Cardizem drip
Try ICU or ER?
2024.05.14 02:56 gbug24 Try ICU or ER?
Hi everyone! Baby nurse here, graduated in May 2022 and spent a year in the OR. Ended up leaving due to toxic environment and wanting more direct patient care. I’m now on a cardiac PCU with a ratio of 5:1… sometimes 6:1 (which definitely sucks), but 4:1 if we are the cath nurse or if we have titratable cardizem drips. I’ve been on this floor for 6 months and on my own for 4 months. I do enjoy my unit and I have great coworkers for the most part, it does feel kind of cushy if that makes sense.
Don’t get me wrong, I’m still learning everyday and gaining confidence in my skills… but apart of me is already getting bored of the 90 year old full code meemaws with afib or CHF. Plus, I feel we are more a med-surg tele floor at times and other times I feel we are more like a step down unit just with higher ratios….both sides are frustrating bc when I have higher acuity patients, I just don’t have the time to do the things I would want to do with a more critical patient. Then when I have a more med-surg like assignment, I get tired of all the BS and nonsense that goes with that.
I’m in no rush to leave my unit at this point as I’m still very early in my career, but I feel eventually I’m going to want more. I want to learn more and challenge myself more, I guess I feel that eventually I’m going to “cap out” on my unit if that makes any sense? I’ve always considered the ER or ICU, but not sure which direction would be best. Do you guys have any advice or can talk from personal experience on how you chose your specialty?
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Don’t get me wrong, I’m still learning everyday and gaining confidence in my skills… but apart of me is already getting bored of the 90 year old full code meemaws with afib or CHF. Plus, I feel we are more a med-surg tele floor at times and other times I feel we are more like a step down unit just with higher ratios….both sides are frustrating bc when I have higher acuity patients, I just don’t have the time to do the things I would want to do with a more critical patient. Then when I have a more med-surg like assignment, I get tired of all the BS and nonsense that goes with that.
I’m in no rush to leave my unit at this point as I’m still very early in my career, but I feel eventually I’m going to want more. I want to learn more and challenge myself more, I guess I feel that eventually I’m going to “cap out” on my unit if that makes any sense? I’ve always considered the ER or ICU, but not sure which direction would be best. Do you guys have any advice or can talk from personal experience on how you chose your specialty?
2024.04.24 22:04 mth724 Stepdown unit issues
Hi I work on a stepdown unit in a small community hospital. We seem to be the dumping ground for all patients that are “too sick” for med surg but not sick enough for ICU. It is a constant battle with the critical care intensivist who is a NP on night shift. The attending or house officer has to call the critical care NP to see if they will accept the pt to ICU. Which majority of the time they find every reason not to unless the pt coded. It’s incredibly frustrating. More times than not we have 6 pts to 1 RN, and the aides have 8-11 pts. I’m just wondering what everyone’s ratios are and what are your thoughts on an NP being able to dictate what comes to the ICU and how an NP can d/c transfer orders when an MD orders it. Also what is the best way to get the hospital CNO to understand 6:1 on a stepdown unit is impossible. I know they only care about money but it is getting more stressful and lots of nurses on my unit are burnt out. We have 4 nurses leaving, 2 from dayshift and 2 from nights. I’m sure the answer is to find a different job but I have worked on this unit for 12 years and this is the worst it has been. I am one of 2 nurses on night shift who have stuck around for this long. We get NIVs, high flow, cardizem, , amio, heparin drips, stroke pts, CHF, total care trach/peg pts, ETOH W/d, frequent iv meds. It’s a disaster waiting to happen. Is the grass ever greenier on the other side?
Also they closed the progressive care unit and transitioned most of the pts that use to go there to our unit- they were 1:3 or 1:4 but somehow we are 1:6. No difference day or nights. It’s difficult on nights but I don’t know how our dayshift nurses do it. The only types of pts we don’t take that the pcu did are insulin drips and levo/precedex/nitro d/t us not having monitors in the room just the portable tele in the pocket. Also the med surg/med tele/ and obs have the same ratios but yet we take pts that those units deem are not appropriate for their floors bc our floor can monitor them more closely. We also get rapids from other floors for various reasons. How is this okay? Sorry for the rant had a terrible shift last night and PMSing.
submitted by mth724 to nursing [link] [comments]
Also they closed the progressive care unit and transitioned most of the pts that use to go there to our unit- they were 1:3 or 1:4 but somehow we are 1:6. No difference day or nights. It’s difficult on nights but I don’t know how our dayshift nurses do it. The only types of pts we don’t take that the pcu did are insulin drips and levo/precedex/nitro d/t us not having monitors in the room just the portable tele in the pocket. Also the med surg/med tele/ and obs have the same ratios but yet we take pts that those units deem are not appropriate for their floors bc our floor can monitor them more closely. We also get rapids from other floors for various reasons. How is this okay? Sorry for the rant had a terrible shift last night and PMSing.
