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Cardiac Telemetry/PCU, SNF
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Spatialized has 5+ years experience and specializes in Cardiac Telemetry/PCU, SNF.

quit job, moved cross country, passed NCLEX...life is good!

Spatialized's Latest Activity

  1. Spatialized

    24 Hour Observation Unit & Charting

    My unit is in the process of starting an observation unit. It will be detached from the ED, under our Internal Medicine service, catering to CP r/o MI, COPD, CHF, Cellulitis, Syncope and Pneumonia observation status patients. Obs is based around CMS guidelines regarding outpatient treatment, where the patient is a little too sick to go home, but not really sick enough to be admitted as an inpatient. Goal is a less than 24 hour stay, but CMS allows up to 48 hours of observation status. A couple of questions for those out there dealing with this kind of unit. 1. Charting. According to our understanding of the CMS rules, we have to be "doing" something for the patient to be there, documented every hour. A good example to me is the patient who is waiting on cardiac enzymes to either rule out, or rule in. How/what do y'all chart about these patients during this time frame? Simple focused assessments and/or vitals every hour? Or some variation thereof? 2. Discharge. Is discharge protocol and nurse driven, or are the physicians still intimately involved? 3. Testing. Echos? Stress tests? Ultrasounds? How involved are y'all getting? Any other information about what has/hasn't worked would be appreciated as well. Thanks for reading and sharing! Tom
  2. Spatialized

    Medication Incompatibilities with Sodium Bicarb

    When we have someone who needs bicarb, they get another line. Easy to get around incompatibilities that may happen that way. Yes, it is inconvenient for the patient (and the staff who has to start the IV) but it seems to be the best work around. Our cath lab will look at lab values and let us know if the doc may want bicarb so we can start another line. Tom
  3. Spatialized

    No respect...or...our profession's public image sucks

    Our image too often is formed based on the twisted stereotypes portrayed in the popular media. Sexy nurses, pillow fluffers and doctor's handmaidens is the image shown to the world and they all believe it (well, not all of them, but a good majority do!) Until the lay public actually begins to truly understand what it is we do, the level of knowledge and professionalism required to work and thrive in our environment, they will still perceive us as such. And with those people who believe in such a twisted way, you could have said the exact same thing the doc said and they would not have believed it without the white coat of "authority". It sucks, plain and simple. We can attempt to correct this mis-assumption, but sometimes it's just not worth the breath it would take. I hear though, it is frustrating and it makes you want to bang your head against the wall, but think about it this way: maybe they absorbed all of what you said and the doctor confirmed it for them. It was your teaching that laid the groundwork of their understanding and the doc confirmed it for them. Keep your head up! Tom
  4. The odds of developing a hematoma 3 days out is fairly slim, but if by chance the MD accidentally created a pseudo-aneurysm during the procedure it could manifest itself later like that. Usually a hematoma is a firm/hard lump, sometimes ecchymotic, sometimes not. The lump may differ in sizes depending on how bad the leak is. There is always a small chance of bleed from a cath site, you did just have a large bore hole placed into it afterall. Hope this helps a bit. Tom
  5. Spatialized

    Not really "feeling it"

    There are days I still don't feel like I have it together and December will be 3 years for me. If you really think about it, 6 months is not that long at all on an active cardiac floor. There's a very wide scope of information that you have to understand and figure out how it all weaves together which takes time. Instead of thinking how little you know, try to think about how much you have learned. I can remember when I was a newly minted RN on my floor and the very thought of having someone in active chest pain scared the dickens out of me. Sure, I knew what to do, but I hadn't done it. Then late one night I had a patient decide to clot off the the 5th out of his 5 grafts. 10/10 crushing chest pain, he's freaking out, his wife is freaking out, I'm freaking out. I'm giving nitro, morphine, starting a nitro drip, more morphine, beta-blockers, the works and finally as the sun was coming up transferring him to the ICU. But I learned a lot that night. Now, when someone has chest pain, it all becomes near-automatic. I know what I'm doing - but importantly, I know why I'm doing it. That first night I'm going, "Beta-blockers? Why?...OK if you say so." Now I can ask the doc if they want it in an evolving case. You learn as you go. Last summer we hired a big bunch of new nurses and I watched as they struggled through and between 6-8 months in they started to "get it" some faster than others, but nonetheless, still they were getting it. And those that felt the exact same way you do all asked the same thing as you. And I counter with the same thing: look at what you HAVE learned and achieved, then start looking at where you feel you're weak. Some positivity can go a long way y'know? And for awhile, nursing will be task-oriented for new nurses, that's a given. Until you can get the tasks under near-robotic control, having the time to think about the bigger picture is rough. Be patient, it will come, just give it some time. Good Luck, Tom
  6. Spatialized

    Don't you want to be a Doctor?

    I just smile and say, "Nope, I love poop too much!" Then in all seriousness I relate how that I wouldn't even be done with residency until my forties and would like to raise a family and lead a semblance of a normal life. Beside, my last name doesn't exactly sound great as a MD - I can hear it now, "Dr. Long, Dr. Long, please call your answering service." Yeah, at that point the cheesy porno-film funk starts up... Tom
  7. Spatialized

    What the heck is going on in Portland right now?

