RiverNurse

The hospital should have a back up plan in the event the nurse is not reachable. I also do not think writing the nurse up is appropriate, given the situation. Reliability is important, however, reliability should not soley rest on the back of one nurse. If that is the case, there is a problem with the system.

Yes. I did remove the pt's MIC-Key button for one day. The pt does not have prune belly syndrome, but her abdominal muscles are hypotonic. In addition, she has a history of button displacement which further complicated the issue. At our facility, if the pediatric team also agrees, the order is placed and the button removed for the specified period of time so that the musculature can contract with the hope that leakage can be resolved. However, in this instance (and this is why I posted my question), the pt's issue has not been resolved by this method. The pt continues to leak formula from her site. As to the question regarding nutrition, this pt had leaked a significant enough amount of formula to cause her electrolytes to be off. As a result, I recommended (and the team agreed) to have an NJ tube placed, and the button removed. There was still some drainage, but not nearly as much. I returned 24 hours later and reinserted the button with no difficulty. At first, there was no drainage and I had hoped the issue was fixed. Now, though, the drainage has started again. The other potential option is a MIC Key GJ - but the patient is still likely to leak non-formula gastric contents from the site. While likely not as much, I would still be concerned about electrolyte imbalances. Rivernurse

First off - hang in there. I think almost every nurse has experienced this sensation and stress related illnesses. Mine was diabetes (II). It is definitely a crucible, trial by fire. It's like eating an elephant... you do that one bite at a time. Being a new nurse is much like that. It's one crazy, sleep deprived, basket case step at a time - at least that's how it was for me. This is my second career - I thought the first year would kill me. All the stress, night shift work and surprisingly co-workers. The best I could do back then was just trudge along. The PCAs would not help and complaining didn't work, either. I had to get creative with solutions - how to avoid the radar/laying low/avoiding conflict - but I learned. Plus there was so much I felt I didn't know. Crazy making stuff... and I was in a marriage that wasn't working... Bad, bad combo. Now, though, I've been in nursing for almost 7 years. I've specialized and love it. My marriage ended a little over a year ago and things have calmed down considerably in my personal life. Now the only drama I have is deciding what's for dinner - and I like it that way. Take it easy (seriously), RiverNurse

Hi all, I am fairly new to pediatrics. I'm a wound care nurse and have been working in pediatrics for a year now. I work primarily with the infant population that have had issues with gastric mucosa visible around low profile buttons (MIC Key buttons - that is what we use in our facility) along with large amounts of drainage. All of the infants with drainage/leakage issues have all had poor muscle tone and three of them have had their MIC Key buttons replaced with MiniONE buttons. I have found the design of the MiniONEs have helped to clear up much of the drainage and hypergranulation tissue problems. However, I have two patients where this solution hasn't worked. In both of these patients, their buttons have become dislodged previously and then each began experiencing excessive drainage. I have also tried removing the buttons on each patient for a day to see if the stoma would begin to contract. Initially it did, until the button was replaced. I would like to see if there is some way to at least slow down the drainage so that these children do not experience any nutritional/electrolyte disturbances as well as protecting the skin from breakdown. Thoughts? Thanks, RiverNurse

Not yet. In fact, I just finished up the distance learning Ostomy module yesterday (through Emory). I have read about it - now I'm just wondering about the "Oh my Lord" moments that aren't always listed in books. Thanks ~ RiverNurse

Hi all, Any tips on stoma site marking? RiverNurse

Scream? LOL... Rant? Not as much as I used to! Now if I have an off day, I usually refinish a piece of furniture or do something creative to get my mind off of it and to gain perspective.

I did the distance learning option for my CWCN last year. Back then, that module for the didactic portion only was $1200.00 (not including registration fees, books, clinicals, lodging). I attended bridge week there - technically three days for the wound scope, bit the bullet and stayed an extra week to do my clinicals at a local wound care clinic. I am considering (due to work requirements) finishing the ostomy and continence portions. Now, the modules are $1500.00 each. This time I will still have to attend bridge week, but will do my clinicals in my locale. When all is said and done, the approximate cost for my education will be right around $6000.00 - ballpark estimate - factoring in hotel costs and food.

Yes. PM me privately and hang in there.

Thanks for this. Apparently I received the wrong info from KCI. I was told by our KCI rep that there were income requirements and that the family "made too much money". I did find out from them that the VIA would be the way to go with this situation. Take care, Rivernurse

All I can say is, I wore those "shoes" when I turned 40... If you want it, go get it. Another "word of advice" from the peanut gallery - take care of your back (think Yoga), your feet (always by the best shoes - 2 pair and rotate them), and your down time - don't let anyone guilt you into working more overtime hours than you *want*. I learned really quickly where the "off" button was on my cell. Best wishes, Rivernurse

Hello all, I have a question about wound vacs. Scenario: Ped pt in foster care and is on wound vac. Wound is about 9 x 7 x 2 cm with approx. 75 cc drainage per day. Pt needs a vac for home. Foster family is in process of applying for Medicaid - but isn't approved yet. The vendor has a "charity vac" program, however, the vendor states the foster family makes too much money to qualify for a charity wound vac. I was thinking of a disposable wound vac, like KCI's Provena. Has anyone worked with a disposable vac like this? Thanks, Rivernurse

Yes, nursing is hard, but has it's rewards in the end - like a bad back and bunions. LOL LOL...

How long have you been a nurse? Now then, onto options: 1. Get out of Med-Surg. Sounds like you're burned to a crisp. 2. Continue your education (i.e. specialize) 3. Consider nursing informatics (downside - then you'll have a different level of "entitled clientele"). Just a few thoughts from a middle aged frumpy nurse, rivernurse

Update: We had a 3M brand of durable barrier cream. I tested it on my hand/arm before introducing it to the pt. Love, LOVE the stuff! However, the pt refused to try it. Rivernurse