Latest Comments by AnnieOaklyRN

AnnieOaklyRN, BSN, RN, EMT-P 21,817 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'Previously ER RN, 17 years in EMS (yes, I still love it) , IV RN 8 months!' year(s) of experience and specializes in 'IV RN, (911) Paramedic'. Posts: 2,006 (32% Liked) Likes: 2,218

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  • 1
    AJJKRN likes this.

    Hi,

    If a person is awake enough to eat and drink they do not need a nasal airway in.

    This is going to sound blunt, but that doctor is a moron! He is going to increase the chances that she actually aspirates her food and drink. What is he thinking???? A nasal airway is not going to have any effect on a patient coughing up thick mucous from the lower airways, the point of a nasal airway is to help open up an airway for an OBTUNDED patient!

    I would seriously stop feeding this patient until the nasal airway is removed!


    Annie

  • 8
    nursiebean, Zyprexa, NRSKarenRN, and 5 others like this.

    Hi,

    When a patient is having an inferior MI, you should always do a right sided EKG ( V3, V4, and V5 on the right) PRIOR to giving NTG. The right ventricle is very dependent on after load and preload especially if its infarcting, thus as another poster eluded you should be giving fluids to the patient, not NTG, after you assess lung sounds of course. Also the right sided leads will not have crazy amounts of elevation, and it can be very vague because the right ventricle is a lot smaller than the left ventricle, thus the waves are smaller.

    That was rather negligent to begin patient care with NTG before he had an EKG or IV in place! Please don't ever let that happen again. Tell you clinicians to read the research, as NTG has never been proven to lessen morbidity or mortality in MIs! Morphine has been shown to INCREASE mortality. If a narcotic needs to be given, which in most cases it can help calm the patient and take the edge off, Fentanyl should be given instead of Morphine, especially if a STEMI with right side involvement is present.

    Please encourage your nurse manager to provide increased education on the management of STEMIs and chest pain patients, as it would seem the knowledge is lacking, or at least that is the picture you are painting.


    Annie

  • 0

    Hi,

    Be understanding of your new facility, as they do not yet know your capabilities and they do not want to risk patient safety if they start you off with critically ill patients that you are not ready for. You may know or think you are ready for them, but they do not know you and do not know that you are ready just yet.

    In other words, try and be patient, even when you are bored. Be proactive and in your down time, if you have some, start reading or looking up diagnosis information for the patients you frequently receive.

    Annie

  • 0

    Honestly, I am pretty sure most nurses can do basic math; however using a calculator to do that for us decreases human error and speeds up the process, thus being safer and more efficient than doing it by hand!

    Would you rather your nurse (who is both human and prone to error) do it all manually or the calculator?

    Annie

  • 2
    NRSKarenRN and JustMe54 like this.

    Hi,

    Does the patient have a valid DNR in place? That would be the key or is he on hospice services?

    I would do some research in your state and if the patient is willing to sign a DNR, then I would encourage that, or the family if the patient is no longer able to make decisions for himself. Make sure they don't just have a will or some other piece of paper. In most states EMS can only honor a valid state provided DNR form which you would need to get from his physician or social work.

    The biggest missing peace of information here is as to whether or not the patient also wants to call it quits and if he is still mentally capable of making decisions about his own healthcare. Some physicians may not be willing to sign the DNR if the patient's issues are caused by a problem that can be cured (Meth use) and not from a terminal illness, although in my opinion addiction is in fact a terminal illness for most.

    You can force a patient into detox, but that doesn't work unless they truly want to stop. It would be like taking cigarettes away from a smoker for two weeks who has no intentions of quitting.

    Good luck.

    Annie

  • 4

    Hi,

    I work as an IV nurse and we use arms (upper arms included) and feet, but only if absolutely necessary and with a doctor's order. I will not do a foot IV on an elderly person, someone with PVD, or a diabetic. I would NEVER put an IV in someones chest wall, especially a female because if they end up with a bad infection or infiltrate that could mean the loss of breast tissue and could be disfiguring! Not worth it when here are alternatives. We can usually find one in the arm with ultrasound. If we cannot we will consult with the physician and they can opt for some other access, either a PICC, midline, or EJ.

    In emergency I recommend an IO if there are no contraindications.

    Annie

  • 1
    BookishBelle likes this.

    I know how you feel, it is so gross, but I find a lot of men want women that are far younger than them!

