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IVRUS 18,882 Views

Joined: Dec 16, '04; Posts: 1,099 (42% Liked) ; Likes: 1,070

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  • Jul 18

    I don't think that's the norm with the worst of agencies but it most certainly is not for any reputable agency concerned with quality of care and patient safety. Or retaining employees.

    You have a year's experience, you're marketable to any agency now. Just be aware that you have probably developed practice habits out of survival that won't be acceptable by agencies who prioritize quality, satisfaction and patient outcomes.

  • May 23

    Immediately stop all "gun free zones", you are just making those places sitting ducks.
    Use school funds for metal detectors instead of putting it in admin pockets or other wasteful expenditures, prioritize the funds.
    Better ID of bullies with appropriate punishment/intervention of bully only (no punishment for the one who was bullied)
    Check facts and have a plan prior to protests (merely protesting stopping school shootings will not stop school shootings)
    I believe in upholding the 2nd amendment while at the same time having appropriate gun (owning) controls, we need to be able to have an adult conversation about where this ends up without screaming at each other.
    Know and understand the facts, do your own research instead of just listening to news people or politicians, they are bias
    Get back to teaching our kids how to deal with life, the ups/downs etc, stop with the everyone gets a ribbon mentality, kids don't learn that way, guns have been around a long long time and this has not happened until (relatively) recently, its not the guns, its the people/society that has changed
    And, most importantly we need to hold those who commit crimes accountable, stop with the stupid defenses, no excuses, you commit crimes, you pay. And don't blame parents unless there is very clear cut evidence that they were somehow also actively involved, this will not stop any shooter (anyone who could commit such a heinous crime will not care that their parents will be sent to jail etc)

    I am so sorry to those who have been personally hurt by these crimes and hope we, as a country, can come together to try to stop these evil people.
    Thank-you OLD DUDE for opening this very important discussion!

  • May 23

    Quote from Mary3010
    This 1996 mass shooting incident was the last of its kind in Australia.
    Australian Mass Shootings since 1996:
    1999 Adelaide Massacre 10 casualties
    2002 Monash University 7 casualties
    2011 Hectorville Massacre 6 casualties
    2014 Lockhart Massacre 5 casualties
    2014 Sydney Hostage Crisis 4 casualties
    2018 Osmington Shootings 7 casualtie

    If you look at the frequency of mass shootings before 1996, it is no worse! Yet, Australia has some of the most draconian gun control laws in the world. It is also an island with 7% of the population of the US and different culture/demographics.

    The other contention usually presented by activists relating to Australia is that the Australian virtual gun ban cut violent crime. There was only an observed decrease in violent crime if cherry picking time frames. The ban occurred during an an already existing downtrend in violence, which then later reversed. Gun homicide rates later increased as well.

    Western Australia massacre: 7 dead in Margaret River mass shooting - The Washington Post May 11, 2018

  • May 23

    Quote from Penelope_Pitstop
    I don't agree with it being a mental health problem.

    I believe calling it that does little to get to the root of the issue, for the root is not a mood disorder, psychotic disorder or personality disorder.
    While shooters may very well have diagnoses that are in the DSM V, that is not what causes these events. Also, this encourages mental health stigma.

    I believe the cause is bullying. Calling it a mental health issue removes the blame from the bullies and places it on a psychiatric illness. I don't know how to stop bullying, or make its long term effects disappear. Lord knows my emotional scars from years of verbal torture from my peers are permanent.
    THANK YOU. I get so tired of hearing these incidents being blamed on mental illness and those who suffer from it. Some shooters do have psychiatric diagnoses, but I believe there is such a thing as evil and some people carry it within them.

    I once knew a seven-year-old boy who was just plain mean---he tortured and killed small animals, caused other kids to have accidents on their bikes, set the playground on fire. He injured one of my sons one day and I took him back to his house, where he gave his foster mother and me a look that chilled me to the bone. I saw evil in his eyes that day, and if I ever had to choose someone as Most Likely to End Up on Death Row, it was he. As he grew he got into bigger and bigger trouble and ended up in a juvenile detention facility, and the last I heard of him he was in prison for arson and attempted murder.

    I too think bullying is part of the problem, but for my money the general coarsening of our culture is mainly responsible for this. Kids have access to all sorts of video games in which killing is celebrated. It's OK to use horrible language and watch violent movies. Too many parents neglect to teach their offspring how to accept disappointment and failure as a normal part of life; they don't get the idea that the world doesn't owe them something just for breathing. With this entitled attitude, some fail to grow a conscience, and we end up with...this. Murder, death, bodies, blood. Over and over and over again.

