I'm sitting at work in the library on our unit. I'm in this little room staring at the computer screen doing my Essentials of Critical Care Orientation. [ECCO] I've been here for an hour and I am going nuts. TORTURE.

Although it IS good information. I'm reading about cardiovascular stuff right now. It's good to know but I just can't sit here or concentrate. ADD much?? LOL

I almost forgot to mention the most exciting thing about my week! So with my sick heart patient, the Cardiology Attending came by and wanted to cardiovert my pt. I guess they had done it on Sunday, but it was unsuccessful. So they wanted to try it again on Tuesday (yesterday). So we prepared him for cardioversion. Had RT and a beside intubation tray and vent on standby just in case he coded. Had Anesthesia there to give Propofol for sedation. And the Cardiology Attending to deliver shocks. I was on standby with the crash cart (with my preceptor of course b/c at this point I was already freaking out! haha). So first shock delivered with 200 joules. Asystole. Then heart rate comes back at 70-80s, then jumps right back into Afib, rates 140s. Second shock...360 joules. Same thing, except the time in Sinus was a little longer. This happened 2x more at 360 joules and same result. Unsuccessful cardioversion again. The attending thought the amount of IV Amio was too much and pretty much blocking the SA node, so we switched him to PO Amio. That seemed to help because today he was a new man (see previous post).

And that was my week in a nutshell. Although I'm working the weekend, so there may be more stories to tell!

So this week is my 3rd week on the floor. Last week I was at nursing orientation for the 3rd time ever. BUUUUT it will be the last time! :)

This week was pretty busy! Monday I had 3 patients...started with 2, discharged one to the floor, admitted one from the OR. Tuesday I had a guy with CRI, Chronic Afib, and a sick heart. He didn't look that good and was on so many drips. Most of my day was spent titrating his Amio, Dobutamine, Lasix, Insulin, Nipride, and Epi gtts. I also spent the day shooting cardiac outputs and indexes. I had to attend a family meeting with his wife and daughter to discuss the plan of care and what measures they wanted to take if he were to take a turn for the worse. It was very emotional. I come in today and have the same patient and he's only on Dobutamine, alert and talking, and looks like a different man. His family told me that I fixed him. haha He's going to have an ablation done to try and fix his Afib. I'll be at work, but I'll be doing my ECCO class all day. I will make sure to drop by his room and see how he's doing.

My other patient on Tuesday and today was an ETOH withdrawal guy with rhabdomyolysis. He also had compartment syndrome in his left leg and had a fasciotomy done. He also had renal failure and was hypotensive, so I was titrating his vassopressin gtt while he was getting hemodialysis done. I discharged him today to the IICU. I was looking for Kelly (mine & Mary's clinical instructor from Sem 5), but she wasn't there. :(

So now here I am. I'm going to go back to reading about PA catheters and doing PA dialstolic and pulmonary artery wedge pressures now. It'll tie in to my ECCO class tomorrow since I'm doing cardiovascular stuff.

Mary, Caroline...updates please! :)

First of all, yes. We DID set the wedding date and booked the venue. We are getting married on Saturday, May 15, 2010 at Wedgewood Wedding & Banquet Center. It will be from 6-11pm. And I have a bunch of wonderful fun ideas that will have everyone raving about our little happy day. Because you all know I can't just do what everyone else does...gotta have some flava in the mix! Like grape koolaid! :)

And as you know, this was my first week of work as an RN! Tuesday I took one patient...a post-op day 2 CABG x2. Extubated that morning. My job was to shoot cardiac outputs/indexes, titrate his neo and nitro drips for perfusion without getting too high of pressures that could possibly rupture the vein grafts. It was a little hard being back because I had been gone for a while. Some things had changed. Had to refamiliarize myself with the new pumps and new beds that we got. But it was good.

Wednesday I had the same patient, plus another pt. He was an ARDS, multi-organ failure, septic...among many other problems. They had him vented at 100% FiO2 with pressures and volumes 4-5 times the amount that they would normally have on a patient. It was a very complicated case and a very sick guy.

Today I had the same 2 patients. It was different because the Ethics Committee was called to discuss the plan of care of my ARDS patient, so myself and my preceptor went to sit in the meeting. After an exhaustive search for family, surrogates, anyone who could make a decision, the committee convened with the treating medical team to discuss withdrawing life supporting measures. I won't get into all, but the doctor on the committee asked us all what our thoughts were. I was even able to voice my opinion about the situation, although I had only cared for the pt for only 2days. The final decision at the end of the meeting was that those measures be withdrawn and comfort care instituted.

It was an interesting experience to be able to sit in and participate in that meeting. I even heard words we learned in nursing school like "beneficence." They still had to bring up the recommendations to the Chief of Staff and Director of the hospital, so I don't think anything will be done today. I'm off tomorrow but work Saturday, so we'll see if they do anything.

So that was my week in a nutshell!