tattooedrn

The difference between just chest pain and full code depends on amount of damage done and also which vessels. first if its the lad or left main, that vessel goes to the main muscle of the heart for squeezing the left ventrical. so as muscle dies, the ventrical squeezes less. second, also depends on if pt has collatoral blood flow, if pt has collatoral blood flow it means blood from one of the other main vessels is supplying blood to that area as a secondary filler. the dr will refer in his report filling left to right or filling right to left, means which way blood is flowing to the area that is blocked. third, a pt may have cp and still have blood flow to that area in which it supplies, the pain is a lack of or insufficient amount of oxygen to the muscle. a muscle spasm with some blockage will cause cp. people with angina which is a chronic cp that is related to coronary vessels that are to small to bypass or stent, causing on and off cp for that pt. everytime pt has cp it causes more and more muscle to die. Basically mi's dont present the same in every person, a womans mi presents with symptoms of chest pressure, gas, indigestion with sob, diabetics present totally different as well. Not all americans have the cardinal signs of mi. left sided cp or sternal pain radiating into neck and down left arm, with sob, n/v, so many may have symptoms of not feeling well for couple days to couple weeks. and by the time they do come into the er the mi is over or pt has signifigant damage for life. muscle damage also relates to ejection fraction. normal is 60-65%, after a mi it is always reduced. The amount reduced is equal to amount of damage to the myocardium and the lateral wall that contracts the left ventrical. Hope this helps some.

at my facility the policy is to run any strength levophed gtt in a picc or central line. may start levophed gtt if pt only has a piv site but will need a picc line as soon as possible. pharmacy frowns on quad strength in piv, only in renal and chf pts will pharmacy make acception. With a pt who is septic, fluid is needed in the body and single strength is ok as far as volume goes. The more concentrated a medication is, the more irritating it is the the vein. Thus making it more dangerous for infiltration of medication into tissue.

I was wondering the opinions of other ICU nurses on the rotoprone bed therapy for ards? Do you think it works? Do you like using the bed? On your experience what percent have had good outcomes? Thankyou in advance for your input.

Just to clarify my post. I do not question what i did. Or if i would do it all over again. I am a senior ICU nurse. If pt is full code I only stop for 1 of 2 reasons, dr tells me time of death or family says stop and let nature take its course. If dnr/dni i go all the way to that point of code. It's a sad case. This pt is a retired dr. Who has no paperwork in place. The reason it has stayed with me is, I didn't allow him to live. My coworkers and myself did our jobs. We gave him the chance to live. It is God who decides the rest. God gives me my knowledge, wisdom, and skills to do my job daily. The rest is in his hands. To this pt he has what he wants, time with family. He is mentally sharp, body just doesn't work. To him he has quality you are right though, it is hard to watch someone deterioration . It is how choice. I do thankyou for your input.

At beginning of my shift I learned who my pts were going to be. One pt was one I had taken care of before. I assisted in his care about 5 months earlier. He has ALS disease. Pt is now trached and pegged and is unable to move. I mentioned to a couple of coworkers I wonder if I really did him a favor by assisting another nurse when pt deteriated and placed on ventilator. Couple hours into my shift, I asked him if he needed anything? He mouthed the words no. Then he attempted to tell me something and I was unable to read his lips very well. After he mouthed the words about 15 times, I thought I knew what he was trying to say. I said, are you trying to tell me- thankyou for allowing me to live? He mouthed the words yes with small smile. I said your welcome. That my coworkers and myself, that is what we do here in ICU. I was glad that we were able to get a good outcome. He smiled and mouthed the words I apprieciate it and thankyou. It has been 2 weeks now and it still is with me. I make a retorical question and couple hours later the pt answers my question that he had no idea I made earlier. So if you ever wonder if you did the right thing, I would have to say yes. God made it clear to me that I had done the right thing. ethically everything was done correctly and quickly between my coworkers and drs and myself as a team effert. I wonder how many other nurses get this feeling when they see a pt come back at another admission to hospital? That pt is not at previous base line prior to deteriation of disease. Does anyone else ever get such a feeling? If so did you get a sense of yes or no in that situation?