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ms.greyrn 2,180 Views

Joined: Jan 19, '13; Posts: 13 (15% Liked) ; Likes: 2

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  • Jul 16 '13

    Always go from verbal to tactile to painful

  • Jul 15 '13

    Diazepam (generic name), is well-known to us old-timers by its brand name, Valium, or as I lovingly called it, Valley-ally-um.

    Did you find the answer to this question? I wanted to hold off posting this to give you time to research this yourself. Some of it I knew you wouldn't find.

    Institute seizure precautions to

    • protect the patient from injury
    • protect the patient from complications as a result of the seizure
    • observe the characteristics the patient exhibits during the seizure
    Nursing interventions prior to the administration of IV Valium:
    • gather and have ready at the bedside
      • an oral airway - tape to the wall above the bed or have at the bedside
      • a padded tongue blade - tape to wall above the bed
      • oral suction equipment
      • oxygen
      • cover side rails, headboard and footboard with specially designed pads or several thicknesses of blankets and keep the side rails up
      • keep the bed in a low position
    • when the patient begins to seize, stay with the patient and do not leave. Then,
      • if the patient is in the bed, get the bed flat
      • insert the airway or tongue blade in the patients mouth before the seizure starts and the patient clamps down on their jaw and bites their tongue - do not put your fingers inside the patient's mouth! - if the jaw has already become rigid you'll just have to wait until the seizure is ended to insert the airway, but do not try to force it into the mouth
      • make sure the side rails are up and the padding is covering the rails.
      • protect head and keep it from hitting any surfaces; do the same for the limbs
      • do not attempt to restrain or restrict the patient's movements in any way during the seizure
    • When the seizure ends
      • anticipate a postictal period of confusion/unconsciousness for 30 minutes or so after the seizure activity ends and just allow the patient to lie quietly during this time if there are no other complications to attend to
      • turn the patient to his side to facilitate drainage of secretions
      • suction if needed
      • assess for injury, particularly of the tongue
      • take vital signs
      • when the patient becomes conscious ask about any aura they might have experienced just before the onset of the seizure to include in your later documentation
      • things you should be noting for later documentation:
        • time of onset and how long it lasted
        • any head or eye deviations at onset
        • how the seizure activity progressed, the form it takes (tonic-clonic, jacksonian, petit mal, myoclonic, status epilepticus)
        • any incontinence, vomiting or salivation that occurred during the seizure
        • any medication given during the seizure
        • whether or not an IV access was established
    Giving IV Valium
    • establish a patent IV access - a little difficult to do if the patient is seizing
    • IV Valium is irritating to the veins when pushed directly into a vein, so avoid small veins to avoid phlebitis or extravasation
    • Can be injected over one minute in adults; 3 minutes in children
    • start with smallest possible dose and increase it based on the patient's response
    • side effects of IV injection: bradycardia, hypotension, cardiac arrest
    • you MUST have emergency oxygen, respiratory assistance and flumazenil (Romazicon) available when you give this drug IV and resuscitate as necessary
    • anticipate that the patient will need to be on bed rest for several hours after an IV injection of Valium
    • Valium is incompatible with pretty much most other drugs and will cause precipitates in the IV tubing when mixed with them; best action is to remove all other IV fluids and get a mainline of normal saline established, but direct IV push through the most distal port of the existing IV tubing or through a saline lock is considered most ideal
    • increases serum concentration of digoxin, phenytoin and benzodiazepines
    • should not be used in patients who have glaucoma or hypersensitivity to soy protein
    • onset of action in treating seizure activity is immediate (which is why it is the drug of choice)
    • if the patient's seizures are due to brain lesions, the Valium is not as effective as other medications
    • not normally used for petit mal seizures
    • if the patient has a pre-existing chronic lung disease or unstable heart condition they will need to be monitored very closely after getting IV Valium
    • If large or extended doses are given over time (and I've seen this done in cases of status epilepticus that just won't stop) the patient will need to be monitored for withdrawal symptoms

  • Jun 27 '13

    In my short career as a nurse I've seen some terrible behavior among nurses, and I'd like to share my take on things.

    I've only been a year for two years, and working as a nurse for 13 but in that short amount of time, I've seen an astounding amount of hostility between my coworkers and directed at me in the two facilities I worked at. It made me sad, it burned me out and it made me feel like I was working in a mine field.

    As a fellow nurse, I respect you. We ALL had to work our tails off to get through the hell that was nursing school, study feverishly for the NCLEX exams, then scramble desperately for a job - hopefully in our chosen specialty or facility - after graduation. We have ALL earned our licenses and are all worthy of respect.

    As a fellow human, I respect you. We all have feelings, different psychological and familial backgrounds and different emotional and interpersonal needs. We all share the same basic few reactions to negative situations. We all liked feeling liked, respected and valued by those around us.

