Here.I.Stand, BSN, RN 36,217 Views
Joined: Nov 18, '13;
Posts: 4,677 (75% Liked)
; Likes: 17,405
13 year(s) of experience
SICU, trauma, neuro
Ok, I did copy/paste the questions from the assignment. But I have to compile the information from 3 nurses and write a three-page report including my reactions and if it changes my perspective on anything.
If anything, you're being lazy for such a short response
Well if the physician calls it, even if you continued compressions there's an impending limit. I mean if the pt is in asystole, compressions will keep circulation going for a bit, but even with a Lucas it can't go on forever... hours at best, but not days or weeks. At some point that pt will need defibrillation & drugs, or successful treatment of underlying cause or a pacemaker -- inappropriate for a deceased person.
It's true that confirmatory brain death testing is done by two MDs, independent of each other... I'm assuming the child is on a ventilator though? If one is brain dead, the heart will continue as long as it's receiving O2 because of its intrinsic electrical ability -- unlike other vital functions which require brain stem function.
However if the child is pulseless, it's not a question of brain death or not. If ROSC is not achieved, that is CARDIAC death and not dependent on the results of brain death testing.
It's horrible in any case...I can't even imagine. As parents you want nothing more than to protect your child. Once I actually ran into the path of an oncoming car after my toddler wandered into the street (little guy is FAST!!). I can honestly say in that moment my ONE thought was "save my baby!!" I'm sure they want to save theirs... but here all they can do is plead with the staff to keep going.
But the child is already gone.
Uh... you used correct practice to prevent safety violations!! THAT is being a team player!! I mean nursing school 101 -- you cant check ANY med administration "rights" with nothing to check the drug against. Plus, mere telephone and verbal orders aren't supposed to be done; the nurse is supposed to READ THE ORDER BACK. You can't do that here.
I'm not typically one to worry about losing our license. BUT, if you practice medicine AND pharmacy you WOULD lose your license. No order: practicing medicine. No verification or dispense: practicing pharmacy.
So anyway, heck no. The physician really should enter the order him/herself. A distant 2nd option is for the RN to enter it -- only if the MD is busy with a true emergency.
Sorry for all the caps... this nurse irritated me.
She doesn't listen to reason
The only universe where that is abandonment is her fictional universe.
She needs to woman up and own her decision. Not interfere with the livelihood of another person. I agree with the advice to get a lawyer. I would hope that a letter from an employment or nurse-attorney would set her straight
Are you not in the US? 0.45% NaCl is widely available.
That said, ALL IV fluids not stocked on our floor are mixed by pharmacy.
Our pts get a daily soap-and-water bath, FOLLOWED BY a rub-down with the CHG wipes. Our body wash and lotions are all CHG-compatible.
A few years ago I remember the manager saying that rubbing down with the wipes alone is NOT a "bath." And they're not... ew.
I would advise her that such a log is neither secure/HIPAA compliant nor legally binding, PLUS even if you did agree to write on it, you can't promise that anyone else will (we already chart in the legal medical record plus have other pts, and it's not a reasonable use of limited time.)
But in any case, you say that the pt doesn't want you to log those things. Therefore, it isn't up for discussion: to note his medical info and care on a log that anyone can see, would be a HIPAA violation.
However, if the pt agrees, she is more than welcome to stay at his bedside to advocate for him.
Generally speaking, with THAT family member I may go further out of my way to explain things or lay out my plan for the shift. For example, a NP advised a family about the benefits of early mobility, and they CLUNG to that. While most other families may be ok hearing: "due to some sudden episodes with his ICP overnight, we're going to hold off on getting into a chair for today," to THAT family I said,
"It's true that early mobility is our perfect-world goal; however it's not a perfect world, and we have to weigh the risks and benefits with everything.
Overnight, your dad was looking quite stable -- until they had to do a big turn to get him off soiled sheets, and his ICP went up into the 40s. That was such a short time ago; my concern is that with an EVEN GREATER movement this will happen again. It could become a true emergency... and the chair is a very restrictive place for us to administer necessary treatment -- and impossible to obtain necessary imaging like a stat head CT.
What I WILL do is raise his HOB and drop the foot of the bed, so he's more sitting up in bed. I will stay in here, watching his body for showing any signs of distress. If it happens, I can intervene IMMEDIATELY. If he tolerates it, great -- and we'll be more confident about moving him to a chair."
I'm kind of known as the difficult family whisperer and don't even resort to customer service type gluteus kissing. I am almost always able to gain trust by 1) ensuring that they feel heard, and 2) demonstrating that I too want what is best for the pt and will do everything in my power to give the best care possible.
I think we've all left an EVD clamped. What I did was got into the habit of looking at the monitor before leaving the room -- is there a telltale pulsatile waveform, indicating that it was still clamped? (Obviously that doesn't work if the pt has a craniectomy, but we tend to be extra careful with those pts anyway)
And an infiltrated IV?? Unless you infused a bag of IV fluid into the tissues (or otherwise obvious that it had been used for hours but not assessed), how is an infiltrated IV an incident report? PIVs infiltrate. It's a tradeoff risk, vs putting a central line in everyone.
1) Unstable neuro pts are extremely time-consuming! Between the multiple focused assessments, medical management of the high ICPs, shiver management (uncontrolled shivering creates the metabolic state that the cooling is supposed to prevent), rechecking the ICP, oh **** the ICP is 40 -- what's going on?? -- grab some 23% NaCl, then pack up for a stat HCT (AND summon the RRT, if pt is vented)........ talking to the TERRIFIED FAMILY.............
During an acute emergency you have so many things to take care of, all the while knowing that time is brain, and that ICP needs to come down already! It's okay that you don't feel ready for it. Like not.done.yet said, it should help to sit down and analyze your performance. I would take notes on how it SHOULD go, and review those notes frequently.
2) Caring for stepdown pts can be deceptively busy. One would think a critical and an intermediate pt would be easier.... except it's not. Stepdown pts are sick enough to need frequent assessment/intervention, but well enough to be VERY needy.
I'm so so so jealous!! Bring comfy shoes -- you'll likely be walking a lot, possibly on cobblestone.
The BON has bigger fish to fry.
I would love to see the hospital provide the ability to check out electronics that can be voice controlled, but with budget restraints I don't see that happening. You've given me something to consider.
He might have some ability to do so.
aship -- I sent you a pm
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