Latest Comments by Lev <3

Lev <3, BSN, RN 42,439 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has 'A few' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,602 (52% Liked) Likes: 4,791

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    Quote from MDMBSNRN
    I've worked in both ED and ICU, but I've only ever precepted in various critical care units. Usually for orientees who are unsure of rhythms, I take them into the room, and ask questions. "What rhythm do you see on the monitor? Do we need to immediately intervene related to the rhythm/rate/blood pressure? Do you have any concerns about the rhythm, or how it relates to the patient's chief complaint?" I try to be gentle with these, and not make my orientee feel like I'm belittling or insulting them.

    During downtime on the unit (which is seldom), I also tried to make it a point to show my orientee rhythm strips (especially of concerning rhythms like A. fib, A. Flutter, V. Tach, V. Fib, and various degrees of heart blocks). I would ask what the rhythm was, and ask my orientee what should be done if the patient converts into one of these rhythms. Together, we would review treatment algorithms for each rhythm.

    As far as giving her telemetry patients alone, I wouldn't feel comfortable with that. I would supervise, even if from a distance, until I felt that she was more competent with identifying various rhythms, and knowing what to do in the event of an acute cardiac issue.
    Thanks this helps. We had a patient in a-fib the other day which is a fairly regular occurrence. However, she doesn't know what that means as far as the hearts electricity, does not know interventions if it were to go faster.. etc. She was able to document a-fib off the EKG but that was about it. I was just kicking myself because I went into the room to draw labs on the patient and noticed he was in a-fib and felt I should have known that an hour ago - in my mental back brain of patient facts.

    The other thing that happened which was alarming is that she started rolling my patient out of the room to go upstairs - I was with her - and the O2 tank was empty. I had told her to check the O2 - I guess she hadn't heard me. Fortunately I glanced at it and realized. This patient was practically breathing with only 1 lung and was on a venti mask at 12 liters.

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    I get the feeling that this poster does not have prior relevant RN experience, or has very little experience.

    From taking two graduate level NP classes (advanced pharmacology and advanced patho), I already know that there are resources and treatment algorithms out there for many common conditions such as hypertension, diabetes, and high cholesterol. It seems like this poster was not very well prepared.

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    evastone likes this.

    The little things matter and treating patients and their families like human beings makes a huge difference.

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    Ok some updates. She is more experienced than me in years (half in a different country) however, knowledge is far behind. Did not know to do blue top before purple topped blood cultures.

    She is also taking on too much at a time. She had two patients, I told her I was going out to get one for myself. She comes into the room when I bring the patient back and starts taking over and starts assessing the patient. I understand that she wants to help but leave me alone for a second! I left the room to tend to HER patients who needed to be hooked back up to the monitor, labs, meds, bathroom, and belonging sheets. Hopefully she got the message. I will speak to her explicitly about it.

    If she doesn't know the monitor should I be giving her patients who need tele to care for alone? Should I be assessing them to? She documents the cardiac rhythm, but she copies the rhythm that the EKG machine spits out which is not always right. (I checked her assessments to make sure she was documenting it correctly).

    I've given her lots to read and told her to review EKGs first.


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    MLPN, NYbabyRN, lindseylpn, and 12 others like this.

    A Letter to the Doctors and Nurses Who Cared for My Wife

    After his 34-year-old wife suffered a devastating asthma attack and later died, the Boston writer Peter DeMarco wrote the following letter to the intensive care unit staff of CHA Cambridge Hospital who cared for her and helped him cope.

    As I begin to tell my friends and family about the seven days you treated my wife, Laura Levis, in what turned out to be the last days of her young life, they stop me at about the 15th name that I recall. The list includes the doctors, nurses, respiratory specialists, social workers, even cleaning staff members who cared for her.

    “How do you remember any of their names?” they ask.

    How could I not, I respond.

    Every single one of you treated Laura with such professionalism, and kindness, and dignity as she lay unconscious. When she needed shots, you apologized that it was going to hurt a little, whether or not she could hear. When you listened to her heart and lungs through your stethoscopes, and her gown began to slip, you pulled it up to respectfully cover her. You spread a blanket, not only when her body temperature needed regulating, but also when the room was just a little cold, and you thought she’d sleep more comfortably that way.

