Latest Comments by LovingLife123

LovingLife123, RN 5,653 Views

Joined: Dec 20, '16; Posts: 716 (75% Liked) ; Likes: 2,825

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  • 0

    Quote from KelRN215
    Sorry, but does anyone else think this is a dumb policy? Patients who aren't ordered for anythign IV need 2 IVs just in case?
    Also, since the patient refused further sticks and the MD agreed that 1 IV was fine, you didn't leave anything for the next shift. If I was a patient on your unit and on no IV meds, I'd refuse 2 IVs too.
    It's not really a dumb policy in the icu. If your patient is in the icu, they are deemed critical. That means you need access just in case. We have our share of stable patients, and usually they transfer out quickly, but anything can happen at any time. You can have that post ztPA patient who is required to be in the icu for 24 hours and not have anything IV, all of the sudden have a hemorrhagic conversion at hour 20 and decline rapidly. You need access. It's better to have that access prior to TPA as you can't stick them for 24 hours post TPA.

    I've seen too many patients that I thought were completely stable only to go in for my next assessment and completely decline.

  • 0

    The only reason in my mind to need a masters is to be an NP, get into upper management, or informatics. I had a job before graduation with my ASN. I only got my BSN because I personally wanted to. My job did not require it.

  • 2

    She needs to sell her home, plain and simple. She then uses that money for AL and once that is depleted, she gets Medicaid. Don't get Medicare and Medicaid confused. Medicare is not for long term care.

  • 3
    Kallie3006, ICU-BSN, and brownbook like this.

    Quote from brownbook
    It can't understand the logic of this policy. Two IV's...that according to most policies and standards have to be changed every 72 less sites available every time they are changed, so they go bad, leak, so have to be changed again. All for "possible" emergencies? Even in ACLS is has never been hinted at that two IV's is recommended.

    I am assuming you mean two peripheral IV's.

    A critically ill patient needs a triple lumen central line, or VAP, or PICC, right from the get go. And maybe one peripheral IV

    A moderately ill patient needs one IV. Maybe two IF both sites are being used, needed for multiple infusions or incompatible IV solutions or such.

    But a routine blanket policy that every patient have two IV's irregardless of their condition doesn't make sense to me.

    It is also my unit standard in the ICU to have two access points. We do not change IV sites every 72 hours. And not every patient gets a line. Too much risk for infection with a central line so we see less and less of them these days. We only really get PICCs and line people if the are on vesicsnts. We are actually starting to do more and more midlines to reduce infection rates.

    I personally wish every icu patient received a PICC. I love them.

    But sometimes they only end up with one peripheral. You can't help it. Nursing is a 24 hour job and don't feel bad when you can't get it all done.

  • 0

    Do many of your Foley patients need UA's? Is q12h Foley care actually being done?

  • 1
    brownbook likes this.

    Quote from Wuzzie
    By "measuring" I meant putting the leads in the correct spot related to the anatomical reference points we use for lead placement. I did not mean getting out a measuring tape but there is a reason the leads are placed where they are. It takes no more time to place them correctly than it does to slap them on somewhere sorta near where they are actually supposed to be which I have seen done repeatedly.
    Our ECG machine has a visual on where to put V1-V6. I will look for reference.

    I was replying to the OP who stated that her mentor measures and puts them perfectly every time. I work in ICU where my patients are already on a 5 lead, so if they need a 12 lead, it's usually at the point where I don't have the timr for precision. Something is going south.

    We do have a tech who is very technical. I could see her measuring. And while I often appreciate her attention to detail, sometimes, in the icu, that goes out the window and you have to see the bigger picture. It can be frustrating.

  • 5
    It'sYaGirlK, RNperdiem, Fiona59, and 2 others like this.

    Quote from Sour Lemon
    You'll want to go to work to recover once you have a few small children at home.
    Haaaaa!! Totally true. I consider work a 12 hour reprieve from the screaming. Three boys are more exhausting than any 12 hour shift.

  • 1
    brownbook likes this.

    I almost always put the leg leads on the abdomen. Especially on men. Their legs are very hairy and the leads don't stick well.

    I have never once measured to put leads on. Usually, if I'm getting a 12 lead, I need it now and don't have time to piddle around with that stuff. I never have issues with reading.

  • 1
    brownbook likes this.

    Lol. I'm still confused by the PCA. All of ours are a lockout if 10 minutes. So, to me, the fact someone could push it every 6 minutes and get a delivery is crazy. Most of ours are morphine but we also do dilaudid. And I think it's .2 q10 with a 4mg/4 hour lockout.

    I've had numerous jaw dropping moments. Some within the past week. I won't mention for fear of being recognized on here.

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  • 11
    canoehead, TriciaJ, audreysmagic, and 8 others like this.

    I don't give medical advice to friends. I may tell my mom a thing or two if she calls and asks me a question. I did chew her out when I found out she had a TIA about a year ago and she didn't seek treatment right away.

    As far as the meds, I wouldn't give a kid meds without asking the parents. But your teacher was stretching it a little. When my husband has a headache and I give him excedrin migraine, I'm not prescribing. I'm not a nurse at home. I'm a wife.

    I'm not on duty 24/7. Now, giving my patient in the hospital excedrin migraine without an order is prescribing. But me at home giving my family an ibuprofen is not.

    I used to have nursing school instructors like that. Loved to scare us with not true stuff. When I found out the truth, I lost all respect for those instructors not just as a teacher, but as a professional nurse.

  • 2
    brownbook and NurseBlaq like this.

    Eh, I had a doc get crappy with me for calling him over an ABG the other day. My pt had scheduled ABGs. If it was a normal one I would not have called, but my pt was getting acidic and needed a change in vent settings. I had to listen to why this was so stupid. I was like, well it's ordered so I did it. The results were way different from 6 hours ago. I need you to treat it.

    Honestly, I think physicians think we like making extra work for ourselves. I know I don't. But I'm a patient advocate. If you don't like it, take it up with your fellow colleagues is my opinion. I doing what's safest for my pt.

    I would like to check WNL on all my boxes and not do labs or tests and not have to assess my pt extra and leave on time every shift. That's what I would love. Stable, normal patients. Unfortunately they are in the icu because they are abnormal and sick.

  • 3
    PeakRN, brownbook, and AceOfHearts<3 like this.

    Most places with a decent trauma center have a designated trauma icu.

    I like getting the surgical icu patients sometimes. My favorite are the open belly patients.

    Trauma patients are usually pretty straight forward. Just a fun fact. 85% of trauma patients are falls. Usually the elderly who break a few ribs. Trauma is not all gun shot wounds and car wrecks.

  • 11
    Elaine M, Sparki77, NurseBlaq, and 8 others like this.

    I would explain that I can clock out right on time every shift, but do not expect my charting to be perfect or all of my tasks done.

    It irritates me that every week we are given another duty and are told it doesn't take much time. Well, no, this one extra charting item or extra line change doesn't take a lot of time in and of itself. But adding a new thing every week adds up over time. Getting a brand new admit 30 minutes before shift change, expecting to transfer at shift change plus all of the other crap adds up. It adds up to an extra hour each shift.

  • 7

    Sometimes, you just have to advocate and do what you need to do for the patient. I've had to on several occasions. Sometimes I was right and the patient crashed, and others I've been wrong. I'm glad when I'm wrong. But 80% of the time if I feel something is going bad, it usually is.

    I'm not there to pacify a doctor. I'm there to advocate for the health and safety of my patient. Sometimes, that means stepping on some toes.