2024.04.08 05:13 -CarmenMargaux- VENT/RANT: Intermediate/PCU/Stepdown units are dumping grounds & horrifying.
 | I am a relatively new RN with approximately 7 months under my license in a step-down ICU. We are a dumping ground for the hospital. Our patients vary from simple COPD exacerbation to Cardizem drips titrated every 30 minutes. We run at 5 maximum & we are always at five. submitted by -CarmenMargaux- to nursing [link] [comments] I am trying my hardest to stick it out for as long as I can but I can't go on like this. It isn't even personal because I am new. We all run like this.. Every time I think I have reached my limit with insane acuity levels the unit just has to prove me wrong. Last week, I had one patient on three drips by the mid-point of my shift: Q6H Heparin gtt, Cardizem Q30 mins, and Q1H an insulin drip. His K+ was all over the place and we had Q4H BMPs and I kept having to change the cont IVF per protocol and replace K+, too. I also had four other patients one of which was COVID isolation. How do you expect anyone to do a full head-to-toe, medication pass, and put on/remove PPE before 30 minutes have passed? Charge RN was from another floor & also had a full assignment. I made clear after they added that insulin drip, too, that it is NOT safe for me to have a patient with this acuity on top of my 4 other patients. Suddenly, we could get a float from another floor that had a scut nurse. I saw red. Today, I had the most bizarre patient. Presented to ED for AMS the day before, BG >500 in EMS so on non-DKA insulin drip for roughly 20 hours. Patient is a poor historian, unable to tell us anything about their medications, caregivers, etc. Their family is non-reachable. We chased their BG up and down all day. Endocrinology eventually decided to give 150 units of HumulinU-500 (500 units/mL) AND SSI Humalog (100 units/mL) with meals. It hardly TOUCHED their glucose but finally could keep it down. I am FLABBERGASTED at the concept of someone needing the equivalent of 750 units of regular insulin at a "basal" rate 3x a day plus some Humalog. I am sure this is more common than I think but I was so scared as a newer nurse. Me, all day.. Another patient kept going into non-sustained v-tach on tele, longer duration over the day, and had the most insane ECG I have ever seen in my life & different from on admission. The auto-read it gave me felt like Simlish and the patient was completely asymptomatic and told me they felt great. Sinus arrhythmia with premature ventricular complexes & left anterior fascicular block, left ventricular hypertrophy, and lateral artifact age unknown. They were NSR with nonspecific T changes the day before. All electrolytes WNL, no new meds, no procedures, just hanging out in their chair snacking in non-sunstained VT \cries\** I almost had a friggin MI today but cardiology was like eh they're fine until tomorrow since they're asymptomatic let us know if it changes. I also had a CVA rule out with Q2H NIHSS scoring who spoke a different language. No acute changes in 48 hours and CT WNL. They ordered an MRI at 1804 with no transport and MARRTI was dead. Guess who did not get that MRI? Oh, and let's not forget to shout out to the one stable pt only there for case mgmt to f/u and their significant other who wanted to harass me and cuss out the tech because, in all the chaos, I didn't change their dry, intact protective Mepilex I'd placed the day prior soon enough for them or the PM RN who got angry with me because there was roughly 50 mL of 2-hour old urine in the suction canister from the PT they were getting after I had to put a Foley in because of retention in the pt PV residuals :) :) :) |
2024.04.05 14:14 SheShells23 Getting so very frustrated with this...
I was officially diagnosed with Afib last summer. At that point I probably got it 3-4 x yrly but was not liking the length of it (4-6 hrs). Thinking they would not catch it on the Zio home monitor (which they didn't - NS R the whole time with little bouts of other arrhythmias popping up here or there but not Afib). I then went for an ECHO which was normal, except that on going to the car I went into Afib that was all day. I later went back to the ED where they put me on an overnight Cardizem drip which finally around midnight got me to a lower rate and I converted on my own. Discharged on Cartia XT and blood thinner. (I do home INR testing as well). I was also given the non time release Cardizem to take during Afib episodes. For a while I was getting Afib on average once every other month. Now it varies from 4-6 weeks. The episodes can be up to 8hrs. I was given Flecanide as a p-i-p before this last episode but it did nothing but lower my rate a bit faster than the plain Cardizem did. Just had one last night as I was stressed over my disabled husbands medical conditions and an ED visit that ended up fruitless and a waste of time for him... This morning self testing INR - went thru 2 strips (which they dole out very sparingly as if they are gold) with error codes and have to call company cust. service. To make matters worse we leave on a trip very soon and it seems things around the house are having issues too. Forgive my whiney long tale of woe but I am getting frustrated with thinking - Was it the food I ate? Stress? Not enough water? Not enough sleep? Heck, I even got a sleep study and CPAP a month or so ago and was hopeful that it had helped as most of my episodes are at night and I hadn't had any since starting it. Have any of you felt this way? It is just overwhelming sometimes for sure...
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2024.03.30 03:39 CageSwanson Cardizem drip to achieve heart rate under 80??
I work at a step down unit, and this patient has a cardizem drip running for a-fib with RVR. Most cardizem drip instructions say to titrate until you achieve a heart rate under 100. But recently that I've been getting patients that have instructions to achieve a heart rate below 80. I feel like that's a bit much, and more of a small window considering that u don't want the heart to go below 60 either. Are your cardizem drips the same or is it also 100?
