RN12345656

If I understand planeflyer correctly, the issue is that the family had not come to grips with the gravity of the situation, and all heroic measures were being made. If that is the case, stepping over 5 family members is ridiculous. If, however, the family had come to some kind of decision, and I don't have to run my tail off to keep your loved one alive...then I don't care if the entire family is in the room. There is nothing a family member can do or help the patient while he/she is in the ICU. Me personally, being on both sides, I have no problem letting the nurse do her work--there is nothing I can do to help...especially if my loved one is unstable. I would want my father/mother's nurse to have her entire focus on my parent..not jumping over my brother to do her job. And, if this was the last time I would see my family member, I would have made the end of life decision for my parent and planeflyer would have not been put in the situation she was forced into. :wink2:

I feel your pain planeflyer...I would definitely bring your concern up in your next staff meeting. That is absolutely ridiculous and should not have be allowed. It is one thing if your patient was stable. Or, if the family had come to some agreement on code status or heroic measures...that was not the case, and as far as I am concerned, they prevented you from doing your job proficiently. I am sorry...I am one of those nurses who do not sugar coat anything. I tell the family exactly how I see it. Giving a family false hopes is never a good thing. I do think it is necessary for the family to see how unstable their loved one is and how much care I am delivering to the patient. However, not if it is preventing me from doing my job. I work in a CVICU and we have limited visiting hours.. 4x/day, 30 mins in length. If the patient is unstable or if we are in a middle of a procedure--during the visiting time--they family does not come back and can not make the visiting time up. I remember when I was a new nurse and felt that my charge nurse made all the decisions, including the care of my patient. I soon developed a backbone and questioned anyone who wanted to tell me how to do my job. There would have been nothing wrong if you decided to ask your family to leave or to limit the numbers. You have the final say...it is your license.

Of note...Medicare will no longer pay for hospital acquired MRSA infections. That is why most hospitals/facilities now are screening patients on admission

Abiomed AB5000

I think the nurse who was taking care of you was being polite when she told you that it would be an easy transition from RDU to CVICU. Just last year, we had a dialysis nurse who was told at the end of her orientation that she was not ready to be on her own. She was encouraged to work on a stepdown unit for at least 6 months. Can it be done???..Absolutely! It all depends on your wife's skill level. What did your wife do the twenty years before dialysis? Does she have any experience in a critical care setting? How does she handle stress? There are many days that I don't eat lunch, sit down, or go to the bathroom. Can she handle that? I have worked side by side with many dialysis nurses in CVICU. Where I work, if the patient is stable, the hemodialysis nurse or tech will come to the bedside. (Unstable patients receive CRRT which I manage). I can tell you--no matter how long they've been a nurse--they have not a clue what a swan ganz catheter measures. Unfortunately, dialysis is so specialized...it will take alot of refreshing!!

Just curious if anyone has given IV Methylene blue post cardiopulmonary bypass for catecholamine-refractory vasoplegia. The only knowledge I had of methylene blue was the antagonist to cynanide poisoning. I thought it was interesting...and thought I share it with you. Please give me some feedback! This patient presented in a ER c/o CP, IABP placed in cath lab was flown to our facility. A LVAD was placed to come off pump. When I received and attempted to recover this patient, he was on: :redbeathe Nitric oxide 40ppm Norepi- 0.35mcg/kg/min, Epi- 0.2 mcg/min, Vaso 0.1 units/min, Dopa 10mcg/kg/min, Neo-200mcg/min, Milrinone 0.5mcg/kg/min. Blood pressure 80-90s, sometimes dropping in the 60-70s. CO/CI was normal, hyperdynamic. SVR--580, SVO2- 68% Asystolic underlying the temp pacer. These numbers are after I volume resuscitated the patient. A stat TEE was ordered, because the pt was an open chest...EF was calculated @ 5 (FIVE) % Anyways...as a last ditch effort the surgeon ordered methylene blue 1.5mg/kg over 30mins. Apparently, in Europe it is used often for patients who exhibit postoperative vasoplegic syndrome: hypotension, low filling pressures, high/normal CI, low periphereal resistance and high vasopressor requirements. In some cases, vasoplegia is refractory to norepinephrine...and that is why they use methylene blue. I ran the methylene blue a little slower b/c I was told the BP will drop initially. It did!! However, within 4 hours the vasoactive gtts were cut in half!! The patient is still sick..he took a hit to the kidneys and liver. CRRT was initiated the first night. I wouldnt be surprised if he took a hit to the head too. :uhoh21:

