DaughteroftheKing 7,913 Views
Joined: Feb 21, '07;
Posts: 215 (13% Liked)
; Likes: 63
Sounds like you are dealing with some variation of septic shock. This game is about MAP and preservation of end organ perfusion. There is no "Max" dose of norepinephrine. It is just a nursing myth similar to renal dose dopamine. Your doc was correct and he was referring to mostly observational studies done in the late 1990's up to present day. Norepinephrine has also been shown in some research to reduce mortality and protect end organ perfusion more efficiently than other pressors available.
When you are up to 40mcg/min of norepi or higher, what else can you give that is going to press the patient more?? Okay, hang some vasopressin. You most likely will see a higher MAP because you are shunting more blood from the periphery back to central perfusion, but what do you think splanchnic perfusion looks like? The kidneys turn into the Sahara and the gut will be dead.
It would be interesting to know the pH and SID in this patient. Receptor sites for pressors and inotropes do not work so well after you start dropping below 7.1. Sometimes Jesus wins and protoplasm loses.
Here is a retrospective study that looks at conservative vs liberal use of pressors in septic patients. Liberal vs. conservative vasopressor use ... [Intensive Care Med. 2008] - PubMed - NCBI
An ass? No.. a confident, professional that is smart enough to know her limitations and will put patient safety first, instead of rushing to appease her b/c you're the new kid? Yes! I commend you, I can't honestly say I would've had the guts to do that when i was orienting, but i was also a new grad at that time.
I think you handled it very professionally, she was wrong to tell you to hurry, especially since a lot of this is new to you. However, i do agree with her quizzing you w/scenarios and why you're doing certain treatments. Even though you are new to this area, i think she's trying to get you to use critical thinking skills which is definately important in dealing w/critical patients. If you can give some examples of questions you asked I'd be more than happy to help you understand what i mean and show you that you already have the skills, just need to understand how to apply them.
Just curious, what kind of unit did you come from, and what kind of unit are you in now?
just remember: always always always put the patient's safety and needs first. Never let anyone bully you into doing something if you dont understand or are concerned about doing. And never be afraid to ask questions, the nurses who dont b/c their afraid of looking dumb or think they know it all, are the most dangerous nurses out there. We are always learning and nobody knows everything!
That's awesome!! I'm sooo glad to hear someone likes their job off orientation!! haha
Thanks for sharing -- its nice to hear about things going well for someone for a change! I think allnurses could use a few more "reverse rants".
the only problem I have with rewards for tenure is that not all tenured nurses deserve rewards. Maybe they stuck around because no one made them leave and it was easier to stay put. I am more in favor of rewarding service, regardless of how long the person has been employed.
I am, as I posted on the first page of this thread, pro-choice. I also have a grad dip and a masters in health ethics.
I'm appalled by how many members are not only comfortable with forcing nurses to perform tasks deeply incompatable with their personal beliefs but even, in some cases, appear to relish it.
I don't believe a zygote has a right to life but I respect the beliefs of people who do. I imagine that, for them, participating in a termination would be as traumatic and deeply distressing as suddenly having to administer a fatal injection to a death penalty prisoner would be to me.
If I applied for work in a US prison, knowing that this was a part of my expected duties then I've got no grounds for complaint. That's not the case here, from what I've read. It's in no way similar to a vegetarian refusing to assist a patient with a beef dinner, BTW - an analogous situation would be that the role now included slaughtering the animal that patient was going to eat.
I want my nurse well-rested. I don't need an insomniac calculating my meds.
Personally, I think if you're given paid time off or sick time as part of your compensation, you shouldn't have to offer any excuse for your absence, as long as you don't abuse the benefit. My old boss required me to ask every caller for an excuse, and I hated doing it.
However, I could be persuaded if I was given full tuition reimbursement,......reimbursement and additional pay should be part of the bargain!
I really don't want to go back to school for a BSN just because some education nazi ...
What I can't figure out is why the OP, after getting red flags from the get go, proceeded to go to not only one, but two interviews at this sketchy place and didn't ask any questions about the company, patient population, etc.
.....because Lemonjello and La-a were already taken......
needless to say, with all of my worrying and trying to find ways to ask him out--he was straight to the point at my appt, said he found me gorgeous, asked me to switch physicians, and got my number.
[quote=curleysue]Once when I was working in the ER as a tech a guy came in short of breath and his heartrate was really rapid. After triage I took him to his room and helped him undress so I could hook him up to EKG (wow he was buffed and handsome!).
I've been reading/posting to the "male nurse" forums and related topics... as a male nurse, imagine the responses I would get if I said regarding a patient:
"... I took her to her room and helped her undress so I could hook up the EKG (and wow, was she stacked!)."
Sorry to be off-topic, but this just illustrates the double standard. If a famale nurse has a young, attractive male patient and takes a peek at and/or evaluates his exposed body... well, it's no big deal, it's understoood that she is a professional, etc. If a male nurse does EXACTLY the same thing with a famale patient he's a deviant predator.
I would guess the same double standard would apply to dating patients. If a female nurse does it it's cute, if a male nurse does it, it's abusive.
Curleysue, that's a gorgeous story - good for you!
It proves that nurses are human and that sound judgements can be made.
My cousin married her patient. They have three kids, a house, a mortgage and two cats. He came in with two broken legs from a skiing accident and three months into caring from him requested that she be moved to another department because they were falling in love. She was up front, honest and took the possible consequences on the chin. None were forthcoming. She had a good reputation, was a respected practitioner and when the wedding was held, half the staff attended and a good time was had by all.
I love being human sometimes.
Interesting topic - nurse dating a patient that is. Had that happen to me. I was the patient, in a British, Royal Navy hospital back in the 70's. At the time I was being admitted on to the ward, other patients - all sailors - were playing the games that sailors do - asking the on duty nurses for a date. I joined in the "fun"
Thirty two years later, our family is well grown up and we - one of those sailors' and nurses', have two lovely grandchildren.
My wife retired just over a year ago. I'm the Registered Nurse now, and the law today would have prevented us - legally, if not morally - from dating. I guess I'm glad the whole world hadn't quite gone to hell in a hand cart all those years ago, but in this day of safe professional conduct, I'd want to be pretty sure of my relationship with "the patient" before "risking" a date with a patient.
Once when I was working in the ER as a tech a guy came in short of breath and his heartrate was really rapid. After triage I took him to his room and helped him undress so I could hook him up to EKG (wow he was buffed and handsome!). Anyways, when I hooked him up his HR was 160, so I immediately called the ER doc in and we took his BP which turned out to be 42/20. They immediately worked on him, got two lines in, called x-ray stat, O2 15L on NRB. And found out his lung was full of blood. I wanted to watch the chest tube insertion since I was a student nurse and he asked if he could hold my hand. I said okay. Well, they started giving him Versed and he got a little giggly, and asked me my name. I told him even if I said my name he would never remember cause he had been given a drug that will make you forget. Then he bet me if he remembered my name by the next day, I would have to go on a date with him. I agreed to the bet knowing that for sure he wouldn't remember it. Well during the whole procedure he kept repeating my name over and over and over, all the docs and nurses were like "your going to end up on a date with him!" Then my shift was over and I went home smiling. Coming back the next day I looked him up and went to see him on the med/surg floor. When I walked into his room he said, "Hi Amy". I just started laughing and got bright red. I couldn't beleive he remembered my name! So we went on a nice little date. But we just turned out to be friends. It was fun anyhow.
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