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2024.03.25 13:30 jtodd94 Cardizem Drip- help!
Hi all, I have a question about Cardizem drips and titration parameters. I had an order for a cardizem drip last night that stated to start the drip at 5mg/hr and titrate q30 mins to maintain a MAP between 60-80. The order stated to titrate no more than 2.5 mg/hr. How many mg do you titrate the drip by every time you titrate?
I got ripped into by my charge nurse because I was titrating by 0.5 every time I needed to titrate to stay within the parameters. For example, after the initial loading dose of 5mg/hour, my MAP was 58, so I reduced the drip to 4.5mg/hour. My charge was telling me I was supposed to titrate by 2.5 every time I titrated, so in the previous check, I would have reduced the drip from 5 to 2.5mg/hour. If I needed to titrate twice within an hour, it would be a 5mg total change. Isn’t that against what the order states? There was no indication in the order of how many mg titrate by every time a titration is needed. This is only my second time having a cardizem drip and I could have sworn in my training, I was told to titrate in increments of 0.5mg.
Please advise me, as I’m probably going to have this patient back tonight and I don’t want to make the same mistake if I was titrating incorrectly.
submitted by jtodd94 to nursing [link] [comments]
I got ripped into by my charge nurse because I was titrating by 0.5 every time I needed to titrate to stay within the parameters. For example, after the initial loading dose of 5mg/hour, my MAP was 58, so I reduced the drip to 4.5mg/hour. My charge was telling me I was supposed to titrate by 2.5 every time I titrated, so in the previous check, I would have reduced the drip from 5 to 2.5mg/hour. If I needed to titrate twice within an hour, it would be a 5mg total change. Isn’t that against what the order states? There was no indication in the order of how many mg titrate by every time a titration is needed. This is only my second time having a cardizem drip and I could have sworn in my training, I was told to titrate in increments of 0.5mg.
Please advise me, as I’m probably going to have this patient back tonight and I don’t want to make the same mistake if I was titrating incorrectly.
2024.03.16 13:40 NightmareNyaxis Please just run the fluids.
Fluids are annoying and yeah sometimes we should absolutely get clarification on why they’re ordered (I work cardiac, we get a lot of CHF) but please don’t just ignore them and let them sit.
2 patients today both had fluids ordered during dayshift. Neither patient had fluids running when I got there. One had an EF of 35% but his fluids were ordered very slow for about 12 hours, post-cath for some kidney hydration. Of course even with me running them, his creatinine is higher than admit. The other patient - Large man, some pitting edema, no pBNP, in for afib RVR and sepsis. Didn’t tolerate cardizem, didn’t tolerate IVP metoprolol, not a candidate for digoxin. Amiodarone drip - not touching the heart rate, hanging out 150’s - 170’s. Got 3L in the ED, lactic barely elevated, abx, etc. But no one started the continuous fluids. Within 2 hours of starting the fluids, heart rate is coming down. By the time I left, 90’s (sleeping) - 120’s when up.
So please. Run your fluids. If you’re uncomfortable with it, call and clarify. Document your concerns and the providers response. But don’t just ignore them.
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2 patients today both had fluids ordered during dayshift. Neither patient had fluids running when I got there. One had an EF of 35% but his fluids were ordered very slow for about 12 hours, post-cath for some kidney hydration. Of course even with me running them, his creatinine is higher than admit. The other patient - Large man, some pitting edema, no pBNP, in for afib RVR and sepsis. Didn’t tolerate cardizem, didn’t tolerate IVP metoprolol, not a candidate for digoxin. Amiodarone drip - not touching the heart rate, hanging out 150’s - 170’s. Got 3L in the ED, lactic barely elevated, abx, etc. But no one started the continuous fluids. Within 2 hours of starting the fluids, heart rate is coming down. By the time I left, 90’s (sleeping) - 120’s when up.
So please. Run your fluids. If you’re uncomfortable with it, call and clarify. Document your concerns and the providers response. But don’t just ignore them.
2024.03.08 05:29 Leather_Government_9 Needing some insight!
Hi all, I have been offered two spots at a hospital as an RN and I have no one to ask about how to pick. One is like a med surg obs unit that is still very new and in the managers words is kind of like a pilot program. It’s 11 beds, no isolation patients, 2 RNs and a PCT. The other is like a critical care step down unit where you get drips, IV pain meds, and IV cardizem and is more like a progressive unit. This unit has 24-28 beds with some semi private rooms and your ratio is either 1:6 with a tech or 1:12 with an LPN and a tech. Both are night shift and come with a very nice sign on bonus that is not taxed upfront. I am not new to the nursing world and I have 12 years of experience behind me between being a CNA and being an LPN. The thing is, the manager from a critical care unit I really liked emailed me as well to talk but they do not have the sign on bonus that I really need to get by right now. The terms of the sign on are two years on nights which isn’t a problem for me, I’ve already worked for the same hospital for almost 10 plus years off and on. I just don’t know which one is the best option and how to pick. Anyone have any insight to this or have worked on similar units with similar patients and ratio?
