Content That Hygiene Queen Likes

Content That Hygiene Queen Likes

Hygiene Queen, RN Guide 21,339 Views

Joined Sep 13, '07. Posts: 2,325 (72% Liked) Likes: 7,789

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  • 9:31 am

    Quote from Spidey's mom
    That's how I do it too. I'm not sure about sailor nurse's post

    . . . if you break open an ampule and invert it, all the med spills out.

    I'm confused.
    I've never had the medication spill when inverting an ampule, surface tension keeps it from leaking out. You just wouldn't inject air into the inverted ampule like you do with stoppered vials. You also want to be sure not totouch the needle to the rim of the ampule, because that can also cause the medication to dribble.

  • Jun 28

    One of my favorite stories ever, although more funny than odd:

    Back when I was a tech at a hospital, I had a patient who was in his early 20s, alert, oriented x3, walkie talkie. At that hospital, patients needed an order to be able to shower, so most got bed baths, or in the case of the walkie talkies, would be given a basin and supplies to wash up. When I went to his room to give him washcloths and towels, etc. he insisted that he was unable to wash himself, even after I explained how most patients usually did it, and then I even filled up the basin and set everything up for him. Being that he had absolutely no physical limitations whatsoever, I asked him why he believed he couldn't wash himself, and he started with some story about feeling "weak," and unable to move his arms enough in order to wash himself. The strangest part of all of this was that his girlfriend was right there and even started crying. It was so awkward. Even though I wanted to slap him, I very politely offered to help him wash his back, but stated that he should be able to do the rest himself. He kept insisting that I needed to do his "entire body." He then ripped off his hospital gown, and while sitting at the side of his bed, closed his eyes and spread out his arms as if to say "wash me." The girlfriend then cried even more.

    I excused myself, stating there was something I needed to go do, and I went to the male nurse who was on that shift and told him the story. He decided that HE would go in there and offer to "help." Now this nurse was probably about 6 1/2 feet tall, on the heavy side, and had a handlebar mustache... I was DYING with laughter! When he went in the room, I hovered near the doorway to listen in.

    Male nurse in his big deep voice: "Hello, I heard you needed some help washing up."
    Patient: "Where did that girl go?"
    Nurse: "I'm afraid she's busy, and I'm the only one here who can help you."
    Patient: "Man, bring that girl back here, I don't wanna get washed up by a dude."
    Nurse: "I don't understand why you can't wash yourself. What seems to be the problem?"
    Patient: "Well, I can't reach here, and here..." as he points to those places.
    Nurse: "Well it looks like you just did."
    Patient: "Oh screw this BS, I'll wash myself."
    Nurse: "I thought so. Have a good day."

    The tears were pouring down face and my stomach hurt so bad from laughing! That nurse was awesome!

  • Jun 28

    Quote from kbrn2002
    The hallucinating residents can be hilarious. One particular gal that comes to mind regularly has visits from "friends" and even helps herself to snacks to pass around to them. Kind of funny to see about 15 little ice creams scattered around her room all open with spoons in them for her friends. She will also occasionally insist her friend is sick and needs to go to the hospital. She gets very upset that we will not call the ambulance for "Dr Bob" after all, he's right there in that chair, "CAN"T YOU SEE HE NEEDS HELP!"...umm, no I can't see him. Gotta admit I've been kind of tempted to call the ambulance to pick up her imaginary friend just to see how they react.
    I know a nurse on a Memory Care unit who will call one of the extensions, hand the phone to the resident, and the go pick up the extensions. Works every time-she acts like whatever friend or relative the resident is hallucinating about, and the resident is happy.

  • Jun 24

    When I say "as helpful as they have ever been," I'm being sarcastic. What I'm saying is that they have not been helpful in the past, and I expect them to continue to exist in their state of unhelpfulness. Thanks for wanting to understand.

  • Jun 23

    I am a psych nurse and psych nurse practitioner student. Forced psych meds and the legalities of it are commonly misunderstood by nurses who do not administer them frequently. The ONLY time that a restraint and forced meds is legal is if the person is a danger to himself/herself or others. Out of control, throwing things, threatening staff all falls under this. If a psychotic patient refuses his/her PO meds and is Involuntary, this is also not a reason to force IM meds in place of PO meds, it has to be court ordered and this is usually done in a third or fourth court appearance, not in the initial 72 hours. If you see an order by a physician like this you should question it! Even psychotic patients have the right to refuse PO meds while involuntary! Only force IM psych meds when acutely a danger to self or others.

    It sounds like your charge nurses and your nurse manager need to sit down and do restraint training for the entire ER. You should always wear gloves, the police can never be involved. Perhaps designate a restraint code team for each shift, page a code overhead when a situation calls for it, quickly administer the IM injections, put a psych 1:1 on the patient, and continue on with the shift. It just doesn't seem like there was enough communication on your floor in this situation.

    I hope this helps.

  • Jun 22

    Hmmm I haven't heard of putting a pt and family goal in there. Managers haven't mentioned it. I can see it now...we bring in a pt with nonsurvivable TBI and family is trying to decide whether they want to wait for brain death or go to OR for a DCD (donation after cardiac death.)

    Clearly, pt is not going to give me a goal.

