estherojin

Could also be heart failure- patients with poor cardiac output would be cool to the touch and would have edema.

Sorry, but I disagree with you. I worked in the cath lab for 5 years and have heard quite a few incidences of dissections, not all fatal, but dissection regardless. Even if the material of the balloon is pliable (which I don't know if you've felt, but is actually pretty tough), not all patients have perfect ideal aortas, many are calcified, many are plaque-ridden, many are aneurysmal. When the balloon pumps are inserted in the lab under fluoro, we generally do an aortogram, but in dire circumstances, if the patient is in shock, we put it in without losing time even before revascularizing the occluded vessel. Even small movements by the patient can cause significant migration of the balloon especially in short patients, it can make the difference of pre renal and post renal balloon placement. Regardless, I think it's a no brainer that IABP pts ought to be singled, even if the patient's being weaned. Docs don't put in IABPs willy nilly, they're wicked invasive, expensive, and incredibly helpful. I have a big problem with attitudes that assume things will be fine because there have been no problems in the past. Perhaps there were no problems because of the vigilent nurses! At the hospital I work, the nurses are one to one with VADs and IABPs, we don't have techs to manage IABP timing. It sounds like a great idea, but I think knowing how to manage IABPs is a critical care nursing skill.

RCA = Right Coronary Artery. Coronary arteries are visualized by injecting radio-opaque contrast or "dye" under x-ray.

If I was in your shoes, I would give it one more shot on the GRE. Did you score at least a 4 on your written portion? Focus on the verbal, study the vocab and I think you can improve. My school's median score went up and I believe their lowest score was 1140 from the most recently accepted applicants. I think your GPA's pretty fabulous, but since you are competing with people with years and years of critical care experience, make the scores and GPA speak for you. You might want to add CCRN to the list of things to get done.

while working a case in the cath lab, my (unbelievably hairy) patient went in to VF after an RCA injection. back then we had these old school defibrillators and for some reason the hospital opted to go with these orange electroconductive pads (not defib pads) instead of the goop. these pads looked a lot like the american cheese slices, anyway, they were just as difficult to open. back to my story, guy goes into VF, i get the paddles and the pads, i try to open the pads, the package opens weird, making it nearly impossible to open while holding the paddles. so i ditch the pads and shock the patient with the paddles without the pads. good news is that the pt's in sinus, bad news is that the shock produces a puff of smoke and 1st degree burns... not to mention the smell of singed hair that lasted the whole day.

Happy Halothane- Thanks for your reply. I have been living #5 for the last month, it feels great! I'm down one cup of coffee a day and it's purely for enjoyment purposes. Anyway, I was wondering if you could give me some advice on PDA's. What kind do you have and what applications/software were helpful to you? I've ordered the Basics of Anesthesia yesterday and will dilegently start indoctrinating myself. Thanks all for your advice and good luck to the fellow first years! Let's keep supporting each other.

reading what you wrote about your personality and what you enjoyed in your clinicals, it seems like you are already leaning on an ICU.

honestly, i think you should wait until you have a full year's worth of critical care experience. you are not going to do yourself any favors by not meeting the admissions criteria. they might be willing to overlook one, but falling short on two might not reflect well on you as a candidate. your first year as a nurse in the ICU will be tough, there will be a lot to learn. on top of that you will be working on your BSN and studying for your GRE (not to mention NCLEX). what you don't want to do is waste money and effort in the application process if you aren't a strong candidate (yet). I think you have a good start already, your experience in the ED and surgicenter will help you on your first year as a nurse. a few of my colleagues who are excellent nurses and had top grades hurried their application and unfortunately did not get accepted. Anesthesia programs are competitive, you want to make sure that you can meet (and exceed if possible) all their admissions requirements. good luck to you. it took awhile for me to figure out this was the path i wanted to take, i admire you young folks who've figured out what they want early on.

This seems obvious to me- to work and save. However, I've worked my butt off for the last 6 years. I've been juggling a full time with a part time/per diem position, supporting my husband's graduate education. Cutting down my hours this spring to take the two classes was the first "break" I had from work in a long time. I will be working part time through my first two quarters, so I will be getting tuition reimbursement and I don't have kids, so the money thing isn't too bad of an issue. The syllabus suggestion seems sound, but I don't see how professors or students would want pass their syllabus on- it might be considered an unfair advantage? Thanks for the suggestion to brush up on the autonomic nerv. system. I will definitely do that. Thanks all for responding. One more question, what classes did you find most difficult in your program?

nope, even cheapo free ones from pharmaceutical companies are good enough. you'll really be using to measure intervals. it's about the skill, not the tools necessarily when it comest to getting good with ecgs. good luck with your class, you'll enjoy it.

