curlynurse

We do it all the time as well. My favorite is when a non-urgent patient who walked in doesn't want to wait and CALLS 911 FROM THE WAITING ROOM OR AN OUTSIDE PAY PHONE. When they are then brought in the back by ambulance we send them back out to the waiting room with the new triage time. So annoying!

Angioedema as a side effect of ACE inhibitor Lisinopril? I like these "case studies", too.

I recently had titers drawn for a new job. I was not immune to measles, so I was given an MMR. I am 31 years old. The infection control nurse told me that they used to only give one dose of MMR with childhood vaccinations and that the few people that she has seen who were not immune were in my age group and had only received the one dose. Doesn't really answer your question, does it?!?

After I posted I looked at the California BRN website & the ENA website but couldn't find anything about EJ's. I have, in the past, called the BRN to ask scope of practice questions and have always been able to get an answer from a nurse within a few minutes. You might want to try that. I hope everything works out for you. This is truly a case of you doing what is best for the patient, with no negative outcome, and at the very most a write-up is all you should have received. Let us know what happens.

In the ER that I work in, RN's used to start EJ's frequently. I didn't simply because I am not comfortable with them. However, we have a new educator who has many, many years of experience who has told us that it is out of the RN's scope in the hospital setting (it may be different for CCT and other settings), therefore we are no longer allowed to do them. I would look up your state's nurse practice act and the hospital's P&P, as others have said. Good luck...

I also found ABG's to be the most difficult thing I learned in nursing school! If the pH is normal, you can still use the ROME method to figure out the problem. For example, if the pH is on the lower end of normal range and the PCO2 is high, it is still respiratory acidosis. But in this situation the HCO3 is probably getting higher as well, as the body is correcting the respiratory problem by excreting more HCO3. The pH is starting to return to normal because of this compensation. So it is compensated respiratory acidosis. If you go back and do ROME you will see that your pH and respiratory component arrows are going in opposite directions, telling you that it is a respiratory problem (Respiratory Opposite) and your pH and metabolic component arrows are also going in opposite directions to compensate. Since a metabolic problem would result in the HCO3 and pH going in the same direction (Metabolic Equal) you can see that it is a respiratory problem with metabolic compensation. It really helps me to put the arrows next to my actual results. Hope this helps!

I learned the "ROME" method, and it seems to work... R = respiratory O = opposite M = metabolic E = equal "Respiratory opposite, metabolic equal". If the pH is low and the PCO2 is high, it is respiratory acidosis (PCO2 and pH moving in opposite directions from normal value). If the pH is low and the HCO3 is low, it is metabolic acidosis. If the pH is high and the PCO2 is low, it is respiratory alkalosis. If the pH is low and the HCO3 low, it is metabolic alkalosis. Hope that makes sense!

We get time and a half after 8 hours, double time after 12 hours. We are union. I work days, so there is no shift differential, but I think night diff is 3.25/hr.

I don't think it is right for the charge nurse to be ultimately responsible for all other RN's, as we all have the same license and should be responsible for our own actions. However, I had an experience at work where I feel that the supervisor put me in a dangerous situation with an unfair assignment (as a new grad working in a busy ER). She gave me 2 critical patients within 5 minutes of each other, and did not offer to help. Did not send anyone to help. When I finally went to her and told her I needed help, she sent me an EMT student (supervisor was busy flirting with medics). Needless to say, it was a disaster. Both pts ended up intubated. I cried the minute I got in my car and didn't stop for 12 hours (until I had to be back at work). I almost quit nursing. In this case, I feel that I did everything I could to ask for help. I guess I should have refused the 2nd patient, but I was new. I could have gone above the supervisor and asked the doctor to let someone know that I needed help, but again, I was new and hindsight is always 20/20. In this case, yes, I feel that the supervisor should have had at least SOME responsibility if anything had gone really wrong.