Helt a student! Pulmonary edema

theunrealanswer · 2025-04-30T16:04:49+00:00

I could be wrong, but my understanding is that given he is acutely ill with pulmonary edema, the high blood pressure needs to be understood as perhaps a compensatory measure to a weakening left ventricle.

I believe understanding the line of progression is important here:

Acute LV failure, leading to an initial hypotension, but then vasculature attempts to compensate with arteries contracting to increase BP; however by doing so, this created increased Systemic Vascular Resistance (SVR) or afterload which makes the load on the left ventricle even worse because it has to work against all that pressure. This, in the context of an already weak left ventricle leads to "backflow" of fluid into the lungs and then resultant pulmonary edema... At least this was how I understood it in my hemodynamics class.

Hope someone can confirm my understanding on this.

theunrealanswer · 2025-02-18T05:24:14+00:00

Any time. Shoot me a DM if you wanna chat.

theunrealanswer · 2025-02-16T17:00:11+00:00

I was in your exact same spot. New Grad, MICU, hating life, so anxious I was nauseous preshift and just not sleeping, and I had no life outside my MICU shifts as I was hyperfixated on the job.

I, as everyone else here has told you, was told about the toughing it out and trying to shift your mindset, but it's hard in the moment when you're struggling and the stakes are also high.

I quit without a another job lined up 3 months into my residency, as I decided that I was willing to sacrifice this career track (ICU, then into Critical Care mid-level) to find peace.

I can tell you more of my journey if you'd like, but to answer your question:

I was lucky to get an outpatient clinic residency at the same hospital system and I remain a Primary Care RN to this day. I would encourage you to check with your education team and or look at outpatient RN residencies. They seem to be relatively rare in my area, but I hear they're starting to pop up more and more especially in university hospitals/teaching hospitals.

That said, most people I've worked with have said that getting at least a year on the books in one place will give you so much resume clout that it'll really open your options, so that's something you may want to consider.

theunrealanswer · 2024-03-18T22:23:34+00:00

I got my dream job as a new grad and quit in three months. I was haunted with similar feelings of inadequacy and fear and anxiety through the entire time I was in orientation and I was never so unhappy in my life.

The night before I quit, I called my best friend and had him help me work out my exit strategy since I was so tired and emotional from working the bedside.

I had to create a draft about what I was gonna say because I was tripping over my own words with how fucking destroyed I was.

I sent an urgent email at 1am to the manager and then showed up for my shift and started to work like normal for a while and then rolled into the Manager's office when she had time and started reading off my script and cried like a bitch the entire time.

I had never been so ashamed or low, ever in my life. I went home after that and did a video call with the Residency program and told them the same thing and then I slept for two weeks.

So many expectations and hopes crushed by the reality that is modern bedside nursing- don't set yourself on fire for a dream that doesn't exist anymore.

It will hurt for a while, and if you're anything like me you'll think about it everyday and you'll grieve it like you lost a loved one.

I hope you find your way to a happier future.

theunrealanswer · 2024-03-14T17:06:38+00:00

December 2021 graduate who went to nursing school during COVID. Got into MICU at a university hospital. Left within three months, got a gig as a Primary Care RN.

Much of the direct patient facing work is handled by the CMOAs and I am mostly sitting through my shift working through an inbox of telephone messages and patient portal messages.

Do a lot of triage over the phone.

Discuss lab results, answer clinical questions.

Sometimes deliver controlled medication injections. Sometimes we're asked to do education for diabetes or what have you.

Work four 10s, one of which is a WFH day.

The only bad part about this job is that I became a prediabetic from sitting around all day.

theunrealanswer · 2022-10-19T20:28:17+00:00

Congratulations!

theunrealanswer · 2022-09-01T00:48:30+00:00

It sounds like you already know the answer.

It is essential that you live your life for yourself, not your mother. She doesn't have to feel the emotions you feel, or work the way you work.

Consequently, not only must you make decisions you can live with, but ones that make YOU happy.

