marienm, RN, CCRN

Burn, ICU

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All Content by marienm, RN, CCRN

  1. marienm, RN, CCRN

    New grad-IV question

    marienm, RN, CCRN replied to Tds5110's topic in Patient Medications

    I don't work in a PICU or (presumably) at your hospital, so take this with a grain of salt: 1) Check with pharmacy or a database (we use Lexicomp) and make sure all the stuff you want to run is...
  2. marienm, RN, CCRN

    Where are all of the Burn Unit nurses hiding?

    marienm, RN, CCRN replied to Cisabel's topic in Burn

    Our hospital has things that are protocol driven, but they all must be initiated by an MD order. The MD can order the "hyperglycemia/insulin gtt" protocol and then the nurse can titrate the insulin...
  3. marienm, RN, CCRN

    Hemodynamics in Burn Unit

    marienm, RN, CCRN replied to WestCoastSunRN's topic in Burn

    I found a decent article that summarizes some of the resuscitation protocols: Fluid management in major burn injuries But, spoiler alert, they all come down to urine output being the best indicator of...
  4. marienm, RN, CCRN

    Hemodynamics in Burn Unit

    marienm, RN, CCRN replied to WestCoastSunRN's topic in Burn

    We get a lot of femoral CVCs and we often don't transduce a CVP. A-lines, yes, with a Phillips Vigileo monitor for the more unstable patients. (Some of our A-lines are pedal, so I question the...
  5. marienm, RN, CCRN

    Better Health Care Elsewhere

    marienm, RN, CCRN replied to Ashley Hay, BSN, RN's topic in General Nursing

    I wonder if the patients are different in different areas? I'm in the northeast and I called a specialist's office today to schedule an appointment. I've been there before but not for a couple of...
  6. marienm, RN, CCRN

    Setting priorities

    marienm, RN, CCRN replied to Cbaldwin's topic in Medical-Surgical

    I've never worked med-surg; I started in an ICU as a new grad. So...maybe these thoughts are helpful, or maybe not? 1) WHY do they think you are not prioritizing well? Are you missing critical...
  7. marienm, RN, CCRN

    Stank Face during Clinical: How to prevent?

    marienm, RN, CCRN replied to hepnande's topic in General Students

    I agree that watching your facial expression takes work & is important. For SOME patients, I find that simply acknowedging the situation helps, too. Especially with ostomies (ostomys? now...
  8. marienm, RN, CCRN

    Where are all of the Burn Unit nurses hiding?

    marienm, RN, CCRN replied to Cisabel's topic in Burn

    I started as a new grad on a burn unit in 2013. I work at a level 1 adult/ped trauma center teaching hospital with a children's hospital (so peds burns go there, not to my unit). My unit is very...
  9. marienm, RN, CCRN

    Hospital policy for Paralytics/Train of 4

    marienm, RN, CCRN replied to SkiRNBABSN's topic in Critical Care

    I'm at home & can't get to our policies, but we use TOF as described by Okami (and Nimbex is the primary paralytic that I've used too) as well as a BIS monitor for sedation. TOF measures...
  10. marienm, RN, CCRN

    Nurse advice to Lab needed

    marienm, RN, CCRN replied to DebLabTech's topic in General Nursing

    Minimum time needed to run each test? I had docs ordering q2hour CMPs for a critical pt. Our lab results these in about 75-90 minutes usually...maybe as little as 60 but not frequently unless they...
  11. marienm, RN, CCRN

    References/Help for Peds Burn Pts.

    marienm, RN, CCRN replied to WestCoastSunRN's topic in Burn

    I only work with adults...peds pts go to our children's hospital no matter their diagnosis. Burn-specific issues that *might* apply to kids include range-of-motion/PT/OT (does it get done during a...
  12. marienm, RN, CCRN

    EMESIS ASSESSMENT

    marienm, RN, CCRN replied to FurongQin's topic in General Nursing

  13. marienm, RN, CCRN

    EMESIS ASSESSMENT

    marienm, RN, CCRN replied to FurongQin's topic in General Nursing

    Our emesis bags are kinda marked on the side...for more than 200mL, the weight is probably enough to pull the bag down & open. Assuming the pt makes it to one, that is! Occasionally the only...
  14. marienm, RN, CCRN

