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Double-Helix, BSN 27,253 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. Posts: 2,767 (50% Liked) Likes: 4,837

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  • Oct 23

    Quote from Xlorgguss
    As far as cranking the oxygen, each liter of air adds 3% O2. So 2 liters would add 6% to the 84 to give 90% so that seems completely appropriate.
    That's *not* how that works. You are confusing two different measurements. Each liter of oxygen adds approximately 4% of oxygen to the percent of oxygen in *room air* (after 1L). Room air is 21% O2. A nasal cannula at 1L is approx 24%, 2L approx 28%, etc. It is not a guide to determine how many liters of oxygen to give to increase the SpO2 by a set amount.

  • Oct 16

    Thanks for explaining this. You're very knowledgeable!

  • Oct 15

    Quote from Noctor_Durse
    There is still a risk for bleeding though yeah?
    I....think you need to look up these meds.

    Tylenol is acetaminophen...metabolized by the liver and given for pain/fever.

    Enoxaprin is Lovenox....a low molecular weight heparin. Giving these meds and not knowing what they are is asking for a disaster to happen. This would be a SERIOUS med error.

    Are you in school for nursing?

    We try as best we can to assist and not confuse the students. We are trying to help students become the best nurse they can be so giving the correct interventions is helpful. I have been ill for a long time but I am better and I will be here helping students.

  • Oct 10

    And that attitude also isn't going to encourage anyone to respond.

  • Mar 14

    Just take it as practice for the endless useless continuing ed requirements you'll face throughout your career.

    Now, breathe deeply, in and out. Imagine your peaceful center, that calm, happy place, free from discord and strife. Nothing can disturb your peace of mind.

  • Mar 2

    Have you taken the time to review your Candidate Performance Report? This report can provide information about what areas are strengths, what areas are near passing, and what areas are weaknesses. That can help you with developing a study plan.

  • Feb 7

    You're certainly not going to see people at their best in the ED, so if they are a jerk on their best day... I try to keep in mind that they are in pain, or that they're having to watch their loved one in pain, and getting inadequate treatment. I usually will explain that the fewer things on my list that I have to do, the quicker I can get to getting them pain medication, and having to deal with a disruptive patient and husband isn't making my list any shorter.

    What sticks out to me though is that the doc is only giving one time pain med orders for a patient with a known kidney stone, I've never known an ED doc to do that and is pretty much guaranteed to inadequately treat the pain. I'd tell the Doc that the patient in bay 12 wants to talk to them about their poor prescribing habits.

  • Feb 5

    Quote from HippyDippyLPN
    You never know though some docs are odd about stuff, it may he a rule he really put in place for his own peace of mind
    Then I'm surprised they let me sign in when the doc is not in the building--that pen could fly out of my hand and land in my carotid artery.

  • May 13 '15

    A question was posted

    By whom? You? A faculty member?
    The nursing student was given a zero on the assignment, after being reported to faculty, for a hipaa violation/ division policy violation ("posting anything related to clinic on social media") and is facing the possibility of not being allowed to participate in patient care/ have limited access to patient information, during future clinical rotations... pretty stiff penalties, for asking for help.

    Aha. It was by you. So even if you didn't do a HIPAA violation, what you did was, in fact, a division policy violation. Don't you think it's a teeny bit disingenuous (look it up) to say, "I didn't even say it was a real patient" when you're trying to finish homework on your clinical day during which you took care of ... a patient? Of course it was related to clinical. Your faculty is not as dumb as you think.

    So your question isn't really about HIPAA in this context, is it?

    What do you want? You want somebody to tell "the student," by which I think you mean "you," that you were grievously maltreated? You want resources to take to your appeal? What?

    Be upfront here, apparently not having gotten the answer you wanted when you posted it before.At this point you want to go to your appeal with abject and very sincere apologies for an unforgivable lapse in judgment, because you did your best to leave off HIPAA-related identifiers but even if you did this successfully you have violated a division policy. You want to make good and sure you convince them that you will never, ever do it again, that you are ashamed of having violated that rule, and you understand how serious it is. Throw yourself on their mercy and then shut up and see what they do, because at that point it will be out of your hands.

    Good luck.

  • Oct 18 '14

    I was assigned a patient tonight in clinical that was getting prepared for emergency surgery. He was in extreme pain and his nurse gave him dilaudid for the first time. I was asked to stay with him while she called the doctor to update him on the status of the patient's condition. He was panting and shaking and kept repeating "I can't breathe."
    I started out by trying to reassure him that he was breathing and his O2 stats were perfect. But no change in his condition. I was frustrated (not with him) because I felt like there was nothing I could do to make him feel better and wondered what in the world would convince the nurse to leave me alone with him???? So, out of desperation I sat on the side of his bed, grabbed his hands, made sure he looked in my eyes and had him breathe in and out with me and tried to keep the both of us from panicking (To be honest I needed the breathing as much as he did ). He calmed almost immediately. He squeezed my hands and said simply thank you. He asked me to stay with him until his family got there...... And then it hit me.... He was scared. He was alone. He thought he might be dying. I only held his hand but I helped him feel less afraid. I helped the person, not the assignment. I made a difference. I felt like a nurse.

