EDValerieRN 3,165 Views
Joined: Mar 10, '05;
Posts: 178 (21% Liked)
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I think that as an L&D nurse, it would be important that you don't push your beliefs onto others. Not that I think you would, but I'm just speaking from personal experience. I got an epi and my nurse made me feel bad about it. That's not cool.
I do know that at my hospital, there are nurses who are particularly good at NCB, and patients who want to go natural often request these ladies. Sorry, not an OB nurse so I can't offer much guidance, I just thought I would throw my 2 cents in.
I figure a nurse could get into a whole lot of problems administering meds w/o an order... plus, why would you want to paralyze someone when you don't have anyone there to manage an advanced airway? Paralyzing someone before an airway can be managed seems like trouble to me.. order or no order.
So being that I'm in a neuro-focused ER, we give lotsa the tPA. Here are a few points.
~ Our window is six hours from time of onset. However, I have never seen it given more than four hours out.
~tPA can only be given for an ischemic stroke. The patient will have a stat CT-Head (we strive for a door to CT time of 20 minutes)
~IF the CT is negative, but the patient is experiencing symptoms, we will screen the pt for eligibility, get permission, and give the juice. If you see an ischemic stroke on the scan, then it's too late to give tPA. Reason being that if you see the stroke, the stroke has been there too long to benefit from clot-busters.
~tPA has a six percent mortality rate due to head bleeds.
~Often, you'll see marked improvement in only a few minutes after giving it. Truly is a miracle drug. However, a large scale study just came out that shows tPA to be no more effective than an aspirin. More research really needs to be done, and other studies have shown it to be tremendously effective if used correctly.
~ You'll need to do more neuro checks in the next few hours than you've probably done in your life... unless you give tPA a lot. It is REALLY important to get a great baseline assessment of your patients neuro status. Without it, you won't have anything to go on.
~The very first sign that there may be a bleed is a subtle change in LOC. The patient will seem tired.... will stutter, or not recall certain things... may get agitated, combative, or just sit up in bed and have a wild look. Pupillary changes are a late sign of a bleed. While helpful to assess, it won't be the first thing you see. You may also see bleeding at IV sites, tachycardia (early) and bradycardia (late), blood pressure changes, etc. None of this is good. When you see it STOP THE TPA and do a stat head CT. tPA patients can herniate fast.
~When we give tPA I'll often sit in the room and just visit with the patient/family for about 30 minutes. I can do that because I don't have a patient assignment as charge, but a lot of nurses don't have that luxury. tPA pts should be 1:1, due to the high risk for bleed/death. I've caught a bleeds before, and it's scary. I've also seen a lot of fab outcomes from it as well.
Lemme know if you need anything else.
He's got these wide boots on, and wears them with shorts... and poops... poop falls into boots, hence Poopboots.
He also had some Cheetos in there.
My daughter has received all the recommended vaccines with no ill effect. On a personal level, I wouldn't be able to live with myself if she suffered permanent or even transient damage from an illness that I refused to vaccinate her against because of my own 'beliefs'.
But the parent and child are not the only ones who are subject to the consequences of refusing to vaccinate against diseases that are readily transmitted in the school setting. If an unvaccinated child posed no threat to anyone other than him/herself and family, I would have no problem with your argument. But they do, and can cause harm to others. Where should personal rights end when they result in harm to others?
OK. I'm posting first of all as a nurse, and also as a mom of a three month old girl. I welcome debate, because it's how we learn... I'm just hoping I don't get flamed.
My daughter will recieve some vaccinations. Not all. One of you spoke about the kids who get the short end of the stick r/t diseases. What about those that get the short end of the stick r/t vaccinations? It does happen, hence the vaccine adverse reporting system. There have been several studies linking mercury-based preservatives in vaccines to autism and other neurological disorders. Before you say they've taken mercury out of vaccines: no, they haven't. They put it in, and then pull it back out, leaving trace amounts. I've researched my butt off, because I want what is best for my daughter.
To those of you who don't want un-vaccinated kids attending public school: if you're so sure your vaccine works, why are you so worried? Seriously, not trying to be smart, I really want to know.
Certain vaccines are only somewhat effective, yet, they are required. My daughter will recieve the DTaP (mainly for the pertussis benefit), the MMR, the Polio, and the Hib. I will not give her the rotavirus vaccine (because she's not in an at-risk population, and the recent link to intersussception of bowel), the varicella vaccine (marginally effective, and wears off), or the Hep B vaccine (as she will not be shooting up or having unprotected sex any time soon). We will delay the MMR until she is at least three years of age (due to the autism links previously reported). My family will have the flu shot, however, she will not. I will make a joint decision with her when she is older regarding the HPV vaccine. I don't feel it's been around long enough to really make an educated decision yet. I'm undecided on Prevnar, however, I'm leaning towards no.
I have a big problem with the government telling me what to do to my child. Especially a government that is ran by lobbyists, special interests, and pharmaceutical companies. Lots of people make a lot of profit off of these vaccines, and I just don't trust that they have my kid's best intrest at heart.
Plus, once it's in, it's in. There's no going back. Some of you talk about parents that don't vaccinate like they're ignorant... I find that they're really much more educated about the risks/benefits than the general population.
But I guess that's just my opinion on the matter.
I had the priviledge of taking care of a holocaust survivor. Such an interesting man, I found it hard to take care of my other patients because I enjoyed listening to his stories so much.
In three years, I've had one physician talk to me in a less than respectful manner, and he promptly apologized the same day. I think it depends on the culture where you work. Where I am, yelling and berating are not accepted, period.
If your fiance plans on retiring at 48 or up, your child should be out of the house by that time. Regardless of if you adopt or not, you're always gonna have a kid around. I'm not sure what difference two years would really make.
I had a daughter in nursing school, and I never got to really spend time with her when she was a baby. It was hard, but worth it. Good luck with whichever you choose.
I have a cheap band I wear to work, and I keep my platinum and diamonds at home. The last thing I need is to lose my stone, or cover it with bacteria...
I think it's a good idea. Sure, it'll be abused and mistreated, but it will also catch a few things that could have been prevented. A patient one time on a floor was complaining of SOB and palpitations. The nurse blew them off. The family member ended up calling the operator and speaking with the house sup, who went to the room. Patient had a Saddle PE, transported to the ICU, and nearly died.
Because she was only in her early 30's, the nurse thought it was anxiety. Didn't check to ask if she was a smoker or on birth control (the patch).
If it wasn't for this woman's family, she would have died, and the hospital would have had a really big lawsuit on their hands. I think this one case alone justifies the use of RRT for families.
we give out a fair number of cab vouchers, easy cheap way to get them out the door with little argument.
A nurse that I work with put it this way: People don't go to the grocery store and demand the clerk give them a ride... why would they think they can do it in a hospital?
We give them out, and I HATE it. People abuse it sooo much. We had one guy who lived across town, and would call EMS to bring him to us, get discharged, and get a cab to his girlfriend's house a few blocks away. He got away with it for about a year before someone noticed his home address wasn't the voucher address. Ugh.
Another guy was homeless, and got a cab to go to the Circle K two miles away... he lived behind it. Seriously.
I'm really stingy with them, and try to only give them to people who were traumas, or who came in for a legitimate reason and really don't have a ride home. Otherwise, they can hang in the waiting room until the busses run.
I just delivered my second daughter on July 19th. I thought I would share my birth plan with you ladies:
Please do all you can to make sure my baby and I remain healthy. Also, I would like food ASAP after delivery.
They got a kick out of it.
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