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2024.02.28 05:14 More_Entertainment78 New onset Afib with RVR
I am 20 years old, female, fresh out of the hospital from a 5-6 hour stent of Afib that reverted back to normal sinus rhythm in the hospital on a Cardizem bolus and drip. It happened at 5am after a long 10 hour shift. Ive never had anything like this before, and they couldn’t really pin why it happened. I am concerned because I am so young. I haven’t even enjoyed my 21st bday yet. Will I even be able to have a drink and not go back into AF? I already have health anxiety and this just made it 100x worse. They decided that I didnt need blood thinners due to my CHADSVASC score only being 1 (for being female). I am already diagnosed with POTS so I was already taking propranolol when the Afib happened and am still taking it. Will this happen again or was it a one time thing? I feel like I have no answers. :((
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2023.12.21 12:01 brcg2 Heart rhythm going but no pulse-first patient death
6 months nurse on a cardiac med/surge floor. I got a pleasant reasonably 94 year old patient with a pacemaker 4 hours before my shift ended. He was A/O x4 and told me he didn’t know what DNR was. He told me he had an estranged son and seldom talk to him. He showed me he was fairly strong while doing head to toe assessment. Afib between 120 and 82. Freshly off cardizem from ED. BP was low but coming up from (80/60) His BP was never high enough to meet the perimeter for metoprolol attending prescribed. He also had CHF with fluid restriction. So I wasn’t quite sure about NS drip. I got the charge nurse involved with the doctor. He prescribed amiodarone bolus and drip. Charge nurse was concerned and ordered me to slow down the rate of bolus. I charted in his room so I could keep an eye on him. PCA and I noticed that he looked awfully pale and quiet. He was unarousable. No pulse while the monitor still showed a arrhythmia rhythm. We got help and in the frenzy of CPR. We contacted the son and he thought vaguely he had a DNR. Dug it out of the system from May 2022 and all motions stopped. Looking back I should’ve noticed the signs-black tarry BM he kept excreting(which we gathered for lab), the nausea/ vomit he had( we thought from indigestion), the short of breath,( which happened after we turned him to clean so dismissed it as SOB with exertion) the pale complexion( dismissed it as old age) Moving forward, I don’t think o can ever leave my pacemaker patient alone. I want to comfort myself that he was old and had multiple diseases yet meanwhile, I wonder if I were more experienced, the outcome might’ve been different. What did I do wrong?
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2023.12.08 06:10 Electronic-Store6196 Taking patients without Epic access
I am beyond pissed. I work in home health, and I also work at a hospital PRN, which are both the same hospital system. For some reason tonight I didn’t have access to the patients in the hospital when I went in for my PRN shift tonight. I immediately told the charge nurse that I couldn’t get into epic to see my patients. She told me to call IT. I was on the phone with IT for a while, and I kept telling her and the nurse trying to give me patients that they didn’t know how long it was going to take. I thought maybe they should just split the patients up across the floor since all the other nurses only had four patients. I would take the patients back if I got into the charts. But this floor is notorious for being every man for himself, and both the charge nurse and the dayshift nurse forced me into taking patients after I told them multiple times I wasn’t comfortable doing it. Now this is on me, I should’ve stood my ground. It was hard with two different nurses were pushing me, saying oh my they’ll be able to fix it. I got the shittiest report ever, but I couldn’t see anything about them. One was on a heparin drip, and another was on an amiodarone drip, heparin drip, and the cardizem drip was just discontinued. Another patient was on Tikosyn. We are supposed to sign off the drips when we do shift changes but obviously that couldn’t happen if I didn’t have computer access. I eventually went to my charge nurse on the floor I usually work on, and she called the supervisor and had them pull me from the floor. I just can’t believe they would think it’s OK for me to take patients with all these drips. If I needed to call the doctor or secure chat them, guess what I also can’t freaking do that either. I’m just so ticked.
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2023.12.02 16:28 CraftyObject I'm a new grad in an ED. I think I need a psychiatrist or a therapist.
Having some major anxiety because of this job. I'm an AEMT too so I thought I'd have a better handle on this. I've been in healthcare for 8 years. I didn't think this would be easy at all but I didn't think it would be this hard. Why am I constantly overthinking things? I agonized about giving IV digoxin to a pt that was on max cardizem and it really backed up the waiting room. I don't want to rush giving out meds period, but especially not cardiac meds.
I totally missed the signs of a head bleed because dude had a bunch of alcohol too. Thankfully, the PA did a head CT and caught it. I knew something was off about that guy but I didn't escalate and I should have even though it probably wouldn't have made a difference.
I had my first ICU pt from start to finish bibems and my first levo drip. Damn near maxed him out on accident if I hadn't double-checked myself. He got to ICU alive but damn I was all over the place. It was embarrassing.
Does this uncertainty and anxiety get better? I don't feel like I belong here because I feel so damn stupid half the time.
What do you guys do for this feeling?
submitted by CraftyObject to nursing [link] [comments]
I totally missed the signs of a head bleed because dude had a bunch of alcohol too. Thankfully, the PA did a head CT and caught it. I knew something was off about that guy but I didn't escalate and I should have even though it probably wouldn't have made a difference.
