Wednesday, December 17, 2008

Graduation Day :)

In this Life ... if you want to be someone, be it!
In 848 days I became a Registered Nurse.
In Life everything is possible! Because Life is a Miracle!

Take Control of Your Life.
Prioritize, Focus & Achieve.

And Remember, every second counts...

Wednesday, December 10, 2008

Day Twelve

Always know the medication that you are administering!
Orthostatic hypotension:
Treatment of symptomatic orthostatic hypotension. Because midodrine can cause marked elevation of supine blood pressure (BP greater than 200 mmHg systolic), it should be used in patients whose lives are considerably impaired despite standard clinical care, including nonpharmacological treatment (such as support stockings), fluid expansion, and lifestyle alterations. The indication is based on midodrine's effect on increases in 1-minute standing systolic blood pressure, a surrogate marker considered likely to correspond to a clinical benefit. At present however, clinical benefits of midodrine principally improved ability to perform life activities have not been established. Further clinical trials are underway to verify and describe the clinical benefits of midodrine. After initiation of treatment, midodrine should be continued only for patients who report significant symptomatic improvement.

Tuesday, December 9, 2008

Day Eleven

The class is getting closer to its final point.
I am getting the feeling that this "training" was really useful in the matter of getting to know the ICU, discovering some new pages of the medical field.
Communication appears to be an important part of the nursing profession.
As a nurse, you are constantly involved in the web of communication that includes your colleagues, assisting staff, MD's, supervisors, patient's relative and patient himself.
Implementing the right communicating skills is essential in delivering the patient care.

Wednesday, December 3, 2008

Day Ten: ATI exit.

Believe in yourself!
You smart!
Understand the question!
Read the question till the end!
Read all answers till the end!
Do not click until you decide for sure and then don’t come back!
Follow the safety!
The first is the right!
The right answer is simple!
Go for priority!
Look for Key Word in the question and it’s reflection in the answer!
Look for two opposite and two similar in the answer!

Tuesday, December 2, 2008

Day Nine

Ventolin via nebulizer: Administration Considerations:
*** Check the heart rate of the patient***
If it is 110 - be very careful, but give it.
If it is 120 - consider risk versus benefit.
If it is 130 - don't give it.

If at rises on 20 beats per minute - stop it.

Wednesday, November 26, 2008

Day Eight

:) Tip on finding the drug:
Medication Administration Record has a letter code on the order number. Based on that you can figure out where to locate your medication:
U - in the bin.
F - in ACU dose.

:) Tip for cutting the EKG strips:
Use you ID badge to cut the EKG paper strip when you place it the Flow Sheet:
It comes out nice and neat.

Tuesday, November 25, 2008

Day Seven

Documentation is inevitable part of the nursing process.
For some reason nurses don't like this part of the job and don't take this seriously.
The fact is that once you grasp the concept and the purpose of documentation itself you will use it as powerful tool that helps you to be organized, keeps you on top of things and protect you as a nurse professional.
I enjoy my documentation process and I hope I will keep it this way. Every time I go over documentation part I refresh the knowledge base of my nursing process.
My personal advice to the followers of the blog:
When life gives you lemons, make lemonade! :)

Wednesday, November 19, 2008

Day Six

You just came to the Hospital unit on a cold day in Miami and were wearing a sweater while driving...
Patient's body temperature obtained with a thermometer 94 degrees F...
Patient is covered with a tiny sheet and shivering...
When you touch the patient's body with a glove it seems to be cold.
What is your conclusion to the situation:

A. It is a normal condition of the ICU patient.
B. Thermometer is low battery.
C. Patient is hypothermic and requires according interventions.
D. You did not place thermometer correctly.

This was a real situation that occurred in the ICU.
You are welcome to post your comments.

Tuesday, November 18, 2008

Day Five

I think just by being present at the ICU, the whole perception of the human mind changes.
I have noticed that an importance of the healthy lifestyle was reinforced in my mind.
It is sad but it is reality... Only after I looked at all the suffering of the patients who got into the ICU for the reason of not following the healthy lifestyle, I realized...
Few milestones that I think any person in the right mind should follow:
1. Daily exercise.
2. Zero tolerance for "street drugs"
3. Healthy eating habits: Low fat diet, fruits and vegetables daily.
4. Stress avoidance: " Taking it all easy! :)"
5. Daily educational activities.

