Content That ixchel Likes

Content That ixchel Likes

ixchel, BSN, RN 41,616 Views

Joined Jun 3, '11. Posts: 5,154 (75% Liked) Likes: 19,700

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  • Aug 19

    Quote from ixchel
    In my head, after I read a story by you, I secretly end it with, "then I popped a cap in his ass," and imagine you standing in glorious rock star 80s poses with smoke/steam billowing behind you as car headlights beam through it toward you. Then in totally awesome slow-mo, you light a cigarette with one of those flip lighters. You drop the lighter with some badassery, and a trail of gasoline suddently ignites. You walk forward (as badasses do), staring into the distance. And as we see you in focus, walking toward the horizon, a random (but somehow important) building blows up behind the smoke of awesome.

    eta - OP, if you need to chart in quiet then chart in quiet. I know I prefer it. And some nights you really do need to sit near a patient's room. Maybe toward the end of a shift when you're caught up, you can go see what everyone is up to.
    Have you thought about hanging up this nursing thing.. and writing romance novels?

    I didn't blow anything up.. but I did send a scathing retaliatory letter to little missy that canned me, HER manager, and HR. That facility closed a couple of years later. Karma ..she is a friend of mine.

  • Aug 17

    Quote from ixchel
    I found this thread!!!! Omg I can't believe I just found it. It was on, like, page 4 of search results.

    Guys.... There is a new thread up now. I didn't expect to actually find this thread, so I didn't save the link. I'll try to come back with it. If you happen to be better at this and you don't see I've come back here yet, please post the link!
    Here you go!

    (what was I saying about crummy search results? heh)

  • Aug 14

    I learned that I might actually know what I'm doing.

  • Aug 14

    I like the expression "Treat the patient, not the machine" and use it all the time when I teach Basic Arrhythmia, along with the story of a patient whose night nursing assistant documented a HR of 72 at 0600 by standing at the monitor banks and reading the screen.

    Day shift arrived, the new day nursing assistant went in the room to take vitals, and found the clearly dead patient in rigor mortis. Meanwhile, the pacemaker kept firing beautifully.

  • Aug 14

    Quote from jk2185
    I wish people on this site wouldn't ask damaging things such as,"are you a nurse?" or "how many years have you been a nurse?" just bc you disagree. I find this very childish and cutthroat. I wish we were all more supportive of each other. This is supposed to be a forum for discussion and learning, not bullying and chastising.
    Quote from jk2185

    As for the BLS survey. You most definitely perform the BLS survey first during a code, albeit you may do it in 3 seconds, you still do it. Even on the vented patient. Not all vented patients are sedated either...we may be trying to extubate or performing a sedation holiday. Also, not every patient in the ICU is vented; in my experience half are and half are not. ACLS is the heaviest protocol used in a code, but step one is always BLS.
    Pardon my ignorance, but I fail to see how asking "are you a nurse?" Or "How long have you been a nurse?" Is damaging, childish or cutthroat. So far, the least colleaguial and most chastising posts on this thread have been your own. Or is disagreeing with you childish and cutthroat?

    If you've been paying attention, you will have learned from this thread and this discussion. Perhaps that isn't what you wanted; perhaps you just wanted to see posts agreeing with you. Fortunately, unthinking agreement won't be found much on this forum.

  • Aug 14

    One reason I quit ICU work and went to floor nursing with a passion is I got sick of watching machines. For me they seemed to interfere with my communication with the patient. That was MY own feeling. Of course then the floors got all the things that bing and bong and we wound up running after the alarms. You really get alarm fatigue quicker than you realize. I took care of full code vent patients on the floor, those who were medically stable enough to come out of the ICU. Take a vent, a few IV lines, etc and there you are right back taking care of alarms. The alarms are also distressing to the patients and families. May be there is a way to have the alarms go to a pager that the RN carries? I don't know the answer but I know what drove me crazy. Alarms on new machines that continued to beep regardless of what you did, so we went back to what we knew, manually timing drips until we could get a different machine. Sometimes we went through 3-4 machines until we got one that worked. They were so over used that pieces of them broke off after a few months. Who knows, maybe in a fit of pique some nurse tore the machine up so they would not have to listen to it. Fluid and electrolytes, drips, antibiotics, all need close monitoring but if you can't rely on the machine they give you then what do you do? I learned timing drug and drips by drops/min. I calculated the H---l out of those things and watched the patient like a hawk. Anyone remember the chambered IV lines used in pediatrics?

