Latest Comments by Lev <3

Lev <3, BSN, RN 44,162 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: 2,713 (53% Liked) Likes: 5,025

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  • 1
    OrganizedChaos likes this.

    Yes, a dying person can have some or all normal vital signs. There is no 100% fool proof way to predict when death will occur
    . Some go in a matter of hours and some linger on for days.I'm sorry for your loss. -spoken as an ER nurse who recently was a hospice nurse for an ER patient.

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    Do you type or write out notes? I have discovered that writing notes in class vs typing on the laptop helps me considerably.

  • 10
    Passion8RN, NewGurl, Caffeine_IV, and 7 others like this.

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

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    ICUman and JBudd like this.

    Unvaccinated, immature immune systems, easily dehydrated

  • 1
    poppycat likes this.

    The answer is yes. 2 peripheral lines (one large bore in the AC) is appropriate even if starting most pressors. Sure a central line is lovely but not always ED priority.The answer re: central line for pressors depends on institution specific policy.

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    What type of triage scale/system does your facility use?

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    WestCoastSunRN likes this.

    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.

    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.

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

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    Work as a tech

    Volunteer experience - healthcare related

    Tutoring other nursing students newer cohort

  • 2
    zacarias and SeattleJess like this.

    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

  • 3

    Quote from KatieMI
    I accidentally discovered, and therefore learned this week that Bloody Mary mix (sans vodka) can be used as oral rehydration solution if you got several people with severe stomach flu 30.000 feet above the Atlantic.

    Also, it was fun to run the floor, so to say, with a British doctor. Apparently, I was the first US nurse he ever encountered and he was clearly impressed
    There's a story here. Tell us more!

  • 6

    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.

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    Quote from nursebabyxoxo
    Sometimes we are adequately staffed and when we are we have 5-6 patients. Most times though we are either short staffed or have so many holds in the ER that we end up having 7-8 patients. There was one night nurses had 8 patients and this included one cardiac arrest, a stroke code, a post trauma, 2 icus holds who were intubated and 3 other ER patients (YIKES). I just don't get how ICU floors can have max 2 patients and in the ER it is okay to have 5 critical patients on top of 3 other patients. On orientation I have been able to juggle my 5-6 patients but i have not experienced a lot of critical critical things that people have experienced (like a fresh intubation). My preceptor was a great teacher but is the type of person that would pick fights with family members and talk down to people just because it makes her feel powerful. There was this one day a tech went out of her way to draw labs for patient and she was mad saying how she already did it and how he should open his ears and not have add. (which i took offense because i struggle with add). I liked her criticism but her tone of voice and the way she said it was in the worst way and I felt like she didn't understand what I meant half the time. For example: an ALS patient came in with hypoglycemia and she said what interventions would you do. I always think beyond the box so i said I would put an IV in blah blah and she was like "you wouldn't check the blood sugar? what did you learn in nursing school then?" And she would like yell it in front of all the staff. It was embarrassing having everyone stop talking and staring at me while she raised her voice at me. Stuff like that. Obviously i would check the blood sugar if the blood sugar was low. I just thought she wanted to know what else I would do beyond that.

    There was also a time a staff member told me she did everything for one of my patients. I had no idea she did until she told me. and my preceptor overheard and said to me "what did i tell you about getting help from other people? i told you numerous times not to get help! you need to learn on your own".

    There was also a patient who asked for a sanitary napkin. I did not know what a sanitary napkin was. And my preceptor says "how do you not know what a sanitary napkin is.. it is a pad" and I was like "why can't they just say pad or a sanitary pad" and she said "it doesn't matter. that is a word for a pad. you should know what that is."

    I constantly felt stupid.
    I think she is just mean. That is beyond just a strong personality. Wow, one nurse had all those patient? Your ratio is very high and there are better places to work. Ratios tend to vary with geographic area. It is ok to ask for help but you do want to be capable of doing things without the tech because there may not be a tech one day.

  • 3
    Nursingblue, CalArmy, and WSMom like this.

    This book --> Pearson Reviews & Rationales: Medical-Surgical Nursing: 978�133�836�6: Medicine & Health Science Books @

    And this book --> Saunders Comprehensive Review for the NCLEX-RN(R) Examination, 7e (Saunders Comprehensive Review for Nclex-Rn): 978�323358514: Medicine & Health Science Books @

    And this one --> HESI Comprehensive Review for the NCLEX-RN Examination, 5e: 978�323394628: Medicine & Health Science Books @

    I used these books during med-surg class (older editions). The Hesi book has very good, to the point content in addition to questions. The Saunders and HESI book are new editions but the old editions are still around and are less expensive.

    If I had to pick one, I would get the Saunders book.