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GingerSue 27,158 Views

Joined: Oct 20, '04; Posts: 1,975 (9% Liked) ; Likes: 254

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  • Dec 10 '08

    You should keep your mouth shut about the actress with the flesh eating wound though.

  • Nov 6 '08

    If the med was indeed the correct med, then there was no med error.

    There was, however, a procedural error on your part that could have stung you badly. You know this by your own admission, so you've already learned a valuable lesson.

    Sometimes a good scare is a highly effective teaching tool.

    BTW, don't let yourself be pushed around by more experienced nurses or other staff who take shortcuts. Develop a reputation as someone who does it by the book, and eventually they'll get the idea that they shouldn't even ask.

    Be especially careful with wasting meds. if you don't get a look at the med and actually see it being wasted, don't co-sign. Again, make that part of your standard operating procedure, and you might become known as an old stick in the mud, but you'll be a stick in the mud who still has her license.

  • Nov 6 '08

    both responses are correct. it is YOUR license on the line since you GAVE the med. There are 3 rules I follow being a new student that i have learned are most important to avoid med errors, DO NOT GIVE OUT MEDS YOU DONT TAKE OUT, Do not document for anyone and check 3 times and check your 5 rights ALWAYS! She cannot and will not cover for you when asked WHY you gave that medication. Always remember, the things you do have to stand up in a court of law and a lawyer will eat you to pieces saying, SHE TOLD ME TO GIVE IT! Do not feel bad, use it as a learning curve and never do it again. It may be a standard order, but you have no clue what she gave! Good job for recognizing it was wrong though, some just dont care! You have EVERY right to say i am not comfortable doing that, you give the med, and she can not be upset with you! They are teaching you BAD habits! Good luck and congrats on the new career!
    LPN Delgado

  • Oct 30 '08

    1. identify abnormal lab values and specify whether it is low or high, slightly or critically.
    2. give specific names for deficiency or excess of the values.

    not all will have specific medical terms for a deficiency or excess of a value.
    3. which ones are reportable or not and to whom?
    report panic values to the physician who ordered the test
    4. list possible reasons for abnormalities.
    many times this may be a disease.
    5. what further data is needed? (pt. assessment, head-to-toe, subjective and objective data, hx, questions to ask, etc)

    patient #3
    71 y.o. female
    hx of glomerulonephritis

    sodium 126 - this is below normal; elevated sodium is called hypernatremia; decreased sodium is called hyponatremia
    • normal adult:
      • 135-145 meq/liter
    • panic (critical) values:
      • below120 meq/liter
      • above 160 meq/liter
    potassium 6.9 - this is a panic value; elevated potassium is called hyperkalemia; decreased potassium is called hypokalemia
    • normal adult:
      • 3.5-5.0 meq/liter
    • panic (critical) values:
      • below 2.5 meq/liter
      • above 6.5 meq/liter
    chloride 92 - this is below normal; elevated chloride is called hyperchloremia; decreased chloride is called hypochloremia
    • normal adult:
      • 90-110 meq/liter
    • panic (critical) value:
      • below 80 meq/liter
      • above 115 meq/liter
    bun 28 - this is above normal; elevated blood urea is referred to as azotemia; there is no term for decreased levels of urea
    • normal adult:
      • 10-20 mg/dl
    • panic (critical) value:
      • above 100 mg/dl
    creatinine 1.2 - this is above normal; there are no medical terms that i know of for deficiency or excess of the values
    • normal adult female:
      • 0.5 - 1.1 mg/dl
    • panic (critical) value:
      • above 4 mg/dl (indicates serious renal function impairment)
    this patient has a very high potassium (hyperkalemia). here are the symptoms of hyperkalemia. you want to, at a minimum, assess for these. hyperkalemia causes heart block and slowing of the heart rate. note the very last one which is why this is a panic value and the doctor needs to be notified of this immediately:
    • tachycardia that changes to bradycardia
    • ventricular arrhythmias
    • on ekg: peaked t waves, widened qrs complex, depressed st segment
    • hypotension
    • nausea/vomiting
    • diarrhea
    • abdominal cramps
    • decreased gastric motility
    • muscle weakness
    • muscle cramps
    • flaccid muscle paralysis first in the legs and then in the arms and trunk
    • paresthesias of the face, tongue, feet and hands
    • drowsiness
    • oliguria
    • cardiac arrest due to hypopolarization and alterations in repolarization
    here are 3 websites where you can get lab test information:
    you will not find information on bleeding time on these websites because i already checked them. i answered your other post on bleeding tome from information from my lab reference here at my home. you need to look up information about each of the lab tests for the other patient scenarios just as i did for the 3rd one from the web links listed.

  • Oct 30 '08

    i would honestly just tell her because some people really don't know they are offending people.

