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cathering, ADN, BSN, RN 2,440 Views

Joined Aug 21, '12 - from 'Buena Park, CA, US'. cathering is a Registered Nurse ADN, BSN. Posts: 77 (21% Liked) Likes: 37

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  • Sep 25 '15

    Thanks for your thoughtful response LuvScience, and for yours beentheredone that, I am asking for opinions! There was absolutely no room for a lift and no safe way to get him to the ground. I've been through a hundred vagal responses and this one presented pretty much the same, we always wait it out (within seconds, not minutes). This one had a seizure component, which threw me for a loop when he stopped breathing. The supervisor didn't think I should have done anything different but I just doubted myself after the fact. It scares me that I didn't immediately go into rescue mode, I don't know when that instinct would have kicked in. So I guess this has prepared me for the next time, "better to be safe than sorry" and start rescue efforts asap. I did review BLS/ACLS, believe me! I think I'll hash it out with a couple EMS guys (on their next non-emergency trip), they usually love to tell nurses what's what!

  • Sep 21 '15

    Funny (bad) story of me screwing up. I had an admission from a nursing home and am very particular about making sure I get my admissions done. I was doing the home med section, pt had over thirty medications. I was charting them so well, so thorough, I was just beaming with pride. I was a little annoyed that the old medications entered previously were wrong and I had to take them off and add every single one from the nursing home. It took over forty minutes total.

    Then when I clicked "save" I got an alert that medications I entered and took off were different from what the physician ordered this admission, and to make sure to notify the doctor. I thought huh... That's not this patients doctor.

    WRONG PATIENT!!!

    I about died. I had two chart tabs open and did the wrong patient! Had to correct that mess (took 20 minutes or so) then re-enter all those 30+ medications on the correct patient. I took about two hours total doing all of this. Thankfully it was a super slow night.

    NEVER again have I don't that! Lol.

  • Sep 21 '15

    Anything I could contribute would just be from my experience. Contributing factors could be look alike/sound alike names, having multiple tabs/charts open at a time, or being rushed. I have documented incorrectly on the wrong patient for all three reasons. For medication documentation, an EMAR and scanners helps to prevent because it will automatically pop a warning that you have scanned a patient different from the chart you have opened. Things like vital signs are best charted one at a time on the computer in the patients room (if possible) rather than jotted down on a paper list and charted in the computer later. Less mix ups. Charting in "real time" in patients rooms in general probably cuts down on mistakes, but again that's just my experience.

    That's about as helpful as I can get. You got assigned a kind of difficult topic.

  • Sep 21 '15

    where I work, they're more necessary than *I* am. Yes, the folks need their medicine and treatments and assessments, but the CNAs are the ones who clothe and clean and feed them. All of which come first on Maslow's hierarchy before anything I do.

  • Sep 21 '15

    Many new nurses are graduating and starting their first nursing jobs (as am I). I am curious as to what you wish you would have known as a novice nurse (regarding organization, stress, communication...anything at all). If you have any advice for all of us new nurses out there, please share!

  • Sep 21 '15

    As a night shift LPN In a nursing home, I thank the good lord we have as many standing orders as we do. I often see posts on here from nursing home nurses who are at an ethical dilemma on whether to give a routine OTC pill @ 2am. Just want to share our standing order book and show how easy it makes life.

    SOB: o2 at 2L/m. If unrelieved duoneb 1 vial. If still unrelieved, send to ED for eval.
    Comstipation: MOM 30cc, May give biscadoyl suppository if unrelieved
    Pain: Ibuprofen 400mg q 4hrs PRN or APAP 650 mg q4hrs PRN
    Nausea and Vommiting: Zofran 5mg q6hr PRN
    fever up to 101.5: same as pain
    Heartburn: Mylanta or Pink Bismuth 30ccs q 4hr
    Itching: Diphenhydramine 250mg q6 PRN
    Hypoglycemia: Glucagon Injection per house stock protocol if unresponsive Orange juice or milk if awake.
    Insomnia: APAP PM x1 dose. Notify MD office in am.
    Severe HTN: Clonidine per house protocol. Notify md In am.
    Diarrhea: Imodium as directed per house stock.

    Probly a few ive left out but isn't our Medical Director the best

  • Sep 21 '15

    WAIT A MINUTE... You mean you have a DOCTORS stethoscope???

  • Sep 21 '15

    I'm cheap, I just use a name bracelet and write my name on it.

    Annie

  • Jul 21 '15

    I dislike calls and complaints about "normal" or chronic things.

    Patient: I had a bad dream.
    Me: OK, what do you do at home when you have a bad dream?
    Patient: I just go back to sleep.
    Me: OK, so go back to sleep. Goodnight.

    Patient: I can't feel my toes.
    Me: Is this something new for you, or has it happened before?
    Patient: It happens all the time. I've had that neuropathy thing for 12 years.
    Me: Oh, OK. I'll see you later. Goodnight.

