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PeachTea7

PeachTea7

Medical Surgical
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PeachTea7 has 3 years experience and specializes in Medical Surgical.

PeachTea7's Latest Activity

  1. PeachTea7

    Metoprolol IVP vs IVPB

    Hello everyone, I work in a small rural hospital (critical access hospital) in Med-Surg. Last night, I received a patient from the ED with stated complain of left chest pain. FYI: the patient visited the ED twice this same day for stated complain of left chest pain and was sent home! (Yikes)! Patient returned to ED later that day. While on the ED: Pt was placed on tele: SR. Pt received 4X 4mg Morphine IVP and sent to my floor. From the moment I received this patient on the floor, patient is holding his chest. MD notified and in to see patient. few minutes later, I gave PRN Maalox due to history of GERD and heartburn. Few minutes later, I administered 4mg Morphine IVP. Drew labs and Troponin is critical 8.145. VS assessed, EKG done. Tele monitor in place. Provider comes to bedside, stays with patient and asks me to override nitro patch order in Omnicell. I notified provider I cannot override this order. Provider then asks me again to override order for Nitro SL 0.4mg and he will put orders in a minute. Patient received nitro SL 0.4mg. Provider leaves Pt’s room and puts orders for nitroSL, ASA, and Lipitor and Trop lab. Patient received meds STAT. Trop came back at 11.564! At end of my shift, provider puts STAT orders for Heparin drip, heparin bolus, Metoprolol IVP. I was starting to give hand off report on another patient when provider interrupts and ask me to give Lopressor IVP STAT. (BP:166/87 HR 89). I tell the upcoming nurse that I cannot push Lopressor 5mg IVP on the floor. I call CCU nurse, and I am told by both nurses that I can hang it IVPB in a 50 mL bag of NS. I connect patient to VS machine to assess BP/HR. Patient is already on tele. I start the infusion. I call Shift director and CCU nurse to request one of them to monitor my patient while the infusion is running. CCU nurse comes in and assumes care of my patient. Patient received additional Lopressor doses by CCU nurse, Nitro drip, Heparin and Morphine while on the floor. Patient is then transferred to a level 1 trauma center, Patient is safe, hemodynamically stable. Question after long rant= I scanned the Lopressor 5mg IVP in the eMAR. The medication was administered as IVPB at a slower rate. I documented everything about the Lopressor administration in my nursing note. BP and HR are within normal limits. BP: 126/87, HR:72. Should I be concerned that what I scanned (Lopressor IVP) does not match what I documented in my nursing note (Lopressor IVPB)? Due to the seriousness of the patient scenario, acute MI, critical Trops! Should I have done things differently? Should I have bothered transferring this patient to CCU? I feel like I got involved in the middle of chaos and I was doing my best to keep patient alive and safe. But I don’t want to jeopardize my license. *Hospital protocol states only ED/CCU nurses can administer Metoprolol IVP. All RNs can administer Metoprolol IV. *Must monitor BP/HR and place on a Tele monitor prior, during, after infusion. Please share your thoughts! I need advice! Can’t sleep!
  2. PeachTea7

    Metoprolol IVP during acute MI

    Hello everyone, I work in a small rural hospital (critical access hospital) in Med-Surg. Last night, I received a patient from the ED with stated complain of left chest pain. FYI: the patient visited the ED twice this same day for stated complain of left chest pain and was sent home! (Yikes)! Patient returned to ED later that day. While on the ED: Pt was placed on tele: SR. Pt received 4X 4mg Morphine IVP and sent to my floor. From the moment I received this patient on the floor, patient is holding his chest. MD notified and in to see patient. few minutes later, I gave PRN Maalox due to history of GERD and heartburn. Few minutes later, I administered 4mg Morphine IVP. Drew labs and Troponin is critical 8.145. VS assessed, EKG done. Tele monitor in place. Provider comes to bedside, stays with patient and asks me to override nitro patch order in Omnicell. I notified provider I cannot override this order. Provider then asks me again to override order for Nitro SL 0.4mg and he will put orders in a minute. Patient received nitro SL 0.4mg. Provider leaves Pt’s room and puts orders for nitroSL, ASA, and Lipitor and Repeat Trop lab. Patient received meds STAT. Trop came back at 11.564! At end of my shift, provider puts STAT orders for Heparin drip, heparin bolus, Metoprolol IVP. I was starting to give hand off report on another patient when provider interrupts and ask me to give Lopressor IVP STAT. (BP:166/87 HR 89). I tell the upcoming nurse that I cannot push Lopressor 5mg IVP on the floor. I call CCU nurse, and I am told by both nurses that I can hang it IVPB in a 50 mL bag of NS. I connect patient to VS machine to assess BP/HR. Patient is already on tele. I start the infusion. I call Shift director and CCU nurse to request one of them to monitor my patient while the infusion is running. CCU nurse comes in and assumes care of my patient during Lopressor 5mg IVPB administration until patient is transferred out. Patient received additional Lopressor doses by CCU nurse, Nitro drip, Heparin and Morphine while on the floor. Patient is then transferred to a level 1 trauma center, Patient is safe, hemodynamically stable. Question after long rant= I scanned the Lopressor 5mg IVP in the eMAR. The medication was administered as IVPB at a slower rate. I documented everything about the Lopressor administration in my nursing note. Should I be concerned that what I scanned (Lopressor IVP) does not match what I documented (Lopressor IVPB)? Due to the seriousness of the patient scenario, acute MI, critical Trops! Should I have done things differently? Should I have bothered transferring this patient to CCU? I feel like I got involved in the middle of chaos and I was doing my best to keep patient alive and safe. But I don’t want to jeopardize my license. Although I am happy that patient is safe. please share your thoughts! I need advice! Can’t sleep.
  3. PeachTea7

