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Nursing_excellence

Nursing_excellence ADN, BSN

PCU, ICU, LTAC, LTC, SNF
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Nursing_excellence has 9 years experience as a ADN, BSN and specializes in PCU, ICU, LTAC, LTC, SNF.

Nursing_excellence's Latest Activity

  1. Nursing_excellence

    Should have I called rapid response?

    Pt had infectious workup done d/t high temp. Procal was high. Wht ct 22 from 14 . Cxr diffuse b/l infiltrates. UA pos. Pt already on vent. 100% VCV/AC 300/14/9/40. Resp 30s to 40s. NSR 70s to 80s on tele. Started on IV abx. Bcx pending. Called NP cause BP 103/50. Was 120/60 this am. And pt was hard to arouse. She was responding to painful stimuli and follows commands like opens mouth during oral care, but tonight initial assmt. Was not opening eyes. And AM CNA, who is doing overtime, [this happened at 2000] said pt hadnt peed whole day. NP said to call rapid response due to change mental status. IDK how to page rapid overhead so I asked one of the seasoned nurses to call rapid. She asked what for. And told her the situation. She went and assessed my pt. Pt woke up with pain stimulus. Recheckef BP 103/67. She said pt OK. And cancel rapid. Do I get in trouble for not following the NPs order to call rapid? Im still worried bc pt hasn't put out urine. And BP staying soft . And I don't want to play catch up later. And I wonder why they cant just give me order for fluid. isn't that what you do for susp sepsis?
  2. Nursing_excellence

    need nightshift sleep/health tips

    I have been working night shift for 8 years now. Usually I work my 3 shifts fri sat sun. On Thursday night, I do meal prep including coffee to bring to work. I always go to bed at 10am and wake up 6pm. I try to keep this waking and sleeping schedule even on my days off. And it becomes easier to keep regular sleep pattern with this.
  3. Nursing_excellence

    Don't be afraid to ask why...

    I know this is very old post. But jic someone else is looking for answer. The insulin helps potassium uptake of the cells. And the d50 is to prevent hypoglycemia. Correct me if im wrong.
  4. Nursing_excellence

    Scripps New Grad Residency June/August 2019

    Are you internal?
  5. Nursing_excellence

    Scripps New Grad Residency June/August 2019

    Which cohort are you guys?
  6. Nursing_excellence

    Scripps New Grad Residency June/August 2019

    Who did you interview with?
  7. Nursing_excellence

    Scripps New Grad Residency June/August 2019

    Has anybody gotten any offers yet?
  8. Nursing_excellence

    Scripps New Grad Program Jan/March 2019

    which surgical unit? what floor?
  9. Nursing_excellence

    Scripps New Grad Program Jan/March 2019

    When did you receive the offer? Which floor did you get the offer from?
  10. Nursing_excellence

    Getting orders noc shift

    I usually think about those things too. But the patient was on TF and NPO. Also the patient was chinese speaking and it didn't seem like we were understanding each other that much. I gave her an alcohol swab to smell. It works on other patients according to my professors in nsg school. She said she felt better when i was leaving for my shift.
  11. Nursing_excellence

    Getting orders noc shift

    There's no one in the facility that can prescribe medications. If it's emergency. We send the residents out of the facility, to the ED. The DON is already aware of this. One time a nurse called the Doctor for a critical lab at noc shift. Idk what lab it was. But the doc got mad. Reported the nurse to the don and the nurse was asked to do an incident report for not following the "do not call the doctor before 9am.anyway it is just this specific doctor that we cant call at noc shift. The others we can.
  12. Nursing_excellence

    Getting orders noc shift

    Hi. Im a new grad nurse who just started working in a snf. I was supposed to orient that night. (I work 11 to7) but 2 nurses called in sick so they had to put me on the floor. Then around 2 am. I had a patient who was nauseous and was asking for a medicine. I looked at her prns and nothing for nausea. So i thought i need to call her doctor to get an order for antiemetic. But my charge nurse said that we cant call that physician until 9 in the morning. So she told me to just hand it off to the next shift. And they will f.u with the doc. Is this common in snf? I know it does not look emergent or anything. But my resident was uncomfortable and there was nothing i could do about it.
  13. Nursing_excellence

    Need help with HW!

    There are so many sad stories in out profession. I dont think I could handle these situations. I'll prolly be around well patients. I salute you guys that stay on the frontline and help patients and their families during those tough times.
  14. Nursing_excellence

    Need help with HW!

    Guys help me out with my meds for my burn patient!!! superficial and deep partial thickness burns covering 36% of body (Chest, head, and right arm) For pain management I have narcotics, ketamine, clonidine, dexmedetomidin, or acetaminophen abx prophylaxis for the wound, im not sure if they need systemic or powder or cream like mafenide acetate, silver sulfadiazine, silver nitrate solution, and silver-impregnated dressings (Mepilex?) And I also read about benefits of propanolol in burn patients. Has anyone seen this ordered for their burn patients? Other orders that I thought I might see: LR COHB Test BMP ABGs CBC insert foley Two large gauge IV access VS (whats the frequency?) 100% O2 NPO NG tube tetanus prophylaxis Thoughts???? Thank you guys in advance!!!
  15. Nursing_excellence

    Need help with HW!

    Thanks! Is there also a formula for that? I mean how much urine output would say the patient is not tolerating fluids and how much would you have to decrease the fluids? or infusion rate?
  16. Nursing_excellence

    Need help with HW!

    is parkland formula the one recommend by ABA? what i have is 4ml/kg/%TBSA 1/2 is given in 8h the other half is given in next 16 h Why is there a 900 seconds wait to comment?