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Instagram post 2198283598732465943_6816277 Let’s talk about every ICU nurses 𝘧𝘢𝘷𝘦 drug....⁣
⁣
𝐏𝐑𝐎𝐏𝐎𝐅𝐎𝐋!!! 💤💤⁣
⁣
🔹It is a general anesthetic.⁣
🔹Indications include:⁣
▫️Induction of general anesthesia in children & adults.⁣
▫️Initiation & Maintenance of Monitored Anesthesia Care (MAC).⁣
▫️Sedation of intubated patients in the ICU & ER.⁣
🔹It is a short-acting hypnotic. The mechanism of action is not entirely known...but propofol is known to work on GABA.⁣
🔹Produces amnesia (so you don’t remember)⁣
🔹 No analgesic qualities. This is important to remember that while your patient may be snowed on propofol, you still need to treat any underlying pain they may have with other drugs.⁣
🔹The most common side effects that I see would be bradycardia & hypotension. A rare side effect is green urine. 😳 Anyone seen that before? I have it’s weird.⁣
🔹If not contraindicated, patients should have DAILY “sedation vacations 🏝” in which the propofol dose is lowered to get a neurological assessment. This has also been proven to better patient outcomes, shorten length of hospital stay, and decrease the incidence of ICU delirium or Post-Intensive Care Syndrome (PICS), which is basically PTSD following an ICU admit. 👎🏼⁣
⁣
Pssst...if you’ve made it this far, this post is a hint 🤪 any guesses as to what I’m hinting at?! 🤐
Instagram post 2196088912160989955_6816277 We all have scars. 
My scar used to look good. A nice clean cut after my first surgery. But as the months passed, I fought a physical and mental battle daily following my accident. I rejected what was reality. I couldn’t accept it. I was internally bleeding emotionally, and then one day, physically. Blood began to pool under my scar, and my hope, patience, and skin began to stretch thin. 
It hurt. One day it couldn’t stretch anymore, and my scar burst open. I evacuated a hematoma in my bathtub. The pressure was released, and the fragile skin began to repair itself again. 
Another month went by, and the emotional buildup continued. I was depressed and jealous of others who weren’t going through what I was. I kept asking “why me,” what did I do to deserve this? The scar began to stretch again. One morning I woke up in a pool of blood. My scar was demanding attention. 
Then came yet another setback... osteomyelitis. The bones in my leg had become infected. I was rushed to get a PICC line and was on IV antibiotics q8h for 6 weeks. I had allergic reactions to every antibiotic I was put on, some requiring me to go to the ER for IM Benadryl. I was still in a wheelchair. I was exhausted. I was covered in a rash the entire 6 weeks, and prescribed atarax to basically sedate me enough to not feel the itch. My mind and body were giving up. I had seen this at work before. The young girl who dies after a straightforward surgery, followed by every complication and infection. I told myself I was going to die. 
But then one day, I didn’t. The thing about scars is that they demand attention, acknowledgement. They will continue to push and pull at you until they burst. What you resist, persists. While your scars may not be physical like this one, we all have emotional scars from our past that will continue to build up until we explode. If instead we accepted our scars, our battlewounds, our past...we are then able to move beyond them and develop scartissue... that while jagged-looking and not a clean cut, it forms even tougher skin than before. 🖤
Instagram post 2193901986528094758_6816277 LETS TALK DRIPS. 💧⠀
⠀
Drips can be intimidating when you’re starting in the ICU. It’s extremely important to understand the mechanism of action behind each drip, and not just follow orders/handoff to “keep MAP > 65.” ⠀
Each drip is very unique, and it’s gonna be on YOU the nurse, to speak up on why a prescribed drip may not benefit the patient, and be able to recommend another drip + give the rationale. 🗣⠀
⠀
I can’t count the times I’ve called the doctor at shift change and ask for a different drip when I see what’s hanging. For example, getting report to maintain a cardiac index > 2 on the med above (norepinephrine/levophed), and the nurse was going up and up on the drip to make the goal but still not meeting it. ⠀
⠀
When given a history of heart failure and an EF of 10%....this patient may need DOBUTAMINE instead of levophed to improve cardiac output. That’s because I know that dobutamine helps with CONTRACTILITY of a poorly functioning ventricle, and it DECREASES AFTERLOAD to help pump that blood out. THAT will actually help maintain your CI because you’ll stop vasoconstricting, causing an increase in AFTERLOAD for a failing heart if they had used levophed. Make sense?⠀
⠀
Would you guys be interested in more drip specific education? What drips do you guys see the most? Lemme know below! 😃
Instagram post 2185954718529320955_6816277 And as you become more successful,⠀
The amount of haters will grow. ⠀
There is a direct correlation⠀
As you check off more boxes⠀
Smiling as you go⠀
They are watching⠀
But do not forget⠀
You were not born to please other people. ⠀
Getting their approval ⠀
Was not part of your bucket list.⠀
Keep your head up 
And
Eyes fixed on your daydreams⠀
Because soon⠀
They will no longer be daydreams⠀
It will be your reality⠀
If you keep this mentality. ⠀
So⠀
Envision your future self often. ⠀
Set your intention daily.⠀
And get to work.⠀
-⠀
Sincerely,⠀
My exhausted jotted-down thoughts post nightshift 3 in a row. 😂 .
💾 Save this post for motivation 👍🏼
Instagram post 2184325088189709002_6816277 Y’all asked for ECMO education...I’m gonna break it down real simple. 👌🏼 ECMO stands for ExtraCorporeal Membrane Oxygenation. “Extra” = outside, “corporeal” = body so, outside of the body. Membrane oxygenation = oxygenation by a membrane. Outside of the body. Ya?