Hi All- So, I need some advice. Having finished the last of my prerequisites in spring, I find myself in a very fortunate position of actually getting a summer break. Working Fri/Sat, I have 5 days free to do as I please. I have been keeping myself busy with misc. hobbies such as guitar class, sewing lessons, and salsa lessons. However, I am thinking now that I ought to devote at least a small amount of time preparing for school. Here's my question for all you guys waist deep in school. Are there things I could be doing, concepts I could be reviewing that might benefit me this fall? I am so psyched to start school, but am starting to feel wicked nervous. Thanks and cheers!

you mentioned that you might be able to work at this hospital through your agency? just to be on the safe side, i'd investigate the HR policy regarding agency use. many of the hospitals place clauses in the employee contract that state the employee will not be able to work at the hospital through an agency for a given amount of time. at the few hospitals i've worked, if you were an employee, you couldn't come back to work through an agency until 2 years after your last day.

no way. i'd have more respect for a MD who's walked in a nurse's shoes.

no, you're not stupid. it takes an intelligent person to know what they don't know. it's those people who are overconfident of their skills and knowledge that are the most dangerous people to our profession. i know it's overwhelming, it'll get better. just hang in there and try to walk away from each day learnining at least one solid lesson.

on our floor, we check residuals with our scheduled flushes for pts on continuous feeds. i'd check residuals more frequently on pts who have distended abd, who havent had a bm for a while.

shouldn't you be doing your own homework?

We would allow the patient's family to witness the tail end of the code, after we had exhausted most of our resuscitation efforts, so that they would know that we had done as much as possible to care for their loved one and be able to spend the last few minutes with the patient. it's worked well the few times we did it, only because there was an APN to explain what was happening. i don't think it's appropriate to have family witness everything such as putting in invasive lines, drains, etc, but that usually happens in the beginning/middle of the resusitation process.

agree with queen216. sounds like she might be going into CHF. she's obviously volume overloaded. i'd put her on oxygen, get a set of VS, and listen to her lungs. also, i noticed there was nothing mentioned about her breathing pattern. if she' in CRF, is she responding to the lasix dose she's getting? if her pain wasnt well controlled early on post op, she probably had atelectasis that didn't improve. She might also need some aggressive pulmonary toilet.

In the EP lab, we've paced pts out of A flutter, but generally I believe you can't overdrive pace A fib since it's a disorganized rhythm- for the same reason you can't pace VF, but can overdrive pace VT. During EP studies, if you pace the atrium too fast, you can cause A Fib.

when they order a rotoprone bed for your patient.

oral care on intubated patients. there's nothing better than freshening up a smelly crusty mouth. love brushing those teeth and deep glottic suctioning. another obsession- i have to have the IV bags hanging directly over it's corresponding pumps.

hmmm, if i had to do it for a job, nursing tops it all specifically being a nurse in a large teaching hospital in an urban setting in a fast paced ICU. i guess i'm lucky cause that's what i do.

love love RRT. i work in a critical care area, so many times i get report from the RRT nurses for the patients that get admitted from the floors. they're the rock stars of nursing!

What is it at your job that makes you happy -Comraderie- I don't see it as much on my current job in the ICU, but when I worked in the Cath and EP labs, I relished the teamwork approach to patient care- MDs, RNs, and techs all focused on one patient at a time. There is comraderie in the ICU, but to a lesser degree- it's mostly just among the nurses. is there a particular program in place that has a great success rate with the overall attitude? -no, i wish there was. there was a large group of new grads (10-12) as well as some seasoned nurses that were hired when our unit expanded from 13-23. the education department on our floor was unable to meet the demands all of the new grads and i think after the one year mark, we were able to retain only 2 of the new grads that were hired. after this "failure" the leadership team on our unit decided to orient at most 2-3 new grads at a time to allow for more comprehensive orientation program. i feel for the new grads that left because i think most of them had great potential if only they had been oriented properly and it saddens me that most of them left feeling defeated. the newly adapted appoach of hiring and orienting smaller groups (2 new grads and 2 seasoned nurses) at a time has been successsful so far, we'll see after a year how it goes.

In the Electrophysiology lab, the MDs used 40/40. From what I heard, the general recommendation is to use the lowest power setting as possible. I do remember that on our older units, we had to crank up the power to get it to where our MDs wanted. check this website out, you might find something helpful. it helped me understand how cautery worked. http://www.valleylabeducation.org/index.html