discobunni

Has anyone tried Propet? I noticed that they make several widths, but are a bit pricey... so I haven't dropped the cash to try a pair.

One I remember is an 11lb 2oz baby that was SVD! I couldn't believe it, I saw the mom and she was average build. OUCH I had a 37 weeker the other day 10lb 9oz (IDDM) Poor kid could barely open his eyes his cheeks were so fat!

Newborns: 1:6-8* newborns requiring only routine care 1:3-4 normal mother-newborn couplet care 1:3-4 Newborns requiring continuing care 1:2-3 Newborns requiring intermediate care 1:1-2 newborns requiring intensive care 1:1 newborns requiring multisystem support 1:1 or greater -unstable newborns requiring complex critical care Can anyone tell me how "continuing care" and "intermediate care" and "intensive care" are defined? What are the factors involved that place each pt in any particular category?

How many pts are you assigned on a daily basis and their acuity level? What is the "standard"? I am wondering because in the NICU I work in, we have had an unusual amount of overflow babies where we have had to open a closed unit. Many nurses have had rather heavy assignments lately, and we have been short on nurses. We have had many instances where Level 2 and 3 babies are mixed together with assignments, and most of the time are left with no charge nurse and no clerk..... we are suppose to "share" with the other unit, but they don't really have time to be of use to us, so we are most of the time left with no supplies, left to scrounge for supplies, restock, put in our own orders, answer the door and phone. Mostly we have feeder grower assignments, but there are always others put into the mix such as babies on IV's, TPN, PICC lines etc.... People started complaining so the manager sent out an email to everyone saying that "4 babies is the standard" and it has been passed around that the director even made a comment that if we kept complaining that everyone was going to start getting 4 baby assignments all the time. Well it seems like that has happened, and it is even worse now because everyone is so tired, noone wants to come in and work any extra shifts to help out. Nurses are starting to turn on eachother because not everything is getting done on the previous shift and it just seems like it is turning into a nightmare. Its like if we bring up what I think are valid points, we get into trouble and they make it worse on us. Plus, there are "clicks" where a select group of nurses get better assignments or a regular basis, such as 2 babies and others will have 4. Can anyone shed some light on what the "NATIONAL STANDARD" is? I'm just wondering where she is getting this information. Thanks for any feed back!!

I got my license in January. I've been working at a hospital I really love, with healthy newborns and NICU. The training to NICU was only 4 weeks, and sometimes I go home and replay over and over in my mind what I forgot to chart...document...notify the doctor for....etc.... So many things happen in one day. I guess part of this is just a vent. About 2 months out of orientation, I got a feeder/grower assignment. Well I got in report that one of the babies had a " tiny nodule" on the arm, and the nurse told me the doctor had looked at it and that is was probably a "calcium deposit". Well in my inexperience I thought, ok, I have a couple of those, no big deal...so I charted it and its current size. About 4 weeks later 8 nurses including myself got written up. Turns out it was an infiltrate from calcium glutenate from TPN, and the baby had to have surgery. Well, the nurses who didn't document anything was wrong didn't get written up. The one nurse who never reported the infiltrate when it happened on her shift didn't get written up, because she didn't document anything about it. We got written up because nowhere had it been charted that the doctor had been notified, (basically didn't cover the intervention part after the assessment was their reasoning) and he never bothered to write it in his progress notes. OK, then the last couple of days, I was given a pretty heavy assignment. I was trained to level 2 which are feeder/grower babies. However, they will still assign pts to a level 2 nurse who are classified as level 3 babies as long as they are not on a vent. The ratio for that is suppose to be 2:1. I had 3 babies, two level 3's and one level 2. The level 2 should have been a level 3 IMO. All three were desatters, one baby hadn't even reached the 3lb mark yet. We had no charge nurse or clerk assigned (we are in a seperate unit that sometimes gets opened with overflow pts upstairs from the main NICU) They are suppose to be there for resource for us but are so overrun downstairs that they are regularly unavailable. One baby constantly had to get blow-by at least hourly and sometimes up to 4X per hour. One time HR was 51 and I thought he was going to code. Anyway between feedings and parents calling, rounds and new orders, putting in and executing my new orders, notifying the NNP everytime I thought any little thing looked wrong, distended abdomens, thought maybe the baby threw a pneumo (hard for me to discern O2 flow on an NC and clear lungs really...I just couldn't make out an actual breath sound) then more new orders, a new KUB and CXR would come up (all three had sonos and XR's that day because they were ALL going downhill) I had 30 meds to give on my shift. We are suppose to use this electronic MAR which tells you when meds are due, but there is also a paper MAR and you write your notes on your own sheet. I had them on my status board, somehow two meds did not show up on that, and I didn't write them down on my sheet, and don't know how I missed them off the paper MAR, but incidentally when the paper MARS are printed out for the next shift, that is when I saw they were not given. So I had to write two incident reports with Med errors that I made (Reglan X2 and NaCL X2, both PO) I also had a Vanc to give and noticed that it was the 9th dose so I put in for the trough and peak, and noone had done a peak or trough after the 3rd dose. One nurse told me I should write an incident report on it because it was my license, the charge nurse told me I didn't need to because I wasn't the one that had made that mistake, I was the one who had caught it. Well, I've already seen the damage that can be done, nurses getting blackballed for "writing everyone up" I informed the nurse when she came back in of the mistake, and thought she could report herself if she wanted to. No harm came to the pt. Anyway, since the TPN incident, all I can think about is how much crap I have to chart, what all is important to notify the doctor about and constantly trying to CMA....did I get everything? Did I miss something extraordinarily important? What am I going to get in trouble for/written up for now?!?!? Now, since yesterday, I am really paranoid even more....... sometimes just plain scared to go to work... What do ya'll think? Any advice?

