November 20, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Natriuretic peptides promote water and sodium excretion, increase peripheral vasodilation, and inhibit the RAAS. In early heart failure, they play a key role in compensation for LV dysfunction.

November 19, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Increases in myocardial wall stretch activate release of cardiac natriuretic peptides, which are important in volume and sodium homeostasis. They include atrial, C-type, and brain (B-type) natriuretic peptide (BNP).

November 18, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Afterload can be thought of as the pressure against which the heart must pump to eject blood. Afterload represents the tension on myocardial cells during contraction and is determined by the vascular resistance and the cardiac chamber size.

November 17, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Preload is the amount of force stretching the myofibril before contraction. In the intact ventricle, preload is produced by venous return into the chamber, resulting in stretch of the myofibrils constituting the chamber walls.

November 16, 2018

Simple To Complex Nursing Interventions


Simple to complex interventions is a common trend in nursing. Textbooks often lead to concrete thinking and an inability to think in this manner, as books list interventions randomly and in no specific order. What you learn, mainly the steps to nursing interventions are usually done concurrently. When someone is coding, I don't have to do one thing at a time. I can grab defibrillation pads, while catching an amp of epinephrine in one hand, while telling someone to get me a doppler for me to drop some peripheral IVs for access, and lowering the bed for the provider to intubate. The point being, nursing isn't something that happens in a particular order or sequence. It's five things going on at once. I wouldn't fixate on what you think "should" be done first and then second (in most, not all, clinical situations). I would focus on simple to complex nursing interventions.

If you had to either elevate the head of the bed or get an arterial blood gas (ABG) for someone in respiratory distress, I'd say elevate the head of the bed first. It's simple and easy to do. Yes, the ABG can provide quality information, but as a nurse, you go from simple to complex. Nursing school and the NCLEX-RN exam aren't trying to confuse you. They are trying to get you to see what matters and what can be done in the immediate moments of crisis. What can or should be done when certain disease processes present themselves. Respiratory distress? Elevate the head of the bed, apply an oxygen device, collect the vital signs, perform focused respiratory and cardiovascular assessments, then call the provider. You shouldn't be going straight to intubation. Least to most invasive. If you can resolve this issue by applying a nasal cannula oxygen device, why would intubation even be on the table? You shouldn't be calling the provider first, either. What are you going to tell the provider? You have no information to disperse. These are simple things. Don't go 0 to 100 real quick (in my Drake voice), haha. I'm not sure if you've seen the intubation process, but it takes a few minutes. The nurse has to grab medications, call respiratory, make sure the mechanical ventilator is ready and on standby, prepare per provider orders, order upcoming chest x-ray... it's a lot and takes time.

If there is a crisis, you are expected to assess the crisis. Simple to complex actions. Stethoscopes and head to toe assessments, yaasssss! I know, they aren't sexy, but they are pillars of the nursing profession. What you see, what you hear. That is where it's at folks. I don't know where you work, but many of the providers I interact with don't perform head to toe assessments. They perform focused assessments of systems that are under review. Most don't even have a stethoscope (and that's fine). Providers create medical plans, they treat and evaluate disease processes. YOU ARE THE ASSESSMENT GO-TO PERSON! There is no fail-safe, you are it. Don't go all central lines and cardiac catheterizations on me. Simple, safe interventions is the name of the game. One student asked me, "Why would I assess lung sounds if I'm giving fluids?" I asked her, "How would you assess if the patient was hypovolemic or hypervolemic? Give me your head to toe assessment." After about 45 seconds, she finally keyed on why lung sounds were significant in fluid administration. I promise you, nursing isn't hard, it's all about simple to complex operations. Don't tell me pharmacology, don't tell me central venous pressure (CVP) measurements. The NCLEX isn't assuming everyone will work in critical care. What can you see? When you close your eyes to visualize this patient, what are you looking for? The answers are within you, take it one step at a time and don't go all CSI lab on me. Keep it simple.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Contractility can be affected by physiologic depressants (hypoxia, hypercarbia, acidosis, ischemia) and pharmacologic agents (antidysrhythmic agents, calcium channel blockers, beta-blockers, alcohol) that decrease myocardial function.

November 15, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The normal cardiac index is 2.5 to 4.0 L/min/m2 at rest and is determined by contractility, preload, afterload, and HR. In normal hearts, the collective force of contraction of the cardiac chamber is the sum of forces generated by myocytes.

November 14, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Dysfunction of the heart or any component of the cardiopulmonary system initiates adaptive neurohormonal activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, natriuretic peptides, endotheli, and vasopressin.

