Anna Flaxis, ASN 23,187 Views
Joined Oct 15, '10.
Posts: 2,858 (67% Liked)
Something I have learned from my experience in the diagnostic role: you miss some. You do your best but some will still surprise you.
Per NIH "no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required." This is my kid we are talking about. Use sterile procedure, culture that green and yellow stuff, determine if and what antibiotics are necessary. I would expect the same for my patients.
I do I&D's as a clean procedure. I do not culture or script abx unless there is a complication.
It is a clean procedure where I work. Instruments are sterile but sterile gloves are not used. I don't routinely culture unless the patient has recurrent abscesses. Antibiotics are not necessary unless this is a recurrent problem or the patient has systemic symptoms. This is per our health system's protocol.
I use a disposable scalpel, which is sterile. I only touch the handle and never touch the site after it's cleaned. The sterile blade is the only thing that touches the abscess.
I certainly hope not.
What about experience; how many veteran nurses and new grads are there?
Great thread with lots of thoughtful responses.
A couple of thoughts for OP
Its unwise to "jump to solutions" until you actually know what the problem is. In my consulting years, a lot of work involved reversing the superficial "improvements" that were implemented to solve problems - AKA, it seemed like a good idea at the time. My mantra became "Today's problems were yesterday's solutions". Don't fall into that trap.
Look at the research being done on "missed nursing care", "failure to rescue" and "nursing surveillance".... there's a ton of evidence out there to inform your decisions. Better yet, start analyzing those near misses or nursing failures using a system like HFACS or a rigorous root cause analysis process to determine the systemic problems that may actually be the causative factors.
I'm sorry if I don't belong here, or if I angered some of you. I just wanted some insight, and THANK YOU, I think I got it. I never gave any thought to the fact that my straining might cause me to pass out. That IS a piece of the puzzle that was lacking.
To explain further, yes I was a fall risk, for more reasons than one. I am diligent about NOT moving without staff present. I had also gotten permission from both the Doctor on staff and the PT department to use the toilet for BMs.
In reply to the harassment comment: I surely WOULD NOT call it that. They were doing their job and I better understand why now. Yes, it was more than one nurse, more than once, but again, I GET IT NOW.
And as for laxatives, stool softeners, and enemas. I have to take some responsibility for the fact that its just NOT that simple. I have a neurological condition that renders my abdominal muscles all but useless in the act of defecation. I can't bear down. I manage the situation quite well on my own at home by using my elbows, jammed into my lower abdomen, to facilitate bowel evacuation. When that fails I use a warm water enema with enough volume to literally flush out my lower colon. Unfortunately this information was not in my records and no one seemed willing to believe it or seek it out. I was given laxatives, stool softeners, and enemas (Fleets) all of which fail to solve the problem. Thus I was left with the intense need to strain, fortunately SOME of my nurses were willing to manually disimpact me.
I assure you all that next time (and I'm expecting to have the other hip replaced soon) I will be more considerate of my nurses' dilemma
and there need for more information.
Thank you for your help!!
I recently started working in a LTC memory care/dementia/alzheimer's unit and last week we had an inservice on caring for patients/residents and during that inservice we were told that our facility encourages you to say the patient/residents' name regularly and also tell them that you love them every day because it brings them joy. Would you feel comfortable telling a resident/patient you love them? I am just trying to get other opinions because others I work with said it sounds odd. (I should add: I am one of three people who work full-time on my unit, everyone else is part-time or PRN so I am usually on the unit 5-6 days a week and have very strong bonds with my residents, so telling them I love them isn't really an issue for me).
I don't have a problem with this as long as it is just a suggestion and not a requirement. I understand the objections voiced in this thread by most of the other posters. However, I have worked in a memory care unit before and believe that this type of emotional validation goes a long way with residents severely affected by dementia. Many of them live in a perpetual state of anxiety and confusion due to their disease. Trying to re-orient them to reality is usually impossible and sometimes even harmful.
This happens to me less often as a nurse now, but when I was a CNA it wasn't unusual for one of these residents to say "I love you" to me as I was assisting them into bed at night. They had no idea who I was. In their mind I was just someone who had cared for their personal needs and shown them kindness. I could have been a friend, relative or complete stranger. They just couldn't remember but believed that I must care about them in order to be providing them with such personal care.
When they said "I love you", I could have tried to side step the issue or remind them that I was just their nurse or CNA but why? It would have served no real purpose. They still wouldn't have remembered who I was and I would have missed an opportunity to quell their insecurities and reassure them that someone in their world does indeed care about them.
I admit that I'm not completely comfortable saying to "I love you" to residents since I would normally reserve such a statement for family members. However, I believe that a moment of awkwardness or discomfort is a small price to pay for another person's sense of peace and happiness.
Three to consult:
1. Hospital pharmacist
2. Occupational/employee health
3. Your obstetrician.
Give the lasix. Labs will be back before she starts peeing. Correct k as needed.
But an automatic foley isn't called for any longer. Foley's cause UTI's which lengthen hospital stays and make the bean counters angry. If they are able to get on the bedside commode then they need to do this unless they are too medically fragile to do so.
In the ED, I would place a Foley for accurate I&Os and given her edema, it must not be easy to move quickly to the commode.
I wouldn't hold the Lasix. So #3.
As a side note, I would not order a drug screen unless the patient agreed to it. I'd never do one without patient consent unless we're talking about an OD for example and we don't know what they took.
Sent from my iPhone -- blame all errors on spellcheck
Without going into potentially revealing detail, care was assumed, pt was heartily diuresed as per physician intent, and released from ER with script and attempts at pt education.
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