    You cared so greatly for her parents, helping them climb into the room’s awkward recliner, fetching them fresh water almost by the hour, and by answering every one of their medical questions with incredible patience. My father-in-law, a doctor himself as you learned, felt he was involved in her care. I can’t tell you how important that was to him.
    Then, there was how you treated me. How would I have found the strength to have made it through that week without you?

    How many times did you walk into the room to find me sobbing, my head down, resting on her hand, and quietly go about your task, as if willing yourselves invisible? How many times did you help me set up the recliner as close as possible to her bedside, crawling into the mess of wires and tubes around her bed in order to swing her forward just a few feet?
    How many times did you check in on me to see whether I needed anything, from food to drink, fresh clothes to a hot shower, or to see whether I needed a better explanation of a medical procedure, or just someone to talk to?

    How many times did you hug me and console me when I fell to pieces, or ask about Laura’s life and the person she was, taking the time to look at her photos or read the things I’d written about her? How many times did you deliver bad news with compassionate words, and sadness in your eyes?

    When I needed to use a computer for an emergency email, you made it happen. When I smuggled in a very special visitor, our tuxedo cat, Cola, for one final lick of Laura’s face, you “didn’t see a thing.”

    And one special evening, you gave me full control to usher into the I.C.U. more than 50 people in Laura’s life, from friends to co-workers to college alums to family members. It was an outpouring of love that included guitar playing and opera singing and dancing and new revelations to me about just how deeply my wife touched people. It was the last great night of our marriage together, for both of us, and it wouldn’t have happened without your support.

    There is another moment — actually, a single hour — that I will never forget.
    On the final day, as we waited for Laura’s organ donor surgery, all I wanted was to be alone with her. But family and friends kept coming to say their goodbyes, and the clock ticked away. About 4 p.m., finally, everyone had gone, and I was emotionally and physically exhausted, in need of a nap. So I asked her nurses, Donna and Jen, if they could help me set up the recliner, which was so uncomfortable, but all I had, next to Laura again. They had a better idea.

    They asked me to leave the room for a moment, and when I returned, they had shifted Laura to the right side of her bed, leaving just enough room for me to crawl in with her one last time. I asked if they could give us one hour without a single interruption, and they nodded, closing the curtains and the doors, and shutting off the lights.

    I nestled my body against hers. She looked so beautiful, and I told her so, stroking her hair and face. Pulling her gown down slightly, I kissed her breasts, and laid my head on her chest, feeling it rise and fall with each breath, her heartbeat in my ear. It was our last tender moment as a husband and a wife, and it was more natural and pure and comforting than anything I’ve ever felt. And then I fell asleep.

    I will remember that last hour together for the rest of my life. It was a gift beyond gifts, and I have Donna and Jen to thank for it.

    Really, I have all of you to thank for it.

    With my eternal gratitude and love,

    Peter DeMarco

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    Medicfire - thinking about you...

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    The hospital based TCU I worked in had up to 7 patients on days and 8-9 on nights.

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    Where did this scenario come from? There are any number of things wrong with this patient: severe GI bleeding, hypovolemic shock, right sided MI, aortic dissection. Temp is kind of low - could be sepsis.

    If this was a patient on the floor I would immediately call a rapid response and obtain 2 more IVs. If this was an ER patient, I would start fluids, get bloodwork, EKG, monitor, a couple lines, and call my coworkers and the doc in the room stat.

    The doctor will probably order IV fluids, labs, cardiac monitoring and transfer to a critical care unit.

    If the patient is passed out and not breathing, you need to initiate rescue breathing with a bag-mask (ambu bag) and call a code blue.

    In general, with scenario questions - you need to think safety first, then immediate nursing interventions, and then call for help.

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    HIPAAPotamus likes this.

    For prioritization, think about your ABCs and then pain and everything else.

