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mamiekay

mamiekay

Med/Surg GI/GU/GYN
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mamiekay specializes in Med/Surg GI/GU/GYN.

mamiekay's Latest Activity

  1. mamiekay

    SHOES... glorious shoes

    At the hospital I switched between my Danskos, which I really like but do not love, and a good pair of either stability or motion control running shoes. I wore the Danskos when I was on the floor and the running shoes when I was charge. I usually put on more mileage as charge than I did working my little section of the floor and the Danskos were too heavy for that much running back and forth. At my current job, an endoscopy center, where I do equal parts running and standing in one place, I wear the Danskos. I always buy my work shoes 1/2 size larger and ADD a Superfeet insert. That way I've got enough stability for my ankles (I'm very flat-footed) and enough cushion for my feet. Unfortunately good shoes are expensive and it may take some trial and error for you to find the right shoe/sock/insert combo that works well for you. Just remember, you only get one set of legs and you need them the rest of your life. Take good care of your feet and your legs and they will take good care of you. Good luck!
  2. mamiekay

    Nursing care for diverticulitis

    What is your role? Will you be providing long term care or short term, hospital stay care? Long term, every one of her co-morbidities will affect her outcomes. However, you can't bombard her with too much information. Start simply, post-op care & recovery first. If you're caring for her while she's in hospital, add to your summary whatever your role is in getting home care/post-hospital care set up. If you'll be caring for her longer term, can you say in your summary that you will focus first on post-op care and then add in subsequent cares and education as appropriate? Good luck!
  3. mamiekay

    "Stop Trying to Help Him---He's Not Worth It"

    And THOSE are the moments, precious few and far between for some of us, that make us remember exactly why we got into nursing. We give and we give, we care and we care, and there are a few of those who just seem to suck it all up and need even more, and yet, even they can give us those glimmers of hope that what we're doing is making a difference. Maybe Donald Lee is on the bandwagon for good, maybe only for a short time. But no matter, Viva, you've done what you knew in your heart you needed to do and for now he's safe.
  4. Perhaps the person you knew on the panel has reasons for not wanting the others to know where he worked previously??? You never know. I'm sorry it didn't work out for you.
  5. mamiekay

    Looking for Advice-New Grad, 8 patients?

    I am curious about where RN's work that they have to take so many patients! I've got a little over 3 1/2 years' experience, I work 12's and I usually have 6 patients at night. Our day RN's never have more than 4, and that's a full day's work! Of course, during the day, that can turn into 6-8 different patients by the time discharges & admits are done, but never more than 4 at a time. There have been a few times at night when I've had to take 7. Six is doable most nights, although there have been more than a few nights where five was impossible. Seven? All it takes is one patient take too long to pee and the whole night gets thrown out of whack. We work with one CNA per 12-15 patients at night, more due to the layout of our floor than to do with actual numbers. I'm sure we'd get fewer if the floor layout would allow for it. In any case, fully utilize your preceptors during orientation. Ask the other RN's you'll be working with how they do it. Watch them. Take notes, use your resources and never be afraid to ask for help, even with the simple things. If you do nothing else, open the MAR at the bedside & chart your meds as you give them. Write everything else on your brain sheet so you can chart it accurately later. As you go, you'll learn what YOU need to see and do, and what you can ask someone else to do. Pain meds? Antibiotics? Potty call? Ask your charge or another RN. Wound cares? Probably want to do it yourself so you can see what it looks like, although asking for an extra pair of eyes and/or hands is often a good idea. It won't be easy but you will figure out how to make it work for you. And remember, hospital nursing is a 24-hour job. That doesn't give you license to slough off stuff you don't want to do, but sometimes you just can't get it all done in your shift and do need to pass on some of the work. Good luck!
  6. mamiekay

    Time in Nurse Handover??

    Our shifts overlap by 30 minutes so there's time for report, e.g. night shift ends at 7:30 am, day shift starts at 7:00 am. We do written sign-outs online and then do a verbal hand-over when the next shift is ready. That generally takes 5-15 minutes, depending on how many patients the oncoming RN is taking & their acuity levels. We only take report on our own assignments and it's face-to-face. It works well.
  7. mamiekay

    Meperidine vs Morphine for Pain, Acute pancreatitis

    We use either morphine or hydromorphone for acute pancreatitis. In our facility, meperidine is rarely used on a med/surg unit. The following article explains why meperidine is not the drug of choice. http://www2.kumc.edu/druginfo/pharmkey/Meperidine%20pharmacy%20key.htm It's from 2002, but it's the most current I could find. Now, anyone who's ever been a nursing student knows that tests don't always represent the real world. Good luck!!!
  8. mamiekay

    Where do you put your stethoscope?

