Bethy-lynn

Our a-line kits have a 3-way attatched to them right out of the package, most likely for blood draws if a vamp is not available (like when they come back from cath lab or OR, where they don't typically furnish vamps).

3. Midwives originally birthed babies, not physicians. In fact, the first known Um, I feel the need to remind you that back in the day when only nurse midwives delivered babies, the mortality rates were extremely high. When was the last time that you saw a nurse midwife do an emergant c-section on someone with HELLP? When was the last time you saw a CNM take care of any high risk pregnancy? There is a reason that this profession has moved over to physicians- Its requires the amount of time and training that physicians put into it (I.E. 4 years med school, plus at least 4 years of specialized residency). And to respond to the question of pay, If one bothers to look at the actual amount hours worked in a week, v. the overhead of running an office, minus malpratice insurance, physicians (on average) make less than we do per hour. Do the math. People, if you want the responsibility, and the pay, and the headaches, and the ability to do procedures, and go to med school. I, personally do not feel that I have given up any nursing responsibility or duty or role to anyone else. Remember the term "deligate"?

Where I work, we have sort of an "all or nothing" policy when it comes to DNR (i.e. they either want to be a full code, or not, we don't do chem codes, or intubation only). In fact, according to our policy, we can't intubate someone that is a DNR. However, that doesn't mean that we couldn't use lido or amioderone on someone in stable v-tach. According to acls guidlines, these could be given per protocol without calling a physician first. I think that in this case, it could almost be thought of as a comfort measure, not necessarily heroic (cause let's face it, even stable v-tach can be a little uncomfortable). Really, what would be the difference between giving someone morphine and nitro for chest pain, which could also be life-saving, and doing this? I think that if ever in doubt, it is always safer to call the MD. Also, this should serve as a reminder to all of us to be sure to have very frank and Honest conversations with our pts and fams.

I'm wondering about a few other lab values here...What were the ABG's, lactic acid, liver, bun/creat? Those will give you a better indication about sepsis. Also, look at glucose. Also, what did the pt look like before they coded? How were the resper's, vs, etc. I've never had a complication with TPN per-say, but I would think that If you took a closer look at some of the other labs, besides mg and k, that might paint a bit clearer of a picture.

I'm so OCD that my students laugh at me. The tease me about not being able to function unless I have all of my lines labeled (and, yes color-coded...Red labels on Xigris and Bicarcb, green on ns, yellow on other drugs that may be compatable with some things, but not with others like Neo, Levo, Versed,....). I even got some butt pats for being the only one who could get the ng, art, tlc, periph, vent, and dialysis lines sorted, orgtanized, and COMPLETELY untangled in a rotoprone. When I walk into my room in the morning, I end up spending the first twenty minutes getting things sorted. Granted, I don't get upset with others because they don't have it the way I want, unless it's a pt safety issue...That's just where we have to draw thew line. I guess you could say that I am one with my OCD, and its Good For Me.

E-gads, Intubate, intubate, intubate. Remind your physician (politely and nicely) that the pt is no longer able to protect their airway, despite the ok abg, along with the requirment of very frequent suctioning.

While being respectful is always he best policy (i.e. the ol' please don't speak to me that way, walking away, etc...), I personally am a big fan of "Do you need a hug?", sometimes preempted by "my, you're fussy today...". :trout:

I (during my pre-wisened professional days) once lopped off most of the tip of my thumb, including part of the nail, while making mashed potatoes...Never found the missing piece, but everyone seemed to enjoy them anyway....:smilecoffeecup:

if your patient was alert enough to shake her head "yes/no" appropriatly to ques., then she probabaly would have died a very uncomfortable death if you had let her wait, and pass on the vent. She was already alert enough to know that she was dying, she could probably feel it, and sustaining that would be how much worse?. If she only took a few breaths after you detubed, then God already had his plan in motion. People that are ment to survive don't linger. Have faith that you gave her a death with dignity. We forget sometimes that GOd created Death, just as he created life, and both should be dignified. We also forget that we can't fight God forever. All the tools that we have, all the knowledge, it is nothing if God has another plan for that person. You simply took away the hands of man, and put the patient in the hands of GOD.

For the love of God, and All things holy, please call the state. And which should you be more afraid of...loosing your job, or a patient (like a six year old having a tonsilectomy) dying because he's asleep and not paying attention?

Whenever we have someone on an insulin gtt, we aim for an a-line.. otherwise we go for capillary...try sometimes lower on the fingers, and on the meat of the hand, near the thumb, or pinch well and aim for the forearm. It's not a good idea to draw blood from your iv's because every time you do, risk introducing bacteria into your lock, also creating a vacuum when pulling back can damage the vein. Lastly, keep in mind that even if you have something thats compatible with insulin, everytime you hang that piggyback, you are bolusing them with whatever is ahead of it in the line, and when its done running (even if you run it in simultaneously), they aren't getting as much as you've programmed because it isn't in the line, and most pumps don't account for this.

My Ho is trying to go magnet (isn't everyone?), but so far it seems that the only thing that has changed is that now we spend more of our time filling out paperwork and documantation than we do on actual patient care...Funny, isn't magnet supposed to better the patient care?

Perhaps it would benifit you in the meantime, seeing as there is a hiring freeze and all, to start focusing on the great things about ICU. Not every patient on a ventilator and Inotrops is supposed to die. And even the ones that we think are, aren't. Who hasn't had that patient that we swore was only leaving on the velvet trolly with elvis come back a few months later baring chocolat and thankyou cards, and walking around very much ALIVE. Granted, yes, some of them are supposed to go, so find pupose in that, if nothing else. Advocate for them, help their families uderstand that we can't save every life, and that sometimes, it's just better to let them go, and then help those patients to die with digity, and help their families to not feel guilt over it, and find comfort in knowing they did what was right. ICU isn't about saving every life.

I just have to say this. Love the idea of going commando, especially in the Summer or in the dead of Winter, when they finally decide to turn the fricken heat on, and of course, it's stuck at three thousand degrees (because there is no in-between, it's either Antarctica or the surface of the sun), so I do wear girl boxers on those days (again, loose enough to not cause double butt), But actually going commando at work scares the bejeezus outta me. I have icky visions of the drunk of the month puking on me, or my favorite MRSA pt's wound oozing belly juice down my leg (which has happened), or our GI bleed of the day leaking butt juice on me as we dance on over to the ol' BSC, and I just don't want any of that stuff anywhere near my HO-HA. Scrubs just aren't thick enough. Mask, gown, gloves, undies; all vital elements in the fight to save lives, and stamp out disease, and not catch the plague in the process.

I LOVE my Birki Professionals. I tried Danskos, nursemates, sneakers in every variety, but my Birki's are the best. The Professionals are wider that the superbirki, so when my feet have swollen by the end of my shift, they are still loose. They are a little big on me, but it makes them more comfortable. As long as the footbed fits, which conforms to your foot after a little while, they are the best shoes aver. I've dropped needles straight down on them and not gottn stuck. Nothing seeps through them, they are autoclavable, and they have a lip on the back so you don't walk out of them. Oh, yes, I LOVE MY SHOES!!!!!