    In the face of conflict, it's easier to turn your back on someone, come up with reasons why you don't like them and find reasons justifying your ill treatment of them. It's easy to cling on to that anger. For some of us (myself included), that anger mobilizes us and is how we're most used to expressing ourselves. It's hard to resolve conflict in a mature, diplomatic fashion. But it's worth it. Our interactions with other people are more meaningful if we can move past anger, communicate our feelings without hurling insults and get back to working together.

    So the night nurse gave you a poor report which you took the fall for later that day. She was probably tired from a long night and the missed information slipped her mind. One should always give the most complete report possible, but mistakes happen. Forgive her and make the best of it. So the day nurse left you with meds to finish and missed orders in the chart. She probably had a hectic day with never-ending distractions and demands made of her. FORGIVE her and make the best of it. So your coworker spoke to you sharply when you asked her a question. She was probably in the middle of thinking about something and you inadvertently interrupted that thought. FORGIVE HER and move on. Sensing a pattern here?

    We get so wrapped up in little issues and small infractions with our coworkers that it completely clouds our ability to look at the bigger picture: your coworkers are your team members and you owe it to them to be respectful. You owe it to yourself to have them at your back when you need them.

    So the next time another nurse is giving you the stink eye or says something rude or snaps at you... Forgive her, and try to resolve the issue after tempers have cooled. We owe it each other to respect each other. Nursing is hard enough.

  • Jun 18 '13

    My answer is strictly from my own point of view, floor nursing is not necessary to become a good OR nurse.
    OR is a totally different learning experience.
    The OR that I work at does not have that as a requirement and we preceptor and train as soon as nurse completes OR post grad course.
    The nurse may be a new grad, a mat nurse, a surgical nurse or nurse who has worked long term care & psych.... I have seen all of these nurses with these backgrounds become excellent OR nurses!
    There are different skill sets in each area of nursing and they all can be valuable to OR nursing!
    From what I can ascertain, the steps to becoming an OR nurse in the US are a little different from Canada, but we all get to the same place eventually..
    Good luck in your pursuit of OR nursing.

  • Jan 27 '13

    what's a lunch hour???

  • Jan 27 '13

    What are some of the habits that you pick up from work?

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  • Jan 26 '13

    I'm not trying to be negative, but I did do my research. I interviewed real nurses before and after nursing school. I read blogs and visited websites with nurses talking about their experience, but it was not enough. I've had a lot of great and wonderful experiences, but so far let's just say that if I knew what I know now back then, I'm not sure I would have chosen this profession. Don't tear me apart for telling me truth please.

  • Jan 26 '13

    It's normal for newly-arrived foreign nurses in a new country to feel homesick and long for the environment they're accustomed to. It's a new culture, a new way of speaking a language different from how they learned it, as well as sights and sounds, seasons and climate that is very different from what they grew up with. Having a passion for nursing or national origin has nothing to do with it, it's human nature to seek the familiar environments of home when living in a foreign land for the first time.

    When I arrived in the US, I started out in a town in the Midwest where there were very few people from the Philippines. Yes, I missed the family and friends I left, the co-workers I had, and the hustle and bustle of living in Manila. Yes, I got excited when I hear Tagalog spoken whenever I was out in the mall, I lit up when a fellow Filipino recognizes me or acknowledges me as Filipino, and I sought out Asian supermarkets just so I can find ingredients to make Filipino food. In time, these feelings changed. Like me, you will also get accustomed to your new country, new friends, new co-workers, and your new way of life.

    In my case, I will always be Filipino in appearance and soul but I've adapted to the lifestyle in the US and could not see myself living or working anywhere else. I live in California now and I see a lot of people from the Philippines many of whom just recently arrived. I don't envy the fact that I did not have this kind of environment when I first moved to the US because I think my personal experience of being exposed to very few Filipinos when I arrived strengthened me to adapt and brought out the person I've now become.

  • Jan 26 '13

    [QUOTE=Dorables;6360994]hello fellow nurses.I really need your help.I'm currently working here in saudi arabia As a DENTAL nurse.To tell you the truth im not happy with my work, coz i know its not a job of a nurse.

    Dental nurse - its a nursing specialization too.
    Take it as an opportunity, that can help you find a more exciting career later on. That dental nurse experience can help you land a rosy career in TRAUMA CENTERS, ER, OR, MAXILO-FACIAL surgery units.
    Think positive! View it an an opportunity to learn new craft.
    Be patient.

  • Jan 26 '13

    As with your other post regarding allergy testing prior to giving antibiotics, it would appear that some practices in your country are significantly different from common practice in the U.S.

    We do use a protocol with inpatients with documented allergy to iodides who need a non-emergent CT scan - it's a 16-hour regimen of pre-medication with steroids and diphenhydramine prior to the scan.

  • Jan 19 '13

    ((HUGS)) you are perfectly normal.....I always share my brainsheets....a collection of ways to keep organized for the use of AN members only...they are a collection from other AN members (daytonite) over the years. feel free to modify them

    here are a few.

    1 patient float.doc‎
    5 pt. shift.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    i hope they help