    Whatever y'all. Nearly everyone in PDX is a transplant of some sort or another. Sure, some have been here longer than others, but what does is matter? How long you have been somewhere makes no difference when it comes to the caliber of the nurse. Were they new grads as well? If they were experienced, maybe they should get the job first? Maybe they had stellar recommendations or fit a particular need on your unit... Hiring new grads isn't easy. It takes a lot of time, energy and money to train new grads and get them up to speed as new RNs (believe me, we hired 5+ new grads last summer and it took awhile to get everyone comfortable). Hiring an experienced RN cuts that down dramatically. And as for PDX being a new LA, I'm more worried about it becoming a clone of the city we love to emulate, Seattle. The reality is, who cares? A nurse is a nurse. If they are better than the next, shouldn't they get the job? I've worked places (not in nursing) where people got the job due to connections, not merit, and it isn't pretty. Yeah, it's a tough, bleak outlook here in Portland, thanks to a poorly timed recession and a glut of new nurses. BUt there are places where it isn't. Problem is that they aren't in PDX. Cheers, Tom
  8. Spatialized

    New grads: hows the job hunt going?

    'Tis the season for low census, that's for sure. We're getting canceled (or at least placed on stand-by) at least once a pay period at Good Sam. And as for hiring? Nothing. Nada. Zip. We had a student do her senior practicum with us and she's going to continue to work as an aide as she can't find a job for her as a RN. Last year she would have already had a job with us. We've hired no one in the last 2 typical hiring cycles (December grads and now Spring grads) where we usually hire at least a couple. Every senior I talked to that rotated through our floor has pretty much said the same thing. Good luck to all... Tom
  9. Spatialized

    I actually like my coworkers

    My night shift co-workers rock, plain and simple. Not such a big fan of the day shift, but I don't hate 'em by any means. It's sad when it is perceived as "odd" or "strange" to like ones co-workers. Says something about our profession eh? Tom
  10. Spatialized

    Really Bad Code...

    Yep, push away, you're really only going to help. I responded to a code on a post-op day 4 CABG and ended up doing compressions. They went to the Unit and came back. I was helping a nurse with their bath and he said, "Be careful around here -pointing to his chest- it still hurts." But he was alive and later went home. The moral: just do the compressions. As for decompressing post-code, we all need it. It doesn't happen all that much, many times we just run back to whatever was interrupted for the code and carry on. Best of luck, Tom
  11. I second the others thoughts above, don't beat yourself up, we've all been there before. One of the first codes I responded to I walked (well, ran) in with the code cart and went completely blank. I "woke up" as a second nurse pushed past me into the room! Now it's better. Don't apologize, thank them for their help. Tom
  12. Spatialized

    ECG: Confused about calculating rate of irregular rythm

    You've got it right, take the number of QRSs in 6 seconds and multiply by 10. Because the rate is irregular you're not going to get an exact rate. That is unless you print a minute of strip and count, which is a little silly. The better way for calculating an irregular rate is the 300, 150...method. Counting each big box you get 300, 150, 100, 75, 60, 50. Counting from the first complex count the big boxes to get your rate range. This link gives a visual for this: http://medinfo.ufl.edu/~ekg/Rate%20and%20Rhythm.html Technically you shouldn't use the x10 method, but it gives you a quick idea of how fast the rate is going. Hopefully your instructor will take a range, because it is near impossible in a 6-second strip to get an exact rate. Good Luck! Tom
  13. Spatialized

    Things you would like the ICU to understand

    Actually, blood cx prior to ABX is a core measure for pneumonia. It is not required, but it goes into audits for our friends at the Joint Commission and reported on the hospital compare website. So it's neither a standard of care or a regulatory thing, it is an arbitrary measure of performance foisted upon us by a faceless commission. And we all know that evidenced based medicine and practice is something TJC is not too keen on (sometimes). Cheers, Tom
  14. Spatialized

    MI: when to go to cath lab

    If someone develops a STEMI while on the floor, we can call in the cath lab team who are on-call 24-7. We've had a couple of times where the patient comes through the ER with mild symptoms and they are being admitted for observation, then start to extend in a bad way. Our typical protocol is to contact the cardiologist and they can decide to activate the cath lab if they feel it is warranted. Usually we're only calling them for new ST elevation and/or large jumps in cardiac enzymes. Sometimes they'll have us treat conservatively with nitro, heparin, Gp IIb/IIIA inhibitors, beat blockers (if appropriate) and morphine. Others they're in the cath lab in 45 minutes. Tom
  15. Spatialized

    Lasix gtts

    If a patient is being admitted under our CHF order set then they get q6 basics and potassium replacement protocol. Any other patient who is placed on a Lasix drip is left up to the MDs discretion for checking labs and K replacement. If I'm the one to start the drip I do check vitals more frequently for the first couple of hours and obviously pay attention to the urine output, but we have no solid protocol for initiating the drip. Tom
  16. Spatialized

    Violence against nurses

    I noticed this thread was originally from 2007, any further updates? In Arizona where I went to school, it is a felony to assault a health-care worker. They have signs all over ERs there noting this. There is no reason why we as nurses shouldn't have this sort of protection and a law would make it so that employers would balk at interfering with nurses reporting violence and getting charges filed. We've had run-ins with families at my work, I've had patients swing at me and have never felt that if push-came-to-shove, management would have my back (frightening, eh?). Now it's one thing when Mr. Demented Sun-downer swings at you out of fear and delirium, but it's something else altogether when a cognizant adult does it. For some reason we're just supposed to take it. What gets me is when the Hospital Association work against somehting like this. You better believe if someone walked in off the street into their office and hit them, they'd be filing charges in a heartbeat. Double-standards like this...well let' say it doesn't make me happy. Cheers, Tom