I had my first ICU pt from start to finish bibems and my first levo drip. Damn near maxed him out on accident if I hadn't double-checked myself. He got to ICU alive but damn I was all over the place. It was embarrassing.
Does this uncertainty and anxiety get better? I don't feel like I belong here because I feel so damn stupid half the time.
What do you guys do for this feeling?
2023.11.18 02:17 brcg2 Time management frustration
(4 1/2 mo new grad. Background: cardiac med surg) I’m perplexed to say the least and seeking honest feedbacks: 1)morning med pass- from getting patient’s meds to dispense them( and educate them on side effects), assessment and flushing IVs. It takes me 1/2 hour with each patient.( I also have to retake their BP if their previous vitals is outside of the 30 minute window of me giving them BP meds) They told me that other nurses never listened to their heart or breathing but they were charted. Hummm? 2) Manager told us we are not allowed to look at patients’ info before shifts and not allow to stay L8 to chart. I try to look at clinical notes before med pass so I can give report at rounding at 10Am. Sometimes patients want stuff or going off for tests or toileting and take time away. Then I put off giving meds to patients before 10 so I can catch up on reading the clinical notes for report and I am late giving out meds to the last two patients. I don’t have time! 3)Yesterday I was pretty caught up by noon. Then 2 discharges, one started dialysis and needs blood work. The other one needs cross match for surgery next day and also 2 IV antibiotics and Cardizem drip running at the same time. At 18:45, one new admit and another at 19:00( shift change) while I was hanging a new antibiotic IV in another room. I managed to finish initial nurse patient history input with the 18:45 admit. Night shift nurse asked me about the patients at shift change(19:00). I gave barebone info on 18:45 one and knew nothing on the 19:00 admit at shift change. Eyeroll from the night shift nurse and I felt I sucked big time but meanwhile I felt it was out of my control.
All day I was running around while I see other nurses have time eating lunch and chatting. I know they are better at time management but it still takes time to do the same charting I am doing? I just want to know what I do wrong to speed up more!
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All day I was running around while I see other nurses have time eating lunch and chatting. I know they are better at time management but it still takes time to do the same charting I am doing? I just want to know what I do wrong to speed up more!
2023.11.02 23:03 PartyNightAway Should I accept a Tele contract if I mostly have MS experience?
I’ve been a nurse for the last 5 years. I’ve mostly worked on MS floors in the past, but a lot of my patients are usually on tele monitors. I am comfortable when it comes to certain cardiac drips.. like cardizem, amiodarone, heparin, lasix... and I’ve seen a fair share of cardiac cath patients but I don’t have much experience with other cardiac procedures. Should I accept a tele contract? Im a fairly fast learner but I just don’t want to be looked at as incompetent if I don’t know how to do something cardiac wise.
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2023.10.27 06:07 MommyXMommy Ablation scheduled FAST
50/F. My first episode of afib lasted a few weeks (I thought I just had a rough virus with a lot of fatigue because I also have multiple sclerosis), and ended on 12 Jan 2023. I went to the ER and converted back to NSR after 2 Cardizem boluses, an ambulance ride to the heart hospital, and about 12 hours on a Cardizem drip. Echo was normal. At post hospitalization appt, we agreed to discontinue Xarelto since my CHADS 2 score was 0, and I was monitoring with the newest Apple watch. At my 3 month follow up, EP lowered Cardizem dosage from 180 mg to 120 mg which is lowest possible.
12 July 2023 - 4 hours of afib. Converted back to NSR at home.
20 Sept 2023 - 17 hours of afib. Converted back to NSR at home, but made urgent appt with my EPs NP.
21 Sept 23 - NP increased Cardizem dosage back to 180.
24 Oct 23 - Saw my EP/clinic director. Expected to have to convince him to just go right to ablation before I am any less young. The first words out of his mouth when he sat down were, “I’d like to schedule you for an ablation as soon as I have an opening”. He also had me schedule a chemical stress test for next Wednesday, 1 Nov 23.
Today: 26 Oct 23 - I’m minding my own business, and I get a call from the cardiology nurse. My EP has had a cancellation, and my name “popped into his head” as a good fit. I also think it’s a little bit of favoritism since we get along extremely well and most appts run long with lots of laughs. So I am having my ablation 2 weeks from today. 😬
I’m not sure if I am looking for reassurance, thoughts, or just to get the words out since I am not really telling anyone but immediate family and my inner circle. Wish me luck!
Fortunately, I trust in my surgeon completely ❤️
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12 July 2023 - 4 hours of afib. Converted back to NSR at home.
20 Sept 2023 - 17 hours of afib. Converted back to NSR at home, but made urgent appt with my EPs NP.
21 Sept 23 - NP increased Cardizem dosage back to 180.
24 Oct 23 - Saw my EP/clinic director. Expected to have to convince him to just go right to ablation before I am any less young. The first words out of his mouth when he sat down were, “I’d like to schedule you for an ablation as soon as I have an opening”. He also had me schedule a chemical stress test for next Wednesday, 1 Nov 23.