November 13, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
With the total artificial heart (TAH), the failing heart is removed and the TAH implanted. Because the native heart is removed, TAH patients have no cardiac electrical activity (asystole). Therefore defibrillation and pacing are not indicated.

November 12, 2018

I Just Can't & That's Okay


There will be moments in your nursing career when you can't do something and guess what? That is okay. Overworking yourself, both emotionally and physically will cause distress in your life and make you resentful of the nursing profession. Every time I've mentally told myself I couldn't do something and pushed and pushed on anyway, someone or something suffered. Whether it was my family or my professional standards, some part of my life took a hit. Let's all acknowledge that we can't be 30 places at once. Let's accept that we aren't perfect. You will have to prioritize what you can do and what you can't do given the time frames you have to work within. That doesn't make you a terrible nurse, that makes you human. If I'm not able to do something and I can't delegate to someone, it won't get done. And I hope the oncoming nurse can pick up the pieces. I can't be there 15 hours (without eating) trying to do everything. I won't. A 12-hour shift flies by when someone is crashing. Don't tell me to find the time. Don't tell me to make it work. Sometimes I can, given the right team and proper support system. But sometimes, I can't and pushing myself isn't healthy. Last month, I also peed my pants at work. I'm almost 40 damn years old, that's insane! I can't find time to pee?! And yet, every nurse has had one of those shifts where they just couldn't care for themselves. A rare occasion is okay, but if this is a pattern, that's a problem. If you NEVER take a lunch and you NEVER can go pee, that is a huge problem. There is no honor in an inability to take care of yourself. You don't get a badge for depriving yourself of things. This isn't a contest.

Listen, I work nights, and I love it. Sometimes I'm able to stay up all day (after a 12-hour shift), clean our home, prepare dinner, and pick our son up from school. I'm able to be that superstar. But some days, I lean heavily on my husband to pick up the pieces. Some days, all I can do is come home at 8:45 AM, get in the bath, eat leftovers, and head right to bed. I just can't push myself some days. I know my limits, I know what I can manage. It's one thing to motivate yourself and squeeze out the last bit of work. It's another thing to be so depleted physically and emotionally, that you can't function afterward. To the point where there is nothing left for you or your loved ones. Going through the motions of living is not living. I love nursing, I enjoy helping others. But trust me, I come home whole and intact. And yes, there are shifts when some tasks aren't completed. And yes management, along with the oncoming nurse, have both been made aware of my shortcomings. My job isn't to almost kill myself caring for others. My job is to care for the ill and help the healing within the time frame I am there.

When I get home, my feet might hurt but I'm mentally intact. I'm emotionally safe and present. If you are not, step back and reprioritize things. I'm all about hard work, but it shouldn't cost you family time or personal relationships. No career is worth that. If you feel this way, sit down, examine where you are in life and what you want out of life. I LOVE nursing, I have a passion for it. But, I've NOT loved it working at some places. A hospital, a floor, a schedule, a manager can make or break your wellbeing. Being strong isn't a contest of who can stretch themselves the most without snapping. You can't care for others if you are on empty. Do what works for you and your support system. But the priorities are balance and wellbeing. If you feel something truly isn't suitable or safe for you, it's okay to trust your inner voice. That voice that is honest and true. That doesn't make you a weak person, it makes you a person who knows what you need. Nurses care for others, but we tend to have a hard time caring for ourselves.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Dysrhythmias are frequent with LVAD patients. Because the pump can maintain forward flow despite dysrhythmias, the patient may remain awake and conscious despite persistent ventricular fibrillation.

November 11, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Like any other patient with indwelling catheters, the driveline can become a conduit for infection and patients with LVADs are prone to infections that may be localized around the LVAD device, as well as systemic including bacteremia.

November 10, 2018

Processing Emotions | Nursing Hacks # 9


So, you have an instructor, manager or preceptor you dislike, huh? Well, I've been there and I wanted to give some advice to those new nurses experiencing this currently or have in the past. Understand that nursing is based on relationship dynamics. Whether it's a patient's wife or your charge nurse, relationships are crucial in the nursing profession. The problem some new nurses face is their inability to see the forest for the trees. You want to mouth off, you want to act unprofessionally, that's fine. But trust me, nurses NEVER leave the profession. We grow, we progress and move upward. That manager you disrespected many times might have left your unit months ago. But now, he or she is the chief nursing officer at the hospital you're working at. And currently, you're at an interview, seeking a management position and guess who walks in? That manager from the past. They have been resurrected like a zombie, BAM! That's what I'm talking about. People come and people go, but they never go-go in nursing. Understanding how to remain professional even if you have strong emotions is essential. So when opportunities come up, your past transgressions or emotional episodes don't interfere. Nurses are humans, with histories and issues (like everyone else). And sadly, some nurses hold grudges. We might not have office politics like some professions, but we are humans with memories and what you have done in the past could impact what you want to do in the future. Some opportunities can be missed based on your past interactions.

