Latest Likes For SoldierNurse22

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SoldierNurse22, BSN, RN, EMT-B 46,406 Views

Joined Mar 29, '10. Posts: 2,215 (67% Liked) Likes: 6,976

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  • Apr 28

    It's certainly an art mixed with a science. Cervical exams take lots of practice. When I was a new L&D nurse, my preceptor would often check the patient, then have me check her. Within a few months, I was pretty confident.

    The Mystery That Is The Cervix – Cervix With A Smile

  • Apr 27

    It's certainly an art mixed with a science. Cervical exams take lots of practice. When I was a new L&D nurse, my preceptor would often check the patient, then have me check her. Within a few months, I was pretty confident.

    The Mystery That Is The Cervix – Cervix With A Smile

  • Apr 26

    To follow up to your story and springboard off my previous post, I had a patient a few months back who was admitted for an elective IOL at 39 weeks. She was a G1P0 and had a borderline favorable cervix, but overall, I felt it was probably best to wait, especially because her Bishop score was close to favorable, but it was definitely not good enough to indicate induction under our new policy. My charge checked her and fudged the numbers a bit, I think because she didn't feel like going toe to toe with the doc that morning.

    After my charge nurse left, I did exactly what you did. I advocated for my patient. I told her that if she kept her water intact, she could opt out of the induction at any time. I told her she could refuse an AROM and to make sure she stated to the doc that she didn't want to be AROM'd with a nurse witness present.

    Anyway, I left for the day and came back that night just as they were taking this patient back for a stat C-section for fetal distress and failure to descend. Apparently, baby had been having lates all day. They AROM'd mom when she was 2 cm and ballotable.

    As the icing on the cake, the doc had the gall to be in a huff and all pissed off that she had to section this lady because it was the doc's husband's birthday, and she was supposed to be eating out with him that night. Nevermind that this poor lady just had an unnecessary c/s because her doctor is a selfish, sad excuse for a human being. Nope, she was all mad because of the missed birthday dinner.

    OK, then don't set up an unfavorable G1P0 for an elective induction the morning of your husband's birthday and expect to be footloose and fancy-free that evening, you moron!

    UGH.

  • Apr 23

    Quote from apnurserock
    You must enjoy reading my post because you keep commenting with the same comment. once again I have none not in school trying to open up topics to network and get to know other nurses. As a nurse you shouldn't make dumb assumptions. Now if you don't like my topics don't read and don't respond. Obviously some people do because they have respond
    Actually, I figure other members of AN ought to know what they're responding to before they respond. You flooded AN with posts yesterday on many topics that already exist--and that is no "dumb assumption".

    Your posts are public. Anyone can respond. Please get comfortable with this concept as AN is a large and very diverse place and you will often get answers/replies that you may not like.

  • Apr 22

    Quote from jonnyvirgo
    statements like these as of late have really been beginning to irk me. Im all in favor of knowledge of pharmacology an pathophysiology, but you're not a low/mid level provider to act autonomously. CNAs MAs LPNs even RNs dont pass or prescribe meds based on their own findings. They assess, and pass it on to the all-knowing all-seeing docs from above that then tell us what to give. They know better, and if thats whats ordered, thats what we give. The knowledge only comes in handy if we're looking to make sure the doc hasn't overlooked something or made an error, which happens to just about anyone and everyone in healthcare at some point in time. Sure you could save a life, and sure it could cost a life, but the bottom line is, we're not nearly as autonomous as we'd like to think. We're merely extensions of the doc, being at all the places they cant be to free up time for them to Dx and Rx
    Wrong, wrong and more wrong. Your work is tightly connected with that of the medical care of the patient, but nursing care of a patient is inherently different than the medical care of that same patient. If you're merely an "extension of the doc", then how is it you can get sued for giving a medication that is contraindicated and the doc isn't implicated in the error?

    No, we don't prescribe. We don't write the "orders", we don't make the big decisions that people see. We're the ones who catch the errors, who make suggestions and collaborate with colleagues (physicians and other providers), hopefully for the good of the patient. How can we do that? Because we are educated and subsequently, we develop the ability to critically think by integrating our critical thinking abilities, bedside skills and knowledge of the patient, pharmacology, anatomy/physiology and pathophysiology.

    A very wise instructor once told us that patients don't get admitted to the hospital to see doctors. They get admitted for the skilled nursing care. After all, if you simply needed a gallbladder out and the doc was all you wanted, you'd get the surgery done and go home, right? Who needs dressing changes, vitals monitoring, assistance with pain management, etc? And while the doctor and nurse collaborate on many of the issues patients face post-procedure or during treatment while in a hospital, it is ultimately up to the nurse to assess, evaluate, advocate and carry through on behalf of the patient.

  • Apr 22

    Quote from That Guy
    It is just a job. Why should it be more?
    Every profession is a job, but not every job is a profession.

  • Apr 17

    I know c/s patients at my hospital head over to PP with NS and pit running. However, I know most of our PP nurses take the NS down when the patient has shown that they are tolerating PO fluids/solids (usually about an hour or so after). We do maintain IV access for a certain number of hours after delivery, but it is saline locked and removed as fast as safely possible, as per our protocol.

