IVRUS 17,784 Views
Joined: Dec 16, '04;
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This is a very stupid question!!
1) An open fracture would NEVER be discharged home from an ER, that is a surgical case that requires immediate attention!
2) We don't use plaster any longer, except as slabs for splinting, nor do we put casts on in the ER. The rare exception would be if an ortho surgeon comes in to do a closed reduction and puts the cast on because the fracture would be to unstable otherwise, and even then they will usually bivalve it and wrap it with an ace.
This is by far the dumbest question ever, and if she got it from a book it must be from the 1980s! The patent would not need to seek medical care because they would be in the hospital for at least a couple of days if not more!
If this client is discharged from the ER they should seek medical care at a different hospital promptly!
Sure you can force a confused patient to take his/her medications. It's also called "assault" or "how to loose your license in 3 Easy Steps!"
IVRUS.I love reading your posts. I can tell you have passion for your speciailty.I will pm you later as I need your opinion as you have the expertise I need.
I am a new grad that has been working in psych nursing for one month. I want to get to med surg, but I landed in psych as my second job since I didn't like the skilled nursing setting and couldn't land a med surg job right away. I am wondering if anyone knows about getting a med surg job as a new grad. I'm afraid it will be difficult to find a med surg job. Thank you!
First of all you must know that the speciality of infusion involves more than just getting catheters into veins.Granted, that is a big part of it (my favorite part) but you must know all the theory and evidence of why we do what we do.If I were you I would join INS and purchase their text and the 2016 infusion standards of practiceand start reading.As you read the standards and learn them check your institutions policies to make certain they are good.This is what I did...I taught myself but used a different text .I used Ada Plumber ...Principles and Practice of IV Therapy.You may want to start with that one...it's easier to get through If you have passion for the subject matter you will find the learning process enjoyable. Then start applying what you learned.and see if you like it.Do this first.
That does not make any sense at all..What determines the time a bag will go dry is the total volume in the bag or cassette and the rate at which it is set and if applicable the small KVO rate between doses. If you have 250 ml and 250 mls is delivered the pump will alarm once it runs dry even though you have set the volume higher.Its best just to set the volume accurately and teach the patient or caregiver how to aseptically disconnect and flush whatever type of VAD they have to keep it patent until the nurse gets there or get there on time!
Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.
It was Christmas Eve and I was in the ER working a 11am-11.30pm shift. I eyeballed her across the ER. She walked in with her son, an old frail lady. I looked at her pallor and shaky steps and knew in my gut that she was deathly ill. "She's not going to make it out of here alive," an unbidden thought sprang to my mind as I walked towards her.
Cindy was the charge nurse and as she looked to see who was on next to take a patient, I reached her. "I'll take her Cindy," I said smiling easily at mother and son and taking the paper chart from Cindy.
"Hi, I'm Annie. I will be your nurse today," I said as I deftly got her on a stretcher and closed the curtains of cubicle #4. I helped her change into a hospital gown, hooked up to the cardiac monitor and got my first set of vitals. Her name was Mary. She had been feeling more tired, fatigued and had lost her appetite for over a week. She was a little short of breath. Her vitals were normal. Her BP was border-line. I listened to her lungs and abdomen while my mind raced. I suspected that she was septic and so drew 2 sets of blood culture along with other labs and got a urine sample that was a tad cloudy. Probably a UTI that turned into sepsis, I thought. By the time the doctor came in to see her 15 minutes later, and EKG and CXR was done and I had normal saline running. The doctor agreed that she could be septic and I monitored her vitals carefully.
The lab called back half an hour later with her blood count. Her WBC was 37. Bingo! I thought. Right on the money! I had antibiotics running and we kept pushing fluids. Her pressure began to drop and she started becoming tachycardic. I knew that she would crash pretty soon and wanted to make sure I was prepared. So I gently broached the subject with her son James who had no clue how sick his mother was or what her wishes were in case of an emergency.
I talked to Mary in her son's presence and asked her. She looked at me, with wise knowing eyes and told me, "If you can save me, go ahead and do what you need to do, but at any point if you see it not going to help me, then let me go. I do not want to be hooked up to machine and it is futile." I told her, we would follow her wishes.
I took James aside and talked to him. I asked him if he had any other family. He said he was the sole caretaker of this 87-year-old mother. His dad had died many years ago. He had a sister, who he had not talked to or seen for 20 years. She lived in the same city but they had a fight and stopped talking. I told him gently that it would be a good idea to call her as his mom was very sick. It would only be a matter of time before her systems collapsed due to the overwhelming infection in her blood. He was bewildered and said, "But she walked in! She can't be that sick". I told him that UTI and sepsis signs in the elderly were very subtle and that she might take a rapid turn for the worse very suddenly. I encouraged him to call his sister Ella.