:redpinkhe I think it depends on the program and how sick the patients are pre-op, nontheless post-op. The hospital I work at does 50 cases weekly...and we recover some sick patients. We use D5 1/3 NS for maintenance. We use 2-3 L of NS or LR for fluid resusciation. Colloids are used next up to 500cc with/without Calcium. We use only Diprivan 30-50mcg/kg/min for the first day or two...then change to Fentanyl/Versed for sedation. Very typical to have one or two pressors, ie; Norepi and Dopa. 80% of the time we start an insulin gtt.A t least one patient a week will come out open chest and they have 1-2 LA lines and a CCO swan. We have all standing orders for vasoactive drugs. Very rare we call the attendings unless the patient needs to go back to the OR. :redpinkhe

Doesn't sound right to me. I don't consider a PPM/AICD major surgery. It is a procedure that takes a couple hours. When did the cardiologist actually start? The pt could have been waiting for the cardiologist. Happens all the time from case to case. Then, the staff recovers the pt before returning to the floor. It is typical to have a 4 hr turn around. I do know that insurance will not pay for a AICD just b/c the pt is getting a PPM. There are perimeters for insurance to pay for the ICD. I know the pt. must have poor ventricular dysfunction with associated rhythm disturbances, ie: VTACH, VFIB. I actually had a pt who had a BIVPPM whose EF was 10%. Insurance did not pay for an ICD initially. The pt coded on me. I had just assessed the pt, left the room to chart. About 15 mins later I heard a LOUD BOOM. Ran to the room to find him face down. He was unresponsive and without a pulse. Long story short...shocked him twice on the floor. He was in Vfib. Needless to say, the insurance company paid for an ICD.

It is not too uncommon for someone like yourself to have a patent formen ovale--a PFO closure is minor compared to your valve surgery. I find it hard to believe your PFO was caused by a IJ catheter--but I guess anything is possible. Did the cardiologist or the surgeon say the word, "split"? If you are seeing the surgeon on the 18th for the consult, have him clarify what he will do during the surgery. If the doc was explaining the valve surgery, he does have to open/cut into the heart to perform the valve replacement. I have never heard of a case in which the heart split as a result of a valve replacement. Again...anything is possible. Please don't worry about that though!!! Usually valves that are grossly overcalcified can be literally scooped out--this sometimes means a lengthy perioperative course. As far as the pain control issue that you were orginally concerned about (and still are, I'm sure)..speak to the anesthesiologist while you are in the preop area. He will be the one to make you comfortable with Versed/Morphine. Stress to him that you require more--you will be surprised that cardiology will not pass that info onto the CT surgery. My girlfriend is the same way (the one I mentioned in this post previously)--she told the anesthesiologist to give her 10 of Versed--he did 5mg at a time 5 mins apart. That is a crapload for the normal person. Anyways...long story, short...She told me that Ativan was her best friend postop. She said the Percocet and the Morphine was nice..but the Ativan made it even better. Usually all 3 are standard postop orders..ask for them!!! They may be a little cautious given your renal status..explain this concern to your nephrologist though..if he is ok to max you all on all the pain meds...make sure he addresses it to CT surgery. Good luck to you and let us know how the surgery goes!!!

Just wondering if there are many Cardiac Surgery services that use mediastinal chest tubes vs. Blake drains post surgery and vice versa. I work on a cardiac surgery stepdown unit btw--and recently I flew to Nebraska to see a friend who had valve surgery. She came out of the OR with a Blake drain--AWESOME!! I spoke with the surgeon myself and he said he generally only uses blake drains--unless the pt has excessive fluid in the OR. (I didn't realize you can forsee upcoming drainage). From a nursing perspective, I would prefer the CT-- I like to visualize when my pts "dump". However, less pain for the pt. Long and short...I am sure it's surgeon preference.