There are two types of ECMO. VA or VV ECMO. Veno-arterial or Veno-venous. First letter is where you’re pulling from and the second is where you’re returning blood. VA ECMO provides heart and lung support. VV is solely lung support. Blood is pulled from the body via cannulas and travels through an oxygenator to be oxygenated and for CO2 to be removed. We control the amount of CO2 removed via something called “sweep.” Then it is returned back to the body. ⠀
⠀
This treatment is a last resort for patients when other conventional therapies don’t work (max ventilator support, max pressors/inotropes, end stage heart failure etc) and there are contraindications of course. But it does work and use of ECMO is growing. ⠀
⠀
Examples of patients who may require ECMO include but are not limited to: septic shock, aspiration pneumonia, ARDS, pulmonary embolism, cardiomyopathies, myocarditis, cardiac arrest. The list goes on.⠀
⠀
These patients are SICKY SICK. K like not well. The ECMO specialist cannot leave the bedside, we are constantly monitoring these patient’s vitals, intake & output/fluid balance and also typically manage the CRRT machine along with it. We are responsible for maintaining therapeutic anticoagulation to maintain circuit integrity, checking pre and post oxygenator ABGs as well as patient ABGs, serial electrolytes, hourly pulse checks to make sure the big cannula doesn’t occlude perfusion to the lower extremities..managing sedation for patient and circuit safety, and sometimes paralytics for ventilator compliance or to decrease oxygen demand. ⠀
⠀
There is also another nurse doing patient cares, medications, possibly managing another device in addition. Who here does ECMO and who wants to?! Doesn’t want to? 😂😝 .

Save this for reference later 📋
Instagram post 2182341693549085563_6816277 TONIGHT AT MIDNIGHT. ⠀
⠀
Wow. If you would have told me a year ago that I would be designing and opening an online shop I would have laughed 😂. I have been working very hard over months and months to design some #nursemerch with a sassy and trendy flair to it. Over the years I’ve had numerous situations where I wanted to buy a nurse a graduation gift, thank you gift, etc, and I was so disappointed in the tacky stuff that’s out there today! (ive seen enough incorrect EKG clip art designs, thanks) Next thing you know I’m designing my own products... that I’m actually excited to gift to my friends and family that are nurses or in school! 🏩📝⠀
⠀
I feel like I have no idea what I’m doing combined with excitement combined with extreme gratitude FOR YOU. You guys that have followed along my nursing journey... YOU have made an amateur blog that was created to get through personal trauma, into a community that gets me excited to keep going, move past my struggles, and continue to spread positivity in nursing. So thank you, THANK YOU 💖⠀
⠀
Shop link will be posted tonight at midnight MST in stories. 💋
@lipstickandlifesaving
Instagram post 2180256768918308180_6816277 Rest In Peace Nonna ❤️
.
My sweet grandmother passed away this weekend surrounded by family. It was very unexpected and sudden, and I am so fortunate to have gotten to Canada in time to be with her when she passed. Also feeling so grateful she was able to make it to my wedding in Arizona just last month.

