December 15, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Succinylcholine has been associated with severe fatal hyperkalemia when administered to patients with predisposing clinical conditions. The mechanism whereby severe hyperkalemia occurs is related to postsynaptic muscle membrane.

December 14, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The depolarizing action of succinylcholine results in fine chaotic contractions of the muscles throughout the body for several seconds during the onset of paralysis in over 90% of patients.

December 13, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Succinylcholine is rapidly active, typically producing intubating conditions within 45 seconds of administration by rapid IV bolus injection. The clinical duration of action before spontaneous respiration is 6 to 10 minutes.

December 12, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The arrested or near death patient may not require pharmacologic agents for intubation, but even an arrested patient may retain sufficient muscle tone to render intubation difficult.

December 11, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Delayed sequence intubation (DSI) is a new technique proposed to maximize preoxygenation in preparation for intubation. Agitation, delirium and confusion can make attempts at preoxygenation challenging.

December 10, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
After confirmation of tube placement by ETCO2, obtain a chest radiograph to confirm that mainstem intubation has not occurred and to assess the lungs. If available, place the patient on continuous capnography.

December 9, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Intubation is intensely stimulating and results in a sympathetic discharge, or reflex sympathetic response to laryngoscopy. In patients suffering from a hypertensive emergency, sympatholysis with fentanyl can optimize the patient’s hemodynamics.

December 8, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Administration of 100% oxygen for 3 minutes of normal tidal volume breathing in a normal healthy adult establishes an adequate oxygen reservoir to permit 6 to 8 minutes of safe apnea for intubation.

December 7, 2017

From Bedside Nurse ➡️ NP Student: The Mindset

One of you amazing folks sent me an email wanting me to explain the different thought processes between a bedside nurse and a nurse practitioner student. Now, I'm not an expert or the “end all be all” of nurse practitioner students, but I will give you my opinion based on my professional experiences. In my opinion, the big difference is the level of responsibility and the extension of the clinical picture. Now, bedside nurses are and will always be fantastic people who are capable of long-term critical thinking and making appropriate clinical decisions. This post isn't a bedside nurse versus nurse practitioner column. This post is about the different goals and distinctive expectations of each practice.

As a bedside nurse, I'm presented with patients who I will care for within a 12-hour time frame. Whatever happens in that window, I'm there, and I am responsible. I check vital signs. I draw labs, I assess and reassess my patients continually, evaluating my patients' clinical conditions, while making sure I'm doing the required tasks and maintaining appropriate documentation. My job is a series of milestones and functions. I've been a nurse for over 5 years. I feel my job is performance and skill based. I'm expected to perform specific tasks and know certain skills. Everything in my nursing bubble is of independent function (i.e., activities of daily living, assessments, medication administration). Anything outside that bubble will require an order before I'm able to implement the proposed action. I'm given orders and protocols to work within, and I abide by them per my institution. For example, my patient has low urine output, and I feel after my clinical assessment, that my patient would benefit from a fluid challenge. Perhaps 500 milliliters of normal saline. As a bedside nurse, I'm not allowed to make this unilateral decision without protocols or orders in place. As a nurse, I must call or reach a provider, explain the clinical picture, any new findings, and make a recommendation. In the end, it's not up to me whether the provider takes my advice. The provider will dispense the order based on their rationales and/or theories. I'm the bedside nurse, I'm caring for critically ill patients. However, it is not within my scope of practice to change, discontinue to alter orders without prior approval. My priority is my patient's clinical condition while I'm present, while I'm performing my job. Think of it as short-term management. You're presented with problems, you communicate any changes in patient condition and work accordingly.

Now, as a nurse practitioner student, the thought process expands and deepens a bit. Let's say you get that same call from the bedside nurse. You must then ask for specific information to create your differential diagnosis list. Does this patient have a history of kidney disease? How low is the urine output? And for how long? What is the albumin level? Fluid balance results? The nurse practitioner student has additional steps and responsibilities that I, as a bedside nurse, never worried about or considered. Let's call this long-term management. When I attended my clinical rotation in the emergency department, nurses often asked for antihypertensive medication for patients. I would have to ask many questions before I had a decision. Yes, a blood pressure of 170/80 is elevated, but in a neurological crisis, hypertension is a monitor-only situation, and no medication should be administered. You must know the presenting disease process or have a list differential diagnoses. With proper clinical findings, diagnostics, and labs, you whittle the list down and go from there. It's all about proving or disproving your differentials. But the thought process is long-term in nature, and corrective measures must work within that approach. You're presented with problems and it's up to you figure out how to approach them based on the information provided. You decipher, analysis, and investigate, with the goal of making the safest choice with the given evidence.

Nursing will always be patient-centered, but the approaches vary from a bedside nurse to the nurse practitioner student. One isn't smarter than the other, and one doesn't merely boss the other around. This isn't a superior-subordinate dynamic. Both contribute, but in different aspects with varying professional aims. The role shift requires an expansive clinical viewpoint, detailed research, and comprehensive decision-making process. That is the difference between bedside nurses and nurse practitioner students, in my opinion. I've been a nurse practitioner student for four years and a bedside nurse for almost six years now.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Use of RSI facilitates successful endotracheal intubation by causing complete relaxation of the patient’s musculature, allowing better access to the airway. RSI also permits pharmacologic control of the physiologic responses to intubation.

December 6, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Rapid sequence intubation is the cornerstone of emergency airway management and is defined as the nearly simultaneous administration of a potent induction agent and neuromuscular blocking agent for the purpose of tracheal intubation.

December 5, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The central concept of RSI is to take the patient from the starting point (conscious, breathing spontaneously) to a state of unconsciousness with neuromuscular paralysis, and then to achieve intubation without interposed assisted ventilation.

December 4, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Management of the failed airway is dictated by whether the patient can be oxygenated. If adequate oxygenation cannot be maintained with rescue BMV, the rescue technique of first resort is cricothyrotomy.

December 3, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Oximetry is useful in detecting esophageal intubation but may not show a decreasing oxygen saturation for several minutes after a failed intubation because of the oxygen reservoir (preoxygenation) created in the patient before intubation.

December 2, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Rarely, ingestion of carbonated beverages may lead to the release of CO2 from the stomach after esophageal intubation, causing a false indication of tracheal intubation. Washout of this phenomenon universally occurs within six breaths.

December 1, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The persistence of detected CO2 after six manual breaths indicates that the tube is within the airway, although not necessarily within the trachea. CO2 is detected with the tube in the mainstem bronchus, trachea or supraglottic space.

November 30, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Immediately after intubation, the intubator should apply an end-tidal carbon dioxide (ETCO2) detection device to the ETT and assess it through six manual ventilations. Disposable colorimetric ETCO2 detectors indicate CO2 detection by color change.

November 29, 2017

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Placement of an extraglottic device, such as a laryngeal mask airway or Combitube, often can convert a can’t intubate, can’t oxygenate situation to a can’t intubate, can oxygenate situation, which allows time for rescue of a failed airway.

November 28, 2017

#NacoleMedMath | Nursing Math - Dosage Calculations

** ANSWER: 383.33 ML **
360 MG / 200 ML = 1.8 MG/ML
150 MG / 1.8 MG = 83.33 ML IN 10 MINUTES
540 MG / 1.8 MG = 300 ML IN 18 HOURS