benmca13

Ours is 20ml/hr, but we can run insulin/heparin gtts by themselves

We're not supposed to use finger sticks if they're on pressors.

Hey guys. I'm just getting info from people at work. I'm not sure how her mental status is today but I know they did an ammonia level and it was high. So they're thinking that. The bleed in the abd was proved by CT scan. Her hemoglobin had stabilized the next day. She wasn't unresponsive when I had her. Very obtunded, lethargic, so that's why I called and got bipap.

They think they knicked her liver when they put in pacing wires.

She became sedated when I gave it to her. But then half hour later she was awake and restless again, rolling around in bed. Husband was holding her arms down bc she was trying to pull off her bipap (which I got an order for about 8 hours prior for prevention).

No neuro scans yet. CT scan showed the bleed though. I'm going to call my educator today and ask why would it be a fent OD if the narcan didn't work? How do you feel about the amount I gave her?

So this is going to be a bit of a long post but I'm just trying to figure this whole situation out. Long story short. My patient was 60 something years old. Had MVR done. Wanted to be on the transplant list due to non alcoholic liver cirrhosis stage 3. Was on pump for about 12 hours. Post op was rough for her her first night. Still intubate. Scv02 was high 30s to low 50s. Hemoglobin at 10 pm was 10.5 after 2 PRBCs given after her first hemoglobin came back at 8.0. Overnight her huge belly became a tad more firm (could hardly tell because it was already firm from cirrhosis). Hemoglobin was 6.3 and it showed a bleed but it was controlled and nothing was needed to be done. Had her the next night (extubated at 1630). She was A/O x3 on days but when I came on she could hardly answer any questions. Got her on bipap overnight. About 3 am she became super restless. Pressure in the 190s on 150mcg/min of nitro and 2mcg of nipride. Gave her 50 of fent. Worked wonderful. She calmed down, pressure came down. Ended up giving her 300mcg fent total over about 4-5 hours. I'd only give it to her after when I had thought the fent had worn off. I'd only give it when her husband was there holding her arms down bc she kept trying to pull stuff out and getting out of bed. I gave her a dose right before I left. That night I got a text and apparently she has been completely unresponsive all day. Gave her a dose of narcan and she still didn't wake up. Now over the past 2 days and still hasn't woken up and the surgeons is blaming me for an overdose. I obviously think I gave too much fent. But is she really unresponsive bc she had 300 fent over 4-5 hours when she was continuously trying to climb out of bed and wasn't neuro intact? Why wouldn't the narcan have woken her back up if that was the case? Thanks so much for all your help!

We do Levophed through peripherals if we have nothing else. Usually they have a PICC/ CL if they're sick enough to require Levo. However, working nights, most of the times when our patients crash, we don't have the luxury that days does to get one. We're extremely careful when we have to though. I think if they're sick enough to require Levophed, they're sick enough to buy themselves a central line.

We do paperless. Honestly, we rarely look at the computers. Most of our report is just done at the bedside or at the nurses desk - but I feel as if we give detailed enough report that we don't need to look at the computer. Works fine for us, I'm not sure why other hospitals spend so much time looking at computers. You should know form report what meds their on, code status, etc.

So I'm new to ICU/CCU nursing. I'm completely confused by MI's and Cardiac Arrest. I've been asking my preceptors, but one tells me one thing while the other tells me something different. I go back to the cath lab and they tell me something different. All of the nurses I've precepted with have 30-40 years of experience, so I'm not sure what to believe. My question is this. I truly don't get two things: why can someone come in with CP and another be coding? If the plaque on the walls is too thick that blood can't pass through, it's an MI, correct? If a embolus breaks off and clots a coronary, it's an MI, correct? What causes the heart to just suddenly stop, while others can go days without the heart actually stop? What's the patho I guess is what I'm asking. I just don't get what's going on in the body that some code and other just have an MI. Secondonly, what happens in the body that differentiates between a STEMI and NSTEMI? Some told me the area of the heart it happens in, others told me it depends if it's an embolus or just plaque build up. I just don't get heart attacks currently. I came from a medsurg floor so this is all COMPLETELY new to me. Thanks in advance!

We just talk on the phone and a tech brings them up. How a floor nurse finds the time to go get their patient enough to make it a hospital thing is beyond me! You must have awesome ratios!!!!

Put it back! I didn't even know policies could be that dumb not to! Hello electrolyte imbalance!

The person above me has taken the extreme approach. You run your butt off like there's no tomorrow. I work on a more surgical floor but we get medical overflow. We get 5-7 pts with no aids overnight. You will rely heavily on teamwork or you will sink! A lot of times I feel like I can't get anything done without being interrupted and I never feel as though I do anything worthy bc I'm forced to do the bare minimum. The nights either are horrendous or a huge joke. You will learn to time manage or you will not last. I've worked as a surgical nurse for about three years and am getting burnt out! It's a great area to learn but most people cant tolerate it too long! It's a very rewarding floor when your patients give you compliments because you know how busy you are - but they think you've done miraculous things for them! Good luck and keep us updated!

I had no idea there was more than one way to draw up these meds!! I always draw them up into a syringe without diluting them! What's the point in that? Can't you just give the med slower? I've never had problems! I flush with 5mL saline, give the med over 1-2 min (3-5 if it's a pain med) and then flush with the remaining 5mL slowly.

We usually have 1:5, but frequently it's 1:6 at night with no aids. You learn to work as a team. Time management is key too. I try to get everyone to the bathroom around the same time whether they have to or not, that way I can find time to sit down and do my charting.