qaqueen

A pt with a trach that is still vented.

Thank you. We have a policy that does not require a MD order for 1:1, however, when pt is intubated and sedated, conventional wisdom at my facility is to dc observation. The odd thing (to me) is that if the pt gets trached, but is still intubated (no sedation) no observer is required.

Our policy requires that a SI pt have a direct observer until cleared by Psych. I would like to know how a couple of issues with SI patients is handled at other hospitals. What if the SI pt is intubated and sedated? Observer or no? What if the pt is trached, not sedated, not restrained but still intubated? Observer or no? Does your facility require that a direct observer is ordered by MD? Our policy does not currently address intubated SI patients, whether sedated or awake. Curious about how the rest of the world deals with this. Thanks in advance.

í ½í¸€ that was a smiley face on my phone

Not for a test í ½í¸€. The pt had atelectasis and infiltrates. At 2 liters, saturation was 93-98%. Colleague thought patient should be on high flow to improve PO2. I was concerned with overdoing the O2.

I have read several articles, with opposing statements about PO2 and aging. My understanding is that PO2 decreases with age. I have seen different formulas for calculating the PO2 reduction, that basically end up with the same value. The simplest formula l have seen is: Normal PaO2 (at sea level)= 100 mm Hg - the number if years over age 40. So, my question is, if you have an 98 year old DNI patient with a pulse oximeter readings > 92% on 2 liters via nasal cannula and a PO2 of 54, would you increase the O2 flow? Would it increase the PO2? According to the above formula, PO2 of 42 would be okay. Thanks for your help.

Gentle_Ben_RN, how is it going?

I don't think there is anything wrong with the OP's actions. BrandonLPN wrote: "As an experienced nurse, I know to monitor for increased sediment and/or low out put. I know to encourage fluids and consider irrigation if sediment is heavy. We are perfectly capable of monitoring for hematuria. We monitor for pain as a matter of course. We do not need all these orders placed in the TAR telling us what to do." As you would have done all of this anyway, why is it a problem that there are actual instructions in the patient's chart? Perhaps, other newer nurses need the instructions. As for being disgruntled about bladder scans, really? What if the catheter really is obstructed, this would be the easiest, fastest way to find out. And, it is likely that you could assign the task to a CNA. Perhaps the term "PVR" was not the best choice, however, was it really worth nitpicking? So, if you don't like the term the OP used, what would you use? Urinary retention?

I was an older new nurse. Now, I am an older not so new nurse. Honestly, if you want to be well rounded, Med-Surg would be my suggestion. You see a lot of different conditions. Often these patients are not so sick that they are unable to turn (or at least assist with a turn) in bed (a little easier on the back). You get experience in several areas, and learn time management. PACU nurses need to be able to identify a deteriorating patient and act quickly. ICU nurses must be familiar with medications, and procedures beyond the scope of the Med-Surg nurse. Although a two patient assignment sounds like an easy shift, if they are both deteriorating, the stress levels can be incredible. As for me, I was 48 when I graduated with my ADN. I completed my BSN at 50. I started out in Med-Surg for three years, then telemetry(PCU) for three years and now ICU for two and one-half years. It can be done. You must take care of yourself. Follow your dreams and if you want to start in ICU, give it a shot. All they can say is "no", and "no" never killed anybody. Best of luck!

Thank you for this article. I have been seriously considering pursing an UR position, but was unsure of the scope of the position and requirements for employment. Thanks again.

Lost the mold? I used to work in plastics, the only mold that ever got "lost" was on a ship, on the way to another country. Molds can crash, but this is strange.

So, what is the material that they are made of? Looks like HDPE to me.

Has anybody else heard about the "nationwide urinal shortage" (the type used in hospitals)? This was announced at work, we are to make sure that urinals are appropriate for patients. We should also consider using a basin or emesis bag as alternatives, if urinals are not available. So, I did a web search...no results. Checked with the FDA...nada. Looked at specific manufacturers, not a word. So what do YOU know? I think management just doesn't want us wasting product making Xmas urinal wreaths. If you have any info, I am dying to hear it. Thanks and Seasons Greetings

If you get a chance to go to a boxing gym, DO IT! Although your knuckles wont bleed :) you may findi it even more satisfying than you think! I know of at least 6 nurses (besides me) that box or kickbox. I love it!