    Oramorph and morphine syringe driver

    marienm, RN, CCRN replied to corelli's topic in Patient Medications

    It is common for a patient to have orders for an oral narcotic, an IV narcotic for breakthrough pain, and hopefully orders for some IV or oral non-narcotics too (acetaminophen, ibuprofen, ketorolac as...
  15. marienm, RN, CCRN

    Hotline blood warmer tubing

    marienm, RN, CCRN replied to jessthoreen's topic in Critical Care

    We change it every 4-6 hours just like regular blood tubing. (Assuming warmed blood is still required after 4-6 hours.) If we're using the hotline for fluids then the tubing would be changed every...
  16. marienm, RN, CCRN

    Tube feedings: To pause or not to pause?

    marienm, RN, CCRN replied to melisach19's topic in Nursing Student Assistance

    Our hospital policy says not to pause. Our Kangaroo pumps take about 15-20 minutes to alarm if you forget to re-start; if you pause every 2 hours and forget to restart around 25% of the time, the pt...
  17. marienm, RN, CCRN

    Blood Draw Help Needed

    marienm, RN, CCRN replied to Marliss's topic in General Nursing

    I only use butterflies (it's all I was taught), so no tips about the vacutainer needle. With the butterfly, I hold the needle in my dominant hand and swap tubes with my other hand. I try to have...
  18. marienm, RN, CCRN

    Excoriated Skin= Sloughing??

    marienm, RN, CCRN replied to Nurse_Nancie's topic in Burn

    Go for it! I only browse AN when I'm not working, so sometimes I don't check in for several days, but I'll always try to
  19. marienm, RN, CCRN

    Kidney Transplant Recovery Floor

    marienm, RN, CCRN replied to kmek30's topic in Dialysis, Renal, Urology

    Our unit recovers fresh transplants, usually for 2-3 days. Some go right home after that and some move to a med/surg floor. A few thoughts: 1) your orders should include parameters for hourly urine...
  20. marienm, RN, CCRN

    muslim prayer

    marienm, RN, CCRN replied to olamuri's topic in Spirituality, Religion

    I am also not Muslim, but I wonder if night shift would make it a little easier? What do Muslim night shift workers do in other fields? Do the times of day for prayer correspond to the sun or to the...
  21. marienm, RN, CCRN

    Anxiety following patient death

    marienm, RN, CCRN replied to Hockeynursing's topic in General Nursing

    This, right here, is why he died when he did. Ancedotal, but I completely believe in this: Before I was a nurse, this is how my mother died and my grandmother before her. They each weren't doing...
  22. marienm, RN, CCRN

    Helpful (?) (!) Advice for burns

    marienm, RN, CCRN replied to Kitiger's topic in General Nursing

    We had a patient come in who had put toothpaste (the aqua-colored paste, as it happened) all over his burn at the advice of family. We do *actually* use mayonaise to remove tar from
  23. marienm, RN, CCRN

    Popping off top from lab tube when drawing labs

    marienm, RN, CCRN replied to pattykolo888's topic in General Nursing

    Twice I've had a burn patient come in who is so hemoconcentrated (Hct > 55) that the standard light-blue coag tube won't work...not enough citrate, I guess. The lab pops the top off a tube for us,...
  24. marienm, RN, CCRN

    Excoriated Skin= Sloughing??

    marienm, RN, CCRN replied to Nurse_Nancie's topic in Burn

    By AllOfMyWat's good definition, slough can be applied pretty broadly. It sounds like the OP is a student, and as I recall from school there can be a lot of discussion in class about the exact...
  25. marienm, RN, CCRN

    (Manual BP) Can't find systolic through palpation. What am I doing wrong?

    marienm, RN, CCRN replied to dumb_'s topic in General Students

    I should clarify from my comment above that we were just taught to do this to locate the artery and know how tight to make the cuff. However, remove my instructions about the stethoscope above and...