    Around my neck with a roll of tape on one side...unless I'm going into an iso room. I tend to take mine off & lay it on my desk when I'm charting, then forget to pick it up before going into a patient's room. IMHO, it looks far more unprofessional to have to go out of a room to retrieve my stethoscope than to have it hanging around my neck! I remember my nursing lab instructor telling the class early in semester 1 that her Littman had "scoliosis" from hanging around her neck for so many years. LOL! I actually live near the Littman repair place so it's easy for me to go in once every year (or three) and have my stethoscope cleaned. They replace the tubing each time so damage from neck oils isn't an issue. I'd be more concerned about the staph accumulating at the back of my neck! But I do clean it between patients & at the beginning & end of every shift. As for unprofessional, I'd be more apt to deem it unprofessional to pull it out of my pocket & have alcohol wipes, brain sheets, tape & scissors fall out on the floor. Bottom line, do in school what your instructor tells you to do so you can graduate & get into the real world. Then you do what works for you...within safe parameters.
  9. mamiekay

    Checking "residuals" q4hr-capped NG

    If you place a NG due to bowel obstruction or ileus, the gastric contents are not moving through the gut. The body is continuing to produce fluids that are building up in the stomach, causing nausea, vomiting and severe discomfort. You hook the NG up to suction and empty the gastric contents to relieve the pressure, nausea & vomiting. Once suction is pulling off a minimal amount, the MD will usually order the NG to be capped and residuals checked Q4. The sole purpose of NG to suction is to empty the stomach. Now think about this: do you replace what the suction has pulled off? IF the NG is placed to relieve N/V, abdominal distention, due to obstruction or ileus, at least in our facility, the residuals are measured and discarded. They are not returned. 1) The gut is still not functioning enough to move gastric contents from the stomach through the bowel. Anything put into the stomach will just sit there and add to the accumulation (and discomfort). 2) With an ileus or obstruction, the body is not receiving any nutrition from the gastric contents. The balance has already been upset and is hopefully being somewhat restored through IVF's. Discarding gastric residuals in this case will not upset the pH or electrolytes any more than they already are. This sounds really gross but a NG to suction does the same thing vomiting would do. If you threw up, would you put it back to keep the balance? Or would you try to replace it another way (e.g. IVF)? >>>"Essentially, if you discard it, we won't get a clear picture of pt's motility if we are removing the stomach content." (some number), reconnect to LIS and notify MD." ***IF a NG has been placed to facilitate a tube feed, it's a whole different ballgame and a different set of rules applies. As previously stated, check your facility's policy. Ask your charge. Ask the MD writing the order what she/he wants done. If you tell them what you've been taught, that you hear varying and conflicting advice, and what your thought process is, most are more than happy to explain why you would or wouldn't want to discard in a particular situation.
  10. mamiekay

    Checking "residuals" q4hr-capped NG

    As always, FIRST check your facility's policy. In our hospital, when checking residuals through a NG on someone who's been hooked up to suction, we don't return the residuals. The reason behind it is that it's just sitting there, it's not going anywhere on its own, and the body continues to produce fluids that are being backed up by a bowel obstruction or ileus. Returning the residuals would add to the volume of fluid building up in the stomach. We DO RETURN residuals when checking someone who's on a tube feed. That's because not returning them could result in an electrolyte or pH imbalance. Rather than removing bilious, acidic fluids that the body produces in response to an empty belly, the gastric contents in a patient on a TF have nutrients and electrolytes needed by the body. In this case, the residuals also determine the timing and volume of the next TF. A good rule of thumb for checking/returning residuals is, if something's going back in, put it back. If things are only coming out, leave it out.
  11. mamiekay

    Moments You Wouldn't Wish To Be A Nurse !!!

    Those are exactly the moments I DO want to be a nurse. There to hold someone's hand, to provide a little encouragement or comfort, to just be present when patients are going through those hard times. Yes, it can be emotionally & spiritually draining, especially if you don't have good support outside of work. In my very short 2 years on the job, some of my best nursing moments have included comforting a patient who has stage 4 cancer with mets everywhere, wondering who's going to take care of her small children & husband after she's gone; doing wound cares for people who are in pain, just talking to them, soothing them as best I can; talking to the 20-year-old patient with ulcerative colitis & a new ostomy, wondering who's going to want someone like him; holding the hand of a patient as she passes from this life to the next at much too young an age. Caring for people is why I became a nurse. I've gotten to see just how strong the human spirit can be and how the will to live can, if not conquer, at least beat back for awhile the ravages of disease & injury. And when those patients with amputations, burns, injuries, infections & diseases smile at me, I don't feel pity. I am reminded of how blessed I am and I am captured by their resiliency. When I've had a really tough night, I find someone to just unload on so I don't have to carry that burden alone. Sometimes I cry. Sometimes there is no redemption in a sad situation, but knowing that I provided the best care I could & offered my care & humanity to someone who is suffering is what gets me through & keeps me wanting to go back. Saying all of that does not mean I never have a bad night where I feel frustrated & annoyed. It doesn't mean I'm not thrilled to walk out of the hospital at the end of my shift. It does not mean that every patient or even every shift has those moments. But they are there and I appreciate them.
  12. mamiekay

