Gingeriffic

I haven’t encountered this, so thanks for sharing. It’s useful to know what is going on elsewhere. Just to clarify - in these situations (I’m mostly interested in accessing the line for labs if it’s not directly prior to or after a run), what other factors take part? Any precedence given to tunneled vs non-tunneled? Are only dialysis-trained RNs able to access the line for samples? Or is the room nurse able to?

If it’s for routine lab orders, you should not be using the dialysis lines for samples. It’s a huge unnecessary infection risk to access these lines and should only be used for labs in an emergency situation or if blood cultures from line are desired. Strictly answering venous vs arterial - unless it’s a blood gas, either source isn’t highly important. Labs can be run from either. Maybe you’re talking about drawing from circuit? Or?

OP, I appreciate and understand your concern and curiosity. It’s impossible to know what truly happened and unfortunately it’s so easy to speculate. I don’t doubt that the “brain is fried” comment came with some aspect of generalizing/stereotyping/presumption from the nurse, and I’d also be afraid that these feelings would impact the care she provides to similar patients. It’s dangerous to attribute mental status/LOC abnormalities to chronic issues (pre-existing neuro deficits or cognitive impairments regardless of cause: drug abuse, dementia, stroke, etc) without being keen to new reasons for abnormal exam. There’s no clear reason for why there was no action between 1751 and arriving to floor, because many aspects of this would warrant various actions throughout this time. The patient ripping out her IV might be evidence of impaired judgment warranting constant supervision (clearly impulsive and risk to self). An IV is usually required for imaging whether it’s used during it or not, so I’m thinking IV was pulled after CT. I wouldn’t be comfortable with any patient under medical care to be without IV access, especially this one and with these CT results. The indication for the CT is unclear, but generally the reasons for needing a head CT would warrant frequent neuro assessments, as well as the results of CT. Lack of documented assessments is unacceptable in my opinion, regardless of what information from this case that we don’t have. Even if there are no specific treatments that patient could have received (which isn’t the case as far as we know), there are clear gaps in care provided. You were right to inquire whether the appropriate care was given. This patient obviously cannot advocate for herself and it’s our duty as nurses to advocate especially when the patient cannot. If the ED nurse provided appropriate care, an investigation will reflect that. If there were mistakes made, it will hopefully show whether there are gaps in the system and protocols, or solely from the treatment team. I hope this answered your questions OP, and don’t take the harsh comments from some of these responses too seriously. You did the right thing.

Assuming patient is tolerating irregular rhythm/ectopy (no shortness of breath or chest pain, and has acceptable blood pressures), don’t expect to do anything urgently just based on abnormal rhythm and ectopy. Especially since patient has history of this and since MD is aware. What you should do in this situation is: -ensure the patient is tolerating rhythm, and monitor for signs that he is no longer tolerating: BPs trending downward, physical discomfort, or decreased level of consciousness. Monitor for further overall changes in rhythm/rate patterns. -Ensure electrolytes are of normal values and don’t need correcting. Even if patient lives in a funky rhythm, optimizing potassium/magnesium will decrease myocardial irritability and possibly decrease ectopy. -Make sure patient is receiving regularly taken antiarrhythmics (and probably anticoagulants) if history of atrial fibrillation. -Rule out any other major acute medical issues that could be causing increased irritability. Such as respiratory issues, fluid volume imbalances, infections, etc -Know whether your patient has a permanent pacemaker/ICD and what the settings are. They will usually have a pacemaker interrogation upon each admission, which noninvasively assesses the device’s function, any detected arrhythmias, and any response to the arrhythmia. Patients with atrial fibrillation have higher likelihood of pacemaker implantation due to common management of atrial fibrillation being rate control with medications (beta-blockers). Sometimes the result is great prevention of tachycardias, but such a low heart rate that a backup pacemaker is needed.

There shouldn’t be such a discrepancy between BPs taken on each arm. The tests/imaging ordered seems aggressive for typical hypertension. Are there any specific reasons or findings prompting this work up? How soon are tests going to be done?

Only an advanced provider can call a code. This seems wild to me that this discretion is left to ?nurses and the rest of a code team?? I’m pretty sure in situations like yours, you can get provider guidance over the phone and that would allow the verbal instructions of calling it. Hopefully you will soon have the option of telemedicine, which we’re seeing more and more for rural facilities.

I crammed through the weekend before the test and passed. The review books, study guides, and practice tests were more difficult than the exam itself. It’s heavy in cardiac/hemodynamics content so spending the most time on that and multi-system was my strategy. Using the exam’s outline as my guide, I used a few different critical care books to review and familiarize myself with concepts and pathophysiology, as well as treatments.

I believe the term ‘clinic/al assistant’ for this position (probably pretty much the same role as MA) for those that have not done a medical assistant program. Semantics. The point of this whole post is that it’s almost silly for OP to consider somewhat of an entry level position despite completing a 4 year degree. No offense meant, but why pursue a job to make half of what an RN makes. The hiring clinic would probably not invest in onboarding a new medical assistant hire knowing OP is a new grad and in the process of taking boards. It’s also not very noble to get a position with the obvious intent to leave as soon as possible.

Here’s a posting for an MA/LPN opening. Do you meet the requirements to work as an MA?

A BSN isn’t “unable” to perform MA duties. It’s a matter of not being an MA. Go ask a clinic and see what they say, instead of asking a bunch of nurses if you “can” take vitals and give shots. Of course you “can.” But you probably won’t get hired as a medical assistant just because you went to nursing school. Two different things. Go be a tele tech or nursing tech if you want to get a jump start while you prepare for boards. Unless you want to work in a clinic basically doing the same thing anyway

Medical assistants get administrative things in their schooling. And my understanding is that LPNs receive training more focused on ambulatory duties compared to ADN more inpatient. Most clinics require CMA or RMA and you can’t become certified or registered unless you completed a diploma or degree medical assistant program.

MAs and LPNs are interchangeable because of duties. Haven’t you noticed that open positions are listed as MA/LPN? As a BSN, you weren’t taught certain things specific to LPN or MA role. A medical assistant isn’t an untrained professional, they have way more education than a CNA, and they require a diploma or more commonly an ADN. Just because you may have learned the skills and tasks doesn’t mean you’re qualified to perform them in a MA role. Good luck!

I really like F.A. Davis Critical Care Notes Clinical Pocket Guide. They’re the ones that are 1/4th notebook sheet size and on little flip rings, about $35. Basic info and not institution-specific (for your hospital’s preferred protocols and whatnot) but so much helpful info. I use the ventilator mode info a lot, just as an example. Unrelated - are you in the Twin Cities?

Knowing answers to even basic things will come over time. Don’t feel guilty or inferior for asking questions about ANYTHING - questions = safe nurses. And you’re lucky you look young for your age, embrace it!! Hang in there and you’ll be more confident over time - you seem diligent and conscientious which are some of the most important attributes for a good human being and a good nurse. Until then, just own that you don’t know everything whether it’s to patients, family, or staff. It’s a lot harder to judge/not trust a nurse that knows their limits and involves resources, rather than those nurses that have to be the ‘hero’

Littmann Master Cardiology hands down. But instead of taking our word for it over the internet, ask around on your unit - I’m sure people are using various steths. Compare (on the same patient is extremely helpful) and see which you like the most! Don’t worry about showing up the first day without one, the unit will have extras or borrow your preceptors. We understand it’s a huge investment that you should put a lot of thought and research into.