starting in ccu any tips?

[thatoneguy]

hey everyone been a little while. well i am starting in CCU at the end of this month. i am a new grad, well kinda. i finished school in 2003 but did not take the nclex till about 3 months ago. passed with no problem. anyway i just got hired and am going straight into CCU. i did work as a student nurse for about a year and a half in CCU at a different hospital. the one where i am going to be working at has all computer charting. a good thing i think. they also have a good new grad program and will be putting me through a CCN class. i will be working on the floor with one of the current rn there for about a month before going through the new grad program and the CCN class. i want to hit the floor knowing what, how to do this or that. i have a good idea of what goes on. just have a couple weeks now to fill my head with things. basically what i am interested in your reactions to a given event and what meds need special attention. i do know about most meds that are used and what there actions are. but would like to know what are the typical meds new nurses or new to CCU nurses have trouble with. i really want to focus on my patient and assessments, so if you have any tips on a certain procedure or medication that i could study up on please let me know. it will be very helpful in allowing me to focus on assessing the effects of a certain med or procedure rather than getting lost in the whats this or that for. i know i will still have to do those things but dont want to lose any focus on the patient. would like to anticipate and be more proactive than reacting to things. even though i understand i will reacting when things do happen, still want to anticipate what my reactions will be. so any input will greatly appreciated.

[Noryn]

I take it you mean Coronary Care Unit? Some people refer to CCU as critical care unit. The first thing I would probably do is to get an ACLS book and study up on algorithms. Code and even critical situations are so much easier once you learn these and really they arent that hard to learn. Study up on your critical meds such as Dopamine and Dobutamine. Make sure you know how to give these based on weight. I learned to use a cal factor on my unit and I love it although it is an older way of doing things.

Look into getting a CCRN prep book--this will give you a lot of knowledge not only on the pathophysiology of the patient's condition but also the interventions you will be doing.

Good luck. Intensive care units for the most part allow nurses to provide good care and you learn so much. Most employers love ICU/CCU experience.

[thatoneguy]

thanks. i just got my acls last month so kinda up on that. will look into the prep CCRN book. that is a great idea. thanks

[Bijou-Spice]

Just in CCU for 5 months....how about learning everything regarding the Swan-Gantz catheter?

[CardioTrans, BSN, RN]

The main drugs that we use in CCU are Levophed, Nitro, Amiodarone, Dopamine and Dobutamine. Those are the main IV meds. Also Heparin and lepirudin ( I think thats how you spell it..... its the one that you give when the patient is in HIT).

Rhythm strips..... PA Caths, femoral/venous sheaths post cath........ As I think of more, Ill post again.

Good luck and congrats on your new job!

[11:11]

All the technical issues are great things to keep in mind while going into a unit as a new grad.

But something else to keep in mind is mindset:

Ask questions

Get a second opinion, I see seasoned veterans do this

Get some sleep before your shift

Respect your elders (this could mean people twenty years your junior of your my age)

[thatoneguy]

well i dont know about that. i am 35. but always show respect to all, unless they do something that would lose my respect. it does take a lot for that to happen though.

thanks everyone for the tips will be looking into all. i do ask question about everything. i think that was one reason i got hired. while the manager was showing me the unit, before i got hired, i stopped and started to ask one of the nurses about her charting and getting orders. they use all computer charting, the ones by every bedside. i am one of those that just has to know how to do everything from ordering supplies to know what exactly house keeping needs for this or that, to how the pharmacy gets the meds to the floor and of course every dealing with takeing care of my patients. its weird i am hoping that one of my patients starts haveing major issues while i am with my perseptor. not that i want bad things to happen to my patients just want to experiance of haveing to react. i know sounds bad. but like this post its just so when i am alone i will be comfortable and confident in my ability to care for my patient. i am so looking foreward to getting going and start working. the one thing that worries me the most is not being prepared from day one. will bone up on all the tips everyone has given me here, thanks again everyone. anything else you can thanks of please do tell.

[bemory]

The most important things I learned about my patients were the things I assessed myself.

Before you go into a room

1. look up all pertinent labs

2. check off all medications

3. check off all orders

4. review their history

5. review their vitals

When you go into a patient room

1. bathe

2. assess

3. monitor all vital signs

4. I/O

5. remove all lines from floor

6. check all vent settings, and medication drips

7. check all tube placement

If you do get a code or someone starts circling the drain, call for help. Assistance is more important then and there- do not think you can handle it alone

The most important thing I learned was to show myself and be assertive. Develop your priorities. Even if your patient has stool up to his ears, and his medication lines are beeping- make sure you assess the ABCs first. I have seen patients whose work of breathing was incredibly labored and find the nurse finagling an IV line.

Also you are not there for anything besides patient care. Developing friendships are nice but being part of a gossip ring will get you nothing but disrespect. Turn a deaf ear to it all.

As far as studying EKGs- go to skillstat and practice with their little game, if you cant figure out how to stick an ABG- ask every nurse on that floor if you can do theirs until you got it down, if you cant get the Swan readings- make two copies and keep one for yourself. Then look up all the terms and write them down next to them. That way next time you have Swan readings you can pull out your copy and it will make sense. Remember CVP- right side of heart, PAP- pulmonary arteries, and Wedge- Left side of heart.

Hope this helps. Tina

[sally123546]

The most important things I learned about my patients were the things I assessed myself.

Before you go into a room

1. look up all pertinent labs

2. check off all medications

3. check off all orders

4. review their history

5. review their vitals

When you go into a patient room

1. bathe

2. assess

3. monitor all vital signs

4. I/O

5. remove all lines from floor

6. check all vent settings, and medication drips

7. check all tube placement

Thank you very much for your tips working in CCU. I have been working in the cadiacthoracic care unit for 4years in China. Also I am experienced in ccu nursing, I can not discribe it clearly. I think you have said what I want to say.

by the way, i will work in new jersey in a year as an RN.

[chloeysmom]

Wow, I wish I had all these tips when I first started in CCU. I especially like the suggetion check all tube placements. Twice now within the past 6 months, I have had to order CXR stat to check ET tube placement, because the "dayshift" gal didn't check it frequently. Her excuse was, that the patient was restrained...patients still cough, patients still thrash their head, etc....tubes can move, especially if the cuff does not have enough air. Well, now my two cents.....DON'T BE AFRAID to ask questions of your preceptor. If that preceptor gets snippy about your questions, don't be afraid to ask for another preceptor. I did. My second preceptor was absolutely fabulous. And, I was brought up that you do your job right, the first time, and if I don't know how to, then I can't do a good job. My second suggestion....don't be afraid of the Docs, many are, I learned that yes, they yell, but eventually they will realize you are trying to be a good nurse. So speak up, ask docs questions, and get in there when they are doing procedures...........................hugs to all............

Meli:monkeydance:

[novice525]

Is there a good book you would recomend about swans gantz caths a cvp ect. that would be a good foundation? Thanks

[chloeysmom]

I know that the websites that Siri posted I found were very helpful. I printed out the info, and took notes. As for books, I have Clinical Nursing Skills by Smith and Duell and it is excelelnt.