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squirtle's Latest Activity

  1. squirtle

    Understanding cardiac gtts

    I could really use a little direction... I work in the SICU but posted here as it has specific regard to my cardiac pts. I have been trying for some time to really understand the gtts that we use on a daily basis and how they act on the body but I seem to have some sort of block in my head when it comes to comprehending the information presented to me Sometimes I feel like I am back in school trying to make sense of algebra- something I was never able to do. :icon_roll I am going to try and explain my confusion in hopes that someone may have an idea of how I can better learn this material. I have bought several books, have bookmarked several websites and something just doesn't click. As an example, I was reading about dobutamine and dopamine today. I don't truly understand the differences between the two. The more I read, the more confused I become. I try to understand vaso- renal dosing vs bp control and become confused by what I read. Why do we like levo in some pts and epi in others? I am not really looking for an answer to those questions specifically- but perhaps a suggestion on a book or some teaching material that goes back to basics and will help me understand why certain drugs act a certain way. Thank you for any direction you can give me.
  2. squirtle

    Should I tattle?

    I agree with Karmawise, but also want to point out that you said she was still charting when you left, so she didn't have that great of a night either. Management, especially these days has really been trying to cut costs down. I would assume she has been given strict criteria on when to call people in. Hang in there and chalk it up to a bad night... and don't get involved in the gossip, it always makes things seem worse.
  3. squirtle

    Bedside report in the ICU setting

    I was curious to know if other hospitals have tried or are currently doing bedside report in the ICU setting? We have recently been told that we are to be doing what they are calling a "meet and greet" in our SICU. We are to introduce the next shift to the family, check gtts, and perform a neuro assessment together(if applicable- so we can determine what the prior nurse describes as "weak" etc). These few items I see no problem with, but I feel very reluctant to give the full report in front of the family- which we are also supposed to be doing. I truly don't see how this is different than giving a pt a full copy of their chart during their stay and we don't allow that. If I were to say "and their platelets are critical at 35 and I am waiting for the docs to decide if they want to transfuse or not" the pt's family is going to become more anxious. Also, won't they interrupt to ask? I feel like the potential interruptions or the need to censor some information (things like, I think its time for the doc to discuss changing status to DNR) will cause vital information to be left out. Just curious how it has worked for others?
  4. squirtle

    Foleys and tampons?

    Just want to clarify that my comment was in regard to the tampon, in response to your comment where you also stated a tampon was only for comfort. There are times when you have to look at the big picture and use the "benefit outweighs risk" frame of mind. This is apparently what the doctor did when he wrote the order. Unfortunately the pts burned skin puts her at high risk for infection, is it so bad to let her skin heal properly, give her some levaquin prophylacticly and call it a day?
  5. squirtle

    Foleys and tampons?

    I don't understand how, in a situation with the pt's skin integrity being altered, a tampon can't be seen as an attempt to promote healing and decrease risk of infection. If she is bleeding heavily with her period- and there are people with heavy flows that do not need a procedural intervention- the area is going to stay continually moist. I just don't understand how this can be viewed as only a comfort measure. I agree in most cases we want to get "out" as much as we can as quickly as we can, but every case isn't text book. I think the foley and tampon are both beneficial to this pts care, even if they are ambulatory.
  6. I feel that if a nurse had been shot it would have been news as well. Reading some of your posts makes me feel very lucky to work where I do. I have had a pt's family member escorted out of the room by security for screaming at me non stop and flinging a stack of towels at me. I have also had a physician come in and threaten to have a family member banned from the hospital room because he screamed at me. I just feel sad seeing that people seem to think it is the norm for nurses to be treated so poorly. Maybe it is though and the respect I feel that I receive is at my job is not
  7. squirtle

    Foleys and tampons?

    You would rather this pt be placed on a bedpan so she can practically sit in her own urine as she is waiting for it to be removed from under her with burns in the peri area? Not my idea of infection control. I'm also suprised at all of the people who have such strong opinions of changing a tampon. If I had a pt who questioned the use of a tampon, whose outcome would benefit from its use, I would have no problem assisting or performing the change on my own. Peripads would have to be changed as often as I can't imagine that the blood collecting on the pad would not be a high risk of infection to healing skin- it creates a wet, warm environment. My thought is that the use of tampons in this case would promote healing and comfort and decrease the risk of infection. Why can a nurse be responsible for titrating life saving meds, administrating meds at regular intervals etc, but not prioritize changing a tampon in a timely manner if the pt's condition benefits from its use?
  8. squirtle

    am I wrong?

    Ovbiously we don't have all the details but a few thoughts... If the aide was needed to assist to first pt with a shower, wouldn't that mean that it was unsafe for her to shower alone? And if so, why would it be ok for her to leave that pt alone to toilet the other? Also, can you explain what you were doing at the time? Did you also prioritize your activity as being more important than assisting either pt yourself? I honestly can't think of anything that would be worth risking the safety of the first pt who is all ready in the shower. I am just hoping you realize you have just as much responsibility in these tasks as the aide does.
  9. squirtle

