Latest Comments by Anna Flaxis

Anna Flaxis, ASN 25,485 Views

Joined Oct 15, '10. Posts: 2,864 (67% Liked) Likes: 8,618

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  • 0

    Quote from caalvarez3
    Can a patient be alert and oriented but drowsy?
    What are your thoughts?

  • 5

    The doctors do it where I work.

  • 0

    Quote from chare
    And thus the intent of my previous post. Don’t you think that there should be some evidence behind what we teach and practice?
    Of course, just as I think that when citing evidence to make a point, one should verify that such evidence is reliable. :-)

  • 5
    bellakat, datalore, kakamegamama, and 2 others like this.

    Why should any further study be done?
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.

    Say, for example, you receive a shipment of 500 widgets, and the supplier guarantees you that no more than 10% will be defective. You can't check every single widget, so you take a sample of 10 and find two defective widgets. You could conclude that 20% of the entire shipment of widgets is defective, or you could understand that perhaps you just happened to pull out 2 defective widgets when selecting your sample.

    Now, what if, instead, you select 50 widgets as your sample, and 2 of them are defective? That would be 4%, and consistent with your supplier's guarantee of 10% or less.

    You can apply this principle to individual experiments as well as what we call the "body of evidence". Two studies (with small sample sizes, no less) is not a large body of evidence upon which to form a strong conclusion, it is merely a starting point for further research.

  • 0

    Quote from chare
    The old “rule of thumb” that a radial (femoral, carotid) pulse indicates an SPB of ≥80 (70, 60) mmHg originated from the ATLS course. This is not accurate, and using this method is generally an overestimation of the actual SBP.
    First, please note that this is a single study with an n=20. This is not a large enough sample size to be statistically significant. Second, please note that in Group 1, the group in which radial, femoral, and carotid pulses are present, 8 out of 12 patients (67%) had an SBP >/= to 70, and 11/12 (92%) had an SPB >/= to 60.

    We would need to conduct more experiments with greater sample sizes to be able to draw a reliable conclusion.

    Also, please see: Accuracy of ATLS guidelines for predicting systolic blood pressure

  • 0

    In my experience, a Code Blue is for a cardiac or respiratory arrest, and I'm not sure why one would perform chest compressions on an adult with a pulse.

    It is reasonable to call for assistance if your stable patient suddenly begins seizing.

  • 2
    poppycat and PsychGuy like this.

    I don't understand. If they're not on a hold, they have the right to leave.

  • 10
    LadyFree28, klone, brownbook, and 7 others like this.

    Quote from Been there,done that
    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.
    Everybody is somebody's kid. Doesn't change anything.

  • 8
    My_toe_sis, iluvivt, brownbook, and 5 others like this.

    Quote from feelix
    This should be an incident report. Don't let doc get away with it. He is supposed to know more than you do.
    He does know more than you do, and I&D is not a sterile procedure.

  • 3
    cocoa_puff, BSNbeDONE, and BSN16 like this.

    I work PRN exclusively. My orientation was as brief as I could possibly make it, as I am an experienced RN and have little tolerance for having my hand held.

  • 9

    I&D is a clean procedure. C&S is unnecessary for simple abscesses, as most abscesses heal without antibiotics.

  • 0

    Hmmm, I've gone as far as I wanted with my ADN. I've worked in cardiopulmonary/post-interventional/telemetry, emergency, infusion services, and administration. I've been approached for peri-operative services, but declined because I don't want to take call. I value my free time too much for that.

  • 6

    Quote from canoehead
    Is it bigger than a bread box?
    I love that! Gonna have to remember that one...

  • 7

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.

  • 7
    BrendanO, TriciaJ, masulliv, and 4 others like this.

    Quote from JWFeeII
    I do not wish to complain I have found most nurses the most kind, sensitive, caring, people I have ever known. I want to know if I'm being overly sensitive or if my nurses (this time) were a bit out of line? I was in a rehab hospital for a hip replacement. Getting from bed to commode to toilet was an issue, but once there I had grab bars and felt myself quite safe. I assured the nurses that I would obey the rules and not get up on my own. I was extremely constipated and wanted some time and privacy to force a bowel movement. Time and again I had to specifically ask that the nurses leave and close the door. Often I was popped in on and asked how I was making out. Quite frankly the interruptions stopped the process in its tracks, I had to ask the nurse to leave, to close the door and begin my efforts all over again.
    Am I being an overly sensitive prude or did I deserve a little more consideration?
    Hi there! As others have stated, it is reasonable and prudent to check on a patient who is on the commode. However, I would knock on the closed door and ask how it's going through the closed door. If I didn't hear a response, then I would open the door to visualize the patient.

    I'm more concerned here that you were constipated and wanted to force a bowel movement. One should not force a BM. As others have suggested, this can cause a vaso-vagal response where you lose consciousness and fall to the floor, potentially complicating your surgical recovery or suffering new injuries. You should have been receiving stool softeners and other interventions such as Miralax, glycerin suppositories, and if those things failed, an enema.


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