This was my first family member being cared for in the ICU. I always wondered over the years how this would go for me, and I am so wowed by the hospital staff who were so accommodating to me and my giant loud Italian family that took over the entire waiting room with people, pizza, and biscotti 😂
.
Not only that, our family included 5 nurses, 2 RTs, 1 medical student, and a million questions. You can only imagine how annoying we would be for that night nurse...but wow. She pulled up every CT, ABG, CBC we asked for, without a single roll of the eyes. This was closure for us. She also made EACH of us one of these EKG strips that she hand cut, and placed a heart bead with her favorite color. THIS is nursing. Don’t ever forget the little things you can do as a nurse in these situations. This meant the world to us.

Nonna you were a light in all of our lives. Always so happy, and had a social life I could only dream about. Heaven gained a beautiful angel this week 💖
Instagram post 2175612208598498198_6816277 This guy here is a Total Artificial Heart (TAH). 🖤⠀
⠀
It is implanted as a last resort for biventricular failure either as a bridge to heart transplant or as destination therapy (this stays in forever). The patient’s ventricles and valves of the heart are completely removed and this goes in their place. Crazy right? 🤯⠀
⠀
In this picture you can see the mechanical metal valves and if you look closely in the middle you can see yes, that is VELCRO that attaches the two plastic ventricles together. The flappy suction cup looking parts around the valves are sutured to the patient’s atria. ⠀
⠀
These patients are usually in the ICU for months...but once they become stable, they are able to go home attached to a 13.5 pound portable pump that runs on battery, and worn as a backpack or shoulder bag. This becomes their new way of life. 🎒⠀
⠀
Who’s taken care of a TAH patient before? Opinions on this therapy? Would you say yes to this if it was your last option to live⁉️
Instagram post 2171229601102553105_6816277 One of my posts from a few years back but still a good reminder to my fellow nurses as winter rolls around 🏥⠀
⠀
“Patients do not put their trust in machines or devices. They put their trust in you. You have already spent years studying, training, doing research & seeing patients. And you likely have many years of education before you. ⠀
⠀
But please remember the more skilled you become, the more specialized you become, and the more dependent on technology you become — the easier it becomes to lose your humanity, forget your compassion, and ignore your instincts. ⠀
⠀
I have one last piece of advice: Never ever lose your moral compass.” 🖤 Margaret Hamburg, MD⠀
⠀
In this photo the patient is on ECMO, Impella, CRRT, and a ventilator.
Instagram post 2167776739236018984_6816277 Back to reality, but forever in the honeymoon phase with you 🥰💕

Lipstick & Lifesaving

Nursing

Why You Should Go to NTI

June 7, 2018

NTI (National Teaching Institute) is an annual critical care nursing conference through AACN that gathers nurses from all over America. It’s basically like Disneyland for ICU nurses. Ok… maybe not that great, but it’s pretty close. There’s over 300 educational sessions offering over 37.5 CEUs, over 400 vendors (hello!), and over 9,000 acute and critical care nurses attended in 2018.

 

NTI Boston AACN

 

The world of ICU nursing is constantly evolving. It is not only important, but it is crucial that RNs don’t remain stagnant in their workplace, and continue to stay up to date on the latest research and evidence-based practice. This was my third time attending, and I can’t explain how energizing it is to go every year. NTI gives you that annual reboot to stay passionate for your career. Because nursing after all, is so much more than just an occupation. It has become a way of life for all of us.