    It was amazing

  • Sep 26 '14

    As has been pointed out previously, a confused patient who pulls his indwelling foley out is not likely to leave a condom catheter alone either.

    You can try a skin prep which helps it to "stick" to the skin of the penis somewhat, however, you DO NOT want to promote any shearing or tearing injuries to that skin.

    Why does this fellow require a catheter? Why is the team focusing on a POC that is irritating, agitating, and annoying the patient?

  • Sep 26 '14

    When the caregiver told him I was removing the foley this morning, he looked at me and said "God bless you!"
    AWW.. give him a little kiss from me.
    Forget the condom cath.. will never work. He is refusing the treatment,, and that's ok. He will continue to pull off the condom cath until the cows come home.Develop a toileting regimen.. use adult briefs as needed.
    This is not about condom cath techniques.. this is about solving a problem.

  • Sep 19 '14

    With some surgeries that are expected air leaks. A gentle intermittent bubble indicating that there is air leaking would be expected in this kind of surgery and in a pneumothorax...which is trapped air in the pleural space. As long as the patient is not in distress and subq emphysema isn't present everything is fine.

    In the case of open hearts it might be different. Air leaks aren't expected as the lung was not operated on so no leak should be there. The pleural chest tubes are placed for drainage if the internal mammary was used and if the lung was deflated during the operation. The mediastinal chest tubes will also not have air leaks, if the do they will be minor and brief because of course there is mediastinal air when the opened the pericardial sac to perform the bypass.

    I was going to type an answer but I remembered GrnTea had a great explanation

    When you breathe in, you're not actually pulling air into your lungs with your muscles. You're actually making a suction inside your chest with them (I know this may seem like a distinction without a difference, but stay with me), and the air enters the lungs thru the route provided for it to do so-- your trachea, via your nose or mouth (or trach tube, if you aren’t so lucky).

    Your lungs are covered with a slippery membrane called the visceral pleura. The inside of your chest wall has one too, the parietal pleura. They allow the lungs to slip around with chest wall motion, like you can slip two wet glass plates around that are stuck together. Like the two glass plates, they're hard to pry apart due to the surface tension of the wet between them, and that's why the lungs fill the chest cavity and stay there. But just as you can easily pop those glass plates apart if you get a teeny bit of air between them, you can pop the bond between the two pleural layers with air, and if you do, the natural elasticity of the lung will cause it to collapse down to about the size of a goodish grapefruit.

    How does the air get in the pleural space where it doesn’t belong? Well, you can do it two ways. One is to play rough with the bad boys (or have surgery, which is, after all, only expensive trauma) and have a sharp object puncture your chest wall and admit air into the pleural space. How does it get in there? Well, you make suction in your chest when you breathe in, and now air has TWO routes to get inside your chest-- down the trachea into the lungs, and thru the hole in the chest wall into the pleural space. This is called a pneumothorax, air in the chest that is outside of the lung. The lung will tend to collapse because the surface tension between the wet layers is now interrupted (remember how the pieces of wet glass can be separated by introducing air between them?) and the lungs are naturally elastic.

    The other way to get air into your pleural space is from having blebs/bullae on your lung surfaces, and pop one (or more), or have some other hole in your lung (sharp things again, including a WEDGE RESECTION, which leaves holes that can't be sealed until they heal by themselves). Then air gets out of your lungs thru the hole(s) and disrupts that pleural side-to-side thing, and there you go again, a pneumothorax. This, however, is called a TENSION pneumothorax, because that air increases with every exhalation (the lung now having two routes to exhale air out of, the trachea and the hole in the lung itself). This allows the lung to collapse on that side, and soon enough pressure (tension) will develop in that half of the chest to push the chest contents over to the other side, compromising blood flow and air exchange in the other lung & heart when it does so. (This is when you see the "tracheal shift.") This is also a bad thing.

    So: now both of these fine folks have bought themselves chest tubes. The guy with the chest wall trauma has had his trauma hole sewed up, so when he takes a deep breath air enters his trachea only. He has a water seal on his chest tube so he can't pull air into his chest thru the tube-- the water seal acts like the bend in your sink drain and prevents continuity of the inside and outside places. The suction on the chest tube setup has done its job of removing the air from the pleural space where it didn't belong--it was seen bubbling out thru the water seal and then couldn't get back in. (When all the air is gone from his pleural space, there will be no more airleak in the water seal compartment.) Now, if he disconnects his Pleurevac (or other copyrighted device), he can again take a deep breath and pull air thru the open tube into his pleural space, where it doesn't belong, collapse his lung, and start all over again. THEREFORE, when this guy disconnects his tube, you clamp it IMMEDIATELY, to prevent air from entering the pleural space. He should ALWAYS have those two big old chest tube clamps taped to his Pleurevac (so they go with him to xray and all), just in case he does this.