Be an advocate for this child... Do what your heart is telling you to do. I think, at the very least, you should educate mom regarding the effects of alcohol comsumption while breastfeeding. If she is well aware of what she is doing directly and/or indirectly...make the appropriate phone call. Both of these parents clearly had an unhealthy childhood and now are continuing this viscious cycle. These two "adults" are "poster kids" for parents who don't belong being parents.

Christi-- Everyone is entitled to their opinion in regards to a new nurse working in the cath lab. It all depends on the nurse. Cath lab nurses may operate in a different capacity compared to other facilities. Where I work there are cath lab nurses, ep lab nurses, and cath holding nurses (they manage pts pre and post cath, transfers from other noninterventional hospitals, post cath/pre surgical pts). You will see and learn alot more in that aspect of cath nursing. In the lab, you are standing, pushing meds and assisting the cardiologist all day. If a pt crashes, you follow the orders of the MD and use ACLS. When there are problems, more than enough people will come to your rescue. Personally, I feel cath lab nursing is monotonous work. However, it is a great stepping stone for something else. There are pros to working in the cath lab--no weekends/no holidays--just the occasional call. If you have a great preceptor and nurse manager, you will do just fine. Brush up on cardiac and take ACLS. Everything else you will absorb during orientation. Good luck!!

FitnessRN-- Please keep in mind that many facilities/hospitals CR nurses work in different capacities. The hospital I work for, the CR nurses exercise "well" patients with cardiac hxs or post cardiac surgery and/or post cardiac interventions. The CR nurses also round on inpatients which includes walking, talking, and teaching the patients. I personally feel the CR nurses are a valuable part of our "team" :redpinkhe , however I find it not to be challenging for me as a nurse. If you prefer to work at a faster pace--I wouldn't reccommend CR nursing. CR nursing does have bonuses like no weekends/no holidays (in most hospitals) and really getting to know the patients on a personal level. If you have not work with adults and especially in cardiac, you definitely need to brush up and take ACLS. You will have an occasion code with your outpts. I believe you have all the requirements to be a CR nurse..but only you know if it would make a right fit for yourself. Speak with a nurse manager..find out exactly first hand what capacity the CR nurses work in the facility of your choice. Shadow them for an entire day. Only then will you be able to decide. Good luck to you!!

I am one of the charge nurses on my unit. I work days 7a-7p and DO NOT take pts. I work for cardiac surgery stepdown for a very big teaching hospital. I handle bedflow, staff assignments, help out the nursing staff, enter orders, assist the docs with procedures, worry if the OR is going to scream at me b/c they have no bed in the unit..b/c CVICU needs to transfer a pt to me to free up a bed for them..so I have to quickly discharge a pt from the floor in order to keep the OR/surgeons happy. Then there is handling customer service issues...the list goes on. I very rarely sit down. It is almost impossible to take on pts as well. Now, I have been in charge and had to take pts (very rare) b/c there was not a relief for an 8hr shift...so I take pts for 4 hrs. If we are short nurses..my nurse manager takes charge..and at times our clinical coordinators will as well. Night shift is a different--the charge nurse has a full pt assignment, however she/he is not responsible for the things the day charge nurse is responsible for. I have placed all the pts and our unit is full. There are no discharges..no families no contend with, no docs/orders to worry about, no fresh postops. I hope I haven't rambled too much!! Let me hear an "AMEN" from you other charge nurses out there!!! :yelclap:

Nurse Kern, You need to report it to your supervisor/nurse manager ASAP. I have been in your situation before--"Oh, she/he is a new nurse..I will give them some time". Listen to your gut!! Put it in writing and give it to the appropriate person immediately. This nurse (shameful to call her one) is so complacent, oblivious, unprofessional and immature. Not to mention scary. I remember being a new nurse...getting there way before my shift, reading my pts hx, wondering when the "lightbulb" would go on, and overobsessing if I assessed my pts appropriately or not!! She is brand new and not doing one of them?! She needs to go!!! At the very least..a written reprimand for her negligence. Be the patient advocate, that I am sure you are, and notify someone immediately. Let us know what comes of it.