It is also a JCAHO violation to wear gloves outside a patient's room :chuckle:chuckle:chuckle

Putting a face with a name always helps. Have you done clinical in the unit that you want to work? That is the best place for them to see what a hard worker you are, and meet the manager of the unit. They are the ones who usually tell HR who they would like to hire. Here where I live anyway, HR is a JOKE, and they try to place you where they want for their needs. Most of the jobs that are available, HR is usually the last to know that one particular unit is hiring. Find a way to meet the UNIT MANAGER. If you know anyone that works there, that can help too. Apply everywhere. Just because a place seems like a nice place to work, doesn't mean it is and vice versa. I got my job by another nurse I know just mentioned my name, and the manager "requested" my application from HR. I hope you find your dream job too!!

We've all had this patient in our NICU. This baby was born with gastroschisis. To make a long story short: He had all of his organs placed back, but had bouts of diarrhea and vomiting. They tried formulas with AR, but then determined there was a hiatal hernia. That was corrected, then he began gaining weight. He kept having this ugly lime green diarrhea. He was about to be discharged on my assignment when I mentioned the funky diarrhea he began having again. They did a culture and it was C-diff. He has been there an additional two weeks. He is about 2 months old now. He is still having this horrid diarrhea, is negative for the C-diff now, but they are about to send him home with it. His poor bottom is so excoriated now I've been told (I haven't had this asssignment since he was about to be DC'd) and seems like dumping syndrome. Shouldn't they be doing more investigative stuff like abdominal CT scan or something to try and figure this out before sending him home like this? He is failing to thrive and has been on a downward curve with the weight loss since that day. Has anyone experienced this before, or can someone lend any information about this type of situation? I am a green nurse, fresh out of school, and don't want to overstep my boundaries if I am wrong.

YAY~~~ I found out today I PASSED!!! I'm in shock!! WHOOHOOO!!!

:bugeyes:LEt me tell you about my NCLEX experience today. .....:icon_roll When I walked in there was a guy about to cough up a lung and spitting lugies in a kleenex for the 1st 30 minutes. UGH! It was hard to concentrate, I could hear him even through the earplugs! Poor guy I know it wasn't his fault, but I wish he would've picked another day, real mean! Anyway....... I am so nervous about looking at the results on Thursday. I knew some of the questions without a doubt, others I totally guessed! I got a lot of teaching questions, priority questions and some pharmacology and ones on diseases. I got one calculation question and 3-4 SATA but no hot-spots. I know I got the last question right for sure because I looked it up, but the questions didn't seem to get harder, it was all stuff I had read about....pretty much..I don't know!!! Although some of the stuff I had NO CLUE and had to disect the word to try and figure it out!!.... My stomach really began turning when I hit 75 and it kept going>.....ARRRGGHHH I am going to be SOOOO EMBARRASSED if I FAILED!!! Lord help me get through the next 48 hrs!:bugeyes:

You know, it really pisses me off when I see people trying to lump the majority of a group and contribute it to the same cause. Its like saying all black people are thieves...give me a freakin break!

I'm not sure what the trend was, I only had the most recent labs available to review. I was wondering if this pt was being over-ventilated because the ABG's showed respiratory alkalosis...perhaps that was the reason for the K+ order?

There isn't a diuretic prescribed. I was thinking that since they are pulling the fluid off with dialysis, a diuretic wasn't necessary. Is that wrong?

Hmph! HECK NO!!! For example: (among others) A very close friend of mine on her way to her last day of clinical as a student nurse about a week ago got into an MVA. She was transported, and checked out by "fellow nurses" HAHAHAHAHA in the ER. Her foot was blue and broken in 4 places, she just had an ORIF yesterday. She told them how much pain she was in, they brought her two tylenol. When they began to set her foot, she is asking for pain relief in which the nurse went "heeheehee" and walked out of the room.:angryfire Talk about wanting to punch somebody in the face!! And the crazy thing was, they KNEW she was an SN (so obviously was educated about pain management), and they deliberately didn't give her anything!:madface: Aside from that...I DON'T CARE if someone is a drug user, or tests positive for drugs. If they are in a situation where they are OBVIOUSLY in pain, then I'm giving it as long as I can get an order and it is safe to do so. Furthermore...another problem is they don't seem to look at the person's tolerance to drugs, someone who is a drug user probably needs a higher dose for adequate pain control.

