Vespertinas 11,837 Views
Joined: Nov 27, '09;
Posts: 678 (53% Liked)
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Ixchel, your understanding of my assignment and responsibilities is inaccurate. Your answers have been not only not helpful but condescending. Whether this was my fault for not conveying the problem clearly or yours for reading too far into it is beside the point- I'd rather not hear any more input you have to share on the matter.
The case challenge is fictitious and we've been given less than two weeks to present a budget, timeline, short and long term solutions, identify stakeholders, read 81 pages of background data, identify community resources, and do our own fact-based research where necessary. etc etc etc
I'm just polling on something that's not really pivotal to the process so give me a break. With that kind of paranoia, I could walk into the ED, ask a receptionist myself and suspect she's lying to me too.
I'm working on an interdisciplinary case challenge being given by the IOM. We're trying to find a comprehensive solution to support the mental health of aging veterans. Our approach will start in the ED but I have 2 questions that I need your help with because I've never actually worked in the intake part of the ED...
1) Does everybody get asked whether they're a veteran?
2) Is intake done by paper form, Q&A with the RN by a computer, both together, either depending on the hospital?
I'd really appreciate your input!
Right. I agree with both of you. Ohiobobcat you made me think that if I can measure a consistent QT interval, then it's likely a T wave. I think my problem was stemming from a patient who was in afib/flutter so the whole thing was unclear as waves kept presenting and disappearing. I appreciate both of your help.
Based on what you said, it sounds like I should measure the T-wave if I suspect that's what it is. But it's entirely possible that I won't find T-waves in which case it's okay to say it's unmeasurable. Yes?
1st year of nursing moment: Agreed to take on an extra 4 hours after my 12 hour shift. Of course someone codes at hour 15. I'm hypoglycemic and full of adrenaline, pumping this patient so hard. When it's time to transfer him to ICU, I offer to grab the emergency medicine kit for the trip. Doctors and RT wheel patient into elevator and it looks pretty crowded in there to me so I figure I'll be kind and grab the next one down.
As the doors close, I stand on the opposite side, grinning and waving. Everyone in the elevator looks puzzled. The doors close. I realize I am about to take the next elevator, alone, carrying emergency meds for no one.
Win Miss State for the Miss America pageant while in nursing school. Use "I want to be a nurse" as your platform. Quit nursing school immediately after.
Can I or can't I positively identify T-waves in afib?
Sometimes I think I can see them and want to measure but then it could always be a P-wave, right? Should I not even bother once I recognize the rhythm is afib?
Nah. I've had trouble getting treatment for autonomous patients with MR. No lorazepam for that. It's so sad seeing them walk out AMA knowing the trouble they'll have ahead.
LOL "The power of Christ compels you!" with your stethoscope on her forehead
You're just wasting a bed that we may need for another patient. Ugh.
My first emergency.... a renal transplant patient who experienced a transfusion-related acute lung injury (TRALI) which is basically an immune-mediated flash pulmonary edema. Uh yeah I totally panicked. I mean within a few minutes she went from talking to me, to having an itch in her throat (which I incorrectly was addressing as reflux), to being unable to breathe, to being intubated. It all happened so fast and being that it was a respiratory code and not a cardiac I wasn't even sure how to operate.
My educator took me aside after pt was shipped out and started to debrief me. My lip started quivering and she warned, "oh no you don't." That pretty much did it; I was such a ball of nerves and I let it all out right there in front of my hard-as-nails smokers-voice ICU-worn twice-divorced educator. Gold.
I tell him ok here it.........asystole. Pt went slump stopped breathing no response.
WHAM hammer fist to the chest. Pt wakes up and says "where did I go just now?"
It's the new nurses who aren't ironic and sarcastic when the patients/supervisors aren't within earshot that I worry about. They're the ones who often don't make it. They're in for one too many disillusions. Being positive and upbeat 24/7 must be exhausting.
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