    To the family, "What is your goal for your 18 yr old daughter's care?" Mother dissolves in sobs, father stares at me and asks "Are you ******* kidding??"

    We typically apply a few applicable templates with admission. I was taught that opening the care plan to enter my narrative note counts as a review, so that's what I do. Once a shift, I open the care plan and enter my note under "multiple trauma, Adult/OB" if note primarily about injuries, or "mechanical vent" if they were having respiratory issues, or "significant events" if it doesn't really fit into any other area.

    When they are extubated, I'll resolve the mechanical vent goal and physical restraint goal if the restraints came off.

    My favorite is when the pt is still sedated and paralyzed, and it gives you that prompt: "the following goal(s) were expected to be met prior to today" 'improve physical strength.'" To which I think, "you're ******* kidding me. PT probably made that goal."

    If I have spare time and feeling all correct, I might do some browsing through that behemoth list o' templates and stick one on the care plan.

    But as far as looking at it to direct my care? It's redundant. My assessment tells me what I need to do, and I document what I do.

  • Jun 22

    My spidey senses tell me you are not a nurse.

    From my experience, nurses (including myself) despise epic care plans. I would say most don't bother with "what the patient wants", and don't put too much thought into them as far as what they put in the computer. They click on what would make sense for the patient in order to get this senseless charting task done and to move on to more important things. The next nurse probably clicks and copies 90% of what the nurse before them entered.

    Care plans are a Joint Commission (haven't been called jcaho in many years)requirement (so I've been told), and it's easier to do in Epic then in other systems I've used. But what is in the computer really has nothing to do with the real nursing care that is taking place. It's just another PIA charting task that takes time away from things that really matter.

  • Jun 21

    The only time I was rude to a student was when she spent 30 minutes in the patients room doing her assessment, then came to me and said "hi, I have your patient in room xxx and I just finished his assessment. Could you tell me his initials? I need it for my paperwork."
    .... really?

  • Jun 21

    Quote from CHESSIE
    I am not entirely sure what a "factory worker mentality" means. "Factory workers," are few and far between today. I have had factory workers as patients, and family members of patients who were factory workers.
    I was a factory worker at a paper mill from 2001 to 2004, prior to becoming a nurse. My mother was a factory worker for 25 years.

    Anyhow, the factory worker mentality entails thinking that a person is doing nothing if he/she is not moving around much or not engaged in apparent physical labor. When I worked at the factory, there was the notion among my coworkers that the 'suits' in the office (a.k.a. managers and engineers) did nothing useful, whereas the workers on the floor did all the 'real work.'

    The concept of knowledge work was not considered 'real work' by my coworkers at the factory who toiled on the floors and worked on the machines.

    Anyhow, as a floor nurse I have had a handful of people assume I was doing nothing when I was seated behind the nurses station. I suppose it is different strokes for different folks, but thanks for your feedback.

  • Jun 21

    Quote from rhernandez748
    Kudos to him for having the personality for putting pills in a bottle.
    the ignorance in this post is amazing.

  • Jun 21

    Quote from Horseshoe
    Oversimplification of others' roles in order to feel better about oneself.
    I concur. Other peoples' jobs have the tendency to appear easy to those who are on the outside looking in.

    It's similar to hospital visitors who think nursing staff is doing nothing if they're seated behind a computer, even though the nurses may be charting and communicating with providers. People with the factory worker mentality will always think nurses are 'doing nothing' if no physical labor is readily apparent.

  • Jun 21

    Quote from rhernandez748
    Kudos to him for having the personality for putting pills in a bottle.
    Says someone who probably has NO idea what is actually involved in getting a doctorate in Pharmacy.

    And it's been said on AN by a CNA that all nurses do is "give pain meds." Oversimplification of others' roles in order to feel better about oneself.

  • Jun 21

    25 years psych rn here. like the other person said, you can do the best you can and think everything to death and they will still " go off" sometimes. dont second guess yourself too much. you could have taken the dresser so it wouldnt be used as a weapon and the patient could barge into another room and use that dresser. sometimes there is no right answer in this job. best of luck to you

  • Jun 21

    I work inpatient mental health as well, I find that with the truly psychotic and delusional that a lot of times it does not matter what you do, they get themselves worked up - because dresser or no dresser they are responding to lots of stimuli that they can not make sense of. If you had left the dresser it probably would have been something else that caused him to escalate.
    It is interesting that this happened when family was there visitng, this happens a lot. The patient will be stable then family will come for a visit...they have a flood of feelings related to seeing family that they can not process because of their mental state. They see family and think, "why can't I go home with them, I am stuck here and they get to leave and go home"..."they must not care about me", or the family can sometimes say or do things to escalate the patient - intentionally or unintentionally.

  • Jun 21

    Well, I always wonder about theoretical quantum effects at the biological level. We know there are more dimensions than we can perceive, and we really don't know if time has an inherent directionality due to the law of thermodynamics or some other physical law that we don't yet understand. Birds rely on quantum effects for migration. Plants rely on it for photosynthesis. I like to speculate wildly that some of the "paranormal" perceptions might in some way be explained by that. And if I accept that (completely baseless) premise, it is plausible that disorders/variations in neurochemistry or neural circuitry could allow some quantum effects to manifest more consciously. But that is nothing more than an idle thought experiment.