    Question regarding lack of bed bath in ICU

    I work in SICU. Our baths are done on night shift (I work days) at very odd hours and are preferably done when family has stepped out. That being said, our patients are cleaned up more than just during the bath at night for various reasons... incontinence, leaking rectal tube, leaking tubes & drains, oozing wounds, etc. I can't imagine that any nurse would just yank the sheets out from under him and not clean him up as well. I should also mention we actually don't give the traditional bed baths,we use wipes specifically designed for ICU type patients which create a barrier that help prevent/ decrease infection. The effectiveness of the wipes is decreased when lotion, soap, etc is applied. Ovbiously we clean our patients the traditional way when they are soiled, but I have had our patients state that they were not given a bath because they had not been washed with the expected bed bath, or allowed to travel to the full shower with their many drips, drains, etc.
  10. I think the NPO after midnight order has just become the norm, I know that in most cases it is very hard to have a pt NPO when they have a 1600 appt time in the OR. However, I actually asked this question when I was in clinicals and the answer had to do with how often the surgery schedule is changed to accomodate changes in pt conditions, etc. Trying to manage the NPO status timing on several different pt's based on a changing OR schedule could become quite hectic.
  11. squirtle

    no cell phones no personal phone calls at work

    It's been interesting reading through the posts on this thread. It makes me feel lucky to work not only where I do but to work with whom I work with as well. A majority of us have cell phones in our pockets and I have never seen anyone using it in such a way that I would classify it as unprofessional or irresponsible. Some people mentioned concerns about not receiving messages in an emergency or not being relieved from their shift if something was wrong at home. This suprises me. My coworkers and I always look out for each other. I can't think of anyone who would absolutely refuse to come in and help out, if they were in a position they could, if someone had to leave in an emergency. Every nurse and tech on our unit carries around a portable phone in their pocket that is issued each morning- basically we have our own extension each shift. Any calls made to doctors, lab, etc are transferred to our phone or people can call us directly. We don't have any rules against personal calls on these phones that are enforced- but mostly because there hasn't been a problem. I am assuming places that have such hard core rules have had problems, which leads to every one being punished.
  12. squirtle

    Edwards Critical Care iPhone app

    Was excited about finding this, so just thought I would share with those who might find it useful. I was at work yesterday and needed to find the computation constant chart while working with a swan, this got me to thinking how handy it would be to have it saved on my phone. While bored today I searched the app store for "Edwards" and voila there was an app. It has quite a bit of useful information, including a chart with all the hemodynamic monitoring "normals". Just wanted to share my find, esp since it is free :)
  13. squirtle

    What do you pack for breakfast & lunch?

    I work 7a-7p- I usually eat a small amount of cereal (grape-nuts, or oatmeal) w/ fruit before work- I have to force myself because I hate eating when I first wake up. Then at about 10am I eat something like yogurt (greek yogurt has more protein) or a fiber one pop tart. Then I eat lunch at about 2ish, really whenever I can fit it in. I either bring left overs from the night before or a lean cuisine and grab a salad from the cafeteria to go along with it. Sometimes before the end of the shift if I get hungry I'll grab graham crackers or a I have string cheese, something small. I also "try" to drink water throughout my shift, but I find that it is sooo hard to do. I can't hold it in and end up having to use the bathroom 10 times for every one bottle of water.
  14. Hi everyone... I have been having a little trouble with something lately and I thought I might be able to run it by you guys for some ideas. I have been a nurse for about 18 months. I began working in the SICU- went through an awesome 6 month orientation which included classes, etc. In the unit I feel that I am doing ok. Of course I still continue to learn new things from day to day and can't say that I feel 100% comfortable in all situations but who does? :) A little background- I floated to a hem/onc floor for the first time recently- any other time it has been my turn to float I have gone to the MICU. I also recently began a PRN position on a surg type floor. On the floor I have 4 to 5 pt's (this was also the case during my float). In the unit I have always worked on I am used to having at most 2 pt's. My prn job gave me 3 days of orientation and I am on my own now- that is typically for their PRNs, I expected it. Now to the problem- I am having a very tough time organizing my day on the floor with having 4 or 5 pt's. I began trying to use the same "brain" set up as I do in the ICU but time-wise that doesn't cut it. I wind up asking much information than it seems I need to care for these lower acquity pt's and driving the poor RN I am getting report from crazy. I even tried to look up the info myself in the EMR after verbal report but that kills me time wise as well because I have meds due at 0730. I made myself a copy of a coworkers report sheet and it seems to have helped me, but then I still felt like I struggled with the flow of the morning. What I was hoping was that maybe someone could share with me the flow of their typical morning- like exactly what you do when you finish report. When do you go in to first see your pt- is it before or after you look up everything in the chart? In the ICU I know most everything before I enter the room. When I first walk in to see them I am usually in the room for 30 mins or more assessing, checking lines, tubes, gtts, giving meds, etc. This routine doesn't work on the floor. I was thinking that I should possibly go in to introduce myself to each of the 5 before even trying to gather more info from the chart, checking labs, grabbing meds so that they have at least seen me and then prioritizing by need/ meds? I would appreciate any thoughts/ideas. :)
  15. Hey guys! So the nursing world (at least mine) has been very trying lately. Have you ever gone back to find something that reminds you of the time you were accepted in to nursing school to help remind you of how excited you were? I just searched back to one of my early posts here on the site where I posted that I was accepted... I got goose bumps all over again :) Silly I know, but I can't be the only one!
  16. squirtle

    ICU politics for a workplace newbie

    good thought, but just to clarify, i wasn't speaking of confidence in the aspect of thinking you know everything. i meant confident enough to not feel stupid for asking questions or, as in my example, the confidence to walk in and help out with a code without feeling sick, or feeling confident enough in your ability to notice changes in your pt that you are willing to point them out... you can be confident but know your limitations, of course :)