Emotions run high when you being pulled in five different ways. I understand, I get where you're coming from but understand remaining professional doesn't require any additional actions. It just involves always understanding you are on. When I worked at Disney (everyone who lives in Orlando works at Disney for at least one summer, haha), they explained front-stage and back-stage attitude expectations. When you were in front-stage, meaning in the view of visitors, your attitude had to be per policy and on-point. When you were back-stage, the employee area, you didn't have these same rules. As you were on break and changing into costumes. The point of this example is to illustrate that each job has communication expectations. In nursing, you are always on, there is no backstage in relation to your emotions. You are expected to be professional to staff, patients and families. There is no discrimination or separation. You have to maintain your chill and emotional wellbeing up until you get into your car. Please don't explode on staff members and act unprofessionally in front to family members. Your job is stressful, yep we get it. You signed up for this, you wanted this. Here you go. Embrace and enjoy getting your dream job and stop giving reasons why you're allowed to act childish and unprofessionally. Nursing is a team effort. When you act unprofessionally and disrespect your teammates, you are less likely to get a team to work with you or support you. It's a lose-lose situation. Whether I like or dislike someone (on a personal level) isn't a factor at work. Helping each other and taking care of patients are the priorities. Stop with the high school shenanigans.

I have a rule. If I'm angry. I stop talking, wait an hour or call my husband (if I have time). My initial reaction is usually one of anger or hurt. I know this about myself, so I don't allow myself to reply immediately. Give yourself a time to process things BEFORE I act on them. I then sit down and write my feelings out on my laptop (or on a notepad), this act will dissipate some anger and allow me to get my thoughts together. By the final stage of actually discussing my feelings with the other party, I'm relatively calm. The two previous steps really slow things down and stop me from making big mistakes. Anger is like a hot stove, the processing turns the burner off. Being busy doesn't mean you get to be verbally abusive. Being stressed doesn't mean you get to be verbally abusive. Process and examine why you're really mad. Most of the time, there is more there. Take a deep breathe and don't allow your emotions to get the best of you or your career goals. You can apologize all day but you will never know why you didn't get that job. Was it based on past dynamics or emotional episodes? Who knows. It's hard controlling your emotions initially. But processing them in a healthy manner works. I've been doing this for years now. Just yesterday someone was screaming at me and I processed in the moment and remained calm. You will get to a point where you're the calm, professional one watching all these folks lose it over nonsense. You will see the power that being in control of your emotional well-being will give you. It brings the ability to see past the emotions and gets you to the real issue or problem. Now that's gold and works in professional and personal relationships.

When I process emotions, I ask myself...
1. Why am I feeling this way? Angry? Disappointed?
2. Am I mad about this current issue or past issues?
3. Is this hindering me from doing something?
4. Do I think this person deserves this? Why?
5. What will the anger accomplish? The value?
6. Is my ego hurt? Does this bother me? Why?
7. Do I think this is healthy? Professional?
8. Will I look back and regret my actions?
9. What points do I want to get across?
10. Is this really about this one thing?

... sounds long, huh? It isn't. I do this in about 2-3 minutes.

Listen, I'm not perfect. I have random freak-outs (serenity now, haha). It's a rarity but happens. I feel terrible when it occurs and I apologize a million times. Attempting to control your emotions and understanding your process is the first step. Working towards these goals is what matters. But you have to try, you have to want to work on yourself.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Patients with left ventricular assist devices require lifelong anticoagulation to prevent the graft from clotting. Most patients also have a pacemaker or automatic implanted cardiac defibrillator (AICD) placed.

November 9, 2018

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The left ventricular assist device supports the patient's cardiac output via a mechanical pump that draws blood from an inflow cannula in the left ventricle and pumps it into the ascending aorta via an outflow cannula.

November 8, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The most common left ventricular assist devices (LVADs) produce a non-pulsative flow, therefore patients are essentially pulseless making traditional hemodynamic vital sign interpretation impossible.

November 7, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
ICD discharge during manual chest compressions poses no risk to providers, although the rescuer may feel a weak shock. Although generally not indicated, the device can be deactivated with magnet application during resuscitation.

November 6, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In contrast to patients with a permanent pacemaker, ICD patients are usually aware of when the ICD delivers a discharge or shock. The most common complaint of ICD patients is the occurrence of frequent shocks.