    This is a complex issue that has so many factors that we may never be able to sort it all out. We don't have a gun problem so much as we have a *heart* problem. The guns are just a means to an end for mass murderers. Perhaps there would be fewer dead if criminals used knives or machetes or baseball bats instead of guns. But for someone who's bound and determined to hurt or kill people, there are plenty of weapons of all kinds around, including explosives. That kid who committed yesterday's killings also reportedly planted bombs around the school which could have killed many, many more. How do you control that? Anyone who wants to make explosives can get bomb-making instructions on the Internet, even easier than buying a gun.

    I don't know what the answer is. I'm not sure there IS one, at least not a single answer to all the bloodshed. All I know is that as long as violence and lack of respect for our fellow humans continue to be par for the course in America, these murders will keep happening and the body count will keep rising.

  • Mar 25

    This is a very stupid question!!

    1) An open fracture would NEVER be discharged home from an ER, that is a surgical case that requires immediate attention!

    2) We don't use plaster any longer, except as slabs for splinting, nor do we put casts on in the ER. The rare exception would be if an ortho surgeon comes in to do a closed reduction and puts the cast on because the fracture would be to unstable otherwise, and even then they will usually bivalve it and wrap it with an ace.

    This is by far the dumbest question ever, and if she got it from a book it must be from the 1980s! The patent would not need to seek medical care because they would be in the hospital for at least a couple of days if not more!

    If this client is discharged from the ER they should seek medical care at a different hospital promptly!


  • Mar 19

    Sure you can force a confused patient to take his/her medications. It's also called "assault" or "how to loose your license in 3 Easy Steps!"

  • Mar 8

    IVRUS.I love reading your posts. I can tell you have passion for your speciailty.I will pm you later as I need your opinion as you have the expertise I need.

  • Jan 3

    Quote from nina12345
    I am a new grad that has been working in psych nursing for one month. I want to get to med surg, but I landed in psych as my second job since I didn't like the skilled nursing setting and couldn't land a med surg job right away. I am wondering if anyone knows about getting a med surg job as a new grad. I'm afraid it will be difficult to find a med surg job. Thank you!
    Wait -- you're a new grad and you're already looking for a THIRD job? Stay where you are for two years, and then start looking for a Med/Surg job. You're already starting to look like a job-hopper, and only desperate managers want to hire someone they think won't stay more than a month or two.

  • Dec 22 '17

    First of all you must know that the speciality of infusion involves more than just getting catheters into veins.Granted, that is a big part of it (my favorite part) but you must know all the theory and evidence of why we do what we do.If I were you I would join INS and purchase their text and the 2016 infusion standards of practiceand start reading.As you read the standards and learn them check your institutions policies to make certain they are good.This is what I did...I taught myself but used a different text .I used Ada Plumber ...Principles and Practice of IV Therapy.You may want to start with that's easier to get through If you have passion for the subject matter you will find the learning process enjoyable. Then start applying what you learned.and see if you like it.Do this first.

  • Sep 25 '17

    That does not make any sense at all..What determines the time a bag will go dry is the total volume in the bag or cassette and the rate at which it is set and if applicable the small KVO rate between doses. If you have 250 ml and 250 mls is delivered the pump will alarm once it runs dry even though you have set the volume higher.Its best just to set the volume accurately and teach the patient or caregiver how to aseptically disconnect and flush whatever type of VAD they have to keep it patent until the nurse gets there or get there on time!

  • Jan 31 '17

    Quote from ital91
    Chill pill Maverick, you get my point. Anyway, thanks much for the explanation I get it now. The order I gave was an example - 100ml for 8 hrs.. Again, calm your horses.
    Hmm...I've never known "chill pill" or "calm your horses" to be appropriate responses to someone who has taken time out of their day to provide a thorough response.

  • Dec 19 '16

    It was Christmas Eve and I was in the ER working a 11am-11.30pm shift. I eyeballed her across the ER. She walked in with her son, an old frail lady. I looked at her pallor and shaky steps and knew in my gut that she was deathly ill. "She's not going to make it out of here alive," an unbidden thought sprang to my mind as I walked towards her.

    Cindy was the charge nurse and as she looked to see who was on next to take a patient, I reached her. "I'll take her Cindy," I said smiling easily at mother and son and taking the paper chart from Cindy.

    "Hi, I'm Annie. I will be your nurse today," I said as I deftly got her on a stretcher and closed the curtains of cubicle #4. I helped her change into a hospital gown, hooked up to the cardiac monitor and got my first set of vitals. Her name was Mary. She had been feeling more tired, fatigued and had lost her appetite for over a week. She was a little short of breath. Her vitals were normal. Her BP was border-line. I listened to her lungs and abdomen while my mind raced. I suspected that she was septic and so drew 2 sets of blood culture along with other labs and got a urine sample that was a tad cloudy. Probably a UTI that turned into sepsis, I thought. By the time the doctor came in to see her 15 minutes later, and EKG and CXR was done and I had normal saline running. The doctor agreed that she could be septic and I monitored her vitals carefully.

