Latest Comments by MunoRN

MunoRN 49,613 Views

Joined Nov 18, '10 - from '.'. MunoRN is a Critical Care. She has '10' year(s) of experience. Posts: 8,386 (70% Liked) Likes: 21,773

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  • 3

    Quote from PeakRN
    ...Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. ..
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.

  • 3
    Here.I.Stand, Cat365, and KatieMI like this.

    There are very clear requirements for ignoring a patient's right to refuse, failing to abide by those requirements is a crime, sometimes even a felony so it should be taken seriously. If the patient is truly incompetent, which is a fairly high legal standard, permission to provide interventions against the patients refusals must be obtained from the POA or court appointed surrogate.

    The first step would be to address why she is not wanting to be turned for a clean up, and in the case of a hip replacement this is likely due to acute pain with turning the hips, proper treatment of this pain prior to turning is expected whether or not the patient is hesitant to be turned.

  • 3
    llg, NightNerd, and Fiona59 like this.

    I was always taught it's proper etiquette to leave a bathroom door open when not in use because it's assumed that when the door is closed it means it is in use. There's not really anything unsanitary about leaving the door open, is it the sight of a toilet that bothers you?

  • 3
    Davey Do, canoehead, and AJJKRN like this.

    There is no CMS standard on how far any kind of dispenser can stick out from the wall, that doesn't mean that Joint Commission surveyors won't claim there are various made-up standards that the facility isn't meeting, this is why the Joint Commission is quickly loosing business to other more competent survey organizations.

  • 1
    MrFoley likes this.

    Quote from hherrn

    What do you mean by no lubricant?
    I have actually come across a couple of nurses that saw no problem with a 'dry' foley insertion, one didn't do it completely without lubricant but used a single small drop on the tip of the catheter, which is essentially dry, the other put no lube on at all.

  • 0

    It's generally pretty basic. An independent testing facility may ask for proof of prescribed medications, although as a direct care nurse your employer is also allowed to ask what medications you take, so long as they are asking after the initial job offer.

  • 3
    cyc0sys, BeckyESRN, and Ruas61 like this.

    Quote from hppygr8ful
    Actually it's not - Dementia is considered a medical diagnosis and can not be used as criteria for admission to a psychiatric facility. Does this patient have family or a conservator. If she has a diagnosis of schizophrenia does she see a psychiatrist at least quarterly if not you may be neglecting her needs and can be cited. Maybe a long acting injection like Haldol dec that can be given once a month would be worth trying - it's general not used for elderly patients so some caution is necessary.

    My mother was extremely violent and is currently on 25mg of Seroquel twice a day (little baby dose) and she is much calmer. Is you facility doing behavior counts to justify medication? The family or conservator needs to be given 90 days to help find a solution or be given notice that she has to be moved. It may be more appropriate for her to be in a specialized dementia care facility.

    Technically Alzheimer's Dementia is considered a psychiatric disorder and is listed by the APA as a DSM diagnosis. As a neurocognitive disorder it's classified as a separate subgroup of mental illness than schizophrenia, but still falls under the general umbrella of mental health disorders.

  • 1
    elkpark likes this.

    Quote from ninsx003
    The FCC destroys both the 1st amendment and the 10th in a single blow. Constitution is on life support. Last thing to go with be guns.

    Maybe you could elaborate.

  • 11
    Beth1978, cyc0sys, NutmeggeRN, and 8 others like this.

    That's an impressive combination of bad decisions you facility is making. To start with, treating the symptoms of a condition or illness is not a "chemical restraint", and actually failing to treat these symptoms can constitute neglect and potentially criminal abuse.

    The patient poses a threat to staff, which is one thing if the facility is making reasonable attempts to mitigate this threat, but choosing to nothing not only opens them up to civil suits, but it exposes them to criminal charges.

    The patient does not appear to have decision making capacity, which requires the facility to legally establish this as well as have a decision make appointed, when this is a court appointed advocate they generally will decline any sort of life sustaining treatment in a patient such as this, including even antibiotics since from your description the patient is likely fairly miserable on an ongoing basis.

  • 1
    Tacomaboy3 likes this.

