Critical Care Orientation

Hi future critical care nurses,

Here were the topics that we covered in my critical care orientation. While the instructor said that this class is not to provoke anxiety, some of the topics made me a little nervous, but I guess that’s normal for anyone doing something for the first time.

Day 1

  • Compensation Mechanisms
  • Pharmacology

Day 2

  • Arctic Sun (Hypothermia therapy)
  • Hemodynamics I – Arterial lines, CVP
  • Intra-arterial thrombolytics

Day 3

  • Hemodynamics II – PA Catheters (Swan Ganz)
  • Hemodynamic Scenarios

Day 4

  • Glycemic Control
  • DKA/HHS
  • Insulin Infusion with Delta
  • Neuromuscular Blockage
  • IABP
  • TPA for MI
  • Temporary Pacing

Day 5

  • Phillips Monitoring
  • Acute Renal Failure
  • Peritoneal Dialysis
  • DIEP

Day 6

  • Mechanical Ventilation
  • Oxygenation
  • ABG Analysis

Day 7

  • Shock States
  • Sepsis

Day 8

  • ACLS Part 1 (BLS + videos)

Day 9

  • Intra-abdominal Pressure (IAP) Monitoring
  • Pulmonary Vein Isolation (PVI)
  • Crash Cart – Defib, Cardioversion, Pacing
  • EPIC Code narrator/critical care flowsheet

Day 10

  • Neuro RRT/tPA
  • Neuro Assessment
  • Neurosurgery
  • Intracranial (ICP) Monitoring

Day 11

  • Exams (Core and Pharmacology)
  • PACU Day – recovery from anesthesia

Day 12

  • ACLS Part 2 (Respiratory, Tachy, Brady algorithms; Test “Megacode”)

At least now I have some background information!

Anyway, happy holidays! Can’t wait to start.

Med-Surg to ICU Interview Questions

I’m so excited to announce that I was recently accepted into the MICU (medical intensive care unit) at my hospital! Critical care class starts in 2 days and I just finished my last shift on the telemetry med-surg and orthopedic unit!! I loved my team there– the people are truly incredible. The CCPs, PCAs, management, my fellow night nurses and day nurses made my time there truly amazing. It felt like a great teamwork every night, making sure essential things get done and always going above and beyond. 🙂

One year ago, I started at a nursing home for a month. 11 months ago, I started at the hospital on the telemetry unit. My hospital is having some of our ICU nurses go to another hospital in the system to build up their units so this great opportunity came up for me to go work in the ICU.

Fortunately, the interview was a “formality” but it’s no excuse not to prepare! With nearly a year of experience under my belt, it was much easier to come up with experiences showing my leadership. And remember, people relate to specific STORIES more than generalities! Here is a list of questions the nurse manager asked me.

  1. May I see your resume? (Asks questions on the resume especially regarding additional schooling aka your future plans and previous experience)
  2. What made you interested in coming to the ICU?
  3. How has your experience prepared you?
  4. What kind of drips have you used?
  5. Have you called a RRT or a neuro RRT or code before? What happened? What was that like?
  6. Describe a busy night for you.
  7. If you have several things going on, how do you deal with that? (Delegation and priority- give specific examples where this came in handy!))
  8. How do you keep your ancillary staff accountable? Do you always or only sometimes have huddles? Do you meet up with them again? How do you make sure they do what you asked them to?
  9. What do you do when you’re unsure of something?
  10. What is a strength you have? A weakness?
  11. What have you heard about this unit?
  12. Do you have any questions for me? (The answer is always yes and you ask questions!! Such as the type of patients, the ratio, the professional nursing organization, scheduling, etc)

I hope this helps! If you have heard of additional questions, I’d be happy to add in more to get a more comprehensive list. And happy thanksgiving to everyone!! I have a lot to be thankful for, including the readers who have given me positive feedback through emails, comments, and likes. 🙂 so thank you!!!

Help by voting please! Affordable senior care depends on you!

help by voting!

Future and current nurses please help!!
And friends and families of nurses!
And those touched by a nurse! Please help!

My parents have helped over 100s of seniors and their families over the last 20 years by providing quality care in Assisted Living homes. However, costs have skyrocketed! Help us provide affordable quality care by voting. Since we need 250 votes by November 15, please vote and have your friends vote too! It’ll take 2 minutes but it will make a big difference. If each Life With Jess reader voted, we can reach the goal in 5 days. Thank you for your help!

More information about the Assisted Living Homes:
In the early 1990s, my mom was working on her Masters thesis on providing affordable quality care to seniors while working as a registered nurse. She put her thesis to the test. Since then, Citizens for Quality Care (CQC) has been home to 100s of seniors in Southeast Michigan and has made a great difference in families’ lives.

More information about the Chase Mission Main Street Grants:
Chase Bank is offering $250,000 for 12 businesses this year. In order to be considered for the grant, we need 250 votes by November 15. The grant will be used to replace an old boiler that would reduce the cost by thousands each month. While we saved a hospital from demolition by converting it into a beautiful Assisted Living home, some expensive parts need financial help to replace for us to continue to provide affordable quality care.

More information about voting:
A Facebook account is needed to vote at the website: https://www.missionmainstreetgrants.com/business/detail/137710! You can also enter https://www.missionmainstreetgrants.com/, type in 49221 and click on CQC Stephenson Home. Thank you for your help and please share!

Feel free to ask questions in the comment section.

Gratitude

I anticipated a rough night. A super needy patient, an anxious patient and one straight up with no manners who didn’t know if it’s a good idea to take pain meds or not. And 3 others.

After running around for 11 hours, I hear a thank you.