    Patient: I woke up and I was hot.
    Me: OK, lets take some of these blankets off.
    Patient: I just feel really hot.
    Me: You'll cool down after we remove these six blankets.
    Patient: Why am I so hot?

    Patient: I'm having trouble seeing out of my left eye.
    Me: Is this something new for you or has it happened before?
    Patient: It's been like that since I was a little girl.
    Me: Alright...goodnight.

    Patient: I dropped my phone.
    Me: OK, so pick it up. What do you do when you drop your phone at home?
    Patient: OK.
    Me: Goodnight.

    These aren't just conversations. People hit the call light for this stuff. It drives me a little crazy, sometimes.

  • Jun 3 '15

    Hey all, nursing student here!

    This is something that's been bugging me for months.

    Listening to respirations on a patient whose breaths aren't easily audible is super difficult for me. So many patients I see during clinical are really sick, and look as though taking deep breaths really tires them out. I feel badly asking patients to keep taking deep breaths because I couldn’t hear well the first time (not like they know that, but still), and I’m concerned about how knowledgeable I look to them if I take what feels like forever to do their heart/lung assessment; I don’t see any of the RNs at clinical listening for nearly as long as I take sometimes. I also don't want to increase their oxygen demand too much or anything.

    Sometimes in clinical, my patients' nurses seem to zoom through auscultating heart/lung/bowel sounds--and I wonder if they’re just very skilled and efficient, or if they may benefit patients by doing longer assessments. I feel super slow in comparison and feel awkward about it. Because of this, I end up skimping on many of my patients' respiratory exams because it feels like I’m taking too long and feel awkward/badly about that.

    I also know I'm going to need more practice before I’m really good at these assessments. I'm hoping it'll get easier with time, but for now, I need to figure out how to stop skimping over parts.

    So, here are my questions:
    When you have difficulty hearing respirations, what do you find helps?
    Especially, when the patient is super sick or SOB/easily fatigued/has diminished breath sounds, how do you approach auscultating their lungs?
    Do you hold off and try to complete a respiratory exam later when they start to look exhausted, or do you continue the exam right then regardless of how they're feeling?
    Any other thoughts/suggestions?

    Thanks so much in advance! <3

  • Jun 3 '15

    Have a good brain sheet-search here on AN for "brain sheet" and pick one to help you get organized; lean that you will need to self-study-just because schooling is over doesn't mean you stop learning-It has just begun.

    And remember what I call the 3 C's in becoming a competent nurse:

    Competence: follow policy and procedure and best practice;

    Consistency: Be consistent in following best practice

    Confidence: meaning; be confident to ask questions, learning and be confident in figuring things out-even when you don't have the answers.

    Best wishes.

  • Jun 3 '15

    I once came in to a patients room (I was helping the RN that was on break) and the patient was visibly agitated post surgery. I medicated for pain. Still agitated. So I turn off the TV, turn down the lights, and say to mom - "Sometimes we just need to decrease stimuli and it helps relieve some of this anxiety."

    Kid was deaf and blind.

  • Jun 3 '15

    Patient: I'm sorry. I'm not a very good patient.
    Me: That's okay, I'm not a very good nurse!


    (The shut down valve from brain to mouth appears to be nada.)

  • Jun 3 '15

    For future reference, the time to negotiate is when you receive the offer, but before you accept it. Congrats on the new job!

  • May 6 '15

    Quote from GuelnRn
    Getimmaaw: Congrats! ANy tips on the interview?
    Thanks, I had the interview 2 wednesdays ago and got the call for an offer last last friday. I've been an RN since 2008, and I recently resigned a high paying administrative RN position to go back into the direct patient care setting, so maybe that helped with their decision. I've interviewed a lot of prospective employees for my former employer so i've learned how to interview.

    As for tips, generally you can kind of tell how an interview is going to go from the very begining. If its going well based on their reactions to your answer, just go with it, and don't try to seem like you are trying to please them with your answers. Obviously if their reaction to your answer appears poor, explain your rational as to why you answered that way. Do not be nervous, do not just sit their quietly and wait to be asked a question. Take intitiative and ask a light non business like question. For example, if its Monday, ask how their weekend was, or if its right after lunch, ask them how it was. When they answer make sure you have a follow up remark, and not just be silent.

    I also think its important to know Keck's Mission and Values. They wont ask you to recite them, but its nice to use their verbage when you answer their questions. Also, I personally think its helpful to know their "Known" service standard, which is the standard they hope all employee use with interactions with anyone they come into contact with while at work. K- Kind Greeting, N- Notice needs, O-Own it, W- Wow them, and N- Next step. For situational questions, think about safety. Your patient's as well as your own. Lastly be genuine, dont anticipate what you think they want to hear, be yourself. If you have the personality and the potential skill set they will see it.

    Do not recite the same cliche nursing language that all new grads want to use, but at the same time know what key words are important that help flag you as a nurse who despite having just graduated, posses the critical nursing skill necessary to proceed from a novice -> expert with the right instructions and experience.

    Good luck GuelnRN!


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