    Pitocin, both intrapartum and postpartum, can cause water retention that can lead to swelling and breast engorgement and may interfere with mom's function and breastfeeding in the postpartum stage. Personally, I'd have no problem stopping the NS and maintaining a saline lock as long as mom is tolerating PO.

  • Apr 15

    I can't believe we're still having this ridiculous discussion.

    OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).

    Quote from Boog'sCRRN246
    Sorry, but if I was that patient, that would be that last IM injection you ever gave me.
    I was with Boog from the start. I just didn't realize how much until now.

  • Apr 14

    You're dating someone who thinks your profession and your work is inferior? No wonder you have an inferiority complex, in addition to your own opinion of yourself and your future career ("I am but a lowly student murse").

    What's your beef with your chosen profession? You make a point of talking about being a male nurse as if there's more expected of you because you're a guy. Is it really your girlfriend who looks down on you, or are you projecting your own insecurities?

    I also dated a doc back in my single days. He had nothing but respect for my profession and the intelligent men and women who work with him in the trenches on a daily basis. I never heard a disparaging word--nothing about how I wasn't smart enough to get into med school (I never wanted to be a doc, thanks) or how nursing was a fallback for the less intelligent. You're a student nurse. You know how competitive it is to get into nursing right now. It is not for the weak willed or the weak minded.

    Nursing and medicine must work hand in hand (no pun intended). Any other combination is detrimental to the patient. Smart nurses and physicians know this, embrace the differences in practice and agree to work together.

  • Apr 14

    Quote from maxthecat
    I understand what you're saying, but sometimes families DO know better than the nurse. As a nurse, I have learned a lot from a few families over the years, especially when dealing with someone who has one of the less common maladies. I don't have the time or energy to keep up with every advance in medicine, but some family members have researched their loved one's condition impeccably. They also know what has worked and what has not worked in the past. Of course they're not usually professional researchers and of course their suggestions need to be run past the medical team first. But don't count them out--you might learn something.
    That is not the scenario laid out in the cartoon. You're describing a family member who is intimately involved in the patient's care and knowledgeable from what is often years of caregiving. Not someone who just googled a bunch of symptoms and slapped on a diagnosis based on what the all-knowing Google spit out.

  • Apr 13

    Quote from nfeese
    So, if it mirrors a CTX in respect to timing but appearance is rapid onset and recovery ud still call it a variable rather than an early?
    Correct.

    Also ATI suggests 8-10 L of O2 to mom for a prolapsed cord... um I hardly see the necessity. If moms o2 sat are fine, which I'd imagine they are, giving her excess O2 isn't going to help the baby or increase her sat level. It also suggests bolus fluids, and while this will raise moms BP, I'm not making a connection of how this will help the fetus. The kinked cord is still gonna be kinked and baby is still only gonna have some much flow toward the placenta to be oxygenated by mom. I mean u could raise moms bp 200 over 150 and if babys cord is kinked and only sending minimal rbc and flow to the placenta ur in the same mess?????? Please help I'm gonna scream
    I think you're missing one of the major interventions in a prolapse scenario: hold baby's presenting part off the cord! That means if you're the first one to discover the prolapse, you're going to have your hand in mom's vagina holding baby off that cord until some helpful surgeon lifts baby's presenting part off your cramping, sore fingers by way of C-section.

    So yes, bolus fluids and increasing O2 for mom makes nothing but sense in this scenario as you've likely got a very compromised soon-to-be-born fetus who will need the increase in mom's O2 sats and BP if he or she is going to live long enough to survive a prolapse.

  • Apr 13

    Quote from maxthecat
    I understand what you're saying, but sometimes families DO know better than the nurse. As a nurse, I have learned a lot from a few families over the years, especially when dealing with someone who has one of the less common maladies. I don't have the time or energy to keep up with every advance in medicine, but some family members have researched their loved one's condition impeccably. They also know what has worked and what has not worked in the past. Of course they're not usually professional researchers and of course their suggestions need to be run past the medical team first. But don't count them out--you might learn something.
    That is not the scenario laid out in the cartoon. You're describing a family member who is intimately involved in the patient's care and knowledgeable from what is often years of caregiving. Not someone who just googled a bunch of symptoms and slapped on a diagnosis based on what the all-knowing Google spit out.

  • Apr 13

    http://allnurses.com/general-nursing...de-921567.html

    Good luck, OP! You can do it! We need introverted nurses just as much as we need extroverts!

  • Apr 13

    I can't believe we're still having this ridiculous discussion.

    OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).

    Quote from Boog'sCRRN246
    Sorry, but if I was that patient, that would be that last IM injection you ever gave me.
    I was with Boog from the start. I just didn't realize how much until now.

  • Apr 12

    I can't believe we're still having this ridiculous discussion.

    OP, aspirating for the majority of meds given the IM route is not only no longer taught,but it is completely unfounded from a scientific perspective--it is NOT evidence-based practice. So whatever you think you're protecting your patients from by aspirating with every IM drug, STOP. It's in your head. (note the CDC, which indicates that vaccines given IM, should you hit a vessel, wouldn't actually be given inadvertently via IV as the vessels in the muscle would blow before you could inject an IM injection IV).

    Quote from Boog'sCRRN246
    Sorry, but if I was that patient, that would be that last IM injection you ever gave me.
    I was with Boog from the start. I just didn't realize how much until now.


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