I hear, “you’re very nice and thanks for taking care of me the last few days. You treat everyone as an equal.”

I hear, “this morning I woke up, crying with tears of joy. I called my best friend to tell him I had the best morning at the hospital since I’ve been here. And it’s all thanks to you.”

It doesn’t get better than that. The gratitude.

And the night before, a patient stated, “I’m so glad you’re here.” And gave me a big smile. He got up; I took his BPs to make sure there’s no orthostatic hypotension (a key sign that not enough blood volume circulates through the body); he walked a good distance for the first time since he had been here and couldn’t be happier.

Using my knowledge to help people get better has always been my top priority and it’s so great to hear it and see it. I love nursing! 🙂

Happy Breast Cancer Month

Yes, I realize that it’s the end of the month but I still want to recognize it. I personally know women who had it and were about to catch it early.

On TV a woman spoke about NFL’s involvement with breast cancer awareness. She asked, why are all the players wearing pink? After her husband told her, she went to get a mammogram. A year later she no longer has breast cancer! So go awareness and go screenings. Get screened especially if something doesn’t look right or feel right.

I went to Providence, Rhode Island over Columbus Day weekend and was welcomed by their WaterFire event and Breast Cancer awareness event. My boyfriend got a free flu shot provided by Walgreens (thanks!!) and I got a free pink pen. It’s pretty neat that an entire town can get together to get really hyped about cancer.

National Mesothelioma Awareness Day

Today is National Mesothelioma Awareness Day.

Now, what is that? It is a completely preventable cancer caused by asbestos, which is in our HOMES. Although it provides resistance to fires and temperature extremes, if you breathe it in, it can cause abnormal growth in your lungs, heart and the lining of the abdomen. About 3 thousand people get it each year.

I still remember that when I was younger and my parents were selling the old house, after going through a house inspection, apparently we had asbestos in our attic. It is a common product used when building homes (like lead in paint!). Immediately it had to get removed so the next homeowner can be safe.

Here are some more facts.
DID YOU KNOW?

    ASBESTOS IS STILL NOT BANNED IN THE US. Roughly 30 million pounds are still used each year.
    Asbestos fibers are invisible to the naked eye.
    Even more than 30 years after the peak of its use, asbestos exposure is still the NUMBER ONE cause of occupational cancer in the US.
    Asbestos can still be found in many homes, schools, and commercial or industrial buildings.
    Asbestos was once used in more than 3,000 consumer products including household items such as toasters and hair dryers – some of which may still be in use.
    Navy Veterans are at the greatest risk to develop mesothelioma as asbestos was widely used in Naval ships and shipyards.
    NO AMOUNT of exposure to asbestos is safe.

    Get the word out!!

My patients blew kisses to me

blowing kisses

 

And for that, I’m super happy. 🙂

It could be because I gave them what they asked for quickly.

It could also mean that I remember the small things that they like and repeatedly deliver it. For example, a patient likes his blankets straightened out so I’ll make sure to straighten it every time he calls. Or if someone likes their ice and water separately. Or wants a straw or not. Or the door closed. Or making sure they are getting pain medication at the appropriate time.

Or even more importantly, if they tell me about an abnormal sign or some problems, I act accordingly (speaking to other nurses, the charge nurse, the PA, etc) and resolve the issue.

I do think that it does start top down — the right management attitude, the appropriate beds clustered together so that the nurse taking care of the 6-7 patients isn’t too overwhelmed, the support received from management, other nursing staff, pharmacy, environmental, transport and the doctors (especially when they are thorough with their explanations with the patients and their families)… it all comes down to teamwork and everyone doing their part!! 🙂

If you have a serious illness, should you get palliative care?

caregivers

Yes. Palliative care provides an additional level of support while still providing curative treatment. Hospice care, on the other hand, also provides support but focuses on pain management and a good quality end-of-life care. Coming from NYU, I’m aware of the NICHE program (Nurses Improving Care for Healthsystem Elders). One thing it does is provide caregiver resources especially useful while you or your loved one is at the hospital. Here is their guide for helping you determine if you need palliative care.

1. Do you have one or more serious illnesses?

Such as: • Cancer • Congestive heart failure (CHF) • Kidney failure • Liver failure • Neurological diseases (e.g., ALS, Parkinson’s) • Dementia • Chronic obstructive pulmonary disease (COPD), emphysema, lung disease

Yes___ No___

2. Do you have symptoms that make it difficult to be as active as you would like to be, or impact your quality of life?

These symptoms might include: • Pain or discomfort • Shortness of breath • Fatigue • Anxiety • Depression • Lack of appetite • Nausea • Constipation

Yes___ No___

3. Have you, or someone close to you, experienced the following:

• Difficult side effects from treatment • Eating problems due to a serious illness • Frequent emergency room visits • Three or more admissions to the hospital within 12 months, and with the same symptoms

Yes___ No___

4. Do you, or someone close to you, need help with:

• Knowing what to expect • Knowing what programs and resources are available • Making medical decisions about treatment choices/options • Matching your goals and values to your medical care • Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, surgery, etc.)

Yes___ No___

5. Do you, or someone close to you, need help with:

• Coping with the stress of a serious illness • Emotional support • Spiritual or religious support • Talking with your family about your illness and what is important to you

Yes___ No___

If you answered yes to more than one of the questions, palliative care is something you or your loved one may need. If you feel you may benefit from palliative care, please talk to your healthcare provider today.


Update from April 24, 2014
To spread awareness about COPD and raise money for the COPD Foundation, you can write your story and Healthline will donate $10. The top 5 stories will receive a $75 American Express card.