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  1. offlabel

    Specialty change Flight RN to CVOR

    I'm sure you'll do fine as far as interview dynamics go, but I don't think you could have chosen a subspecialty further away from flight nursing than CVOR. Be prepared to convincingly explain that seismic paradigm shift and why you think that it is a reasonable switch in the interview because it will raise some eye brows. Not at all trying to discourage you, press on. Just know that you'd be the one of the very few FN's (if not the first) to interview for that job, especially for the reasons you give.
  2. offlabel

    What would you do

    Get a fs bg and go from there.
  3. offlabel

    If the QT Is prolonged wouldn't the QRS Always be widened?

    It measures the time interval of 2 events, ventricular depolarization and repolarization. So, depending on which one (or both) of those events are prolonged, that corresponding element of the ekg will be prolonged as well. So the answer is "sometimes".
  4. offlabel

    Post-Extubation Policy

    Are you working with your department of Respiratory Therapy? There is no need to re-invent the wheel and doing so risks missing some big things. As no one that has responded has (apparently) attached a detailed pdf or word document of a detailed policy, I'd steer clear of All Nurses for such an important undertaking.
  5. offlabel

    Atrial kick and A-flutter

    We're talking about 2 compensatory responses to heart failure that result in "congestion", which is what keeps forward flow occuring, at least in the compensatory phase. 1. Fall in renal perfusion causes volume retention and increased mean systemic filling pressure which is the entity required to push blood past the right atrial pressure into the RV. 2. ANP/BNP (among other things) create a fall in afterload, facilitating LV stroke volume. They do antagonize the fluid retention (see #1) as well to some degree, but not enough to prevent it altogether. Instead of thinking of it as "congestive heart failure" think of it as "congestive heart success" because CO is being maintained (temporarily) in a failing heart.
  6. offlabel

    Nurse Charged With Homicide

    ....
  7. offlabel

    Aspiring Christian & Nursing student

    Be careful about the association a "connection" with God with an emotion or sentimental feeling. Warm fuzzies are not necessary at all.....
  8. offlabel

    What to see in a SICU

    Observe the satisfaction level of the nurses, how they treat each other and you and get a feel for how long they've worked there and how intelligently they approach problem solving. If the acuity there is as high as you say, the rest will just come.
  9. offlabel

    Medication error

    Amount aside, the cardene didn't have time to do anything, let alone cause the patient to arrest if your timeline is accurate. As a Monday morning quarterback, the physician ought to have been thinking about a fluid bolus somewhere in there. Thats why esmolol is so useful in these situations...you can see if a beta blocker will actually help or not, and if it doesn't, it goes away anyway and you can give some fluid. If it does, something longer lasting like Lopressor can be given.
  10. offlabel

    Atrial kick and A-flutter

    Apologies....in the first sentence, "retention" should read "excretion". My bad...sorry for the confusion...
  11. offlabel

    Atrial kick and A-flutter

    A fall in renal perfusion (fall in CO) causes a fall in sodium and water retention, right? That results in volume retention which acts to overcome the impediment to right heart return, or the right atrial pressure. ANP and BNP, as I noted in my post, act to counter act that fluid retention and inhibit systems which increase vasomotor tone. But it isn't a 1:1 relationship. Fluid retention even in the presence of the ANP activity pushes volume through the heart in a compensatory mechanism that maintains cardiac output. It works the same way with any congestive heart failure scenario. If this is confusing, look at some material dealing with "mean systemic filling pressure/venous return".
  12. offlabel

    Atrial kick and A-flutter

    So what I was going for was that CO is maintained by fluid retention as a result of a fall in renal perfusion which increases atrial and ventricular filling and the secretion of BNP and ANP. The major physiological effects of ANP and BNP are vasodilation, natriuresis, and inhibition of the renin-angiotensin-aldosterone (RAA) and the sympathetic nervous systems; all of which are supposed to suppress the progression of heart failure in situations like a flutter and a fib. In these ways, cardiac output is maintained. This is destined to fail if not medically intervened on, but it's how it's done physiologically.
  13. offlabel

    Forgery,

    "consent" forms can be chewed and spit by most any competent attorney...
  14. offlabel

    How to stay up to date as an ICU RN?

    Do you have a continuing ed allowance? You should if your certs/hospital requires CE's for continuing in your position as a CC RN...Yes or no, medical CME and resource sites such as Up To Date and Audio Digest are excellent...they'll have critical care categories that you can subscribe to and benefit from. Truly game changers for nurses that have an above the average intellectual curiosity.
  15. offlabel

    Atrial kick and A-flutter

    Eh...not what I was looking for...there is a more specific answer than the 'body can adapt'....and it's true for anyone with atrial disease....
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