 

girl in ambulance at NTI Boston

 

girl in helicopter at AACN's NTI Boston

 

Each year, NTI is held in a different location. This year it was in Boston, with Orlando coming up next in 2019 (hello Disneyworld trip!). You get to stay in a hotel with your nursing friends, and strengthen relationships with them outside of work. I truly believe hanging out with your coworkers for fun drastically improves your job satisfaction.

 

nurses at NTI Boston

 

social media influencers at NTI AACN Boston

 

The conference goes from Sunday to Thursday, with Thursday being a half day and Sunday offering some preconference classes. I usually attend the Sunday Leadership Development Workshop (LDW) being a board member of my local AACN chapter. Technically, the conference begins Monday. Each day is up to you. You make your own schedule based off of what classes you want to attend. There is everything from hemodynamics to trauma, to political issues in nursing, to advanced practice nursing classes. There’s sessions on safety, nurse burnout, and certification reviews. So many classes. You get to schedule what you want to learn about and check out all of the amazing vendor stands in between classes. The best part is even if you miss a class, they’re all available to you online after attending.

 

Girl in rotoprone bed
Obviously had to try out the rotoprone bed.

 

When you’re not at the conference, you get to tour around a new city with your coworkers or relax at the hotel. They do a “Nurse’s Night Out” during the week, where they host a party at one of the city’s big tourist attractions. Last time I went it was in New Orleans, at the museum where they keep all the Mardi Gras floats. There was a bar with music and dancing, it was so much fun. Nurses know how to party amiright?

If you’re certified, there’s also a Certification Celebration dinner to celebrate your accomplishment along with other certified nurses. This was my first year attending as a certified nurse and it was so much fun! Additionally if you attend NTI, you get a free month of access to AACN’s certification reviews online, as well as lecture printouts which are normally almost $200. This is what I used to help me study for the CCRN. The online sessions are really helpful!

 

certification celebration NTI Boston nurses

NTI is great for bringing fresh new updates in critical care back to your unit. It gives you the opportunity to network with nurses across America and talk about the things that work great for your unit, and the things that need improvement. If you see a piece of equipment you love at the conference and want to implement it on your unit, the vendors are more than happy to set up a visit to your unit to talk about it. There’s also tons and tons of booths from universities you can talk with if you’re interested in furthering your education.

Basically if you’re an badass critical care nurse like myself you need to be at NTI. Let me know below if you’re thinking about attending next year in Orlando – I would love to meet up with you guys! For more info, check out AACN’s website here. Leave any questions below!

TAGGED WITH: aacn, ccrn, critical care, icu, intensive care, nti, nurse, Nursing, nursing school, registered nurse
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Hi, I'm Marissa.