    However, the other guy, with the ruptured blebs or wedge resection and the intact chest wall? Well, his chest tube is pulling air out of the pleural space, but more is still getting in there since he still has a hole(s) in his lung. The idea of the CT is to pull it out faster than he can put it in, and allow the hole to heal up, at which point he will no longer collect air in his pleural space and be all better. Meanwhile, though, you see air bubbling in the waterseal chamber, showing you that there is still air being pulled out of his pleural space. He has “an air leak.” What happens to him if his chest tube gets disconnected?

    Well, remember, he still puts air into his pleural space, because there's still a hole in his lung. You put a tube in there to take it out, remember? OK, so what happens if you clamp his tube? Bingo, air reaccumulates in the pleural space all over again, his lung collapses, and things go to hell in a handbasket. This guy should NEVER have clamps at his bedside, because some fool may be tempted to clamp his tube before his airleak seals, and he'll get in trouble all over again. If he pulls his tubing setup apart, have him breathe slowly and shallowly (to minimize the air leaving the hole in his lung and getting trapped in his pleural space) while you quick-like-a-bunny hook him up again to a shiny new sterile setup. But do NOT clamp his tube while your assistant gets it set up for you.

  • Aug 23 '14

    Good way to remember for the tests:

    Primary - Prevent
    Secondary - Screen
    Tertiary - Treat

  • Jul 28 '14

    I'm a first semester student in an accelerated 2nd degree program.
    So what we're saying is that you're a beginner... a newbie... green as an estate lawn... Each and every one of us starts out at the beginning and that's where you are.

    OK, now that we have some context...

    I just generally feel soooo slow!
    Well, you're a nursing toddler... you shouldn't be expecting yourself to be Usain Bolt at this point...
    And stupid!
    OK, I'll be the first to tag someone with the "stupid" label... there are plenty of stupid people running around but two classes into nursing school is hardly a sufficient sample size to make that determination.
    The first sim, the "doctor" told us to give our "patient" a 30mg IV dose or morphine. I thought it was high but was prepared to administer it, and then another peer of mine brought it up and we discussed it. She thought it was high too, so we called back and the doc said oops, 10mg not 30mg. So it was a good catch except it wasn't really my catch, since had it not been for my peer I probably would have administered the erroneous dose
    Hmm... do you suppose that's why they're having you learn on a SIM? So you have the freedom to make mistakes without hurting anybody? Of course.

    I'm willing to be that you'll never in real life be ready to give a morphine dose like that.

    SIM goal accomplished.

    Second sim, the "patient" was a type 1 diabetic and had just received humalog. It was lunch time and we were also prepping him for a blood transfusion. He kept complaining of being cold, tired and had chills/shakes... For some reason my whole group got hung up on the mind set that he just really needed the transfusion to make him "perk up" rather than the fact that he was experiencing symptoms of hypoglycemia from his rapid acting insulin and having refused his lunch! We eventually figured it out and pushed sugars but again, I just felt so slow and stupid. I know the symptoms of hypoglycemia perfectly well and yet I did not connect them, clinically, to my patient.
    Hummm... well maybe it's a good thing that you're in a SIM lab rather than taking your own assignment next to me in the ED... What did I say about SIMs being a safe place to learn?

    Should I be concerned that I am being slow and missing something
    No... but you should be concerned that you're undermining yourself by calling yourself "stupid" and thinking that, as a newbie student nurse, you should be knocking this stuff down.
    is it supposed to take awhile to make clinical connections like this?
    There's no set template... everybody gets up to speed at their own rate (and yes, some never do... but you're at the very beginning... give yourself some time.

    i feel like I also get nervous because of the one way mirrors and the professors watching us
    I work at an academic medical center and volunteer to work with the med students and residents (that is, MDs who are learning their specialties). I recently volunteered in the SIM lab as a bedside nurse for a doc who was running an ACLS code. Before I went to the bedside, I spent awhile watching her through the "looking glass"... so here's this lady who's just finishing her second year of training as an MD and she looked like a nervous nursing school newbie...

    The point is, most people don't like SIMs and almost nobody likes to be watched and judged. However, SIMs are supposed to be a safe place to learn... and to make mistakes... all with the "no harm, no foul" caveat.

    Practice relaxing and enjoying it... and look for the simple answers before you get hung up in the complicated ones.

    Be nice to yourself and stop using the "stupid" moniker anywhere near yourself. I'll make you a deal... you agree to never call yourself stupid and I'll agree to do it for you if it's justified... 'K?

    Chill out, go forth, and conquer.