WILTW 1/22: Cozy Up To Gas Exchange

Nurses General Nursing

Published

This week's WILTW takes a break from the nuances of being the teacher to being the student.

The best thing about this week was about gas, supergas, SVO2, sweep, FiO2, cavation, cannulation, bypass and the like.

When I went to my boss about going to an ECLS class; my boss asked me what would benefit me and the unit-it was me first THEN the unit.

In retrospect, it was a personal goal of mine, however, when I observe how sometimes there is hesitation or more than a healthy fear of taking care of cardiac kids, after the course I can see a project on the horizon.

I still have to actively sit on pump; I will be orienting, going to meetings, and actively connecting what I can do as a nurse on my home unit to prepare pts that could look like a potential candidate for ECMO.

Upcoming this week is my presentation-have to tweak some parts and I can't wait until next week to opine on learning how to be a charge nurse in a trauma simulation.

What have you learned this week?

Specializes in ICU.
That I must somehow remember patient info spanning the entire admission (as I have been told I am not to write it down. That takes too long and I am too slow as it is.)

Just...:confused: That's terrible. Your whole post is terrible. What a hellhole; you need to get out of there.

Best wishes to OC! Hope you start feeling better, and get the baby out of there sooner rather than later.

I've barely been here because full time work plus full time school is eating me alive. Not nursing related, but I learned that the fact that it's been 12 years since I had calculus or anything of that nature means physics is going to eat me alive. The instructor was going over basic stuff, or what I assume is basic stuff - such as, what is this side of a right triangle called? How about this one? What is this angle? It's whatever sine, cosine, tangent... what is this devilry? It seems like everyone in the class except me said the answers aloud as he asked for them. Yep, buddy, I took calculus in 2005 and that was the last real math class I took. This is trouble.

I remember these words, but not what they mean, so the amount of back-studying I'm going to have to do to even understand what we're talking about now... it's not looking good. Trying to apply new knowledge to "old" knowledge that I don't even know isn't working.

I am feeling very discouraged. It's going to take a lot of mental energy to keep dragging myself to that class day after day, knowing that I am hopelessly behind, probably to the point that I'll spend all semester teetering on the borderline of failing. After my previous two semesters of straight As, even in graduate level classes, this is going to be hard to stomach.

The only bright spot so far in 2017 is one of my patients last week ended up being an organ donor. I have had a lot of brain dead/terminal people in the past couple of weeks, but it was nice that something good came out of one of them. I think I would like my job better if I could have more organ donors, so I could see more of a point to a lot of the things I do.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Just...:confused: That's terrible. Your whole post is terrible. What a hellhole; you need to get out of there.

Best wishes to OC! Hope you start feeling better, and get the baby out of there sooner rather than later.

I've barely been here because full time work plus full time school is eating me alive. Not nursing related, but I learned that the fact that it's been 12 years since I had calculus or anything of that nature means physics is going to eat me alive. The instructor was going over basic stuff, or what I assume is basic stuff - such as, what is this side of a right triangle called? How about this one? What is this angle? It's whatever sine, cosine, tangent... what is this devilry? It seems like everyone in the class except me said the answers aloud as he asked for them. Yep, buddy, I took calculus in 2005 and that was the last real math class I took. This is trouble.

I remember these words, but not what they mean, so the amount of back-studying I'm going to have to do to even understand what we're talking about now... it's not looking good. Trying to apply new knowledge to "old" knowledge that I don't even know isn't working.

I am feeling very discouraged. It's going to take a lot of mental energy to keep dragging myself to that class day after day, knowing that I am hopelessly behind, probably to the point that I'll spend all semester teetering on the borderline of failing. After my previous two semesters of straight As, even in graduate level classes, this is going to be hard to stomach.

The only bright spot so far in 2017 is one of my patients last week ended up being an organ donor. I have had a lot of brain dead/terminal people in the past couple of weeks, but it was nice that something good came out of one of them. I think I would like my job better if I could have more organ donors, so I could see more of a point to a lot of the things I do.

Thank you! I'm sorry your class is so difficult. I haven't had a math class since the beginning of my college career & that was Algebra! I tried Statistics but dropped it. So you're way ahead of me. I know I will have to conquer the beast that is Statistics eventually, hopefully I can master it. I know you will do well in that class.