I'm an ICU Nurse on the nightshift. Here you can find some education & motivation, along with a touch of sarcasm to keep you sane in a difficult but rewarding career. Thank you for stopping by!
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Instagram post 2198283598732465943_6816277 Let’s talk about every ICU nurses 𝘧𝘢𝘷𝘦 drug....⁣
⁣
𝐏𝐑𝐎𝐏𝐎𝐅𝐎𝐋!!! 💤💤⁣
⁣
🔹It is a general anesthetic.⁣
🔹Indications include:⁣
▫️Induction of general anesthesia in children & adults.⁣
▫️Initiation & Maintenance of Monitored Anesthesia Care (MAC).⁣
▫️Sedation of intubated patients in the ICU & ER.⁣
🔹It is a short-acting hypnotic. The mechanism of action is not entirely known...but propofol is known to work on GABA.⁣
🔹Produces amnesia (so you don’t remember)⁣
🔹 No analgesic qualities. This is important to remember that while your patient may be snowed on propofol, you still need to treat any underlying pain they may have with other drugs.⁣
🔹The most common side effects that I see would be bradycardia & hypotension. A rare side effect is green urine. 😳 Anyone seen that before? I have it’s weird.⁣
🔹If not contraindicated, patients should have DAILY “sedation vacations 🏝” in which the propofol dose is lowered to get a neurological assessment. This has also been proven to better patient outcomes, shorten length of hospital stay, and decrease the incidence of ICU delirium or Post-Intensive Care Syndrome (PICS), which is basically PTSD following an ICU admit. 👎🏼⁣
⁣
Pssst...if you’ve made it this far, this post is a hint 🤪 any guesses as to what I’m hinting at?! 🤐
Instagram post 2196088912160989955_6816277 We all have scars. 
My scar used to look good. A nice clean cut after my first surgery. But as the months passed, I fought a physical and mental battle daily following my accident. I rejected what was reality. I couldn’t accept it. I was internally bleeding emotionally, and then one day, physically. Blood began to pool under my scar, and my hope, patience, and skin began to stretch thin. 
It hurt. One day it couldn’t stretch anymore, and my scar burst open. I evacuated a hematoma in my bathtub. The pressure was released, and the fragile skin began to repair itself again. 
Another month went by, and the emotional buildup continued. I was depressed and jealous of others who weren’t going through what I was. I kept asking “why me,” what did I do to deserve this? The scar began to stretch again. One morning I woke up in a pool of blood. My scar was demanding attention. 
Then came yet another setback... osteomyelitis. The bones in my leg had become infected. I was rushed to get a PICC line and was on IV antibiotics q8h for 6 weeks. I had allergic reactions to every antibiotic I was put on, some requiring me to go to the ER for IM Benadryl. I was still in a wheelchair. I was exhausted. I was covered in a rash the entire 6 weeks, and prescribed atarax to basically sedate me enough to not feel the itch. My mind and body were giving up. I had seen this at work before. The young girl who dies after a straightforward surgery, followed by every complication and infection. I told myself I was going to die. 
But then one day, I didn’t. The thing about scars is that they demand attention, acknowledgement. They will continue to push and pull at you until they burst. What you resist, persists. While your scars may not be physical like this one, we all have emotional scars from our past that will continue to build up until we explode. If instead we accepted our scars, our battlewounds, our past...we are then able to move beyond them and develop scartissue... that while jagged-looking and not a clean cut, it forms even tougher skin than before. 🖤
Instagram post 2193901986528094758_6816277 LETS TALK DRIPS. 💧⠀
⠀
Drips can be intimidating when you’re starting in the ICU. It’s extremely important to understand the mechanism of action behind each drip, and not just follow orders/handoff to “keep MAP > 65.” ⠀
Each drip is very unique, and it’s gonna be on YOU the nurse, to speak up on why a prescribed drip may not benefit the patient, and be able to recommend another drip + give the rationale. 🗣⠀
⠀
I can’t count the times I’ve called the doctor at shift change and ask for a different drip when I see what’s hanging. For example, getting report to maintain a cardiac index > 2 on the med above (norepinephrine/levophed), and the nurse was going up and up on the drip to make the goal but still not meeting it. ⠀
⠀
When given a history of heart failure and an EF of 10%....this patient may need DOBUTAMINE instead of levophed to improve cardiac output. That’s because I know that dobutamine helps with CONTRACTILITY of a poorly functioning ventricle, and it DECREASES AFTERLOAD to help pump that blood out. THAT will actually help maintain your CI because you’ll stop vasoconstricting, causing an increase in AFTERLOAD for a failing heart if they had used levophed. Make sense?⠀
⠀
Would you guys be interested in more drip specific education? What drips do you guys see the most? Lemme know below! 😃
Instagram post 2185954718529320955_6816277 And as you become more successful,⠀
The amount of haters will grow. ⠀
There is a direct correlation⠀
As you check off more boxes⠀
Smiling as you go⠀
They are watching⠀
But do not forget⠀
You were not born to please other people. ⠀
Getting their approval ⠀
Was not part of your bucket list.⠀
Keep your head up 
And
Eyes fixed on your daydreams⠀
Because soon⠀
They will no longer be daydreams⠀
It will be your reality⠀
If you keep this mentality. ⠀
So⠀
Envision your future self often. ⠀
Set your intention daily.⠀
And get to work.⠀
-⠀
Sincerely,⠀
My exhausted jotted-down thoughts post nightshift 3 in a row. 😂 .
💾 Save this post for motivation 👍🏼
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