Twisted Nurse

Hi all. I'm a new grad cardiac nurse studying about cardiac meds. I know with bblockers and Digoxin, we also need to look at the HR to see if it is safe to give the med. But what about other cardiac drugs, such as ACEs, ARBs, and Calcium channel blockers? They affect BP, but do they also affect HR? I was also told that antiarrythmics, such as Amiodarone can also affect BP? I thought it just regulates rhythm? Any advice would be greatly appreciated. Thanks!

That's the problem....there are no MD orders. That's why I'm getting conflicting statements from nurses.

I have had several patients who are on Novolog sliding scale at the hospital. Sometimes they have to get certain procedures done like angiograms or stress test or colonoscopy that require them to be NPO overnight. When I check their blood surgars, sometimes their blood sugars are around 170s. Other times it can be above 200s. I've had several nurses say they don't give the insulin despite the number b/c the pts are NPO. Other nurses say they give the insulin depending on how high the blood sugar is. What are your guys thoughts or advice?

Not for MRSA...but for Gram positive bacteria. I just thought if they have positive sputum cultures...shouldn't they automatically be in droplet? Or only if they are actively coughing? Please help me understand...

HR in 160-200s? Sounds like he went into Atrial fib RVR. I agree with the cardiologist and the above poster. B/c he is fresh out of surgery, he shouldn't be on any anticoags d/t the high risk of bleeding. You have a right to worry, being in A. fib is not a good thing. Usually, if a pt goes into A. fib post op, a cardiac drug will normally be ordered. I work with post op CABGs so I see A. fib all the time in my patients. Usually if a pt goes into A. fib, we usually do an Amiodarone protocol. But always remember your ABCs! For ex....Is the pt's sats ok? If not give them oxygen. You said he was asymptomatic. So being in A. fib wasn't affecting him too much. Some pts can be in V-tach and not even know it. Is his BPs really low? If his EF isn't low or if he doesn't have hx of CHF....a bolus wouldn't hurt. Not to mention the cardiologist gave you the order for Metoprolol. Basics are always the key! Hope this helps!

I believe you need to do research around your areas you want to potentially work at. There are hospitals that will accept nurses from LTC. But is the hospital you want to work at accepting nurses with only LTC experience? Talk to HR....talk to the unit managers and find out. I was a new grad who started at a LTC. I desperately wanted to work at the hospital b/c I love acute care. Unfortunately for me, none of the hospitals accepted RNs with only LTC experience. How do I know? I talked to everyone, from HR....to calling the unit managers directly.....to asking ppl who worked at the hospitals to help me get in. They all said the same thing...I had to start as an aide b/c LTC experience would not translate into experience taking care of acute care pts. Because of my pride, I only kept applying for RN positions to no avail. I made the decision to swallow my pride. I worked as a nurse tech for seven years struggling to get into nursing school. Once I got in, I only wanted to move forward. Starting as an aide again was a sting b/c I worked so hard to get my degree only to start as an aide again. I also had to sacrifice a pay cut. But.....with all the struggles, the decision I made was the best thing I could have done. I got into the new grad program and work at a top rated hospital that provides the best care for patients here. And.....the staff I work with are the best colleagues I have ever worked with. So my advice is to do your research and find out what the hospitals you are applying for are looking for. Best of luck to you!!!

I have had several patients who have had positive sputum cultures. But other nurses and MDs say there is no need to put them in droplet precautions. Can someone clarify why? I'm stumped. Thanks

I started using this site post nursing school. I'm 6 months out of my preceptorship training from the New Grad Academy and there is so much to learn. I feel this site is really helping me fine tune what I'm learning. Everyone here is very supportive and it's wonderful hearing the diverse opinions and teachings members here have to offer. Plus, there are times when I get embarassed asking doctors certain questions because I feel so stupid. The members here have given me a lot of clarification. Thank goodness for AllNurses!!! This site really rocks!

I think I'm deaf, hahaha, I couldn't really hear anything with the cheapy stethoscopes. I use the Littman Cardiology III series, and I love it! You can hear everything!!! It's expensive, but I got a really great price on it that I couldn't resist. I love it 3x better than my Regular Littman and 10x better than the cheap stethoscopes. As far as shoes, I agree with the other posters, it is a matter of preference. After working 13 hour days, my feet would ultra sore and tired by the time I got home, most especially when wearing regular sneakers. I needed a good supportive shoe. So I tried Danskos and never looked back. What really mitigates the pain and tiredness of standing all day are Ted hose too! My feet and legs feel less tired wearing them both. And you don't want those varicose veins gurl!

Haha I used to have trouble locating lower extremity pulses as well. Thank goodness for Youtube! This short video helped me locate landmarks to make it easier. Start at 40sec mark. But if you are still in doubt or the pulses are weak to begin with, use the Doppler. Hope this helps!

I did my honors research on the efficacy of the flu vaccine among health care workers. Although recommended, less than half of HCWs get the vaccine. This is due to numerous misconceptions about the vaccine, lack of access and education about the flu and the flu vaccine. And there is substantial research that shows that HCWs are vectors of the flu virus. After reading the literature out there, I am definitely a proponent of the flu vaccine. Of course, I do believe that forcing HCWs to take it or even terminating employment is very severe and out of line if they decline the vaccine. But you have to remember, the patients you deal with in the hospital are sick and vulnerable, and the last thing their body needs is a flu virus to besiege them on top of what they are in the hospital for already. Granted, if you are young and healthy, the flu vaccine is not necessarily needed. Good hand hygiene will do. But if you do take care of children, elderly and/or critically ill patients, I personally would advise to take it. When a person is infected with the flu, transmission actually can occur prior to symptoms appearing. So for example, if you're infected unknowingly, you can transmit that to your coworkers and patients, and they can transmit it to other coworkers and other patients, exponentiating the effect. The flu is highly contagious. As a nurse, getting vaccinated is the ability for me to protect myself, my fellow coworkers, and my patients.

Always go by your hospitals policy guidelines. There should be guidelines regarding blood draws from central lines. In my hospital, you: 1. Stop any infusion for 1-2 min 2. Flush 10cc saline 3. Remove 5cc for regular labs, 10cc for coags 4. Flush 10cc saline 5. Change hub if blood is present d/t increased risk of infxn. If collecting flood cultures, you change hub prior to drawing blood.

Is it really just generalized edema?

I used the Kaplan NCLEX book and the Saunders NCLEX-RN. Personally, I liked the Kaplan b/c it had similar NCLEX style questions. This book familiarizes you with the strategic approach in answering the best answer available. The Saunders I used merely for content review. Hope this helps!

Does anyone know the difference between Acute Coronary Syndrome and Coronary Artery Disease?