  • Oct 29 '08

    i'm not that good with psych, but i do know how to put together a care plan. diagnoses are determined by the signs and symptoms the patient has. every nursing diagnosis has a set of signs and symptoms that your patient must match.

    someone who burns a bible and money to get rid of it is not coping effectively. how many things do you light up and burn when you want to get rid of them? none, i hope! this is ineffective coping r/t unrealistic perceptions and disturbed thought processes. i think it also makes her a danger to herself and others. the diagnosis for that would be risk for injury or risk for trauma r/t hallucinations and effects of cocaine.

    hearing voices (god talks to her) is hallucinatory and is disturbed sensory perception r/t chemical imbalance and substance intoxication (due to the schizophrenia and presence of cocaine in her system).

    i think you should also consider the nursing diagnosis of anxiety. look at the symptoms (defining characteristics) of anxiety listed on this webpage and see if this patient doesn't have some of them: anxiety. the anxiety will be r/t her conflict with reality.

    so, there are several good ideas for diagnoses for this patient. this website also has information of psych diagnoses that may help you in wording you might need for the diagnoses you do end up using:

  • Oct 27 '08

    Both Selegeline and Eldepryl are listed as current in the BNF (British National Formulary

  • Oct 27 '08

    I was able to find it in my Nurse's Drug Guide 2008. Let me know if you need the infomation.

  • Oct 25 '08

    GI bleed really IS as bad as they say!!! Learned this after throwing up in my mouth WITH a mask on. Not fun. Smearing mint toothpaste in a mask is supposed to help. Haven't tried it yet, but I carry a small travel size with me to clinical. Lesson learned!

  • Oct 25 '08

    When burping Colostomy bags, Vick's Vapor rub is your friend.

    Learn to touch people

    Never turn your back on any patient (learned that one the hard way-Elderly man attacked me, Alzheimers)

  • Oct 24 '08

    Quote from Nurse2BB
    I have a question. I am currently an STNA on a hospital floor, and am working on my nursing pre-requisites. Today, a nurse approaches me, and eyeing my full bookbag, says that I wouldn't be able to get a nursing license because I am over 55. Well, slightly over, but still. She said this with a completely straight face, and insisted that she was not joking. I wonder if this is true. I doubt it, but who knows. I know a few nurses who graduated after 55, and that was years ago. But she insisted that this was true, and added that because of nurses' shortage, I might get licensed even though I am 57 now, so when I graduate, I'll be closer to 60. So... what do you think? Have you ever heard of this?
    All answers are greatly appreciated. Thank you all and have a nice day.
    Anna, Clearly this "Lady" is suffering from a common malady given to those whose mouth is larger than their brain..I like to call it FOS for short. Of course you can get a license..I'd also give her a short inservice on age discrimination.

  • Oct 24 '08

    This is why you should always know how to contact your CI in an emergency. As soon as I felt that suspicion was falling on me, you bet your bootie that I would have been the one calling in my senior personnel (CI) to start documenting what is going on BEFORE ANYONE, including the Doc., leaves the room. I certainly wouldn't have waited until the end of the procedure (and everyone had gone home) before they heard from me. I would have been the one threatening to raise H..L in a situation like this. You can't be passive when it comes to stuff like this! Cover your butt, everyone else would have been if those narcs had not turned up.

  • Oct 24 '08

    At the very least I would write up a re-cap of the way things happened including the names of everyone in the room and present a copy of it to someone in power at your school. I do hope that the reason they didn't file an incident report is because they are checking him out but that would not be good enough for me. I'd want to make sure and cover my butt. What a shame this happened to you. I'd be furious.

  • Oct 24 '08

    This reminds me of when I first became a pharmacy technician about 5 years ago.... The overnight Pharm would count the controls and kept coming up short on one of them.... My step mother was the pharmacy manager (nobody new we were family) and so the overnight pharm told my step mother that she thought I was stealing the meds (of course I was new so I was the obvious suspect). My step mother came to speak to me to tell me they would be turning ont he cameras because of the stolen meds (she obviously thought it was me also). What really worried me is if she were to tell others and then the meds stoped disappearing it would definitely seem like I was the culprit. I was very upset because I don't like drugs and don't like to feel high (did too much of that in my teen years). But a few weeks later they caught a PHARMACIST pocketing the drugs.... they called in the DEA and took her out. Me and the night time pharmacist (and my step mother) have been laughing about it ever since.... I know this doesn't help but I know how you feel.... HELPLESS... Try to be safe and make sure your instructor is always around when narcotics are involved becuase drug abusers always need a scape goat

  • Oct 24 '08

    *hugs* I'm so sorry you had to go through this. You did the right thing telling your instructor. Those surgeons were completely out of line. Please, make sure somebody holds those surgeons accountable for their actions.