fusster

Well, there's the two drips I used last night-cardizem and dopamine :) other calcium channel blockers like verapamil, Beta-blockers mostly lopressor, labetolol, and coreg, aspirin, amiodarone, digoxin, rythmol, ACE inhibitors mostly lisinopril, diuretics i.e. lasix, HCTZ, aldactone, demadex, and bumex, plavix, dobutamine, blood thinners like heparin, coumadin, and lovenox, nitrates i.e. SL NTG, IV NTG, transdermal NTG, Imdur; ARB's like cozaar, diovan, atacand. And always morphine for those MI's. Hope that helps.

I'm not a dialysis nurse, but here's my understanding. Dialysis ports (Permacaths, Quinton caths) are usually the only way for a patient to get dialysis. If you draw off of a dialysis port, you risk not flushing it properly and clotting it off. If it gets clotted off, it is useless. The dialysis nurse will not be able to perform the dialysis. Therefore the patient is unable to get the dialysis their life depends on, their BUN/Creat rises, their electrolytes go out of whack, their BP rises, etc, and they may ultimately die from the complications. Also, if it clots off, then the port will need to be removed and a new one inserted, resulting in preventable medical costs. Overall, bad for the patient. If you ever draw off of a dialysis port by accident, be sure to call the nephrologist (and be ready to be yelled at) and call the dialysis nurse to come and ensure that the port is flushed properly. I believe the heparin solution that is instilled into dialysis ports is more concentrated than the heparin solution for central lines (although that may vary by hospital). Except in very few instances (and I mean very few), dialysis nurses should be the only ones to ever touch dialysis ports. Again, not a dialysis nurse, so dialysis nurses feel free to correct me or add any other useful info.

I was in your position about two years ago when I was in nursing school, so I know where you're coming from. It's hard to learn to interpret EKG's quickly, as you need to do in nursing school. Do you need to learn what the interventions are for each life threatening rhythm too? That was the worst part for me. I work on a tele floor now, so I'm looking at them every day and it's much easier. Here are some sites I bookmarked when I was learning them. http://www.gwc.maricopa.edu/class/bio202/cyberheart/cardio.htm http://www.skillstat.com/Flash/ECGSim531.html http://www.angelfire.com/ab/cardiosv/arrhythmia.html#normal http://davidge2.umaryland.edu/~emig/ekgtu04.html http://www.mf.uni-lj.si/mmd/cardio-a/eng/at/vent_ar.html Also consider searching this site, I'm sure there are more resources on various threads that would be helpful.

I work in a community hospital on a telemetry/step down unit-not really sure which you would classify it under. We do drips-cardizem, dobutamine, dopamine, amiodorone, nitro, insulin-pretty much everything except for levophed. The majority of our patients are cardiac or pulmonary-AMI, sepsis, CHF, COPD, pneumonia, PE. Anyway, I was just wondering if at the hospitals other nurses work at in a similar capacity to mine, if you are ever pulled to the ICU? Our ICU is grossly understaffed. Just the other night, there were 10 patients in the ICU (15 bed ICU). I got pulled there, and the assignment the charge nurse made out was that 1 nurse had 2 patients, 3 nurses had 1 patient, and I had 4 patients. I clarified that all these patients were ICU patients, and not overflows from my regular unit or from med surg, then I kindly told the charge that this was not an appropriate assignment, and that I was not able to take 4 ICU patients. She tried to convince me that the assignment was appropriate-that the patients were not on vents, that they were the lowest acuity patients, that they should be patients on my unit, but that was just "a matter of how the order was written." And I repeatedly told her I would not accept the assignment, if they were so low acuity then they should request the doctor to write an order to transfer them to my unit and I would gladly care for all of them. Eventually, a nurse who was supposed to be going home said that he would stay over and I went back to my unit. So, do any of you get pulled to the ICU? If so, what kind of assignment is assigned to you? 4 patients with vitals every hour and who knows what else is way too much for any nurse, in my opinion.

Pressure ulcers can develop overnight. I turn Q2H at a minimum, this is the standard of care for anyone unable to turn themselves, and results in better patient outcomes. They can be very difficult to get rid of once they're there, so it's best just to prevent them. from http://www.emedicine.com/med/topic2709.htm I'm not sure about the death rates r/t pressure ulcers in quadraplegics, however.