Wednesday, November 12, 2008

Day Four

I am feeling that I got more comfortable with charting in the ICU.
I was able to perform the placement of the nasogastric tube. It was a little scary ...
Sticking a tube in the human's nose...
It is a little different from what we've done in our Skills Class as we were practicing and sharpening our skills on a "plastic dolls" :)
As a result of this intervention I felt very satisfied as it was something that significantly changed the status of the patient.
I keep learning new medications and getting to know a little details of mechanical ventilators.
I was introduced to the process of the weaning the patient of the ventilator which includes transition: AC - SIMV - CPAP

Tuesday, November 11, 2008

Day Three

I am moving ahead in process of learning and adaptation to the ICU environment.
ICU always involves goes on margin of the blade. It involves numerous medications with dangerous side effects and adverse reactions. You have to check and analyze what are you doing instantly!

While observing the nurses doing IV pushes I have noticed that an experienced ICU nurse would always double check what is she pushing through the IV and what was in the IV previously. For instance if a patient is on the infusion of Potassium Chloride and you are in about to administer certain medication through the port of this IV - you must administer the medication slowly as the dose of the medication located in the little portion of IV between the port of infusion and the other end of the catheter might be sufficient to induce an unwanted outcome. That is why as a nurse you want to make sure that you are always thinking of the possible outcomes of one's actions. Safety is always first!
Few safety tips on dealing with syringes:
1. Never take an eye away from the needle once it is open and don't let others distract you.
2. When you pressing the safety device of the needle make sure that your hands are not wet as the syringe might slip out of your hands possessing a treat of being stuck with it needle.
3. When you pressing the safety device of the needle keep it away from yourself as blood located on the tip of the needle may drip and come in contact with your tissues.

Wednesday, November 5, 2008

Day Two

Second day at the ICU of MSH was more intense in the matter of my participation and active learning. My new preceptor "J. encouraged my participation in performing nursing interventions. I discovered even more about patient assessment and maintenance of the IV pumps, particularly setting up the time for the infusion and using a "total volume setting" for the insulin drip as a reminder to do the Accu-Chek. What a smart way of the time management and using a critical thinking in Nursing!
Just another new thing that I have learned today is that Acetazolamide, besides it usage in glaucoma patients is a potent carbonic anhydrase inhibitor, effective in promotion of diuresis in instances of abnormal fluid retention (e.g., cardiac edema).
Inhibition of carbonic anhydrase in this area appears to retard abnormal, paroxysmal, excessive discharge from central nervous system neurons. The diuretic effect of Acetazolamide is due to its action in the kidney on the reversible reaction involving hydration of carbon dioxide and dehydration of carbonic acid.
The result is renal loss of HCO3 ion, which carries out Sodium, Water, and Potassium. Alkalinization of the urine and promotion of diuresis are thus effected. Alteration in ammonia metabolism occurs due to increased reabsorption of ammonia by the renal tubules as a result of urinary alkalinization.

Tuesday, November 4, 2008

Day One

First Day in the ICU of MSH brought a lot of positive emotions. The pace of activities was gradually developed from a slow lazy rhythm to an extreme speed.
It was one of these days when I can honestly tell:
I've learned something today!
First of all I familiarized myself with a respiratory equipment
(PURITAN BENNETT 7200), continuous nutrition pumps, numerous sets of equipment and different types of alarms.
I got a chance to learn some useful tips on priming the tubing for nutrition via PEG tube , observed placement of the central subclavian line.
My preceptor "N. was very helpful and thought me some good tips on reading the EKG strips, introduced me to the system: 300 150 100 75 60 (never heard of this method before)
Preceptor "N. tested my knowledge on knowing how to identify the difference between various types of EKG abnormalities, including 1st and 2nd degree block, peaked T wave.
The time went by very fast and I was very surprised when my alarm on the watch signaled to me that the first day of the Leadership Class is over.
Well, tomorrow is another day - a lot more to discover, a lot more to learn.

Wednesday, October 29, 2008


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of development leadership skills in the Nursing Field.

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