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I learned how big of a difference there is between 8 patients and 12 especially when 6 of them are diabetics with very little control of their sugar (or so it seems as all I was doing today was BG checks, texting the doctor and giving additional insulin to try to get my patients out of potential DKA). I also learned the doctor has a wicked sense of humor as his first joking words to me when he came in tonight was "What are you doing to my patients" due to the sheer numbers of secure texts I had to send to him. Then he joked he was testing how fast I could dictate and rambled off half a dozen new orders which I managed to get 100% correct the first time (yay me). That was the highlight of today.

The bad part of today was that I still can't get my timing down to get all med passes and all treatments done on time by the end of my shift and still get my charting done also by end of shift without having to endorse things to night shift (which apparently we are NOT supposed to do per corporate who is auditing our charting with a fine tooth comb). I already got a stern talking to about items on my MAR being red (late) and my TAR not being done yet (at 1pm). When I asked how to improve I was told to "go faster it's easy you should be done with everything by now" Well excuse me for not wanting to make mistakes. I already had to correct 2 entries on my charting tonight because I tried going faster and screwed up...plus I very nearly stuck myself with a needle trying to speed pull insulin. Anyone have any kind of system I could try to use to get things organized and done? That is if I have a job next week. Not sure if my one patient (or family she called) will try to say I didn't give the insulin this morning and if the DON will believe me that I did. I put in some applications to the hospitals so maybe I'll get an interview and get out...either that or figure out how to ask the DON to go to night shift where I might be able to get my flow again and get things done. I feel I haven't improved any in the last month, and even that I'm getting worse than I was before...4 months in (almost 5) and my potential career could be over if she doesn't believe me and reports me to the BON. Or I could be thinking a bit doom and gloom right now.

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This week I am all about podcasts for nurses / healthcare professionals - apparently I am spending a lot of time driving at times or listen to podcasts while I am exercising, cleaning the house....

GeriPal PodCast | GeriPal - Geriatrics and Palliative Care Blog

Also available for smart phones - I have listened to all the podcasts and last week to "Rejecting Neutrality", which was an interesting eye opener. They talk about avoiding "burdensome hospital admissions for nursing home patients", I can relate. Do nursing home really need to send out longterm residents with end-stage dementia for "altered mental status?" It turns out that nursing home send their residents often on the weekends or nights when less staffing or less experienced staff works.

My favorite podcasts were:

Freakonomics - Page 2 of 8

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Specializes in Critical care.

I learned some very exciting (and scary) news! I interviewed for a critical care job at another facility and I got it! My excitement is tampered though, since while I'm not always happy with the workload/acuity at my current job I do love my coworkers. It's going to be very hard to say goodbye and I'm hoping I'm not making a mistake, but something is telling me I'm making the right decision and to just have a little faith.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

If a dialysis patient experiences bleeding at the ash cath, do NOT apply pressure at the spot where the catheter enters the body -- that's not where the blood is coming from.

Instead, apply pressure at the cannula's IJ insertion site. The bleeding is happening at the IJ and then "wicking" along the tunneled catheter's path to exit the body at the surface. Applying pressure where the bleeding is being seen doesn't do anything for stopping the bleeding that is happening at the other end of the catheter.

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I learned some very exciting (and scary) news! I interviewed for a critical care job at another facility and I got it! My excitement is tampered though since while I'm not always happy with the workload/acuity at my current job I do love my coworkers. It's going to be very hard to say goodbye and I'm hoping I'm not making a mistake, but something is telling me I'm making the right decision and to just have a little faith.[/quote']

Congratulations! That's awesome!

Ooh! I'm right there with you. I'm in the process of interviewing for a new job as well. I never, after how my first year in nursing went, thought I would ever be as comfortable or have as much family as I do in my current job. The ONLY way we made it through this past week at work was to work together. I do have the best coworkers and I work with some of the best physicians I could ever ask to work with. However, there are things about my job that annoy me more than anything, and I'm wondering if it isn't time to begin to consider moving on. I think it might be time for a new challenge, I've learned almost as much as there is to learn in my current role. And the bright side of this potential change, I wouldn't be going far. I'd be in the same facility and be able to visit. :)

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Specializes in ED, psych.

Wow, aeris -- I remember when you graduated. I'm so sorry to hear what you're going through (((big squishy hugs))).

OC, yay for almost baby time!

AliNajaCat -- sending you feel better vibes.

Cali -- If you could do calculus, even if it was way back in the day, you got this. Pre-calculus made me weepy.