    White Toe Syndrome

    Obviously we can't diagnose here but it sounds like your toes are a) scrunching up against the ends of your shoes and b) your feet are sweating & toes are staying moist for long periods of time. Definitely get it checked out by a doctor & then buy good athletic socks & find a shoe THAT FITS but has a little wider toe box. Shoes that are too big can cause the same problems as shoes that are too small because your feet will slide in the too big shoes & your toes will still be against the ends of the shoes. At least for the first time, go to a specialty running or walking store where the employee are knowledgeable about the socks and the shoes. Sounds weird but even the socks make a difference. It took me almost 2 years to find the right shoe for 12 hour shifts--good running shoes. Lightweight, cushy, supportive. My back, hips, knees & feet no longer hurt after long hours of standing & walking. You only get one set of feet so treat them well & your entire body will thank you!
  13. mamiekay

    Doing Preceptorship on MedSurg/Tele Floor

    When I interned and did my final preceptorship before graduating, I had brand new preceptors. They precepted by choice, but I was their first student. On my first day, we were out of the count so we could get to know each other a little bit, orient to the unit and get a handle on what each of our expectations were. You want to be respectful, but you need to make sure you're getting what YOU need out of this experience. I told each of my preceptors what things I knew that I didn't know or wasn't comfortable with. I also asked them to tell me right away if they saw me do something that wasn't correct. I'm not at all uncomfortable with someone jumping in and saying, "This might work better..." or "I think I can help you with that" even after being on the floor more almost two years. I'd rather learn as I go than find out after the fact that I could have/should have done something differently. So ask for help, accept correction, go in with the mindset that you have much to learn but you do have some level of knowledge and skill, and above all, practice safely. If you are ever in doubt, ask, ask, ask. Don't be afraid to tell a patient or your preceptor, "You know, I'm not comfortable with doing this. I think I need some help." And don't forget to enjoy your preceptorship. I wish you all the best!
  14. mamiekay

    Tele class right after orientation...Too much?

    I know this is a tough job market and there may not be any other positions available, but maybe you could find an open position on another unit. I applaud your concern for your patients' safety, but obviously the tele class is part of being a tele nurse. If you're not up for it at this point, it may be time to look at another unit. I'd hate to see you leave nursing altogether because you're not ready for the stress of working tele. Every area has its own stresses, but at least it won't be interpreting tele strips. Take some time & really think it through before making a drastic decision.
  15. mamiekay

    What do you say when a patient asks you how old you are?

    I'm 41. I've been a RN for 1 year, 7 months and been at my job for 1 year, 5 months. I've been told I look much younger than my age, which always makes me feel good. Often the conversation starts out with talk about the patient's children or grandchildren and then they ask if I have children and what their ages are. No one's surprised I have an 8 & 11 y.o., but everyone seems shocked that I'm old enough to have a 18 y.o. So I laugh, tell them my age, and just so they don't think I've been doing this forever and am a total expert, I tell them that nursing is my midlife crisis. Not a single person has failed to laugh at that one. And it builds some credibility. With our younger nurses, the patients are impressed with their knowledge and skills "at such a young age." So you can awe them at any age. And as a former poster said, it probably doesn't hurt that they're all under the influence of really good pain meds!
  16. mamiekay

    Help! I should've wasted a medication & didn't!

    When I first started, I took a few things home, the worst of which was a nicotine patch. Thankfully no narcs, but that was dumb luck. :imbar As a result, I started making it a habit to empty my pockets when I leave the floor, every shift, no exceptions. I have found Ativan, dilaudid, morphine and a couple empty toradol vials in my pocket. Because I find them before I leave the hospital, I can usually trace them back to the right patients & waste them in the right way, and I don't have to fret about getting in trouble. The few times I have found meds after getting home, I either call the charge nurse or take them back the next shift and let the charge know. Use this as a learning experience and make it a habit to empty your pockets at the end of your shift while you're still at work.