    ADN programs have given extra "points" for previous degrees for a while now, although it does seem as though it's become effectively a requirement for admissions in some programs given the number of applicants with a previous bachelors. It's pretty unlikely if not simply impossible to get into many of the ADN programs in my area without a bachelor's degree, although varies by region. If you're having trouble getting into a program in your area without a bachelor's then you might consider widening the geographic area you're looking in.

  • 2
    Ddestiny and Kooky Korky like this.

    Treatment generally isn't indicated for PVC's, this can be a fairly normal finding in the general population. Depending on the full clinical picture, ventricular ectopy generally indicates further assessment; electrolytes, cardiac function (echocardiogram), etc. Lidocaine is more of a last resort treatment, it's usually only used when ventricular ectopy is unstable/symptomatic and refractory to other treatments such as electrolyte optimization, cardioversion, and amiodarone. Individual paroxysmal PVCs, pairs, and often even bigeminy is not symptomatic, it's not unheard of for a patient to be in a persistent ventricular rhythm and tolerate it just fine, I've had patients in a persistent V-Tach that are just hanging out watching TV, this is often possible with a slow ventricular rhythm.

  • 1
    sevensonnets likes this.

    Quote from Agatha12
    Probably, I should have described situation clearer. When I worked on the floor, we had a silly bedside handover, which means the coming staff were going from one room to another to receive the report about all the patients. It means that the last nurse will leave a job even 30min later or more, but the first one might finish couple of minutes earlier. And now who was saying that wants to be the first nurse to give the report? obviously mothers because they will always use the argument " I have kids to collect" that single childless person cannot beat. Important to mention, that people who had to overstay are not paid for this time. I know this is managment problem and I advocated to change it but unfortunately there is no will from managment for a change. I left but it sticks in my mind, why those nurses with kids cannot accept that sometimes they will give priority to single person and sometimes they will go first. Also I witnessed situation when nurses took personal call in the moment when It was important to do something for patient, for example checking narcotics together so pain medication are not delayed.. When I pointed out that it is not the moment for personal call, I was told that I dont understand because I dont have kids.

    I really dont find it professional and also it is unpleasant to be told that you dont have kids so you can stay longer or you have no right to correct someone.
    Once you are no longer being paid you leave, there is no obligation whatsoever that you stay beyond that point in time. So you're complaining that you're having to stay longer than people with kids are even though are aren't actually having to stay.

  • 1
    poppycat likes this.

    The general rule is to leave the closed circuit closed as much as possible, if you don't really need to break the circuit then don't do it. There's no rationale basis to believe that dumping the condensation back into the heater/humidifier increases the total bacterial load of the system. Opening the system on the other hand does produce the potential for contamination.

  • 13
    Here.I.Stand, lpndeb, applewhitern, and 10 others like this.

    You don't get "sick" from the flu shot, when the flu shot does what it's supposed to do, you should experience an immune response to the vaccine, that's how it works. This is a self-limiting immune response and it isn't going to progress to the severity that an actual influenza illness can. Unless you ended up on V-V Ecmo which is what can often happen with the flu, you weren't "sick".

  • 9

    Quote from blondesareeasy
    Tell em' you got the shot.
    Go to Walgrens, get a receipt for something, tell em' you bought the shot.
    Photoshop someone else's receipt.

    Flu shots are a pharmaceutical gold mine.
    The flu kills OLD people and the immunocompromised. It doesn't kill people that go to work for a living and are up walking around.

    So play the game until a LOT of years go by that will prove that the flu shot ain't what it's supposed to be.
    I've worked ICU for a decade now and I can tell you that the one thing other than trauma that is most likely to put an otherwise completely healthy, young, and "up walking around" person on aggressive life support is the flu. On more than one occasion I have had to tell the husband of a young, otherwise extremely healthy, mom in her 30's that it's time to have their kids come in and say goodbye because they probably aren't going to make it through the night. I inevitably get asked frequently with these patients "but it's just the flu" and "but he/she was so healthy". I would normally say that everyone is entitled to their opinion, including yours, but after seeing first hand the beliefs that form, and the decisions that are made based on the type of comments you are making here I have come to believe that you are simply an absolutely horrible person for spreading these reckless myths.