Kolt19

Quick Question - On my facility's post-acb orders, it states 'Notify MD if CT output greater than 150 ml/hr." I have been a CVICU RN for 1 1/2 years but still feel like I never know when it is appropriate to notify MD's, etc. My patient was bathed and ambulated at 4:30 am. The past 6-10 hrs the CT output had been 10 - 30 ml/hr. When I checked my CT output at 5 am, my CT output was 180 ml. There was no changes hemodynamically. No change in BP, HR, RR, O2 sat, patient complaints, etc. It was pretty obvious that it was pocketed fluid that drained after ambulating. I went to my charge RN, and informed her of the dump and asked if I should notify the MD. She asked about the patient and she asked me what I thought. I explained that it was just a normal physiological change after ambulating. I told her about the order and I felt like I had to protect my self, follow the order, so that if something happened to the patient in an hour and I hadn't called the MD, if could come back and reflect poorly on me. She said that I have to be able to not be a 'robot' and you only have to follow the orders if warranted by a change or something needs to be done. When I passed report on to the next nurse, the said they would not have called the MD either. Am I wrong in thinking that I should follow the orders exactly to avoid a legal issue? I have just seen some MD's go after nurses and their licenses due to unforeseeable events ... say my patient above coded 30 minutes later, the MD comes in and sees that and starts to question why they weren't notified, not that they should have been, but to point finders... Thanks.

PASS CCRN ... good and thought ccrn was easy ... try that...

Just curious if you wedge at your facility. We wedge here. At the hospital across the street, RN's do not wedge. Thanks.

Go For It! I passed my CCRN last week with 1 year experience. I read the PASS CCRN book. If you have the 1750 hrs ... just do it if you feel prepared. I think the key was experience, the CD with practice questions, and common knowledge. There is a lot of hemodynamics on the exam so brush up. Kolt

CVICU - Locked Doors 10a-6p 8p - 9p 2 visitors at a time.

One of my keys to organization is having a good 'brain' that has all of your critical information, as well as blanks for meds, notes, etc. I have made one I really like. If you need one, PM me.

nyforlove, thank you... I graduated in May '07 with my bachelors. Had a bad job experience first off ... was there 2 months. Been in the CVICU for 1 year with great mentors and support. I am heart training in 2-4 weeks ... I'll take 15 fresh hearts, then I'll be certified. I am now studying for the GRE .. I hate vocabulary so it will be a challenge and a half. Looking to apply to CRNA in September ... time will tell. Thanks for the encouragement.

I passed :) 105/125 correct ... Man, some of those questions were hard. Thanks for the encouragement!!

Im taking CCRN tomorrow at 1:30pm. I've read the PASS CCRN! book and done hundreds of practice questions ... Work in the CVICU so familiar with swans, hemodynamics, etc... Wish me luck ... Kolt

To D/C a sheath - we use manual, c-clamp, or femostop (which requires a MD order r/t cost) We start checking the ACT within an hour after the patient arrives from the Cath Lab and usually pull when the ACT is less than 175 sec. We check the ACT hourly if > 175. We premedicate with Demerol 25 mg w/ Phenergan 12.5 mg IVP or Versed 1mg with Morphine 2mg IVP. Many times I start with the c-clamp or femstop, minor oozing/hematoma forms and i resort to manual pressure ... anyone else?

hey, im 22 and i go to ut tyler. i am in my 3rd semester. if you need anything, let me know.

hello. I attend UT Tyler @ Longview working on my BSN. Admissions is based on a point system with grades, and a few other things. If you have a 3.0 you should be fine, they have like 80 applicants in Longview, and 35 accepted. Whereas, in Tyler, there are 700 applicants and 90 are accepted. any questions, let me know.

Hey Not starting anything, just stating the facts: I attend UT TYLER. We do two 12 hour shifts a week (24 HOURS) or three 12 hour shifts a week (36 HOURS). My mother graduated from an ADN program four years ago and they did 4 hour or 6 hour shifts, never a 12 hour shift, with a max of 15 a week. First semester. at my school, you have 5 lectures plus 2 clinicals in level 1. She had 2 lectures and 2 clinicals in level 1. ****BUT both sit for the same NCLEX, so I do not think there should be a huge pay difference, just a couple of dollars difference. Where I work there is a $1.00 difference in pay. I AM SURE ALL SCHOOLS ARE NOT THE SAME, this is just true of the two school in my city.

. Immune Complex-mediated autoimmune disease - Systemic Lupus Erythematosus (SLE)-"Red Wolf" 1. General a. Chronic, systemic, inflammatory; autoantibodies have specificity for nuclear structures (especially double-stranded DNA) b. Pathogenesis - circulating immune complexes are filtered out of the blood in the kidneys and get trapped against the basement membranes of the glomeruli; others get trapped in arteriolar walls and joint synovial spaces; these complexes activate C' and attract granulocytes, which leads to inflammation and tissue damage c. Females to males = 4:1; highest incidence in childbearing years (10 times more common in women of childbearing age than in men); more common in nonwhites (esp. blacks) than whites d. 5-year survival is 80-90% 2. Clinical Features a. Signs and Symptoms *General-fever, weight loss, malaise, lethargy, hypercoagulation with anti-phospholipid antibodies *Joints and muscles-polyarthralgia or arthritis (90%); symmetric, no bony erosions or severe deformity; avascular necrosis of bone is common (may be because of steroids); myalgias also common *Skin-erythematous rash (butterfly) is most common (on areas exposed to light); may cause scarring, atrophy and pigmentation changes; many other skin problems are seen; the sensitivity to ultraviolet irradiation may be due to its release of DNA from skin, which in turn increases the level of circulating immune complexes and hence the symptoms *Kidneys -75% have nephritis at autopsy; severity is extremely variable; hypertension is common *Heart - endocarditis *Nervous system -psychosis and depression are the most common manifestations; also "stocking glove" peripheral neuropathy *Vascular system -small vessel vasculitis commonly occurs in active SLE *G.I.-pain, diarrhea, bleeding ulceration, pancreatitis and cholecystitis (gall bladder inflammation) b. Lab Findings *80% have a normochromic/normocytic anemia *Leukopenia, thrombocytopenia *80% have increased globulins *LE cell (neutrophil with phagocytosed nucleus) - reflects the presence of anti-DNA *The absence of ANAs (Antinuclear Antibodies) is strong evidence against diagnosis of SLE; high titers of anti-ds-DNA antibodies ("native") are essentially seen only in SLE; anti-RBC, anti-platelet, anti-phospholipid, anti-cytoplasmic and anti-IgG (RF) are also seen c. Treatment *No treatment may be necessary *If arthritis is the major symptom, high-dose aspirin (or other NSAID) may suffice *If skin or mucosa is involved, antimalarial and topical corticosteroids are beneficial *In severe SLE, systemic steroids can suppress disease and prolong life *If patient doesn't respond to steroids, or side effects develop, cytotoxic agents such as cyclophosphamide, chlorambucil or azathioprine are indicated

I was just wondering what experienced nurses think about a new graduate starting out in ICU. I am in a BSN program where we can specialize in ICU for one class, but I realize this is not near what needs to be known. Would I be competent enough to begin here, after going through a 9 month training program? I really want to do ICU but I do not want to put my license / pts. on the line either. Thanks to all.