the book version.

I'm so jealous of those of you with visitation restrictions! The other two ICUs in my hospital do not allow visitors between 6a-8a and 6p-8p. I work cardiovascular surgical ICU, and we have NO limitations on visitors. It nauseates me to see small children running around visiting immediate post-op open heart patients. Not to mention visitors roaming around during report. I usually ask visitors to leave the room while I do my assessments, and many of them perceive this as being rude. They don't realize that I'm trying to consider the privacy of my patients, plus it's much easier to do what I need to do without having to work around a number of people gathered around the patient. Sorry, went off on a bit of a tangent there. Lol.

I work in open heart recovery, and I have not heard of a crescent shaped midsternal incision. I do not work in a large hospital, but I have seen a few patients come through with a MVR via a thoracotomy approach. Maybe this is what she's referring to? Initially it is a bit more of a recovery process and much more painful, but better benefits in the long run, especially if it is a younger patient.

I felt this way when I first started too. It seemed like the more critical patients always went to the nurses who had been there longer. Eventually when I had gained some seniority and started taking the more critical patients, I lacked confidence because I felt that my skills were not as sharp as they could be, as I was not used to taking these patients. I definitely recommend speaking up and asking for more unstable patients now while you still have more seasoned nurses available to use as resources.

Tricky. Is the BP low because of the afib or does the pt normally run low? I think it would definitely depend on how brave the doc was feeling. You could try giving a slow bolus of amio and then starting a gtt. If the pt was symptomatic maybe amio and a pressor to get the BP a little higher. I would say a cardioversion would definitely be the safest bet though.

I also started as a new grad on a tele unit. It took me several months to find a routine that made me most proficient. One thing that I did at first was make a Sort of "check sheet/graph." I listed my pt room numbers horizontally and then tasks such as initial assessment, 2000 meds, I&Os, 2300 vitals, etc. horizontally and placed a check when I had completed each. This kind of helped me to stay on track and saved me time from stopping and going "Ok who did I miss for this particular thing..." It seems silly, but when you have 5-6 Pts and limited time to complete everything, it really did seem to help. I think the most important thing is just try to relax and take your time. Mistakes happen when you rush. One thing that I finally had to come to terms with as a new grad was that being a few minutes late passing meds or getting vital signs was not the end of the world. Nursing definitely requires flexibility.

It's good that you have a mental plan for how to begin. I work both CVICU and tele, and my "routine" is different for each. Everyone has a routine that works best for them. It took me a while to figure out how I could be most efficient. I too do a quick "eyeball" of everyone when I first start. At my facility, you are supposed to complete all initial shift assessments within one hour, which as you can imagine, does not always happen in quite that time frame. We also do our own vitals. I start by doing vitals on my sickest patients first. I usually do vitals and a focused assessment to begin with, depending on the acuity of the patient. Halfway through my first rounds, if I'm "on time" with getting everyone checked over, I begin doing full assessments and passing meds. Also, if a pt has meds due that affect HR or BP, I try to pass their meds when I do vitals to avoid giving the med a while after the vitals were taken and/or having to retake vitals. I think the best advice I can give is to relax and be flexible! When I first started working tele, I stressed over all meds not being passed within the golden half hour window or all full assessment being completed within the first hour of my shift. You have to take your time and work at a pace that suits you. Mistakes happen when you rush, and you will become faster and more efficient as time goes on!

Skillstat.com is another good site for practicing ECG rhythms. It also has ACLS practice and other helpful info.

If EMS picks up a STEMI or if a STEMI walks into the ER, we activate an AMI page, and a page is sent out to the interventional cardiologist, Cath lab team, and the CVICU unit. A nurse from CVICU does not respond to the ER, however. The ER staff are for the most part extremely efficient in meeting the core measures/goals for AMI. I think that a "chest pain" nurse would be a good way to facilitate fluidity in caring for STEMI patients, especially since most hospitals have short windows of time for interventions.