Thank you all! You have all been kind, informative and supportive. I appreciate your input and insight. Best Regards! qaqueen

The meeting was a monthly management meeting. I had actually gotten a great review several weeks earlier (supervisor did not have input). I really feel that if I did the wrong thing, I should have heard about it at the time. Apparently, the reason it came up in the meeting was because the manager had recommended me to be on a quality improvement team. The supervisor then made the statement questioning my critical thinking and skills.

The rooms were one room apart, the nurse's station is right in the middle of all the rooms (small unit). The pt was extubated by the RT (they are dedicated to the unit). The supervisor washed the pts face, put on a fresh gown and turned off the monitor. The supervisor did not take out the IVs or foley. Can't imagine that it took that long. I did tell her that I believed it would be an ME case, she disagreed with me until the House Sup called. For the record, my manager has been very supportive. I am just amazed at the whole situation.

Heron, I fear that you are correct. I do not know what I did to annoy this person, but it seems that I am on "the list". We have only worked together a few times. Nothing was said to me (prior to now) about a judgement in error or lack of critical thinking. I am new to this dept. (though not the company), I cannot afford to walk away from this position (or lose it). I would love to have the confidence to embrace your Gandi quote!

I was not in the meeting. It was a management meeting. This was the first time my manager heard about the situation, it was then relayed to me.

Yep #1. Stupid staffing #2 Backbiting bit@#y coworkers #3 Lack of supplies and supply folks leave at 10p

It's a DSP (dayshift problem) Bats#!t crazy (As in, that pt is ...)

Then: Several months ago, I had two patients in the ICU. Pt A was recently intubated, on a paralytic, pressors, sedatives, and pain meds, Pt B a new admit, found down, unresponsive, intubated, no sedation, no pressors, no pain meds, DNR (brain activity testing planned for a.m.). I assessed Pt B, went in to check on Pt A and found that a clean up and linen change was needed. I told my supervisor what I was doing, which room I would be in, and asked that the supervisor listen for Pt B (monitor right next to supervisor desk). Supervisor said yes. Perhaps the bath took longer than it should have (about 30 minutes including linen change, with no assistance). While I was with Pt A, PT B expired. I was not informed that my pt was bradycardic or even that the pt had died. When I came out of Pt A's room, the supervisor told me "yeah just bradyed down and stopped". The death pronouncement had already been signed by the supervisor and another nurse, the patient was extubated and cleaned up. The supervisor had contacted the house sup to call the M.E., house sup was busy and had not called. I told supervisor I would call, I was told "no, house sup will do it". Okay. I contacted the family, greeted them when they came in. After the family left, I went to assess Pt A again. The supervisor heard from the house sup that it was an M.E. case, so went in and prepped Pt B for transport to the morgue. Although I felt that I should have been allowed to take care of my patient, I was very new to the department and did not feel it was appropriate to question the supervisor. Now: Several months later, the supervisor makes a statement to my manager in a meeting (with other people) about my inefficiency and lack of critical thinking. Telling my manager (not all the info above) that I chose to bathe a patient while my other was circling the drain. While it would have been great to delegate Pt A's clean up to someone else, there was no one to delegate to. Did I believe that Pt B would expire while I was in the next room? No, of course not, but it happened. I feel that the supervisor is being malicious. When my manager asked me about the incident, at first I did not recall it. When I did remember, I contacted the manager and said yes, it did happen, but that my perception was quite different than the supervisor's. I do not want to malign the supervisor. I do not want my manager to think I am an inept and/or incapable nurse. Should I just shut up? Or stand up and speak?

I couldn't like this because...oh my gosh! This is horrible!

Being new to ICU, I know less is better, but I do not know what constitutes "a long time", but it seems long to me.