    I moved out of my condo last year and there was an older man, probably in his 60s, that actually said to me as I was packing the moving truck that if I ever wanted to have dinner out with him and go back to his place (he added that he lived alone for a reason), he would really like that. I vomited in my mouth a little, and then in the bushes, and then in my bathroom and did not eat the rest of the day! So gross, some men just have no social skills and think any women they meet that is single must be desperate enough to sleep with them! This was the same guy who lived in a unit with windows right next to the front door, he would sit in his underwear in his rocker chair almost every night and once he was even watching porno with the blinds wide open I think someone said something because I saw the police there and he never did it again! So discusting!!!

    I tried to erase this memory from my head, but as you can see it didn't work. I had other friends/neighbors in the condo building that I would like to visit, but it would be so very awkward now I will never go back there!

  • 0

    Hi,

    I'd be careful since the exposure to all these chemicals are probably far more harmful then the exposure to 'germs".

    Keep in mind some exposure to the germs are good for the immune system, and to be honest unless you are bringing home virus like those causing cold, flu, stomach virus etc you will be fine, and even if you do unintentionally infect yourself you will still be fine . It would be hard to infect yourself with a bacterial infection from a patient unless you are purposely exposing yourself or not following recommend infection control practices. Hand washing is the most diligent thing you can do (NOT hand sanitizer).

    Try not to be so paranoid. I get it, people worry about their family members, but don't go overboard. Yes wash your clothes and yourself, but no need to lysol everything etc.

    I have worked in the medical field for 20 years and have always warn my scrubs or uniform and shoes into my home, not once have I had an illness attributed to my shoes or scrubs.

    Annie

  • 2
    Pixie.RN and KeeperMom like this.

    Please clarify what you mean by "code", as someone else said some of those meds would not be given during a cardiac arrest.

    Annie

  • 0

    Hi,

    as others have said it depends on the physician and their comfort level with sedation. I find when the general surgeons do it, they often do not sedate well enough. Our ED docs which often times use Fentanyl and Versed or just order Propofol, which my opinion is the best option.

    Chest tubes are VERY painful and I think it's kind of inhumane when they do not sedate well enough, unless there are good reasons not to like BP etc.

    Annie

  • 3

    Hi,

    As the last poster eluded to you may want to see if they are having a CISD for the first responders and participate in that. That may help you work through what you have seen. Good luck and god bless.

    Annie

  • 1
    PrereqTaker89 likes this.

    Hi Cherimcd91,

    I am up in your neck of the woods and can tell you to go for it if you are ready. i will say your kids are still young and it may be difficult to do. Assuming you have a husband who is able to help out around the house and with the kids it is doable.

    There are many community college programs in your area as well as universities. If you can afford to go right for the BSN, I would. There are fewer and fewer hospitals in MA willing to hire ADN prepared nurses as new grads.

    I would also start taking some general education classes just to get your feet wet and lighten the load when you are in the actual nursing program.

    Just PM me if you want any more specific information ! Good luck!

    Annie

  • 0

    I would first get a job at a hospital so you may get some tuition assistance, as well as some experience. Also shift work is more flexible.

    We cannot really help you with making your financial decisions, only you and your wife can do that.

    I would also look into scholarships, as that money may help as well.

    Annie

  • 0

    Hi all,

    As many of you know I have been desperate to get into NICU nursing for several years with no luck since the job market in the northeast is terrible.

    I was wondering you think a unit would let me shadow a NICU nurse for a few hours so I can kind of at least see what it's like, as I am at the point where I need to probably move on and look into a new area, but I also want to see if I "love" it so much that it's worth investing more time and emotional energy and the money to join NANN etc. I have been trying to get into an NRP class, but that has been like pulling teeth. To many candidates, not enough seats

    I just want to know if it's something I truly like, or if I just think I would, and I won't.

    Any input is appreciated.


    Annie

  • 5

    It isn't about what happens during CPR it's what happens after, which can include permanent disability and brain damage (permeant vegetative state), huge medical bills with a person that is still dead. I would focus more on the big picture versus the right now. CPR isn't gonna effect the dead body, but when we bring them back with only their brain stem surviving or worse a small part of their cerebral cortex, that's where people may get that its not something they want to endure!

    Unfortunately society sees what is on tv and that is usually a code, CPR, a shock and like a miracle they all wake up and are fine! You need to emphasize that most patents who go into cardiac arrest stay that way and another percentage will have permanent brain damage that can leave them bed ridden etc. Advise them that only 8% of out of hospital cardiac arrests survive to discharge, that is a very small number and it's up to the patient and family if they want to roll the dice!

    Encourage patients to speak up and voice what THEY want if they are cognitively able and advise the family to make sure there are no advance directives if the patient can no longer make that decision. I think families have a false idea that everyone gets a shock and wakes up and life goes on.

    p.s. let them know not everyone is in a shockable rhythm either!

    Annie


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