    Breathing - anything respiratory related
    Circulation - anything having to do with circulation - including IV fluids to support circulation/ or elevated an extremity to support circulation

    Assessment always comes before intervention - ie. neurochecks before giving narcotic pain medication (morphine)

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    We don't do that on this site. Walk over to the nursing department and find one of the teachers to interview in person or go over to occupational health and see if there is an RN or nurse practitioner working over there.

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    What do you know about GBS? That may help you come up with goals.

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    oldpsychnurse, cleback, bellakat, and 4 others like this.

    They value you as an employee. Good thing you are not being fired because many new grads would be if their employer did not like them. They want you in your company but not on your current unit at this particular time. I would ask for the opportunity to shadow on both units but I would lean toward "transitional" care over hospice. One you get 6-8 months of experience in the new unit, transfer to a different med-surg or tele unit. I personally would not want to back to the same unit. In my experience, transitional care is especially sub-acute rehab. It will be manageable because it is in a hospital setting and tied to the hospital. You may have more patients than on your current floor but they will be less acute with no tele. As a nurse coming with a med-surg background you will be poised to advocate for your patients if they do need to be transferred back to the hospital.

    I started off on a tele floor just like you. It was the unit I worked on as a tech with no issues. I too was asked to transfer to a "transitional care" type unit. I learned a ton and got great time management skills. After about 6 months, I started picking up extra shifts on one of the med-surg units and after 8 months, I transferred there. I stayed on the med-surg unit for a year and I got a job in a different hospital in the ER and I have been there for 18 months. I will be precepting a nurse new to the ER starting tomorrow.

    When I was first "let go" I felt very dejected. I felt like a failure as a nurse. I didn't see it coming. My preceptor didn't give me regular feedback and I only heard about issues when it was too late. An "action plan" had been constructed but I never saw it. I was given the option to transfer to the "subacute" unit which I was so grateful for, that I wasn't fired. I had an awesome preceptor on the new unit who taught me so much with so much patience and I had a wonderful understanding manager who took me under her wing. I loved where I was but I had goals in mind which required acute care experience. So I transferred to the surgical unit where I grew tremendously as a nurse. I have been a nurse for almost 4 years and I would not change my experience. If I never was kicked off that tele floor I would probably still be working there and miserable, because looking back it really is a dysfunctional unit. I would probably not be working at my current hospital in the ER.

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    Emergent likes this.

    We have computers in every room and also there are cows floating around. Each nurse has a mobile which scans as well - but these tend to be very slow and drain the battery very quickly. Our scanning compliance is somewhere in the 85% range, but if you have a critical patient there is no time to wait for the mobile to load up. We tend to scan afterward if there is time on the computer in the room. The mobile does not let us change the time to when the med was actually given.

    In code situations we use paper documentation. If the patient makes it, we put the orders in the computer and sign them off.

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    AliNajaCat likes this.

    Quote from Squidney
    Hello! Thanks for replying! I know that the people I did it with didn't have ~160 for their systolic since they were my classmates and they usually don't have it that high. Neither did they had any syptoms or signs that would explain why they'd have 160 for systole on the days I practiced with them so I am pretty positive I was doing it wrong.

    It always seems I am hearing different noises before the actual systolic sound and I am having a hard time distinguishing which of the noises/sound is the actual systolic sound. Would you happen to know any tip on properly distinguishing the systolic sound from the other noise? Thanks again!
    Any sound you hear can be systole. It starts off loud and then softens. Just listen for when the sound starts. You should feel for when the pulse disappears before taking the blood pressure like I mentioned to determine when systole starts. This is how I was taught in school. Also, you may find it easier to stick the head of the stethoscope under the cuff and let the blood pressure cuff hold it in place instead of holding the stethoscope and risking the sounds of you touching it confusing you. P.s. just because they are your classmates does not mean they can't have a BP of 160. She could be very anxious. Not everyone is symptomatic with a BP of 160. Thinking like that is - i.e. if you don't expect something to be there it's not there" AKA tunnel vision - trips up a lot of new graduate nurses. Seeing the abnormals without justifying that it can't be so even when the patient "was just fine an hour ago" is something that all new nurses must learn.