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Lev <3, BSN, RN 44,094 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,711 (53% Liked) Likes: 5,012

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  • Jan 16

    A little job hopping every few years has not hurt my bank account.

  • Jan 16

    A little job hopping every few years has not hurt my bank account.

  • Jan 16

    A little job hopping every few years has not hurt my bank account.

  • Jan 15

    The first thing that jumped out at me was your insane and unsafe ratio of 9 patients to one nurse. Then I remembered the past couple shifts I have worked in the ED. Last shift - 5 cardiac arrests, critical and after critical, 25 tele patients boarding waiting on beds, full waiting room. The shift before, left the ED at 11pm with about 70 patients in the waiting room, it peaked that night at 82, also many critical patients.

  • Jan 14

    Onwards ands upwards! Perhaps LPN school and then bridge to RN?

  • Jan 13

    Unvaccinated, immature immune systems, easily dehydrated

  • Jan 13

    The first thing that jumped out at me was your insane and unsafe ratio of 9 patients to one nurse. Then I remembered the past couple shifts I have worked in the ED. Last shift - 5 cardiac arrests, critical and after critical, 25 tele patients boarding waiting on beds, full waiting room. The shift before, left the ED at 11pm with about 70 patients in the waiting room, it peaked that night at 82, also many critical patients.

  • Jan 13

    Onwards ands upwards! Perhaps LPN school and then bridge to RN?

  • Jan 13

    Onwards ands upwards! Perhaps LPN school and then bridge to RN?

  • Jan 13

    Unvaccinated, immature immune systems, easily dehydrated

  • Jan 11

    Quote from zacarias
    Thanks for all your comments!! This is definitely one of those threads on this website where everyone is learning.

    FYI, I know liver disease makes lactate levels less useful.

    My question mostly centered around the MAP. I know we treat the patient not the monitor but a liver patient can easily have a MAP of 50 and be talking and acting "normal"; this does not mean that everything is OK!

    Also, do lactate levels meant to be checked so frequently? Also on SBP, a patient a&ox4 with absolutely no pain with an absolutely soft non-tender-non-rebound abdomen because lesser worrisome for SBP in my opinion.

    Thanks again for all your contributions. I like this type of thread.

    Z
    Our standard for septic patients is a lactate drawn every 2 hours. Presumed source of infection + 2+ SIRS criteria = sepsis.

    A great article for those interested...Etiology and therapeutic approach to elevated lactate

    Re: the liver disease - even if a patient has liver disease and presents with an elevated LA, more likely the lactate is elevated for a primary reason other than liver disease. Yes there may be less clearance of the LA but most likely it got high for a reason.

  • Jan 11

    Quote from OllieW
    ICU is more fun and you can be all OCD for your 1-2 patients. ED is sorta like Med/surg part 2.
    Don't agree with you on the med-surg part 2 part. Yes I have dubbed fast track "med-surg on steroids" on certain days but the main ED is a whole other ballgame and type of nursing.

  • Jan 11

    Onwards ands upwards! Perhaps LPN school and then bridge to RN?

  • Jan 11

    Quote from NurseKatie08
    A little confused about why you say high doses of Albumin are never ordered because it will kill the kidneys. I find quite the opposite to be true as a liver nurse. We give large doses of Albumin as part of our SBP protocol on day 1 & 3 for renal protection (1.5g/kg on day 1, 1g/kg on day 3), as well as to aide in pushing fluid where it belongs. NS boluses for hypotension in liver patients are ill advised because they'll just go right to the belly. Hoping you can explain what you mean.
    It may be because albumin/proteins are larger molecules, like glucose. Hard on the kidneys. Some dialysis/renal patients have protein restricted diets.

    As a liver nurse, you give the albumin for renal protection to increase vascular volume and thereby improve renal perfusion

  • Jan 11

    Onwards ands upwards! Perhaps LPN school and then bridge to RN?


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