I have an absolute passion for discharge teaching, especially with new meds and diagnoses.
Sometimes compliance really does depend on convenience.
Cerner is stupid. A one-time stat dose of a med IV will cancel itself and mark itself as complete when that dose isn't given within an hour. The problem with this is if the dose is ordered in the ED and isn't immediately given because the patient needs fluid boluses, dopamine and atropine first, they come up to the floor and it looks like either someone discontinued the med, or administered the med. If anyone less neurotic than me got this med, they wouldn't have spent the half hour I spent going between ED nurse, hospitalist and pharmacy trying to figure out what happened.
Had a patient who is fairly new to alcoholism. New enough that no real damage has been done yet. He came in HR in 30s, SBP in 60s, after falling out in the kitchen. He is the first alcoholic patient I've had that I genuinely believe may be quitting. He's been scared sober.
After sitting on it for nearly two years, I have finally decided on grad school, which one and how to approach it. What I learned from this decision is that I'm probably really going to miss my unit. It's the most chaotic, busy unit in the hospital, and some days are soul crushing, and yet, I just love the people (usually).
If you have an LPN doing an admission assessment, first, make sure it got signed by an RN, but also, actually make sure what was charted is accurate.
If a cardiologist blows off intervention on a patient who has had a ridiculous number of 4-9 second pauses over several days, that patient may become brady and hypotension to a dangerous degree, right before shift change, causing her to need a temporary pacer before she gets the permanent one she was scheduled to get the next day.
AND, if that same cardiologist blows off an intermittent heart rate in the 200s for two days before deciding cardizem might be nice, probably an incident report would be a good idea.
AND, my favorite, most helpful cardiologist has left my favorites list and gotten onto my ess list.
When the generally lazy CN actually tries to "help", she may actually make things SO MUCH WORSE.
When upper management is entirely made of nurses, I genuinely believe this contributes to a wonderful work environment.
Did I mention I love patient teaching?
Four discharges going in simultaneously for four impatient patients makes for a horrible day. HORRIBLE. And of course, discharging 4 means more terribleness. Brace yourselves. Admissions are coming.
When your patient has been saying literally the entire day that she will sign out AMA if she is not discharged, expect her to pull a bait and switch while her husband talks to you at the nurses' station. Also, expect to get security involved when you can't actually find her anywhere. Expect her to be hiding around the corner of the building chain smoking, literally leaning on the "no smoking sign". Expect her to flip out when she thinks security is approaching to force her to go back inside. And then expect your coworkers to be confused when you tell them you had to find her to get her IV out. Dude, I'm not giving her free access to a vein.
(Also expect that to happen at shift change as well.)
Benzos and opiates can metabolize so quickly that ED doses may not pop a UDS positive that evening. I didn't even want to send the UDS to lab because the most likely meds to pop positive on, she'd just gotten in the ED. Unless, of course, grandma is doing coke, meth and ecstasy.
I'm really lacking patience for a couple of posters in the controversy vaccination thread.
Some patients have no problem whatsoever being really nasty to everyone EXCEPT their nurse when they feel the nurse should have done something that that nurse chose not to do. For instance, patient complained of headache and noted there was a nitro patch on, with no order to continue nitro patches. Removed it, waited a little while to see if that worked. The tech goes in and the patient tore him a new one over not getting pain medication. Every time I went into this room, the patient was sound asleep. She got medication and tea with her 2200 meds, and hers were given last because she stayed asleep. When I woke her up, not one single complaint. It's just weird.
I'm incredibly disappointed when floor nurses identify a need, and case management blows it off.
Got a song stuck in my head. It's not all instrumental, I promise. And the lyrics are.... Well, you'll hear. Enjoy.
Phish - "Weigh" (HD) - YouTube
- so many lately that they had several critical event debriefings for the department because we were getting burned out and fried from the sheer number.
.
cardiacfreak, ADN
742 Posts
I learned that a 15 y/o girl that snorts 12 Norco, has a BAL of 246 and high on K2 is going to make my top 10 list of worst patients ever!
I also learned that a 15 y/o girl on said substances will require 50 mg of Benadryl, 5mg of Haldol, and 8 mg of Ativan before I can even go check on my other patients.