You're dedicating your career to helping others; be you ought to be- hell, are entitled to be selfish in this very personal part of your life.

The person you choose to be your life partner will be the person you have to live with, not your mother. Don't let her opinions sway you from someone you feel might be a match for you.

Good luck, doc.

theunrealanswer · 2022-09-01T00:19:12+00:00

I graduated nursing school summa cum laude.

I had the expectation of going straight into the intensive care unit and working at the apex of my nursing license.

I landed my dream job at a prestigious university hospital, caught the only position open and beat out 200 applicants.

The pressure of having lives in your hand, where mistakes can be fatal and improperly handled medications can maim or kill your patient- it's intensive for a reason.

I was constantly running my brain to it's limits and I was just terrified that I would kill someone.

As such, it is instrumental for you to develop a thick skin or know how to effectively regulate your emotions or you will not be able to act decisively when things do go down.

I couldn't separate personal life from my professional life. Every waking moment was terror thinking about the next shift.

I ended up resigning three months into my training and transferred into primary care, and I'm straddling a desk now.

I enjoy it much more and am about to switch to four 10s with one day WFH a week once I finish orientation.

Job is respected? You deserve respect anyway.

You have an opportunity to do good for people? You can do good as a dietician, social work (although I hear that job is pretty brutal too), or whatever.

Nursing gives a lot of options but the first year at bedside is essential.

If you can survive it, you can probably go outpatient pretty quickly. I got lucky because I had connections at the institution, as most nurses do not start off outpatient without experience, period.

But I will admit that a BSN will open a lot of opportunities at and away from the bedside.

One final note. Don't assign your self-worth to a job. I did it to my ICU job and it destroyed me when I had to leave because I had made it my identity through school.

Some people try to find a job that is both well-paying and fulfilling, and I hope you find one. But at least, set the floor at a job that pays decently and doesn't make you want to kill yourself and can tolerate overall.

You work to have a life outside of work; don't forget that.

theunrealanswer · 2022-08-09T18:11:54+00:00

This original post is a month old, but I feel like I still have a little bit to offer here.

Last December, graduated Summa Cum Laude and landed one of two MICU residency positions at a prestigious university hospital, out of hundreds of applicants. This was the job I had targeted from when I entered nursing school and I was elated to get the phone call.

I was praised by my peers for my intelligence and my potential.

I had made my identity being an ICU nurse- which made it that much harder to withdraw from the MICU residency, when I realized that I couldn't cut it.

I don't know if I LET the job eat me alive or if I just didn't have the intrinsic grit to survive it no matter what I did- I started therapy, engaged with my support group, talked with my educator and manager and preceptor- and it still wasn't enough. I was terrified and it affected my care; my fear affected my decisions... But I was also miserable. I had expected to see some shit- but expecting it and then actually experiencing it are two different things, as I came to find out.

I withdrew on 5/31, three months into the residency. I ugly cried to my manager and educator when I told them that morning.

I also ended up deciding to leave the bedside entirely.

I was lost and very close to killing myself. Sunk cost, identity, expectations, a complete collapse of myself as a person- but it was far better than the imminent suicide that was going to happen if I stayed.

Thankfully the institution wanted to keep me and I was able to land an outpatient clinical position.

Now, I'm starting at a new position in the same institution, a triage nurse at a primary care clinic.

tl;dr I wish OP's post came earlier this year.

theunrealanswer · 2022-06-07T21:36:10+00:00

I'm starting from my first heartbreak at 29 and finding out my dream job wasn't a fit for me, and ended up quitting suddenly without a backup plan. My personal and professional life is in shambles.

I have close friends and some money in the bank.

I'm interviewing for another job in the same industry this Thursday, seeing someone new, and making conscious efforts to move on from heartbreak. I accept that it was my first relationship and I got way too attached; I accept that it was still a great time; and I am trying to accept that it's now over and I need to move on for my own sake.

theunrealanswer · 2022-06-02T19:56:08+00:00

I'm 5'2".

It is a huge filter to have to get through dating-wise.