Today: 26 Oct 23 - I’m minding my own business, and I get a call from the cardiology nurse. My EP has had a cancellation, and my name “popped into his head” as a good fit. I also think it’s a little bit of favoritism since we get along extremely well and most appts run long with lots of laughs. So I am having my ablation 2 weeks from today. 😬
I’m not sure if I am looking for reassurance, thoughts, or just to get the words out since I am not really telling anyone but immediate family and my inner circle. Wish me luck!
Fortunately, I trust in my surgeon completely ❤️
2023.10.09 19:19 Mumbles_Stiltskin Pt. Family members who are HCWs
Idk if ITA here or not, but I had a pt with afib rvr, a femoral line, A&Ox 1 and couldn’t bear weight on the right side. Pt family (maybe nurses, maybe techs idk) came in and insisted on moving my pt without talking to me to the chair for dinner. I mean I get what you’re trying to do, but now is not the time. Then when they can’t get the pt out of bed they force the Pt up (who isn’t even able to hold self upright) to edge of bed for meal. Pt is literally screaming in pain as they transfer back to bed after an abysmal attempt at eating. What’s fucked is that the pt was showing marked improvement on independent intake throughout the day when allowed to eat upright in bed. Then they decide they’re gonna give the pt a bed bath. Nvm that night shift is scheduled to do that, they are tossing the pt around in bed like a goddamn pigskin, pt screaming, yanking my lines to their limit. and when the tech and I offer to help at every opportunity of this shit show they refuse. I get that you want to help care for your family. But this isn’t your patient. Stop. Ask.
The Pts heart rate skyrocketed and I had to triple the cardizem drip all because these family members couldn’t restrain their need to play nurse to their grandma in a hospital that they didn’t even work at.
Rant over
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The Pts heart rate skyrocketed and I had to triple the cardizem drip all because these family members couldn’t restrain their need to play nurse to their grandma in a hospital that they didn’t even work at.
Rant over
2023.09.23 18:59 crypto_matrix78 Chest tightness/pressure post-AFib. Anxiety or something more?
27F, 5’6, around 190lbs. Currently taking diltiazem, viibryd, leflunomide, and Humira. I have anxiety and rheumatoid arthritis. I was also born with pulmonary valve stenosis, which was fixed when I was six months old.
Around a month ago, my fiancé took me to the ED because of severe pelvic pain and constant vomiting (I couldn’t keep anything down, including water). I could feel my heart racing extremely fast while at home, but I just assumed it was elevated due to the vomiting. My heart was fine when I got to the ED as far as I’m aware.
The doctor gave me dilaudid for pain. I actually don’t usually like receiving IV narcotics because it always feels so horrible when they push it through the IV, but I took it because the pain was so bad.
After they gave me the meds, I seemed fine for around 5 minutes. However, my heart rate suddenly began rising pretty quickly. Eventually it was over 200bpm. I was informed I was in AFib + RVR (my dad had AFib, but I have no personal history of AFib myself). They gave me a cardizem drip and I stayed in the hospital for several days. I eventually converted back to normal rhythm on the unit while I was sleeping.
Ever since then, I’ve felt a weird pressure in my chest and occasional shortness of breath. It’s not constant or even necessarily painful, but it does worry me. I saw my cardiologist and he didn’t seem to concerned.
To be fair, my hospital stay was very traumatic and I’ve developed pretty bad health anxiety since then, so I wouldn’t be surprised if it was just my anxiety.
Should I be concerned about this?
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Around a month ago, my fiancé took me to the ED because of severe pelvic pain and constant vomiting (I couldn’t keep anything down, including water). I could feel my heart racing extremely fast while at home, but I just assumed it was elevated due to the vomiting. My heart was fine when I got to the ED as far as I’m aware.
The doctor gave me dilaudid for pain. I actually don’t usually like receiving IV narcotics because it always feels so horrible when they push it through the IV, but I took it because the pain was so bad.
After they gave me the meds, I seemed fine for around 5 minutes. However, my heart rate suddenly began rising pretty quickly. Eventually it was over 200bpm. I was informed I was in AFib + RVR (my dad had AFib, but I have no personal history of AFib myself). They gave me a cardizem drip and I stayed in the hospital for several days. I eventually converted back to normal rhythm on the unit while I was sleeping.
Ever since then, I’ve felt a weird pressure in my chest and occasional shortness of breath. It’s not constant or even necessarily painful, but it does worry me. I saw my cardiologist and he didn’t seem to concerned.
To be fair, my hospital stay was very traumatic and I’ve developed pretty bad health anxiety since then, so I wouldn’t be surprised if it was just my anxiety.
Should I be concerned about this?
2023.09.19 20:46 crypto_matrix78 Chest pain after an episode of AFib has ended?
Well, it’s not really “pain” so much as it is discomfort. Sometimes it’s some sort of tight feeling. When it doesn’t feel tight, it just kinda feels like what costochondritis feels like. Not really “painful” per sè, just bothersome.
