http://allnurses.com MedSurg Nurses networking with each other discussing issues that are relevant to Med-Surg Nursing. Medical Surgical nurses work in hospitals, acute care units, home care, and long-term care facilities to provide care for primarily adult patients before and after surgical procedures. They also attend to those who are being treated with medications to manage illness. en Sat, 21 Nov 2009 00:34:47 GMT vBulletin 60 http://img.an-file.info/misc/rss.jpg http://allnurses.com http://allnurses.com/medical-surgical-nursing/calling-experienced-rns-439571-new.html Tue, 17 Nov 2009 16:21:05 GMT I just took a mandatory hospital new grad computerized exam to test my basic nursing competencies. ... I just took a mandatory hospital new grad computerized exam to test my basic nursing competencies. It basically consisted of watching several videos (you just got one chance to look at each video) and had to point out what was taking place in the video. For instance, one pt was having a heart attack, another pt a stroke, PE, there was a diabetic pt experiencing hypoglycemia and so forth. There was a total of six scenarios. After watching the videos you had to first write what your interventions would be; then anticipate what the dr. would order; and then write nursing diagnosis for each one. Needless to say I didn't do so good. Could someone please clarify what to anticipate with these problems - particularly when it comes it notifying the dr. ]]> Medical-Surgical Nursing g61j http://allnurses.com/medical-surgical-nursing/calling-experienced-rns-439571.html http://allnurses.com/medical-surgical-nursing/medsurg-certification-438848-new.html Fri, 13 Nov 2009 14:31:11 GMT Hello fellow awesome medsurg nurses, I am trying to decide on which medsurg certification to go... Hello fellow awesome medsurg nurses,

I am trying to decide on which medsurg certification to go for. The ANCC or the AMSN. I welcome all opinions and advice. ]]> Medical-Surgical Nursing helper T cell http://allnurses.com/medical-surgical-nursing/medsurg-certification-438848.html http://allnurses.com/medical-surgical-nursing/post-lap-nissen-437095-new.html Thu, 05 Nov 2009 22:50:02 GMT Hi everyone! Looking for some advice from some experienced nurses. I am a nursing student which... Hi everyone!
Looking for some advice from some experienced nurses.
I am a nursing student which is how I know about this board. I had a Lap Choly and Lap Nissen 3 weeks ago. I have just started developing a persistent pain at the site of the wrap. I first thought it was heartburn but I have had it so frequently now that I no longer think that is what it is. I never have it when I wake up in the morning but it starts in the afternoon and persists on and off for the rest of the day. I have not taken any meds for it yet. It does not matter what I eat or if I even eat at all. I still have it. Today I accidentally lifted the vacuum cleaner for a few seconds. That got me to thinking that I was also straining for a bowel movement all last week due to constipation from the Lortab. I have since taken some MOM and got some Metamucil which is helping a little. I did still have some trouble swallowing at lunch today so I guess that is a good sign it is still in place.

I see my surgeon next week but wanted to see what everyone thought.
Could I have possibly ruptured the sutures?
Has anyone seen this happen and what are the signs and symptoms?

Otherwise, what is this pain I am experiencing. Should I try some Tylenol?

Thanks.

Lisa ]]> Medical-Surgical Nursing liser79 http://allnurses.com/medical-surgical-nursing/post-lap-nissen-437095.html http://allnurses.com/medical-surgical-nursing/doing-preceptorship-medsurg-437062-new.html Thu, 05 Nov 2009 20:55:09 GMT Okay guys, please throw all your advice at me. I will be doing my preceptorship on the... Okay guys, please throw all your advice at me. I will be doing my preceptorship on the MedSutg/Tele floor starting next week. I need to know what to expect and how to relate to my preceptor. Should I pretend to be a blank slate? I want to have a good time with my preceptor. I am a people person and very easy to talk to. What should I review. I am very happy to reach the end of my journey. It has been a long and rocky road. Looking forward to hear from you :dance: :heartbeat:spin:. ]]> Medical-Surgical Nursing goodnursingstudent http://allnurses.com/medical-surgical-nursing/doing-preceptorship-medsurg-437062.html http://allnurses.com/medical-surgical-nursing/what-do-new-436545-new.html Tue, 03 Nov 2009 20:44:13 GMT what do you do with a new cardiac rythnm changes, after you observe the patient is asymptomatic what do you do with a new cardiac rythnm changes, after you observe the patient is asymptomatic ]]> Medical-Surgical Nursing madgina http://allnurses.com/medical-surgical-nursing/what-do-new-436545.html http://allnurses.com/medical-surgical-nursing/peripheral-pulses-doppler-436359-new.html Tue, 03 Nov 2009 02:57:01 GMT I have recently started in the position of Vascualr Specialty nurse. Does anyone know where i could... I have recently started in the position of Vascualr Specialty nurse. Does anyone know where i could find some audio of monophasic, biphasic and triphasic peripheral pulses on the doppler, to use in teaching sessions?