I see a big one you missed. Remember to prioritize by your ABC's 1. Airway 2. Breathing 3. Circulation: - Look at circulation and the peripheral edema. You've got Impaired peripheral tissue perfusion. With the constipation you may have a risk for (abdomen distended, not soft?) or perceived. Also, Look at Immobility and where it falls on Maslows! Good luck on your careplan;)

If you hate it go somewhere else!!! No point in being miserable!! You probably didn't "forget" as much as you think! If I were you, I would just review a little bit, get some of those "handy" notes to keep with you. Most hospitals will have you orient with a preceptor before they put you out on your own, too. If you can do NICU, you can go anywhere. Just remember adults are just a 'bit' heavier Good luck, I hope you find what you are looking for! Don't stop til you do!!!:icon_hug:

Hmmmm. I do need a KISS! DUH If I paid more attention to the dosage for that part I would've known that. The pt was in respiratory alkalosis, I guess the reason for the K+. The pt gets dialysis (I guess instead of the diuretic) but they use 1000ml of NS for that 3 days/week...I guess I wasn't thinking either that that wouldn't have time to absorb, right? :smackingf

OK so I'm trying to think by KISS (keep it simple stupid) I ran across a vented patient the other day that has Sodium Chloride 10ml Q8h IV and Potassium Chloride 20MEQ qd NGT. Na was 141 and K was 4.7 I thought you would give one or the other for electrolyte imbalance...or maybe I am missing something????. Can someone please help me understand the reasoning? I'm a very new nurse and still learning! Thanks!

I don't understand why most people with CHF are on Lasix and Spirnolactone when they have the same mechanism of action on the distal tubule, is it because the Spirno is potassium sparing and the Lasix also works on the loop of henle? Help.

I was just discussing this with a very experienced RT yesterday. He told me that if you know you are getting close to knocking out their respiratory drive to breathe if their O2 sats do not change despite increase in upping the O2. He said this is a very rare occurance, but you have to be especially careful with COPDers that have had the disease for several years.

Time for him to grow up, or face the consequences of being a partyboy. You've told him, not much else you can do. He has to decide he wants to change and better himself. If he ever indicates he is ready, then you can help him. Until then, I would be reluctant to ride with him or visit his house because if he has drugs on him and he gets caught while you and your husband are there, you could go down with him. Be careful.

Agree... go on the interview. If you still feel good about the job...go for it! You will regret it by asking yourself "what if" later if you don't give it a try.

Hi everybody, I'm on the brink of graduation within the next few weeks, and am studying for boards. I am working as a tech on an L&D unit, and I like it ok, but I'm still not sure that is really what I want to do... but there is a 6 month orientation, and 3 pts max per nurse (and they are STILL always stressed out). I probably have a pretty good chance of transitioning into a job there if I want it...(somewhere in Womens Health- Of course bigger pt load in PPU) However, I'm thinking of working on a med-surg unit to "leave my options open" so to speak. I may want to do ER someday, always seemed appealing (I'm an adrenaline junkie). I have no "niche" I have found that I am 100% certain about.... several things I have enjoyed so far. I'm deathly scared of working on the Med-Surg units here. I'm told the average is 8 pts per nurse at all the hospitals. I'm afraid of losing my license before I even really get it! I'm told the orientation on med-surg units isn't very long...leaving me on my own pooping my own pants! One of my biggest fears is getting all of those patients, with some of them 20+ meds, having to look all those up (because I'm not real good with meds) trying to cross reference them all and getting them all administered within the one hour window....I just don't see how that can be done! Either I make a "med error" because I didn't get the med to them on time (probably some important cardiac drug or something too!) or the other side of the coin is to miss some important detail when administering the 20+ drugs for each patient, because you don't have time to look them ALL up....OMG I'm already panicking! Am I crazy for thinking of doing this? How did everyone else get through this? :uhoh21::uhoh21::uhoh21::uhoh21::uhoh21::uhoh21::uhoh21:

Thank you Chris! I haven't even gotten to see him yet (stuck at home w/sick kid) but my husband said his color was good. I kept asking him the same question last night...he wasn't pale?????? He was carrying on a conversation with you as usual?? I just found that odd. Thanks for the reminder about "treat the patient". I think that is something we can all strive to use in day to day nursing to cut down on mistakes. He's going home, sounds like he will be OK.

:lol_hitti