Oh'Ello 4,786 Views
Joined Jul 24, '14.
Posts: 227 (68% Liked)
How flexible is your living situation. The other side of the state has TONS of acute care opportunities, and I personally know of several practitioners that were hired as RN's (most of them as Casuals and PRNs for supplemental income) because our acute care nurse situation over here is so dire.
Have no idea what this means, but it sounds intriguing. Care to explain?
RN's change central line dressings where I work. A select group who've received training change PICC's (simply because of the displacement risk). I'm not sure who else is expected to change them.... Physicians? LOL
I'll tell ya this right freakin now. Yellow wristbands DO NOT HELP.
Not required to double check insulin here. Level 1 Trauma, Teaching, Magnet, Pennsylvania.
i was always under the impression that it was a matter of maintaining the catheter. Some JP catheters are kinda teensie and can clog if you don't strip out the clots. I've never had to or even thought about stripping a chest tube... I just don't even know how that would work. The tubing (at least that we use) is fairly large bore and isn't really very flexible or strechy, so I don't even know what stripping would achieve.
Whether or not someone needs and interpreter is like the 4th question on our admission assessment, lol. I promise you, that nurse probably didn't give any kind of ****. She's just asking the questions that the computer prompts her to.
It's because the monitors calculate the MAP and THEN extrapolate the systolic/diastolic using proprietary calculations not based on what we use when doing manual pressures. Automatic cuffs do it by measuring oscillation to determine the MAP while direct-measure devices (a-lines) measure the wave form. Blew my mind when I found this out.
Minnesota tube, 27 units in and 30 LITERS out. I think that pretty much sums it all up.
I also reconstitute In flushes. We don't stock saline vials....Because it's stupid. The ISMP assertion is stupid too. If I drew up 10ml of nimbex, and 10 ml diltiazem, how on earth would I know which one is which?????
Labels that's freaking how (which is also an ISMP recommendation)
I've been a nurse for about 4 years now. My husband was shocked/irate/confused/disturbed/befuddled/concerned when he recently found out that I frequently encounter male genitalia at work. I don't think it's uncommon for "the others" not to know what we go through at work let alone what we actually even DO.
With that said, I don't really have any advice to offer you other than, he'll figure out it eventually....in my experience at least.
There sure as **** is never any toilet paper
Are they all in the same health system? Maybe it's just bad culture. I've worked in places (not in nursing) where all of the management were jerks. And then when I transitioned into a management position, I realized why.
I think it's ironic that your username is "Thank god for ativan" but you're apprehensive about giving prescribed controlled substances per order.
You aren't a drug dealer because you aren't personally profiting from the dispense of drugs. She has pain meds ordered and they're indicated.If she is engaging in self-sabotage, self-harm, med-seeking, she will suffer the consequences of those destructive behaviors regardless of whether or not you attempt to control her pain. I think its important here to remember what our job IS and what it is not.
We use intravenous lidocaine perioperatively pretty often and the results are mixed but typically successful. We have specific programming surrounding its use and we're all quite familiar with the protocols. With that said, I've probably seen close to fifty patients with IV lidocaine infusions, and every single one of them was a GI / abdominal surgery patient. We implemented the use of IV lidocaine (in conjunction with ketamine) to reduce opiate requirements in this population because of the heightened risk of complications from decreased bowel motility that come with post op immobility and opiate use. This care bundle is apparently having a measurable positive effect on early recovery after gi surgery in our facilities.
Lidocaine has a very VERY narrow therapeutic index. Serial lidocaine levels MUST be drawn to assess for toxicity. And as we all know, tox labs take forevahhhh to result. Its also specified in our protocol that if the patient's pain is not adequately controlled with the ketamine/lidocaine infusion, and they are requiring more opiates (the opiate requirements are patient specific), the lidocaine must be discontinued and the plan of care can be reverted to a more common pain control regimen. The reason for this is that concurrent opiate use can obscure the early symptoms of lidocaine toxicity which are often very patient subjective (blurred vision, metallic taste, peripheral neuropathy, etc). These patients are also receiving the benefit of sedation for some time post-operatively, which is ultimately aiding pain control by lack of awareness. Long story short, we're giving this to bridge the gi-surg patients from the OR until their bowels start showing signs of movement and then converting them to lower dose opiates if necessary.
with all that said
none of that **** makes any sense for use in an ER.
More (interesting and totally readable) info on ERAS here
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