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arpeggiated

arpeggiated

Med/Surg
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arpeggiated specializes in Med/Surg.

arpeggiated's Latest Activity

  1. arpeggiated

    Great inventions, only sleep deprivatio can stimulate

    Bright pink/green o2 tubing. You would be able to see if your confused patient has his o2 on without going near him and risking waking him up.
  2. arpeggiated

    The worst or strangest orders you have seen...

    PLEASE PLEASE PLEASE elevate legs on three pillows each PLEASE PLEASE Are you gonna come buy the pillows? Because sometimes it's an act of God to get one pillow per pt, let alone 7! Especially on a A/O pt c BRP. Same doc: PLEASE PLEASE PLEASE PLEASE d/c pt. Same orders as yesterday PLEASE PLEASE PLEASE I would love to d/c the pt. Trust me, we don't keep incontinent quadriplegics here for fun. Would you like us to d/c pt home? or to a SNF? And by the way, can we clear up that little problem where the pt's family has been reported to APS? *rolls eyes* If I ever have to be admitted and he's on call, I will go AMA and come back in the morning when one of the other docs is on call. His orders are just ri-donk-ulous.
  3. arpeggiated

    Sometimes it is the Nurse who saves the patient

    Hm. I seem to remember this poster posting about a year ago about his trials and tribulations (and of course, his book.) Call me cynical.
  4. arpeggiated

    What are YOU taking Fall semester?

    Physiology Phelbotomy Pharmacology The 3 P's
  5. arpeggiated

    Hospital nursing assistant

    I work 12 hour nights. I have had anywhere between 4 and 14 patients. Our 3 med/surg units hold a total of 54 patients. When we're full, we're lucky to have 5 CNA's overnight (occasionally we'll have 2 that stay till 2300). My job duties are: vitals q4h, or more often as ordered vitals and room orientation on admit daily weights as needed (luckily, our beds weigh the pts) personal cares as needed (peri care all the frigging time) d/c foleys set up o2 and suction perform oral suctioning with yaunkers assist with dressing changes enemas baths/showers (not done often, because it's nighttime) I/O (oral intake, urine, emesis, drainage, and stool output) pass water before shift change (which is a pain, because our unit doesn't have an ice machine) computer charting vitals, measurements, adl's and activity, foley care (when we d/c) We don't do any nebs (RT's job) or colonoscopes (GI nurses's job). How we're treated depends on the nurse. Some will let me do a smidge more (ie, titrate o2 to get to a good sat, as long as the pt doesn't have COPD) than others. At night, there are no ancillary staff, but the few day shifts I've worked, I haven't had any problems with them. On my break, I can do what I please. It is my unpaid time. I can sit in the break room at the back of the unit, I can go run to Taco Bell, I can go to the nurses lounge and take a nap. As long as I'm back within my 30 minutes, it doesn't matter. California state law doesn't allow UAP to insert foleys or do fingersticks, even though they show up on our task list.
  6. arpeggiated

    Hi, does anyone know where I can take phamacology online?

    http://www.cos.edu offers online intro to pharm
  7. arpeggiated

    Was this true for you?

    This job is HARD. The patients are fatter, more acutely ill than before. The facilities want you to do more with less. You'll hurt your back, you'll hurt your knees, people will cuss at you, hit you, kick you, spit at you, scream at you your entire shift. You'll fall in love with some people who will go down the tubes and die. The ones you can't stand will stay alive (out of pure spite it feels like sometimes). Not to even mention all the poop!
  8. arpeggiated

    What is the funniest thing that you have seen while working?

    Today, we had a confused patient wandering in the hall, holding his Foley bag. We get him to sit down, and he frowns at the bag, and then throws it like a Frisbee. The nurse was on the phone with the family, and us three aides almost peed our pants laughing. He didn't try to do that again.
  9. arpeggiated

    Deprovera Long Term Side Effects

    We can't answer medical questions here, although my personal opinion is that Depo is the devil.
  10. arpeggiated

    Dying residents

    Hmm. Our ER transferred 4 patients last night, all to the same ICU room. Maybe the "they go in threes" rule is true.
  11. arpeggiated

    Violating a Code Status...

