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Double-Helix, BSN, RN 32,005 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,350 (54% Liked) Likes: 6,528

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  • 6:42 am

    No one should care. And if they do, why would you? You’ve got better things to go in school than worry about someone looking up the price of your stethoscope. What you should worry about is someone walking away with it. Stethoscopes, especially nice ones, tend to grow legs when left laying around. Get it engraved, get a name tag that isn’t easily removed, and keep it in your pocket or your hands the entire time you’re in clinical. If you don’t need it for a clinical, leave it in your car or lock it up.

  • 4:21 am

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • 1:05 am

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    No one should care. And if they do, why would you? You’ve got better things to go in school than worry about someone looking up the price of your stethoscope. What you should worry about is someone walking away with it. Stethoscopes, especially nice ones, tend to grow legs when left laying around. Get it engraved, get a name tag that isn’t easily removed, and keep it in your pocket or your hands the entire time you’re in clinical. If you don’t need it for a clinical, leave it in your car or lock it up.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    I would not have asked the supervisor to remove the audit item, nor would I have removed it myself. Medication refrigerators that aren’t in locked rooms need to be locked. That’s a regulatory requirement whether you have it on your audit sheet or not and removing it isn’t going to help you if the JC comes to inspect your unit.

    The question is whether you’re responsible for that form beyond just doing the checks. If not, then it’s on your supervisor to come up with an action plan. You’re only job is to fill out the form and report the results. In my role, I’m responsible for establishing a plan for improvement/compliance and making sure it’s being done. This would probably include education, ensuring that there is an available lock, doing 1-1 reeducation with non-compliant staff, and/or getting a code-protected refrigerator that locks automatically. But again, if your job is not to ensure that the unit is in compliance, I would continue to fill out the form, report the results, document on the form when and who you notified, and leave it at that.

  • Jul 21

    What it really comes down to is depth of the vein and length of the catheter. Ideally you want at least 2/3 of the length of the catheter inside the vessel to avoid dislodgment from shifting of the tissues and skin above the vein. In an antecubital vein there is greater potential for movement of the catheter within the vessel related to bending of the elbow. For that reason, I always choose a longer catheter for an AC vein and don’t prefer them for long term use whenever possible. If it is an IV that needs to stay in for several days, some kind of arm immobilizer should be in place to help prevent this kind of movement. For a short term infusion on an adult patient that can be trusted to refrain from bending the arm, I wouldn’t worry about it- provided that it’s not a super deep vein and a short catheter.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Quote from Renegade girl
    Its not a matter of trying different areas of nursing because I know I wont like it. In school I did not like any of my clinical rotations.
    It’s really way too early in your career and experience to be saying this. There are so many areas that a nurse can work- the great majority you never even hear about while you’re in school. There are nurses that work for insurance companies, pharmaceutical companies, nurses that work in law firms, nurses that work in research institutes, nurses that work in informatics and technology. There are areas of nursing where you would never have to touch a patient if you didn’t want to. There are plenty of ways to direct your nursing career into a job you find more fulfilling. Additionally, like others have said, you have plenty of opportunity to go back to school and pursue another degree. People start college programs in their 30’s, 40’s 50’s. You are way too young to be “stuck” in anything.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • Jul 21

    Quote from Renegade girl
    Its not a matter of trying different areas of nursing because I know I wont like it. In school I did not like any of my clinical rotations.
    It’s really way too early in your career and experience to be saying this. There are so many areas that a nurse can work- the great majority you never even hear about while you’re in school. There are nurses that work for insurance companies, pharmaceutical companies, nurses that work in law firms, nurses that work in research institutes, nurses that work in informatics and technology. There are areas of nursing where you would never have to touch a patient if you didn’t want to. There are plenty of ways to direct your nursing career into a job you find more fulfilling. Additionally, like others have said, you have plenty of opportunity to go back to school and pursue another degree. People start college programs in their 30’s, 40’s 50’s. You are way too young to be “stuck” in anything.


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