ClauICURN

I would start applying to ICU positions somewhere else. This unit is very toxic and you won't be able to change it, so get out with your sanity intact. Good luck!

If you are just looking to buy the patient some time until you can get an IABP, an inodilator like dobutamine might help. The thing is to figure out what is going to be done longterm, like is the patient getting valve surgery or a LVAD.

We use mittens for ventilator patients (which in our hospital are not considered restraints), and they work pretty well. If the patient is appropriately sedated usually there is no need for restraints, and the majority of our patients can be coached/...

I would answer questions in a general sense if it came up, or recommend they discuss it with their provider but would never suggest any specific brand to patients be it generic or proprietary.

I recommend The ICU Book by Marino and The Ventilator Book by Owens

Yes, true, but a pH of 7.20 requires an intervention unless it's trending up? As for bicarb administration, I still see it used in cases of NAG metabolic acidosis and don't think it's going away.

I don't have an issue with it if it's for a respiratory procedure and the physician is at bedside. In practice, however, if it's my patient you better believe I'm the one pushing it!

The only logical explanations I can come up with is that you are either consistently bypassing the scanning step to clear the task before you actually pull the med, that you are scanning some sort of label instead of the actual medication, or that yo...

Colleagues have provided very good information on this. To follow up on PressG33's comments, CPAP is generally used for people with OSA. Not only does it provide a continuous positive pressure (like PEEP but we don't call it that if we are talking ab...

"Less stressful" This part made me laugh, haha MICU patients tend to be older with multiple comorbidities, while SICU varies but can have more of a mix or even a higher number of comparatively younger patients. In MICU you will see very sick patient...

Hi there, Sorry to hear that you are going through a difficult time. I've been in the ICU less than two years, so kinda new myself. I can share what helped me when I was starting out, and maybe some of it can make this transition easier for you. Wha...

I mean it all depends on the severity of the condition. Pulmonary edema, pneumothorax, pneumonia, ARDS can all cause serious problems with lung compliance. I'd say the worst case of noncompliant lung I've seen was a severe ARDS case. ARDS is like the...

OK I think there's a few different things we should consider. OP states that the renal function appeared normal with BUN/creat in range. The patient is in severe respiratory acidosis, which cannot be expected to be compensated by the kidneys to any m...

Why was the patient hypotensive? Was this a MODS patient, volume down? Was the patient paralyzed? How much sedation was the patient on and what was the patient RR or vent rate? And no, the patient being anuric for 24 hours is not an indication for im...

I get what you mean, but diminished breath sounds are abnormal breath sounds. Let's say a patient has clear lung sounds to the upper fields/lobes but diminished to the bases bilaterally, then that's what you would say clear to upper fields but dimini...

Usually yes, intubated patients will have a NGT or OGT unless the patient is expected to be extubated soon. If you think you patient is going to be on the vent for a couple of days, I'd get an order and put it in since you never know when you might n...

I'd advise you to mind your own business and not go through people's phones. Awful behavior!

Yes, for severe agitation in non-intubated patients, where ativan use is ineffective/inappropriate. IIRC up to 5mg IM/IV q6hrs PRN.

Thankfully I work with a very good team, and have never had a situation like this. Usually I just ask another nurse who has patients close to mine to watch over them while I go buy something, but I always come back and eat lunch in the staff lounge. ...

Usually the order will have parameters for titration. Otherwise, I'd contact pharmacy.

I used the AACN website review and didn't find the exam too bad. You should be OK with the sources you are using.

For vecuronium, have analgesia/sedation in place first usually versed/fentanyl. Off the top of my head, I think it goes like this: 1. Start at 1mcg/kg/min 2. Titrate by 0.1 mcg/kg/min q1hr as needed to get 2/4 TOF or no spontaneous breaths depending ...

In my ICU we do chlorhexidine baths daily am for everybody, and change central line/mid line dressings q7 days or PRN.

If the ABG results show the patient was in compensated metabolic acidosis... then the patient was in compensated metabolic acidosis. I'm a bit confused.

My facility allows nail polish, but I've heard of some department directors not allowing very dark colors like black or dark blue. My unit director is super lax about it, though. As for acrylics, it's a big no no.