    You had a measuring chamber that you put fluid in, then added your meds and stood there and watched it while it dripped. Not a perfect system but so many times I hung out in the baby's room and played, changed, bathed while the meds went in so I knew the rate and was sure that they got the right dose at the right rate, over the right amount of time and made sure there was not infiltration. Seeing as how we gave stuff like micro doses of Gentamycin which is oto-toxic it was important. Plus we were giving minute doses of the stuff. I much preferred staying with the patient over answering a machine. Maybe I am too old and need to shut up. I don't know. I just know alarm fatigue is a real problem and it does not help patients. Their anxiety goes through the roof and then you have more problems to deal with.

    There is nothing so good as the "gut" feeling of an RN. Regardless of what a monitor says, trust your gut. If you know the patient then your gut tells you how to go. I know that many docs do not understand that "nurse gut " thing but some do and if you can back up that feeling with any clinical sign at all you can usually get an order for labs, x-rays or something to help diagnose. I have had many "gut" discussions with residents and after you are correct once and they don't see you as a threat(presentation is everything) well, BAM, you have a believer. I have had more than one resident thank me for the heads up. Let the resident know you are on their side and just advocating for your patient and I have found it usually wins them over. It has certainly improved my subsequent conversations with them. After all we are a team. OK now I shut up.

  • Aug 14

    Quote from paige1075

    ...So I think it is important to remember that every patient is in fact very different and all assessments must be taken into consideration when using critical thinking and taking action.

    Would you disregard any other piece of information on your patient Just because your assessment showed otherwise? Or would you dig deeper?...

    it should instead just say "treat the patient." And leave the treatment plan up to the nurse and her resources.
    I'm more of a fan of the saying "Treat the patient, not just the monitor." You have to have both, and know when to apply what weight to each side of the equation when doing patient care. A couple weeks ago I had a patient that was new to the department, came in by ambulance. This patient was a bit tired but otherwise OK. Unknown to me at the time, this patient had some COPD. Every time the patient would nod off, their SpO2 numbers would drop a bit, into the mid 80's from about 91-ish. So I put this patient on a small amount of oxygen, which brought things back up. However when this patient nodded off again, down the sats would go... My mentor then suggested that I should put this patient on a mask. I held off because something was telling me that I shouldn't. I looked at the patient and simply changed out the pillow for a thin folded blanket. This opened the airway a bit and the sats miraculously came up... while I was checking the history. A mask would have increased the FiO2 but wouldn't have changed the volume and this would have made the sats look good while allowing the CO2 levels to rise.

    Sometimes you just gotta look at your patient when the monitor is telling you something is wrong. Don't forget that sometimes the monitor can be a late indicator of something wrong...

  • Aug 14

    And not just LOOK at the patient, talk to him, touch him. I've seen nurses look at the monitor and go on with out a glance to the real person. You can tell a lot also just by touching a person's arm . The monitor will tell you a lot but it has to match to how the patient really really feeling. Ask ,don't just look.

  • Aug 14

    I experienced this when I was in the hospital myself a few years ago. I had a bad sinus infection that led to orbital cellulitis - not the worst thing in the world, but it did earn me a week long stay in the hospital for IV antibiotics.

    Anyway, when I came into the hospital my blood pressure and heart rate were very high for me due to pain and infection, but within the normal rage for most people. I've always been very athletic, and I have a very low resting heart rate. Well, after a few days of antibiotics, my heart rate came down to my normal 35-40 bpm. I was asleep and the nurse called a code when my heart rate dropped into the 30s, and the team of doctors and nurses racing into the room and checking my pulses woke me up in a panic. I was totally fine, and if the nurse just checked my pulse, or tried to wake me, she would have seen I was completely okay.

    Monitors are amazing to alert you to POSSIBLE problems, but you should still look at the patient before jumping to drastic measures.

  • Aug 11

    Quote from ixchel
    What is a CI?
    CI - Cardiac Index. Left ventricle output (HR x stroke volume)/ body surface area, L/min/M2. Norm 2.6 - 4.2. Roughly, below that = cardiogenic shock, guy is cold and mottled; above that = high output heart failure like in sepsis, guy is warm and pink (for a while).

  • Aug 10

    Quote from jk2185
    This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.