I work tele, not ER, but about a month ago had 2 patients in a room together. Bed 1 had a BP that maxed out at 211/110, Bed 2 maxed out at 245/115. Gave a lot of labetolol and hydralazine that night. Lowest was 40's over 20's in a dying patient. Lowest in a living pt was something like 58/30.

We're supposed to do this at my hospital too. I try to do hourly rounds, but if my pt is asleep, no way am I going to wake them up to say this. If they're awake, I'll say "how are you doing? Is there anythin I can do/get for you right now? Push your call light if you need anything while I'm gone, I'll be back to check on you soon" or something very similar. If they're asleep, but their family is there, I will ask the family if they and the pt is doing alright, basically the same thing. But there is no way I'm gonna say "I have the time". That implies that I have nothing to do right now, so start barking off commands and I'll jump and do it right away. I think the way I say it is more genuine and says to them that it is important to me that their needs are met, while not sounding like I'm a waitress who is just there to wait on them and kiss their rear end.

I started nursing school at 18, right after I graduated high school. I went into a BSN program, 125 or so students in my class, and the majority were right out of high school or within a few years of out of high school. At the University I went to, you get accepted directly into the nursing program, you don't do any pre req's first, they just include everything in the required classes, which I guess is pretty unusual. Probably 5-10 of the students were older than their twenties. 20 is definately not too young, in my opinion. I'm 23 now, a nurse, and loving it!

This reminds me of the time when the ER tried to send us a patient whose CT showed a dissecting AAA Now, wouldn't be so bad if I worked at a large hospital, but I work midnights on a telemetry unit in a community hospital with no surgeons in house (but I guess either way, this guy needed OR stat). The ER nurse called down to us and gave us a heads up about the CT results and the the ER doctor knows the results but is still admitting the patient to our unit under doctor such and such :uhoh21: WE had to call the admitting doctor before the patient was transferred down and let him know about the CT results, which the ER doctor apparently didn't find important enough to notify the admitting doctor about. Boy, was the admitting doctor upset when he heard that. The patient was never sent to our unit, he ended up being air lifted to the nearest major medical center immediately after the admitting doctor called the ER livid.

I find that at the hospital I work at there are a couple of reasons ER nurses wait until shift change to give report and sent patients to our unit. First, the census in the ER dictates their staffing. If they have a very low census, but another unit is understaffed, they may have a nurse pulled to staff that unit, and therefore less nurses to staff the ER. We also have a good amount of agency nurses that go to which ever unit needs help the most. So if the nurses hang onto the patients long enough, they will appear that they need more nurses to staff the high census of patients in the ER, making it so they have a lower nurse to patient ratio, and makes them better staffed in case of a massive influx of patients. Either way, hanging onto the patients for as long as possible before shift change makes the staffing situation better for the next shift. The second reason is that the longer the nurse holds onto the patient, the fewer new patients the nurse will get. I guess it's the way of survival in the ER. Sucks for us floor nurses, but I can understand why they do it.

I would suggest you go for the RN. Since you're tyring to work full time and go to school full time, I'm guessing money is a factor for you. It isn't that much more schooling to get an ADN, and the top pay for a LPN is usually about the same as the base pay for an RN. LPNs work just as hard as RNs, there are some things LPNs can't do that RNs can, but to me it doesn't justify the pay difference Overall, however, weigh the pros and cons of going LPN against the pros and cons of going RN, and make the best choice for you.

When you're getting an admit from the ER and the house supervisor calls to let you know that the pt coded in the ER, then the family decided to make him a no code due to his terminal state, so they're sending him to our floor so his death won't be in the ER's death statistics. Myoglobin of 1000 and trop of 0.6, BP in 60's (not to mention his LFT's and renal labs). Thank you, ER. Pt died an hour after the ER rushed him to the floor, and I'd never seen them rush a pt to the floor so fast before. Hadn't even finished to admission paperwork before we had to begin the expiration paperwork.

Look up the possible causes of syncope, then you can narrow down what assessments are priority (as a general rule of thumb, start with your ABC's).

I work in a small hospital, but we do not have this rule. If doctors are the type that don't like to be bothered at night, then they make sure their home phone numbers aren't in our contact information database and they turn their pagers off at night. Most doctors just expect us to use good judgment before calling in the middle of the night. We have a house Dr. and standing orders, so if our pt has a HA or some minor problem there's no need to call to attending.

ok, thank you all for your advice. I've been a nurse for less than a year and had never encountered this situation before. I followed the lead of the preceding nurse who had 20 years experience, but I guess she was wrong. Lesson learned!