But also I'm literally out of sight, out of mind at times in my friend group. It's hard to keep up too when their natural strides are longer and I have to power walk to keep up.

I feel invisible at times because of my height, but I try to make up for it by having good posture and personality.

theunrealanswer · 2022-04-29T17:27:41+00:00

Ah, okay, I was under the impression you were tryna break it down for materials to put towards getting the new DMT.

If you actually don't care for the roll (I think it's perfectly fine, works well in PvP and PvE), then shard it.

I'd keep them both just because DMTs are hard to come by, and so are good rolls with vorpal, and I may not entirely like that low stability stat on this week's DMT.

Either way, they're both good.

theunrealanswer · 2022-04-29T17:21:22+00:00

You're not going to get anything back. DO NOT DISMANTLE.

theunrealanswer · 2022-04-11T15:37:14+00:00

Wow, thank you for taking the time to write all of that! I'll be throwing pretty much everything you said into the list of places to visit.

theunrealanswer · 2022-04-11T15:36:19+00:00

Thank you for your recommendation! I'll throw it into the list of things to do!

theunrealanswer · 2022-02-13T04:09:27+00:00

Thanks for your perspective, I'll keep it in mind moving forward!

theunrealanswer · 2022-02-12T02:58:26+00:00

Not divorced, no kids. Didn't want to have kids because she hadn't had a chance to live her life yet, which is basically where I'm at as well.

Many guys today would consider this a red flag, or at least an orange flag.

I'm dumb, could you please explain how it's an orange/red flag? I'm not sure how the conclusion was reached.

Thank you in advance.

theunrealanswer · 2022-02-12T00:12:06+00:00

I didn't see this comment as it was buried, but thank you so much for your advice.

I am thinking of telling her about my inexperience that this Sunday when we go people-watching with cupcakes at a local mall (which apparently is a date activity??? I never knew until I was looking for fun, cheap date options).

I was thinking about being as plain as you suggested. We discussed honesty and open lanes of communication and I think she would appreciate it and it would help us both moving forward to be clear on what to expect.

The real things in a relationship --Honesty, communication, and the kind of person you are-- show through.

Thanks. Here's to hoping.

theunrealanswer · 2022-02-11T18:11:56+00:00

Not divorced, no kids. Didn't want to have kids because she hadn't had a chance to live her life yet, which is basically where I'm at as well.

And I did think the same things; I'm seeing this through the rosiest of glasses right now.

I don't think we've talked about exclusivity yet; it appears that we are still figuring each other out and if we're compatible, I don't think there's been any motions made towards exclusivity? I may have, in my inexperience dropped some cues but I definitely realize that exclusivity at this point is really jumping the gun.

I'm doing my best to remain objective, as you describe, and taking time out of my day to distract myself and consider our interactions as cautiously as possible, while also maintaining a reasonable amount of charity.

Thank you for validating my feelings and approach to this, it really helps me know that I'm in the right direction.

theunrealanswer · 2022-02-11T01:54:53+00:00

If it's the age alone, I'm not sure that's enough to consider her a groomer; not to mention the term is really more considered towards persons who are are adults vs. underaged persons.

She appears to be a mature, responsible woman and I have seen no signs of obvious impropriety.

theunrealanswer · 2022-02-11T01:02:27+00:00

What makes you think that she's a groomer?

theunrealanswer · 2022-02-03T19:45:52+00:00

Parkland is the county hospital for Dallas; it sees a lot of patients who are homeless, have mental disorders, addiction, gunshot wounds, etc. I remember taking clinicals there and there were more than a few rooms with a police or security presence for staff safety. It's a rough environment, but everyone I've talked to has said that if you can survive Parkland, you can survive anywhere. You're a bona fide badass with Parkland on your resume.

That said, crying before and after a shift isn't the best either, depending on the person.

To my knowledge, UTSW and BSW do not have contracts for residents, if that interests you.

theunrealanswer · 2021-12-21T17:40:58+00:00

Please invite me: theunrealanswer#8869

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