I had my first AFib episode around this time last month. I spent 3 days in the hospital and was converted back to a normal rhythm with a Cardizem drip. They sent me home with diltiazem 30mg and metoprolol 50mg, both to be taken twice a day.
The discharge papers said to take it for only 30 days, but I’m afraid to stop them suddenly so I just cut them in half until I can see my cardiologist on Thursday (they didn’t get me in within a week like the hospital wanted for some reason). Cutting down the meds definitely helped with the chest tightness, but not the costochondritis-like pain.
Is this common after an episode of AFib?
(Just as a side note, yes I am fully aware you shouldn’t alter medication dosages without permission from your doctor. However my doctor is near impossible to contact and I just cannot tolerate the medication side effects, so I decided to risk it).
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I had my first AFib episode around this time last month. I spent 3 days in the hospital and was converted back to a normal rhythm with a Cardizem drip. They sent me home with diltiazem 30mg and metoprolol 50mg, both to be taken twice a day.
The discharge papers said to take it for only 30 days, but I’m afraid to stop them suddenly so I just cut them in half until I can see my cardiologist on Thursday (they didn’t get me in within a week like the hospital wanted for some reason). Cutting down the meds definitely helped with the chest tightness, but not the costochondritis-like pain.
Is this common after an episode of AFib?
(Just as a side note, yes I am fully aware you shouldn’t alter medication dosages without permission from your doctor. However my doctor is near impossible to contact and I just cannot tolerate the medication side effects, so I decided to risk it).
2023.08.12 06:18 Natural-Word-6456 Terrible Resident
Hi all. I’m a nurse working with a resident I think is doing a poor job, and I want to make the best of the situation for everyone involved.
I get this brand new patient from ER and I’m working on organizing all of the orders, etc. This resident ordered 30 units of Levemir on a diabetic patient who didn’t take insulin at home, wasn’t on steroids or anything that would raise his b/s. He was 112 accu-check. As I’m investigating whether I should give this before calling him, my patient’s heart rate drops to 44 on the heart monitor and he’s on cardizem drip for rapid A-fib, he had been running 80s-120’s. So, of course I turn it off but I have to notify him that I did this.
As my routine, before calling the doctor, especially residents, I try to get all pertinent data together before calling so I can evaluate whether or not I’m comfy with doctor’s response, and if he he/she has any questions. It turns out this doctor already ordered for the patient in the ER, and the patient received, home dose Metoprolol XL, and two IVP beta blocker. So I’m thinking, ok this guy has had way too much beta blocker and it’s catching up with him.
So, I call and tell him what’s going on and question whether or not he would like me to give insulin and told him about drip. He comes down to see patient and tells me to continue the drip because the cardiologist will be mad if we stop it. I said, “why would he be mad?” He said because the cardiologist told him to order it…..
I’m like, well yeah, but he’s not tolerating it well now. And resident told me if his HR drops to the 40s just to “ wake him up and have him wave his arms around or something to get it above 60.” I’m so confused. What. The. Actual. F.
Anyway I tell him I’m not going to do that because the order says to titrate to keep hr below 100, and that is good enough for me. He was pissed at me ya’ll! He asked if I knew who he was and I said no. And he said, “ Of course not.” Omg.
Anyway, I wrote in the patient’s chart that he told me to give the insulin and continue the drip with heart rate in the 40’s and contacted the attending to verify.
What do you all think?
submitted by Natural-Word-6456 to Residency [link] [comments]
I get this brand new patient from ER and I’m working on organizing all of the orders, etc. This resident ordered 30 units of Levemir on a diabetic patient who didn’t take insulin at home, wasn’t on steroids or anything that would raise his b/s. He was 112 accu-check. As I’m investigating whether I should give this before calling him, my patient’s heart rate drops to 44 on the heart monitor and he’s on cardizem drip for rapid A-fib, he had been running 80s-120’s. So, of course I turn it off but I have to notify him that I did this.
As my routine, before calling the doctor, especially residents, I try to get all pertinent data together before calling so I can evaluate whether or not I’m comfy with doctor’s response, and if he he/she has any questions. It turns out this doctor already ordered for the patient in the ER, and the patient received, home dose Metoprolol XL, and two IVP beta blocker. So I’m thinking, ok this guy has had way too much beta blocker and it’s catching up with him.
So, I call and tell him what’s going on and question whether or not he would like me to give insulin and told him about drip. He comes down to see patient and tells me to continue the drip because the cardiologist will be mad if we stop it. I said, “why would he be mad?” He said because the cardiologist told him to order it…..
I’m like, well yeah, but he’s not tolerating it well now. And resident told me if his HR drops to the 40s just to “ wake him up and have him wave his arms around or something to get it above 60.” I’m so confused. What. The. Actual. F.
Anyway I tell him I’m not going to do that because the order says to titrate to keep hr below 100, and that is good enough for me. He was pissed at me ya’ll! He asked if I knew who he was and I said no. And he said, “ Of course not.” Omg.
Anyway, I wrote in the patient’s chart that he told me to give the insulin and continue the drip with heart rate in the 40’s and contacted the attending to verify.
What do you all think?
2023.08.08 22:46 Traveling_Ariesx3 Is this safe or fair?
