Content That Lev <3 Likes - page 3

Lev <3, BSN, RN 49,848 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: 2,866 (53% Liked) Likes: 5,310

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  • Jun 11

    Quote from amzyRN
    How much experience though? Would you recommend 5 years, 7 years, 10 years? I have 5 years but only 1 in the ED so far, wanting to aim for 2 at least.
    In my experience in preceprong students with anywhere from direct entry (no experience) to 40 years experience, and everything in between, I have not found a strong correlation between greater than say 3-5 years experience, and a better prepared student at graduation. I have found far more of a correlation between the students ability to think critically, have the ability to act autonomously, and the strength of the NP program.
    A student with strong critical thinking skills from a strong NP program who has two years prior RN experience will quickly catch up with someone with someone who lacks those skills, in particular if they are at a weaker program.

    I have had serious concerns about 3 students in the past 15 years in terms of their ability to practice safely as an NP. All three had at least 10 years experience and we're enrolled in weaker programs.

    My current NP student has two years experience as an RN, and attended a top BSN school, and is now is in a top MSN school. She is by far the strongest student I have had.

  • Jun 9

    Quote from Lev <3
    Here's one.

    Two weak old infant. Fever of 102. VS otherwise stable.
    A 2. A 1 if they look in the least sick (color, work of breathing, lethargy)

  • Jun 8

    Quote from Lev <3
    35 y.o. female comes in with c/o of chills, malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.
    Peritonsilar abscess? Ludwig's angina?

  • Jun 8

    Quote from Lev <3
    35 y.o. female comes in with c/o of chills, malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.

    Quote from amzyRN
    She could be an esi 2 depending on what her throat look like. I'd look in her mouth really quick to make a final determination. In an uncomplicated sore throat, it would be an ESI 4 for a throat swab.
    Agree. I'd be most concerned about peritonsillar abscess, and would assign ESI the same as ^

    Ludwig's I think is usually bilateral/floor of mouth...I remember trying to figure out why it was called 'angina' when I was really new and trying to understand how it compared to chest pain/angina.

  • Jun 8

    Quote from JKL33
    Agree. I'd be most concerned about peritonsillar abscess, and would assign ESI the same as ^

    Ludwig's I think is usually bilateral/floor of mouth...I remember trying to figure out why it was called 'angina' when I was really new and trying to understand how it compared to chest pain/angina.
    I think people with Ludwig's angina have a hard time opening their mouth, that's why I threw that in there.

  • Jun 8

    Quote from KindaBack
    ESI 3

    Going to require labs, IV abx are likely.
    Agree. Doesn't seem to meet SIRS/sepsis criteria yet. Will possibly get an ultrasound as well, depending on the doc.

  • Jun 8

    Good points regarding the generalized, non-specific abd pain in a FF w/ a history of gastroparesis. I'm trying to visualize the case and I imagine that my mind wouldn't immediately go to ectopic. Certainly the history and presentation doesn't scream 'ectopic' but boy can those go all kinds of bad in a hurry.

    I think I would still make her a 2, though.

    Certainly she appears in severe pain and it's important not to let our biases and experience with her dramatic lack of coping skills color our assessment. If I knew nothing about her except what I could get from my initial triage, I think she'd be a 2. I don't think it's appropriate to drop her to a 3 based on prior experiences... but I feel a little wishy-washy in what I just typed.

    I hate these kinds of cases.

  • Jun 8

    Quote from Lev <3
    57 year old female - comes in with right lower extremity pain, swelling, and redness x 1 week, which is gradually getting worse. "I tripped and fell and scraped my leg 2 weeks ago." VS as follows: T: 37.6, HR: 86, BP 140/78, RR: 16, Pulse ox 99% on RA. Reports chills off and on. Didn't check temperatures.
    ESI 3

    Going to require labs, IV abx are likely.

  • Jun 8

    Quote from Lev <3
    57 year old female - comes in with right lower extremity pain, swelling, and redness x 1 week, which is gradually getting worse. "I tripped and fell and scraped my leg 2 weeks ago." VS as follows: T: 37.6, HR: 86, BP 140/78, RR: 16, Pulse ox 99% on RA. Reports chills off and on. Didn't check temperatures.
    ESI 3, may need ultrasound and labs

  • Jun 8

    Quote from Lev <3
    57 year old female - comes in with right lower extremity pain, swelling, and redness x 1 week, which is gradually getting worse. "I tripped and fell and scraped my leg 2 weeks ago." VS as follows: T: 37.6, HR: 86, BP 140/78, RR: 16, Pulse ox 99% on RA. Reports chills off and on. Didn't check temperatures.
    What I would do:

    ESI 5 = simple and local cellulitis (I'm guessing d/t time frame it's more than this)
    ESI 4 = may require lab or imaging but probably not IV abx
    ESI 3 = riskier PMH such as immune compromise, systemic sx, OR lab &/or imaging r/o osteo/gas etc, IV abx

    My guess is the tendency will be to do more with this, I say that based on the amount of time since the injury and the report of worsening and report of systemic sx (chills). Assuming it looks fairly nasty I'll hedge my bets on ESI 3.

  • Jun 8

    Go to the other interview and ask to shadow if they don't already offer shadowing which I've heard is common practice now. Then pay attention to the vibes and see if it seems better run. If its better I would bail from the job you are currently in.

  • Jun 8

    Quote from LovingLife123
    This job doesn't sound so great, but reason for not going full time at the other job was kind of weak. You need a lunch and a break or you are not safe? What makes you not safe by not having a 15 minute break?

    I get needing to eat. I need to eat. I don't get to every day, but I at least shove something down. But never am I not safe and that is a cop out to me.
    I don't know. I think most nurses are just used to the fact that they probably won't get their breaks, and sometimes not even a full lunch. I think it's become so common that instead of speaking out about it, we treat it as normal and tell everyone else to deal with it. I personally don't feel like I need additional breaks to feel safe, but I don't think it's strange that someone working a 12 hour shift that requires a lot of mental and physical stamina would need more than just a 30 minute break in there. The fact is that lots of great nurses out there make fatal mistakes every year, and I believe that if we weren't running around like crazy during the entire shift, we would be safer. Just my $0.02.

    Now, I would never turn down a full-time job because of this, but I wouldn't ever want to normalize this less-than-delightful feature of nursing. It needs to change. Now, whether or not it ever will change is another question for another day.

  • Jun 8

    Your new job sounds like a disaster waiting to happen ... and I wouldn't blame you for leaving.

    But given your job history, you need to be more careful in picking jobs in the future. Do more research before actually accepting a job. It's easy to make a mistake (or even 2) in deciding to take a job. But if you have repeatedly gotten yourself into jobs as bad as the one you described in your post, then there is a problem with how your are choosing the jobs you take.

  • Jun 8

    Quote from amzyRN
    I gave her an ESI 3 but another nurse changed it to ESI 2 for sever pain or distress.
    Probably based on the tachycardia (danger zone vitals) and 10/10 pain. Probably an overtriage, too.

  • Jun 8

    Quote from amzyRN
    How about ESI for the following patient: 28-year-old female presents with severe abdominal pain is screaming at the top of her lungs "help me help me" She is brought in by EMS. She has a history of diabetes and is often non compliant with medication. She also has a history of gastroperesis and is a frequent patient at EDs in the area. Her vitals are stable, with a BP of 160s/100s, HR 110s, SpO2 98% on room air, afibrile. She screams that her pain is 10/10.
    ESI 3 unless some other part of the story or my initial once-over is very compelling for ESI 2.


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