Thanks
Shannon ]]> Medical-Surgical Nursing Shannonagin http://allnurses.com/medical-surgical-nursing/peripheral-pulses-doppler-436359.html http://allnurses.com/medical-surgical-nursing/tight-reign-glucose-436135-new.html Mon, 02 Nov 2009 05:21:18 GMT The hospital I work in within the last year implemented glucose checks and insulin coverage on... The hospital I work in within the last year implemented glucose checks and insulin coverage on everyone, pre and post op stating faster healing occurs with this process. I am researching this, could anyone give me some insight?
dee, rn/med-surg floor ]]> Medical-Surgical Nursing deidreparkinson http://allnurses.com/medical-surgical-nursing/tight-reign-glucose-436135.html http://allnurses.com/medical-surgical-nursing/help-with-charting-435700-new.html Sat, 31 Oct 2009 02:24:32 GMT Ok, another question from a new nurse. I have the absolute hardest time charting. We have a flow... Ok, another question from a new nurse. I have the absolute hardest time charting. We have a flow sheet plus we do VIE notes but I have the hardest time figuring out what to write and make it sound clear and professional. The flow sheet covers so much and I don't want to repeat it. I just can't figure out how to write like a nurse - does that make sense? Is there a website or book to help me?

Thank you everyone! ]]> Medical-Surgical Nursing Lola77 http://allnurses.com/medical-surgical-nursing/help-with-charting-435700.html http://allnurses.com/medical-surgical-nursing/what-do-surgical-434741-new.html Tue, 27 Oct 2009 16:13:23 GMT I have never-worked in med surg and am just wondering what is a typical day for nurses who work on... I have never-worked in med surg and am just wondering what is a typical day for nurses who work on a surgical unit? Are you caring for the patients pre-op or post-op or both? Would surgical nursing be a good start to branch off into other areas such as critical care or ED?

Thanks. ]]> Medical-Surgical Nursing Angel_RN_1 http://allnurses.com/medical-surgical-nursing/what-do-surgical-434741.html http://allnurses.com/medical-surgical-nursing/any-advice-what-434623-new.html Tue, 27 Oct 2009 04:55:14 GMT I had a pt with very small pupils. I found it difficult to assess his pupillary response to light.... I had a pt with very small pupils. I found it difficult to assess his pupillary response to light. I guess they were about 1.5mm diameter. With the light on all I could see was reflections. With the light off I couldn't see the pupils well enough to assess their response. I thought I noticed a brisk response but the change was so miniscule as to be almost unnoticeable because they were already so small.This pt keeps collapsing whenever he walks. We had difficulty trying to assess for orthostatic hypotension because he couldn't stand more than about five seconds. I did notice his pulse went up by 26 beats. Lying to sitting his BP increased by about 20 systolic and 10 diastolic. His tongue was dry and cracked. I pushed fluids and he had nearly a litre during the shift. He's not eating. I tried to assess why he fell but he answers yes to everything I ask him. So he could be weak in the legs, he could be dizzy (I also asked 'so you're not dizzy?' and he said yes), and he could be faint. He is so vague it is difficult to know.
I wondered if the small pupils are due to his Kapanol (slow release morphine) and whether that is causing the problems with his BP too. I never got a chance to look through his notes to see how long he's been on it. Despite having lung Ca with bony mets (I think. One doctor wrote that in the notes) he has no pain at all. That's why I wondered whether it is because he is on morphine or whether not having any pain means the morphine is affecting him more. Lying in bed all his limbs had normal power and movement.
Does a spinal xray show bony mets in the spine? I asked the doctors to please write radiology results in the notes because we can't access the reports. They said his spine showed some osteophytes and age related changes.
I haven't seen the CXR but the doctors little diagram indicates the pt has a pleural effusion that takes up about three quarters of the right lung. He is mediastinal deviation. What I want to know, and can't find an answer to, is whether this can cause cardiac problems?
The doc wanted to start IVT but the pt doesn't want it. He said he'd drink more.
I don't know what else I could've done or assessed either. ]]> Medical-Surgical Nursing Darknights http://allnurses.com/medical-surgical-nursing/any-advice-what-434623.html http://allnurses.com/medical-surgical-nursing/has-anyone-figured-433447-new.html Thu, 22 Oct 2009 16:53:33 GMT I am yet another overwhelmed new grad and I have read the pages upon pages of people saying "stick it out a year" and "you'll feel better after 6 months!

I have been out of a 10 week orientation for about a month now, working nights with 5 to 6 patients. I think I work on a great floor with nice people and a good manager, although it is still super busy and very challenging. There are days where people seem upset and overwhelmed but there are plenty where everyone seems fine. I have had mostly positive feedback and have never been called in to be told I made some huge mistake or anything. I guess I am more concerned about being fired/reported to the bored/sued for something I missed. I feel like I can't give anyone enough time with all the running around I do and we do get some fairly high acuity patients. I have had a code, a couple ICU transfers... heard of patients having a bad outcome a few days later.. I feel like I did all I knew to do with all of these people and I constantly am bugging the charge nurse with questions, but I'm so afraid something is going to come back to haunt me. We also have lots of nursing home, dementia or just plain confused patients who try to get out of bed, pull of their oxygen, pull out their IV, etc, and I know we can't just tie everyone down or have a sitter in every room! We have even had a couple people fall while family members were standing right there and just did nothing. It's scary! I wish I could just have one patient so I could sit there and stare at them and have their vitals constantly monitored like in the ICU. A lot of people tell me "you will get used to it, this stuff happens" so am I just being too sensitive.. people sometimes just decline or code or have bad outcomes and it's not my fault? I am scared that I suck at nursing and nobody is telling me or that I will get sued years from now for some mistake I made as a new nurse. I would think that if I was doing a bad job someone would have said something by now. Am I just being paranoid or do nurses just live with this level of fear all the time? I don't know if I can stay in this field if it feels like this forever, I'm always thinking about it at home. I have no problem with working hard and was looking forward to it, but I also want to feel good about the work that I'm doing! ]]> Medical-Surgical Nursing Kittyfeet http://allnurses.com/medical-surgical-nursing/has-anyone-figured-433447.html