Started a new contract. Had 9 patients last night. This facility has a policy that new nurses off orientation can only take up to 5 patients at a time. There were 4 nurses scheduled last night and the floor holds 31 patients and we were full. So each nurse had 8-9 while the new nurse had 5. My assignment was as follows... *2 CIWA patients scoring and requiring Ativan *A patient with a HGB of 5 requiring frequent blood transfusions, also a hx of CHF and was going into fluid volume overload *a patient on a lasix drip also on tele requiring Cardizem and metoprolol because they kept going into afib w/RVR *a patient on a heparin drip *a patient there for suicidal ideation *covid patient in iso on BiPaP *2 independent patient waiting rehab placement
Idk the other 2 nurses assignments but they too were running around all night.
Multiple times I came to the nurses station to grab things and I saw this new nurse sitting on her phone, headphones in watching a movie. I'm a traveler so it's not my place to tell staff, especially a new nurse what to do because I need to stay in my lane, it's not my facility I don't work there. However, I'm placed in an unsafe situation and an unfair situation.
Should I just leave? Should I say something about the new nurse? Or is that me not staying in my lane? I haven't worked in 7 months because I got in a head on car accident in January that required a really big surgery so I'm pressed for money which makes this hard and annoying
Idk whats fair anymore or safe.
submitted by Traveling_Ariesx3 to nursing [link] [comments]
Idk the other 2 nurses assignments but they too were running around all night.
Multiple times I came to the nurses station to grab things and I saw this new nurse sitting on her phone, headphones in watching a movie. I'm a traveler so it's not my place to tell staff, especially a new nurse what to do because I need to stay in my lane, it's not my facility I don't work there. However, I'm placed in an unsafe situation and an unfair situation.
Should I just leave? Should I say something about the new nurse? Or is that me not staying in my lane? I haven't worked in 7 months because I got in a head on car accident in January that required a really big surgery so I'm pressed for money which makes this hard and annoying
Idk whats fair anymore or safe.
2023.07.15 07:21 certifide Med/Surg is a trap
You go through nursing school and your instructors all tell you to start here. “It’s a good way to get your foundation.” This made sense to me in the beginning. And it was a great way to build that foundation. However, I’m stuck with ICU level patients every week and it’s always the same excuse: “there’s just no more beds left up there”. I have 400+ lb patients on q2 turns, dopamine and cardizem drips, NIH 10+ patients, q2 dilaudid, combative drug seekers, etc etc. and I’m nearly always at 5-6 at a time.
Fast forward a year and a half on the floor, and I’ve tried like hell to apply to new positions. Here’s the fucking kicker. THE SPECIALTIES WANT EXPERIENCE IN THAT SPECIALTY. Countless ICU and ED managers have declined my application citing a lack of critical care experience. The OR won’t hire me because I have no scrub/circulating experience. After literally hundreds of applications I’m starting to feel defeated. Outpatient clinics typically want seasoned nurses with 3+ years.
How the hell am I supposed to get out of med/surg, the quintessential “building block” if no one will take a stab at me? I am more than capable of learning on the job. I am at a point where I feel doomed to only work the floor or a SNF where they are always hiring. I am tired of running my ass off all shift with an endless list of tasks. I want to look at patients charts, spend time with them, learn about their conditions and medications. Instead I am just run ragged for 11 hours, with that one sacred hour of downtime that I want to spend eating food and watching YouTube. Med/Surg was supposed to be the stepping stone to other specialties. Now I think it’s just a trap.
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Fast forward a year and a half on the floor, and I’ve tried like hell to apply to new positions. Here’s the fucking kicker. THE SPECIALTIES WANT EXPERIENCE IN THAT SPECIALTY. Countless ICU and ED managers have declined my application citing a lack of critical care experience. The OR won’t hire me because I have no scrub/circulating experience. After literally hundreds of applications I’m starting to feel defeated. Outpatient clinics typically want seasoned nurses with 3+ years.
How the hell am I supposed to get out of med/surg, the quintessential “building block” if no one will take a stab at me? I am more than capable of learning on the job. I am at a point where I feel doomed to only work the floor or a SNF where they are always hiring. I am tired of running my ass off all shift with an endless list of tasks. I want to look at patients charts, spend time with them, learn about their conditions and medications. Instead I am just run ragged for 11 hours, with that one sacred hour of downtime that I want to spend eating food and watching YouTube. Med/Surg was supposed to be the stepping stone to other specialties. Now I think it’s just a trap.
2023.05.11 17:24 Freck2392 If floated, supposed to specialize in everything under the sun?
So im pcu/tele but have been applying for med surg/med surg tele. These are the job descriptions recruiters are sending me for the positions I inquire about. These are areas I could be floated to. Im well versed in alot of care but not craniotomies, plastics and vents. Would u sign on for this position or am I crazy? Why are we expected to be “specialized” in everything under the sun? This is where im struggling to find a contract. I’ll interview and clarify w the interviewer and if I dont feel comfortable on one of the units to be floated to, they ask if I want to opt out in the submission which of course I do! Help me understand! I cant be the only one!
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