"After all, wouldn't you want to know if your mom was very sick and you were not with her?" I asked. He readily agreed to that and dialed her number (I got it from the patient) as I held my breath. They talked and Ella asked to speak to me. She told me that she was an RN and so I was able to give her an update on her mom’s clinical status. She had just picked up her husband from another hospital after discharge and promised to be there in half an hour. "Try and keep her alive for me, Annie" she begged. I stayed by Mary's bedside but she was rapidly going downhill. I looked at her and marveled at how her dying was bringing her two children together one last time. I now had her on multi drips. She crashed. We intubated her.
Five minutes later her daughter rushed through the ED doors. I took her and her brother to our tiny family room where they talked for the first time in 20 years and hugged each other. Tears and laughter rang as they reconnected. Later Ella came to me and told me that her sick husband was sitting in the car and she had to take him home. She gave me her number and left. James came to me and told me that he could not watch his mother die. By now she was made a DNR after they talked to the doctor. He gave me his number and left.
Another nurse relieved me for break but I stayed at the nurse’s station drinking my coffee and writing my notes playing catch up. A few minutes later I heard a voice in my ear, "It is time”. Probably my guardian angel Providence, I thought to myself. I quietly got up and went to her cubicle. I sat down near her and held her hand. I spoke to her softly, "Mary, you did it. You got them back together one last time. Now it is up to them. Go in peace." As I recited the Lord’s Prayer, she flat lined and was gone peacefully. I sat at the nurse’s station and made the calls to her children.
Mary had gone leaving her final gift behind; the gift of peace to her two children. I walked out of the ER at 12 midnight on Christmas day marveling at a mother’s final act of love where she used her dying to bring her children together. Merry Christmas and God bless us all!
I'm not an infusion nurse, so bear with me, but it seems like the most reliable (and sometimes only) way to know that an IV has infiltrated is to check the site; therefore, you have to risk waking up the patient bundled in a blanket cave. It's kind of like inpatient nursing: nurses try to be respectful of patients' sleep schedules, but you're in the hospital to receive medical treatment, not to sleep. I'm guessing that patients would also rather have their naps interrupted than have their IVs infiltrate.
In order to keep patients happy, I'd just try to clearly lay out that expectation before you begin, i.e. "Mr. Doe, I will need to check your site every 30 mins; we do this so that the IV medication doesn't damage your tissues if the IV becomes dislodged. You're welcome to sleep during the infusion, but it may be more comfortable for you if you leave your [IV-site-extremity] exposed; that way, I'll be less likely to wake you up when I check the site." If a patient is freezing and wants to be wrapped up in 47 blankets, maybe work out a system with that patient so that the site/extremity is covered by blankets that can easily be pulled up to check the site and then be replaced, rather than having them wrapped around that extremity.
No matter what, I definitely wouldn't chart that you checked the site if you didn't, but I also wouldn't want to chart that I hadn't checked an IV site in hours.
I suppose the monkey is a tad bit sharper than me because I still struggle to start IV lines, draw blood and perform cannulation, even after a decade of being a nurse. I am simply not a hands-on person...
Yes Muno is correct.Once you assess patency with the 10 ml syringe you can administer your medication in whatever syringe size that is the safest for the volume of the medication.It is much safer not to transfer smaller volumes.
The OP posted stated that she prays with patients and shares with patients when she is asked to do so. There is nothing wrong with that. She isn't going into each room and forcing a prayer or the Gospel message with those who don't ask. She also stated that her actions have spoken volumes to people. She gave gifts to her classmates which included a tract - not a Bible.
I don't know why people are getting bent out of shape over this. She posted to encourage others to think about doing the same. I can say that when asked, I do the same thing. Everyone I work with know about my faith, yet there are those who disagree. We get along anyway as the reason we have been thrown together is for the care of our residents in our LTC. I don't care what your faith is or isn't as long as you give quality care to the residents. We don't have to be friends outside of work if we strongly disagree.
Also, just because a person is a Christian does not mean they are intolerant, so stop with that.
Where specifically in those recommendations are you seeing that?
I'm not sure where you're getting that from, the CDC hicpac recommendations include a 1A recommendation that staff who insert and maintain IVs should demonstrate competence in IV therapy, but nowhere does it say assessments should only be done by dedicated IV therapy teams.
Why are you so concerned about a patient having anaphylaxis? In 5 years, I have only had 1 pt have an anaphylactic response.
As a nursing student, especially during your first clinical experience, they won't expect you to know what to look for, what to do. Just take a deep breath, and try not to worry about something going wrong. Your clinical instructor should be there for you and if you have questions/problems/concerns to to her(him). If a patient says that something is wrong, call for help.
Honestly, the best thing you can do for yourself right now is take a deep breath and try to relax and learn. Clinical can be very exciting but also sometimes, very routine. And you can learn a lot from the very routine.
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