I'm having an emotional week. I'm truly glad it's over. I had a job interview for a new grad residency position which was fun and stressful. I might actually have gotten the job, and it starts in 3 weeks. On the same day, I learned that my CT scan showed abnormalities and I now need a biopsy to rule out colon cancer. Colonoscopy, here I come. I'm not a happy camper. I've been having bloating, weight loss, and bleeding (off and on) for months, since the summer. I'm spooked. My grandfather died of colon cancer.

Weird thing is, at the moment I'm more freaked out by the colonoscopy. So, I learned that *I'm an idiot.*

Debbie Downer, that's me!

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Wow, aeris -- I remember when you graduated. I'm so sorry to hear what you're going through (((big squishy hugs))).

OC, yay for almost baby time!

AliNajaCat -- sending you feel better vibes.

Cali -- If you could do calculus, even if it was way back in the day, you got this. Pre-calculus made me weepy.

I'm having an emotional week. I'm truly glad it's over. I had a job interview for a new grad residency position which was fun and stressful. I might actually have gotten the job, and it starts in 3 weeks. On the same day, I learned that my CT scan showed abnormalities and I now need a biopsy to rule out colon cancer. Colonoscopy, here I come. I'm not a happy camper. I've been having bloating, weight loss, and bleeding (off and on) for months, since the summer. I'm spooked. My grandfather died of colon cancer.

Weird thing is, at the moment I'm more freaked out by the colonoscopy. So, I learned that *I'm an idiot.*

Debbie Downer, that's me!

Thank you, I can't wait!

*hugs* I hope everything turns out ok with your colonoscopy, you get answers & solutions to all your ailments.

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Wow, aeris -- I remember when you graduated. I'm so sorry to hear what you're going through (((big squishy hugs))).

OC, yay for almost baby time!

AliNajaCat -- sending you feel better vibes.

Cali -- If you could do calculus, even if it was way back in the day, you got this. Pre-calculus made me weepy.

I'm having an emotional week. I'm truly glad it's over. I had a job interview for a new grad residency position which was fun and stressful. I might actually have gotten the job, and it starts in 3 weeks. On the same day, I learned that my CT scan showed abnormalities and I now need a biopsy to rule out colon cancer. Colonoscopy, here I come. I'm not a happy camper. I've been having bloating, weight loss, and bleeding (off and on) for months, since the summer. I'm spooked. My grandfather died of colon cancer.

Weird thing is, at the moment I'm more freaked out by the colonoscopy. So, I learned that *I'm an idiot.*

Debbie Downer, that's me!

I'm sorry - I know how scary it all is. If it helps at all, I don't remember a thing from either of my colonoscopies. The "worst" part was the prep. I'll keep you in my thoughts.

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Yeah, the traditional prep damn near killed me, and in ten years I'll be entirely too old to endure it ... but I have a friend c a strong family hx of colon cancer and she has one q year.

Maybe they'll come up c an easier prep by then, and then I'd be happy to do it whenever.

Good luck!!

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Specializes in ICU.
It is easy for physicians to order HighFlow and it is great when we can treat and reverse something. But when we cannot reverse the respiratory failure because the patient is so sick / endstage it becomes a problem. The other day I was already having scary visions of long lines of patients lined up in recliners with HighFlow who are living in the hospital with a questionable quality of life because their families can't let go....

I love everything you write, but you already know that. I feel the same way about dobutamine. Had a guy with an EF of 10% the other day - he looked okay (and by that, I mean he wasn't quite as gray and he had peripheral pulses, sort of) as long as the dobutamine was running. He was not a candidate for a heart transplant, and not stable enough for surgery to place some other sort of assist device...

...What the heck's the point? A few more hours? A few more days? And I hate to be that predatory person, but who the heck's going to pay for all these people's lives being extended, and extended, and extended, so they can sit in their hospital bed and never go home? It's not a hotel; it's not a condo. They can't just buy a room and stay there the rest of their lives.

I hear people can potentially go home with a PICC and have home dobutamine infusions now. That just seems crazy. I guess it's only one step before they have HHF (we call it heated high flow at my job, to differentiate from high flow nasal cannula, which is a regular nasal cannula with stiffer tubing that can handle 6-15L) at home, too.

Welcome to 2017 - where the whole hospital is a critical care unit and now the patient's home is an ICU, too. And we wonder why we have so much trouble keeping our healthcare costs under control. :confused:

Thanks everybody for the well-wishes with my classes. It's appreciated. :inlove:

Congrats Ace! You're going to love critical care. It's awesome.

Pixierose... :hug:

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