    One of our docs constantly puts that his pts are DNR status on the H&P when he dictates. I see it, I go look in the chart, and he's ordered full code. Sweetest man alive, but really. He does have a lot of older and nursing home patients who are DNRs, but not all of them.
  12. arpeggiated

    Ideas for peer interview questions

    If you can get up and around, have them show you some transferring skills. Do they transfer from bed to chair safely, etc?
  13. arpeggiated

    Complete and total disregard for Visiting Hours! (vent)

    Dying patients we try to put in a private room so family can visit as much as they please. There was one patient if I had on an assignment again, I was going to be very unwise in my choice of words. Her roommate had terminal colon CA, had a colostomy, and was in for a small bowel obstruction. Her daughter was at Stanford, recieving treatment for recently dx brain cancer, with poor prognosis. They had been profiled in our town's paper. She was the sweetest, most wonderful lady I've met. The roommate came in with pneumothorax s/p MVA. Yes, I'm sorry you got in a car accident on vacation and had to come to the hospital. Yes, I know colostomies don't smell that wonderful. But you DON'T need your husband and adult daughter staying with you 24 hours a day. You don't need three cans of air freshener. You don't need me to heat up McDonald's at three in the morning, when your roommate is vomiting. She went home, finally, and the lady with CA ended up dying. Her daughter came back home from Stanford to be with her as she passed. She was gracious to the last moment of her life.
  14. arpeggiated

    LA: High schools add nursing course (The Natchez Democrat)

    My high school had a CNA program. Generally, the ones taking it also were taking advanced courses, or extra college courses to start going to nursing school.
  15. arpeggiated

    Hospital Hierarchy

    In my hospital, there's the CNA (take vitals, clean up patients, organize rooms, collect supplies for procedures/during codes) who takes orders from the nurses. LVNs and RNs are equally respected around here. The LVN works with an RN who signs off on their charting and also hangs blood and does the IV push meds they need. We have a charge nurse who does the assignments, assigns admissions, schedules meal breaks, enters orders after the secretary leaves at 2330, collects all of our 'junk' at the end of shift (thermometers, phones, does the narc count, etc) and helps with anything else we need when things go hairy. I LOVE my charge nurse. She is so wonderfully helpful. We also have a nursing supervisor who assigns beds to admissions, leads codes and the rapid response team (which is when a pt is going bad but hasn't coded and we want to keep it that way), and takes a basic report from all the nurses to help determine staffing. In addition, the nurses do an 'acuity' form on the computer measuring things like assesments, treatments, how much time we've had to spend with the patient which also helps determine staffing. Since I live in California, we do have a ratio of only 5 patients per nurse, but if things are crazy, they'll call more nurses in. No such luck for CNAs! Generally, the max patients our CNAs have is 14 on night shift, which is still a lot when it comes time to take vitals, do I/Os, pass water, etc. Especially if you get lucky and get stuck with a bunch of incontinent patients. During day shift, the DON is there, but I hardly see him (and I like it that way ). Nursing administration is mostly at the other hospital in town, so we don't see too much of them either. Other than nursing staff, we have a unit secretary until 2330. She can be your best friend. Our main secretary has been there for DECADES. She knows where everything is, what you need, what the policy is... She can be a lifesaver. She also helps answer call lights. There is also RT (Respiratory) who come and give breathing treatments, suctioning, and just general help when a patient is not breathing right. They tend to be really busy though, because there are only two of them for the whole hospital, and they attend all codes. Then there is the lab and phelbotomists. I usually get asked to come help them hold a confused patient still for blood draws. And there's housekeeping, who clean rooms and remake the beds after a patient is discharged, bring us supplies (gloves and hand gel), and clean up if a patient has an accident (at least one a week will get in the commode to urinate, and end up peeing all over the floor).
  16. arpeggiated

    LTC tips please!!!...

    Until your patient aspirates his feed!
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