Starburst

It happened this morning. I feel like since I waited this long to report, they would make me feel even more guilty for something I didn't want to happen.

I tried to pushed the guard after giving my patient a heparin injection, and stuck my finger. I bled, so I squeezed as much blood out as I can and then washed it with soap and water and alcohol. I looked at pt chart, he was negative for HIV on his recent blood test on 7/3 , non reactive to HEP A B C on 12/26/2021. I had my Hep B vaccine and my titer. The pt has been homeless. How likely is it that I would contracted something? I should have reported and followed exposure protocol, but since I am new to the unit and the chance of me being ridiculed and being talked about at huddle makes me not wanted to let my charge nurse know (It happened to my coworkers before) and then it is kinda too late now. ??

For the last 4 days I was taking care of a patient who has total of 110 ml/hr (all continous infusions combined). He got more swollen after the doc ordered to give Rocephin, so we stopped it. But the doc think that his swelling may not be from allergic reaction but fluid overload. He got his paracentecis yesterday due to ascites in his abdomem. They left it openly drains into the flexi seal during my shift. He has been having TPN for the last 5 days. His rate was 83 ml/hr. Today, the doc changed the TPN to be more concentrated and runs at 42 ml/hr. I got the new TPN bag, but forgot about the modified rate and ran it at 83 ml/hr for 9 hours before I changed the rate. The patient didn't have any distress. He became less swollen as the shift goes. I can see a big difference from the beginning of the shift to the end of the shift. His BG has been 109 before the new TPN was administered and 129 after 9 hours (doesn't need insulin per my facility protocol). His lungs sound the same, I didn't hear any crackle. I know I made a med error for not changing the rate, and I feel horrible about it. My question is did I unknowingly harmed my pt in anyways that it may not show just yet? What happened (in general) if you run a higher concentration of TPN at the same rate?

I got hired into an ICU residency program right after graduating nursing school. I'm currently on week 8 of a 16 weeks orientation where I am working with a preceptor. My manager and preceptors are very supportive, have high expectations and think highly of me maybe because of I graduated top of my class with a 4.0 (They mentioned it often ). Sometimes I don't feel like I deserve the praises, and because of that I'm fear of disappointing them. Anyways, everything has went well, and I felt confident as though I'm enough until my last shift. I had a new preceptor and she is the charge nurse of the unit but not last night. My preceptor asked me if have I been taking care of 2 patients, and I said I have. I have been taking care of 2 patients, and my previous preceptors were always right next to me if I have any question. I usually will tell them what I plan on doing, what I'm doing, report to them, and they watch me. So, last night were my third day on a roll, we got a dying patient, who is max on all pressors (levo quad, neo quad, epi quad, vaso), and another patient who is stable but needed to go to CT during the shift. The dying patient was very acidosis (7.2), so Dr ordered 1L bicarb running at 250 ml/h. The family was in the room asking me all the questions and saying that the patient wasn't so sick and bla bla bla as I was hanging the bicarb so I accidentally set the VTBI as 250 the rate as 970. The CNA was in the room and told me that she had a hard time getting the pt temp, and the family was very upset about that, so I tried helping the CNA to get the temp. The pump beeped and I added the volume but overlooked the rate. It ran for 1 hour instead of 4 hours. The charge nurse, my preceptor and MD made aware. A report is submitted. And I feel horrible about my mistake and recognized how it could have been a detrimental mistake if it were high alert med instead of bicarb. I tried to pull myself together. My preceptor left me for awhile while I was trying to manage the drips, monitor the patients, give schedule meds, draw labs and deal with patient's family members who kept on calling but are not authorized for updates. It was chaotic and I wished my preceptor could have been next to me when I had questions and gave me guidance instead of trying to figure things out as I go. Anyways, somehow I managed to made it through the shift. Then, I had a talked with the charge nurse, and the manager about the bicarb thing. I told them what happened, admitted my mistake, identified the cause and what I will do to not make the same mistake in the future. They said they were not mad, and mistakes happened. But I feel incredibly disappointed of myself and feel so bad that I probably disappointed them. I felt like I failed my patient, myself and their trust. I went to the car and cried my eyes out. It is half way through the orientation already, but I still feel like I need my preceptor to be next to me to give guidance and check after me. I always feel anxious and worried of doing something wrong. Well now I actually did something wrong. I'm wondering if I am behind, if I could ever be competent enough to work independently without fear and anxiety. Is it normal to feel this way? Can someone give me some advice or share with me your experiences of being a new nurse?