What will Cardiac Surgery Stepdown be like?

[button2cute]

I start working October in the Cardiac Surgery Stepdown Unit. I interviewed for the ICU and they offered me this because ICU was full. They say I will have post op CABG, Vascular, Valvular type patients. I'm just curious what to expect? Will it be like med/surg?

Tiffany

Hello,

No it will not be like med surg at all. You will be dealing with cardiovascular patients with a variety procedures being perform on their heart. I love Cardiac very much.

A step down unit (that I am familar too) is a patient that is stable enough to move out of the cvicu. They can be unstable as well at times. The patients may come in for a procedure and stay for several of days after the procedure. Many of them will come in because they were unstable at home or the physician told them to come in.

You will have them on small ekg boxes which will relay the rhythm to the front desk and they may have some in their rooms. You will do vitals, adminster medications, assess them in the beginning of your shift, making sure your fluids are adequate for the shift and record them, follow the orders of the physicians (I know that is a given), watching for any abnormalities that may occur with the patients, will provide patient and family education, write progress notes (hopefully you will have a computor), maintaining contact with the patients and physicians during the shift, sometimes you will have patients that may have trouble and it is emergency....this where you will learn and bust your butt, and most of all, you will grow to be a great cardiac nurse.

I never compare cardiac with med surg. Because med surg you will recieve any and every thing on the floor. Whereas you will be dealing with cardiac patients and that is it.

Sometimes they would send a patient up to the floor that does not need to be there and you are like why are they here? Well, one is because they have a cardiac history and to fill the specialize beds...and the cardiac unit is specialize. I just to laugh when I have a teenagers with a broken ankle or arm and etc. And med surg floors would close and the rns would go home or if they wanted to stay to work...then be reassign for the evening. I could not stand low census in my hospitals because the cardiac units would be filled all year around.

Emm, you will know your rhythms very well, how to function in a code, learn your patients, recognize s/s of of cardiac problems, and most of all, you will feel like you have accomplish a lot with each shift.

Do not allow them to give you a lot of patients that are requiring alot of care; no more than two unstable patients; do not allow them to dump on you and speak up as well; do not be a runner for anyone....do your work first and then be a team player because there are some nurses who will take advantage of you; do not allow the patients, coworkers or physicians or supervisors or family members disrespect you at all; always ask a questions regardless how small they maybe and keep a note pad; lastly, mark your stethoscope because it will be missing and if you lend it to a physician..get it back.

Oh I forgot, know heparin, coumindian, levonox, like the back of your hand. Know what reverse heparin and coumindan. Remember do not ever run anything with heparin and other anticogulants. Make sure you look at the compatibility of your medications and especially iv meds.

If a patient is on lasix make sure they have a K+ level and oral K+ on board. Make sure you know the different catergory of the cardiac medications. What two cardiac medication catergory should not be together? ace inhibitiors, ca++ channel blockers, beta blockers, and etc. Which two should not be given together?

That all will come in time

Alright that should assist you.

Good Luck and Congrats,

Buttons

[RN12345656]

I start working October in the Cardiac Surgery Stepdown Unit. I interviewed for the ICU and they offered me this because ICU was full. They say I will have post op CABG, Vascular, Valvular type patients. I'm just curious what to expect? Will it be like med/surg?

Tiffany

Hey Tiffany,

I work on cardiac surgery stepdown in Virginia.

It is alot different than Med/Surg. Your pts will have other disease processes. The vast majority of your open heart pts are diabetic. If you can recall from school, CAD and diabetes almost go hand and hand. Review your endo. Also, many pts will also have pulmonary and/or renal problems.

As Buttons said before, review all your cardiac meds: Amiodarone is another one to add to the list. **Know your rhythms**

* Post-op pts come with chest tubes: mediastinal and/or pleural--make sure you know how to check for air leaks.

* Pain control is always important post op--the CTs are a bear until they come out. Also keep in mind, your CABG pts usually c/o their leg (EVH(endoscopic vein harvest--small incision/SVG(saphenous vein graft--longer incision) hurting more than their chest. Left chest soreness is a result of using the LIMA (left internal mammory artery) for the CABG

* Epicardial wires--no which are your atrial and ventricular wires and how to use your TPM (temporary pacemaker)

* All labs are important, but always know your pts H/H, plt, K, BUN/Creat & INR if they are on coumadin

* If they are a valve pt--you should know if they are a repair, replacement, mechanical or tissue

You will get alot in your orientation..absorb as much as you can!!

Good luck!

