Charge200J

The best wound documentation done in the ED that I've ever seen is from "rovers" (aka iphone like work devices) that you quickly log into and with a few taps can upload a photo directly into the chart. Hold up a form of measurement next to the wound (eg the wrapper of a 2x2 has measuring marks on it). No explanations, no descriptions. Just snap a photo and document "see photo upload." It's time stamped and let's providers see what it actually looks like instead of hoping a staff member clicks enough boxes to accurately describe a wound. Super high staff compliance because it's so quick and easy. Helpful for inpatient care as well as they can see what it looked like on admission and throughout healing process.

The ENA (Emergency Nurses Association) worked to make this great documentary about working in the ER. So helpful for those friends & family members that just don't get what happens behind those front doors. https://kinonow.com/incaseofemergency

It gets better! Look how much you've already learned and grown. Sounds like you've got a good group of co-workers. Keep asking questions and looking up stuff that you don't fully understand. Get out of your comfort zone and keep taking those new patients/disease processes/devices etc. Give it 6 months and you'll be amazed at how much you have learned, by 1 year you won't even recognize yourself. Keep at it! ?

I've heard of this happening. Aside from all the legal stuff...what would be really beneficial to actually prevent this from happening in the future is to go speak to each group of new to practice RN's at the hospital during their orientation program and share your story. A face to face personal story on the importance of double checking meds during an emergent situation is way more impactful than another online module on medication safety.

Yeah go for it! Become excellent at what you are doing now so that multitasking/prioritizing comes easier to you in the ICU. Good job looking ahead at classes/certs while getting your solid one year done. So STABLE is for treatment of sick newborns so if you are going into the world of adult ICU you won't need it. What you really need to take is an AHA accredited ACLS course (advanced cardiovascular life support). Contact your hospital's education dept and see if they offer it for free (most hospitals do) or if you can get reimbursed to take it. That will really help you in the ICU as well as on your resume. As long as you've done BLS you can take it. It's kind of ironic that they say "basic critical care" because the nature of critical care is definitely not basic. You'll get a good boatload of info in your fellowship/orientation to the ICU program. But look to see if your hospital offers an EKG analysis course and IV insertion/ultrasound guided IV cert - those will both help you get off to a good start and be something you can put on your resume.

This sounds like homework. But honestly I'd give the patient some sips ginger ale and crackers, help them rinse their mouth out and tell them that everyone vomits. ? If nausea/vomiting is a part of a more serious situation then yes Zofran or Reglan work well. In the inpatient setting I usually advocate for IV antiemetics because it's often hard to get someone to keep a pill down if they are vomiting.

CVVH = how it comes when you open up the package. CVVHD = got to switch it up as per the instructions on the screen. ?

Event/camp nurse here...pre-event/practice/performance give a pep talk on hydration/sun protection and pre-plan breaks. Have the basic stuff like sunscreen/bug spray/bandaids/ice packs handy. Gatorade powder/"drip drop" powder packets are easy to mix for oral rehydration. Try to have a shady area set up for people to cool down and rehydrate. Keep an eye on your seizure and type 1 diabetic kiddos. Know who your asthmatics are and where their inhaler is and where your bee-sting/peanut anaphalaxis kiddos are and where their epi pen is. Check out the camp nurse forum on allnurses for more ideas. Have fun!

Awesome question! MICU is a great place to learn for new docs. I love it when the day team comes to ask the night nurse how the night went, it gives me a chance to directly communicate issues that need to be fixed on day shift. However, they always have a tendency to show up and ask at 7ish AM right in the middle of our nursing shift change report. Try asking earlier (aka before 7AM) and I bet you'll receive a different vibe.

Simple clinical questions that we like to ask for an adult CVICU: -explain the different types of shock (eg septic shock, hemorrhagic, cardiogenic, distributive, etc). What do these patients look like? What are initial interventions for them? -give an example of a time you escalated/advocated for a patient's clinical situation (eg rapid response/code situation) Just do your best, try to relax and let your enthusiasm and knowledge shine through. Listen to what the people interviewing you are saying. Good questions to ask your interviewers are: what your orientation would be like (length of time, experience on both day shift & night shift, weekly classes, how many preceptors will you have (having a couple preceptors is good so that you see different styles, but too many preceptors make it challenging for you to get your feet on the ground.)

So without the use of a swan...an Echo is a great tool...cardiogenic shock often shows global hypokinesis, elevated filling pressures, wall motion abnormalities, and a dramatically reduced estimated EF. This often correlates to a picture of a cold shock/low flow/perfusion state. I find that often these patients are either orthopnic/tachypnic/hypoxic and agitated or very very quiet, cold, and obtunded. The septic patients on echo sometimes have a hyperdynamic LV, flat IVC, etc. Their clinical picture correlates with infection, positive cultures, fluid/vasopressor responsive distributive shock. Yes definitely we get patients all the time that have both septic and cardiogenic shock (eg: really really sick endocarditis patients). These patients are often very tricky to get their fluid/volume status correct.

Sometimes it's a mixture of things (first day observing/nervousness/excitement/overheated/new smells/low blood sugar/dehydrated) that makes people pass out. It happens to SO many people in healthcare. Take big slow deep breaths and slow your heart rate down. Wear a mask if smells bug you. Focus on something else in the room eg count the tiles on the floor, count backwards in your head, etc...something to force your brain to focus. Keep your peripheral vision open so you don't get the tunnel vision. As the feeling starts to go away then slowly direct your eyes back to the task at hand/whatever was bugging you in the beginning. It does get better as you get more used to the hospital environment. Also I've found that when it is your patient and you are having to focus on keeping them safe your adrenaline will kick in and you won't feel faint at all. Hang in there!

Whew, that's a lot to go through all at once. That's good that you know some staff on the unit that he will be on. Heart failure is not a linear path, there are twists and turns and baby steps forward and back. The staff there will be able to help explain each step of the way to you and guide you through it. Sometimes it is so hard being the family support/caregiver and having a medical background. Some tips/tricks I've learned: 1) Rally your troops. Put those well meaning family/friends to work. Make them a list of things they can do to help. Delegate what you can so you can focus on being at the bedside. 2) Pick your battles. To avoid being "that RN family member"...sometimes you'll need to bite your tongue, and sometimes you'll need to advocate for your spouse. At the end of the day it's patient safety that matters the most, don't worry about stepping on toes - no one should ever fault you for identifying safety concerns. 3) It's ok to take a break. Step away from the hospital, go home and shower. Exercise, get outside for some fresh air. Caregiver fatigue is even more insidious when the caregiver is in the healthcare profession. Wishing you the best. Hang in there.

Adult CVICU...2 visitors at a time. 24hr visiting. Only 1 family member can stay the night at the bedside. We make exceptions during end of life/withdrawal of care - then we allow larger groups/whole families to come back at a time but they cannot be blocking the halls/exits or disrupting other patients/families. No kids under 14. No animals, food/drink, or flowers. No sick visitors. I really wish that we'd enforce a "siesta time/quiet time" in the late afternoon - would help the overall stress level of the patients/visitors/and staff.

Sounds like fun! Definitely organize med pass times for campers. As for first aid: I'd make sure to have lots of ice packs and simple bandaging for abrasions. Encourage counselors to frequently remind their campers about staying hydrated and taking breaks. Lastly, just in case, consider learning how to properly size and apply a cervical collar and provide c-spine/spinal precautions - hopefully you'll never have to use it...but depending on how rural this camp is it could take EMS a bit of time to arrive for a really bad dirt bike accident.