    Low Census and Job dissatisfaction

    Hello all nurses, After working in a COVID unit for practically 8 months in a floor without unit coordinators and CNAs (sometimes we have one CNA in a 30 bed floor) I decided to leave after feeling exhausted working 5-8’s= 40 hours a week. I got a new job but it is 4-8’s= 32 hours a week but after two months in this new job, I am finding myself feeling very frustrated with the low census in this small rural hospital in general. Most days, I care for 1 to 2 patients in med surg. But most days is just one patient and I have to give it up at 7 pm to the night shift nurse because they need to take of someone for the rest of the night instead of waiting for me to give report to them on this one patient at 11 at night. I don’t miss my old job but I haven’t been able to find a “happy medium” in nursing job. In my previous job, I had little help and about 4-5 patients to care for in a med surg floor, being the last one to leave most nights due to documentation and charting on late night admissions. Don’t take me wrong! Patient satisfaction is high in this hospital but I am not feeling excited to go to work. If we don’t have patients to care for, we are given the choice to take the day off with pay or not pay from earned time and optional to be placed on call. With the current pandemic and unemployment, I cannot afford to just sit home and use my earned time due to low census. But if I don’t use it, then my paycheck comes shorter that week. I though the situation was going to pick up and the census was going to get better. But I hate going to work to complete required “nursing education” instead of working because there are one or no patients. What would you do? Should I look at a larger hospital for a busier job? I can’t stand just sitting around...
  4. PeachTea7

    What did you do with your old nursing school textbooks?

    I sold almost all of my books online after graduating and passing NCLEX-RN. I only kept my Saunders, Med-Surg and Drug Guide books. In my current place of employment, we have access to UpToDate and other resources. I am currently in a BSN program and I have not needed them at all.
  5. PeachTea7

    References in your job experience

    I am a little under my first year of nursing experience and would like to apply for a better job. I thought about asking my current supervisor but she left for another unit. So, now it feels like starting from zero with a new supervisor if I were planning on changing my job in the next several months. I never considered physicians before for job references. Thank you so much for your input!
  6. PeachTea7

    References in your job experience

    Hello everyone, I am curious about how other nurses use job references in the job application process. I have been working as an RN on a Medical-Surgical floor and our supervisor is leaving our unit to work in another area of the hospital that she loves. How do you ask someone who is no longer your supervisor but knows you well to be your reference, especially after many months or years have passed? Do you stay in touch with your personal references and job references so they can give an accurate and updated representation of who you are as a nurse? Nurses in general change jobs very often. . . how do you keep up with your job references? Please HELP!
  7. PeachTea7

    How to handle patient’s threats

    Yes, I am sorry if I misunderstood what you said in your previous post. I always mention this to patients. This is what I have available for pain for you, I will contact your physician. But most times, providers are very set in their ways and don’t prescribe narcotics. Sometimes, it takes a day for providers to review patients’s chart, assessment, and pain to do something about it. I have also had providers tell me up front Prior to them leaving the floor shortly after I arrive on my shift: “he/she is seeking and this patient is very manipulative, she is only getting this... So try to be assertive”. Most plan of care decisions and medication changes happened during day shift at rounds, not on evenings or overnight. Sometimes, after begging to long, they might prescribed a One time order of Morphine 0.5 mL.
  8. PeachTea7

    How to handle patient’s threats

    Thank you so much for your advice! I have not been personally threatened. You are absolutely right about letting them leave. But what do I say so I don't come off as ”disrespectful, insensitive, bad nurse”? When I give hand off report to the next nurse, he/she states ”let them leave”. But by letting them leave with a terrible infection or bad condition, wouldn't things get worst? Patient most likely return in a worst condition? Every time I followed up with the NP on call in the floor, he rarely prescribes narcotics and wants to stick to the plan set up by the doctors who worK days, other times, he adds a higher strength Tylenol and he is very conservative with opioids but I understand and am fully aware of the opioid crisis. Also, when I am doing a late night admission after spending 1-2 hours doing patient admission, physical, dressing wounds, hanging antibiotics, labs, then hearing them say they want to leave because they are not getting what they want or need, makes me upset after all the work I have done. Sometimes, I feel that some people have terrible expectations of pain control or they are constantly ringing for pain meds and it is the nurse who gets all the backlash.
  9. PeachTea7

    How to handle patient’s threats

    Hello everyone, I am new to this wonderful platform. I would like go have your feedback or advice about how to deal with patients’ threats. In my almost two years of nursing experience, I didn't know how upset patients can get if their pain is not treated and care for appropriately in their own terms. But sometimes, I get patients who say things like ”I want IV push meds only”, ”the oral meds don't work on me, IVP meds work faster”, ”nurse, if you don give me IV pain meds, I am leaving! That's it! I can take better care of my pain at home”. I always offer non-pharmceutical pain management first: ice or heating pads, elevation, etc, then pain medication. I also explain to my patients that I will Inform the provider about the pain not being well managed with the PRN Tylenol and I assure patients that my hands are tight about medication prescription and drug of choice for them. That I Have limitations withing my scope of practice and I am doing my best. Most patients apologize, and state they understand me and feel sorry. I can empathize with people and trust my patients when they are in pain and ask many qusriin about their pain (hint; OLD CART). But sometimes, It is not easy to deal with people who are demanding specific meds and medication routes. How do you deal with these patients who threat to leave if I don give them the medication they want and get upset and sometimes nasty? Background info: I work in a Med-Surg floor on evenings. Thank you in advance for your input!