    The lab called back half an hour later with her blood count. Her WBC was 37. Bingo! I thought. Right on the money! I had antibiotics running and we kept pushing fluids. Her pressure began to drop and she started becoming tachycardic. I knew that she would crash pretty soon and wanted to make sure I was prepared. So I gently broached the subject with her son James who had no clue how sick his mother was or what her wishes were in case of an emergency.

    I talked to Mary in her son's presence and asked her. She looked at me, with wise knowing eyes and told me, "If you can save me, go ahead and do what you need to do, but at any point if you see it not going to help me, then let me go. I do not want to be hooked up to machine and it is futile." I told her, we would follow her wishes.

    I took James aside and talked to him. I asked him if he had any other family. He said he was the sole caretaker of this 87-year-old mother. His dad had died many years ago. He had a sister, who he had not talked to or seen for 20 years. She lived in the same city but they had a fight and stopped talking. I told him gently that it would be a good idea to call her as his mom was very sick. It would only be a matter of time before her systems collapsed due to the overwhelming infection in her blood. He was bewildered and said, "But she walked in! She can't be that sick". I told him that UTI and sepsis signs in the elderly were very subtle and that she might take a rapid turn for the worse very suddenly. I encouraged him to call his sister Ella.

    "After all, wouldn't you want to know if your mom was very sick and you were not with her?" I asked. He readily agreed to that and dialed her number (I got it from the patient) as I held my breath. They talked and Ella asked to speak to me. She told me that she was an RN and so I was able to give her an update on her mom's clinical status. She had just picked up her husband from another hospital after discharge and promised to be there in half an hour. "Try and keep her alive for me, Annie" she begged. I stayed by Mary's bedside but she was rapidly going downhill. I looked at her and marveled at how her dying was bringing her two children together one last time. I now had her on multi drips. She crashed. We intubated her.

    Five minutes later her daughter rushed through the ED doors. I took her and her brother to our tiny family room where they talked for the first time in 20 years and hugged each other. Tears and laughter rang as they reconnected. Later Ella came to me and told me that her sick husband was sitting in the car and she had to take him home. She gave me her number and left. James came to me and told me that he could not watch his mother die. By now she was made a DNR after they talked to the doctor. He gave me his number and left.

    Another nurse relieved me for break but I stayed at the nurse's station drinking my coffee and writing my notes playing catch up. A few minutes later I heard a voice in my ear, "It is time". Probably my guardian angel Providence, I thought to myself. I quietly got up and went to her cubicle. I sat down near her and held her hand. I spoke to her softly, "Mary, you did it. You got them back together one last time. Now it is up to them. Go in peace." As I recited the Lord's Prayer, she flat lined and was gone peacefully. I sat at the nurse's station and made the calls to her children.

    Mary had gone leaving her final gift behind; the gift of peace to her two children. I walked out of the ER at 12 midnight on Christmas day marveling at a mother's final act of love where she used her dying to bring her children together. Merry Christmas and God bless us all!

  • Nov 4 '16

    I'm not an infusion nurse, so bear with me, but it seems like the most reliable (and sometimes only) way to know that an IV has infiltrated is to check the site; therefore, you have to risk waking up the patient bundled in a blanket cave. It's kind of like inpatient nursing: nurses try to be respectful of patients' sleep schedules, but you're in the hospital to receive medical treatment, not to sleep. I'm guessing that patients would also rather have their naps interrupted than have their IVs infiltrate.

    In order to keep patients happy, I'd just try to clearly lay out that expectation before you begin, i.e. "Mr. Doe, I will need to check your site every 30 mins; we do this so that the IV medication doesn't damage your tissues if the IV becomes dislodged. You're welcome to sleep during the infusion, but it may be more comfortable for you if you leave your [IV-site-extremity] exposed; that way, I'll be less likely to wake you up when I check the site." If a patient is freezing and wants to be wrapped up in 47 blankets, maybe work out a system with that patient so that the site/extremity is covered by blankets that can easily be pulled up to check the site and then be replaced, rather than having them wrapped around that extremity.

    No matter what, I definitely wouldn't chart that you checked the site if you didn't, but I also wouldn't want to chart that I hadn't checked an IV site in hours.

  • Aug 29 '16

    Quote from TheCommuter
    I suppose the monkey is a tad bit sharper than me because I still struggle to start IV lines, draw blood and perform cannulation, even after a decade of being a nurse. I am simply not a hands-on person...

    No, no.....IV starts can be very difficult and sometimes "the best of the best" have to be called to get access...and, at other times, they need a central line because they are that hard to get. I don't agree at all with it being a monkey skill.

  • Jul 2 '16

    Yes Muno is correct.Once you assess patency with the 10 ml syringe you can administer your medication in whatever syringe size that is the safest for the volume of the medication.It is much safer not to transfer smaller volumes.