[button2cute]

heartnurseinva said:

Buttons,

It is Coumadin & Lovenox. And Heparin is compatible with other meds, like Nitro

Hello, Heart

Heparin is not usually run with anything else. Check with your hospital policy for Heparin. Heparin is a sensitive medication that can be dangerous to a patient. Therefore, numerous of hospitals I have worked stated "heparin is run alone and includes the fluid it is mix together with the heparin."

Have a great day and evening,

Buttons.

PS What are the medications to reverse the effects of Coumadin and heparin?

[RN12345656]

Vit K and Protamine r used for reversals of excessive anticoagulation at times.

We run Heparin and Nitro together all the time. Heparin is compatible with other meds as well. I know Dopamine and Mag Sulfate are for sure.

We give FFP (fresh frozen plasma) to reverse coumadin effects frequently.

Heparin has a short half life--you would just turn the drip off. Now, if your pt was bleeding out...that's another story :)

[zambezi, BSN, RN]

I don't work in our stepdown unit, however, I know that as far as ratios go, our stepdown has a different matrix than medsurg as well...OUr med surg rations are anywhere from 1-5 thru 1-10 (nights) on our cardiac stepdown it is 1-4 during the day as usually 1-4 or 1-6 (tops) nights...

[ShayRN]

Ohhhh, I am so jealous. You are about to embark on a very rewarding career! I loved working on the cardiac step-down unit. What an amazing and rewarding thing to watch someone come from CVIC with chest tubes and that look of "what the heck just happened here," to walking in the hallways a day later and being discharged in 4 days. I really miss it at times.....

Just remember, pain control. I use to really stress to my open heart patients the fact they would NOT get addicted to narcotic medications in the 3 or 4 days they were in the hospital. What they would be able to do is breath deeper, cough better, preform incentive spirometery better, walk sooner, everything they need to go home on time!

[HappyNurse2005, RN]

i'm on a cardiac surgery step down unit (PCU) as well.

I see lots of chest tubes, blake drains, pacing wires,dressings, etc. YOu'll have to know rhythms, meds, etc as all above have mentioned. these patients also need lots of teaching on things such as post op wound care, exercise, diet changes, and so on. Teaching is abundant. Everything else I would say has been mentioned by others.

[NYNewGrad]

This is a great thread. Im in a similair situation, new grad and offered MedSurg or CardioThoracic Stepdown. I'm entirely confused about which to choose. On the one hand I was always interested in Cardiology and the idea of specializing in something really interests me. At the same time, do I want to be dealing only with Cardiothoracic issues, as oppposed to seeing everything on medsurg?

Also, whats the average age of the CT patients? Are they mostly all seniors?

Funny thing is that my real interest is peds... and here I am consiering dealing with the opposite age group...

[RN12345656]

NYNewGrad said:

At the same time, do I want to be dealing only with Cardiothoracic issues, as oppposed to seeing everything on medsurg?

Also, whats the average age of the CT patients? Are they mostly all seniors?

I work on cardiac surgery stepdown as well. You will see pts who have acute & chronic renal failure, lung diseases, gi obstruction & bleeds, CVAs and alot of diabetes. The other day I had a pt who was a paranoid schizophrenic--that was fun! The population of theses pts have all sorts of problems. You might as well call it Medicine/CT Stepdown.

Don't feel like you are slighting yourself for choosing CT Stepdown. You will be getting alot out of it.

Anesthesia and the "pump" affects all the systems..you will get plenty of experience!!

Hope this helps!

[hzrizen]

natrecor, dobutamine, dopamine....

I work in a stepdown unit and it is very overwhelming at times(i am new as well and just off of orientation) It will be alot but if you can get it you will be the best of the best.

congrats and good luck...

pm me if you have any questions.

Donna

[RN12345656]

NYNewGrad said:

Also, whats the average age of the CT patients? Are they mostly all seniors?

I almost forgot to answer your other question...Yes, you will mostly see senior pts. The is just an approx.. but the age range would be 55-80. However, there are 30yr olds who have CABGs!! Most of your younger pts are the valve replacements and repairs. Generally, the pts who have congenital problems see a pediatric cardiothoracic surgeon.

Last week I took care of an 25 yo OB pt who dissected her aorta. Go figure..

[HappyNurse2005, RN]

Also, whats the average age of the CT patients? Are they mostly all seniors?

NO. I have many seniors, yes, but many patients in their 50s (hardly what I'd consider a senior) and a handful in their 40s, too. As far as strictly surgical pt's, we get a few 30-some year olds too (removal of lung tumors, valve replacements, empyema). But since we also get other cardiac pt's, like chest pain, we see some in their 20's, too.