    We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.

    I just wish we could flush this saying out or maybe change it.
    Numbers have been around far longer than a century. Just saying.

    I'm sorry you dislike the expression. Does "look at the patient, not the monitor" appeal to you instead?

    Years ago -- decades ago, actually -- I worked in an old, decrepit hospital. A brand new hospital was built, and many new nurses were hired to staff the additional beds the new hospital afforded. Moving day came, and we moved into the MICU with it's bright, shiny new, state-of-the-art monitors. The first patient was moved in and hooked up to the monitor with a lot of fumbling because the monitors were new and unfamiliar. The second patient was moved in and also hooked up to the monitor . . . And so forth. Not long afterward, the nurses were gathered around the nurse's station when the monitor alarm went off. Patient 1 was in ventricular tachycardia. Everyone went rushing into his room with the code cart and code drugs, following accepted ACLS protocol. The rhythm deteriorated from ventricular tachycardia to ventricular fibrillation to asystole, despite the interventions. Then a wondrous thing happened . . . The patient began to strenuously object to defibrillation and chest compressions despite the asystole on the monitor.

    During the construction process, somehow the monitoring wires in the two adjoining rooms was crossed. Patient 1 wasn't in asystole; Patient 2 was. And because all those brand new nurses and former medical students (did I mention this was July?) were treating the monitor instead of the patient, a patient died. And the patient they were treating had some pretty bad burns and broken ribs.

    Use your judgement. Sometimes, the monitor can alert you to the beginnings of badness before anything else will alert you. Other times, the monitor's malfunction will send you careening down the wrong path. According to Samuel Shem in "House of God," the first pulse to check in a code is your own. Maybe you like that expression better.

  • Aug 4

    Quote from OrganizedChaos
    Is anyone's tapatalk app not allowing them to log into AN?
    Sent tapatalk an error report in hopes that I will be able to post from tapatalk again!

  • Aug 3

    OC, I once had a June beetle fly into my ear when I was 12. The ER tried and tried to get the little bugger out, but no luck- it was just too deep. The worst part? It was still alive and buzzing around trying to escape until they filled my ear canal with mineral oil. That was on a Saturday night. On Monday morning, I went to an ambulatory surgery center when they removed it under anesthesia. The only complaint my family had was that somehow I got dropped from the list of patients in the waiting room who still needed to be seen. Other than that, we perfectly understood why they couldn't get it out themselves.

  • Aug 2

    Quote from ixchel
    Sent from my Federation Starship using Tapatalk
    I love it when I see off the wall things like this! I've seen Facebook posts from toasters, microwaves, spacecraft...

    What I learned this week:
    Surgeon misbehavior towards staff will be taken seriously at my facility. We currently have two surgeons who will be appearing in front of the highest leadership in a disciplinary hearing over how they behaved towards staff in front of patients this week. Like, this is beyond their immediate chair of surgical specialty and chief of surgery level serious. Nice to know someone has our backs.

    That patients who are doing extremely well when they leave the OR will crump and code (unsuccessfully) overnight. The ones who are on rocket fuel with huge outputs in their chest tubes that you are sure won't make it do surprisingly well.

    Sent from my boring old laptop in my boring family room where I've got a dog on my lap using my trusty old (but completely working) keyboard.

  • Aug 2

    So I went to the ER last night due to pain in my middle & lower right side of my back. I was in the room alone until another woman was brought in, for having a bug in her ear.
    Everything was fine until she started complain about the doctor (who was EXTREMELY nice) & the nursing staff. Now I don't know them personally, but I'm a nurse so I'll put my neck out for you.
    So this woman was ******** because they couldn't get the bug out. It's a small, rural ER with none of the equipment they need to extract small objects from ears. One of the gems she said was,"That Doctor should've never had a plan C. It should've been plan A & that's IT!" Listening to her ******** & moaning about how a doctor was trying his damnedest to help her was boiling my blood.
    I think the kicker was when the guy that was with her, who has alluded to working in a hospital for 10 years said,"Well I've been a tech for 10 years, but what do I know?!" What do you know?! NOTHING! You have zero medical/nursing training to be telling the nursing staff OR the doctor HOW to do their job!!!!
    I wanted to scream at them but I also didn't want to get kicked out because I was in pain. So I gritted my teeth & just laid there.

    Oh, I ended up having gallstones. Whoopie!