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General E. Speaking, RN RN

floor to ICU
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General E. Speaking, RN is a RN and specializes in floor to ICU.

great sense of humor, honest

General E. Speaking, RN's Latest Activity

  1. General E. Speaking, RN

    My friend is dying..you gotta read this update!!!

    Yes and animal things got much worse. Our 17 yr old Sheltie -mix dog took a turn for the worse.. I noticed his head was turned to one side. The he started having seizures. It was horrible, We were all crying and laying on the floor next to him. This all occurred at night when everything is closed. We called an after hrs clinic and the wanted $600. We didn't have it. We stayed with him in shifts. He settled stopped moaning and seizing and even got a little sleep. We were running him into the vet when the doors opened. We knew it was time, We tossed around the idea in the past about how we would KNOW when it was time. Prior the this incident, he was eating, drinking and going to the bathroom outside as usual. Anyway, dh ad I got to hold him in our arms while we talked to him and petted his favorite areas. He is also buried in our back yard. On to my friend with cancer- I am not his friend on facebook anymore, and haven't talked to him. I cannot make myself do it. Others who have been around him say he looks like he is gaining weight. His girlfriend moved back up North. We still talk regularly and she seems to be coping well. Turning your life upside down, getting emotionally involved, spending unwisely has really taken a blown to my psyche . I wouldn;t wish getting duped and taken advantage of on my worst enemy. It hurts and makes you second guess yourself.
  2. General E. Speaking, RN

    My friend is dying.

    Thanks. Yall are making me cry now.
  3. General E. Speaking, RN

    Ativan IVP vs Propofol gtt

    true. We did switch him to A/C.
  4. General E. Speaking, RN

    How does your unit orient new nurses?

    Our new nurses all go thru the usual general hospital orientation. The nurse is then assigned a mentor in ICU who precepts then throughout their orientation. They have a check off list of things to see/preform. The amount of time needed for orientation depends on the experience of the nurse. The new nurse usually gets the same schedule of their preceptor so there is consistency. Everyone on our unit remembers that there are newbies in the unit and will pull them into the room when there is potential to learn/see something new. I believe there is some online education that they are required to do also.
  5. General E. Speaking, RN

    Ativan IVP vs Propofol gtt

    My original post said he told me to "wean" propofol, what he actually said was "stop" the propofol. Sorry for confusion. I did call back and get the fentanyl gtt upped to 50mcg but I agree that Dilaudid PRN might have been better. Thanks for the responses.
  6. General E. Speaking, RN

    Ativan IVP vs Propofol gtt

    He told me to stop the propofol, not actually wean. I saw him yesterday and confronted him about the situation. We bantered back and forth for a while. He eventually told me that he was ****** that I had given so much anti-hypertensives and said if we restarted the propofol his pressure would have dropped.
  7. General E. Speaking, RN

    My friend is dying.

    I haven't wanted to come back to this site for some reason. I have been battling some depression/anxiety myself. My friend is such an awesome person. He is usually positive but has his down moments and confides things to me that would scare his girlfriend (scares me too but i listen). Like talking about suicide before the pain gets really bad. He decided this wasn't a good option- thankfully. I had thought that hospice was set up to see him, however, I have found out that he hasn't called them. His philosophy is that if he goes on hospice he will be dead within a month. He refuses to take any pain meds because he doesn't want to speed up liver damage (has mets to liver) and he doesn't want hospice even in the end to dope him up with strong narcotics because he wants to remember every last hug that he gets. He is, however, smoking pot. This helps with his nausea and inability to eat as well as the pain. Lets see what else: We were having Wed nite dinners at his apartment for a while. All his childhood friends would come over, we would crack open some beers and relive their past. We laughed until we almost fell out of our chairs. Lots of hugs and kisses and 'I love yous" Their lease was up and they were in limbo about where to go because he is still haggling with the court system over the lawsuit that he won when a teenage driver ran onto the curb/grass where he was standing and fx his ribs, tore is rotator cuff and had multiple gashes and lacerations on his legs. he flew into the air and landed on his head causing a concussion. The teenager was only concerned about the dent in her car and when she could leave. A bystander had to actually take the keys away from her because she tried to leave the scene. This is how they found out he had pancreatic cancer...from this accident. Since the money hadnt come in yet and they were at our house a lot anyway, they moved into our living room temporarily. It was great, then the parties were at my house. We play washers and horseshoes in the back yard. Dh BBQs and i make my extra fatty buttery mashed potatoes for my friend (at his request). Got lots of calls by the neighbors because the street looked like a parking lot and we were making too much noise (whatever). He went skydiving again. a gift from the husband of my 44yo friend who died suddenly a while back. The same guy took him skydiving again and told him "I'm going to blow your mind" My friend had told him about his terminal illness. My friend said they dove off the plane backwards and did so many spins, then straightened their bodies and jetted off like rockets. he was the last one of 10 to jump out but the first one to land. lol he had a $hit-eaten grin on his face the rest of the day. One day about 8 of them went to the indoor race track. You should have seen all these men doing squats and stretching exercises before getting into these mini race cars. Too much testosterone. They were steadily talking smack to each other. It was hilarious to watch them haul butt around the corners all bunched up into a ball. A couple of guys got black flagged meaning they had to get off the track. :) A friend treated about 10 of us to a Mongolian restaurant. Food was great. Our bar bill was outrageous (of course we had designated drivers) He and his girlfriend ended up going to his dads in Dallas. His birthday (last birthday) was on June17th. he was hoping to get his settlement money and fly all of us to San Diego. That didn't come to be and he got so depressed and angry. Dh and I had already taken the time off of work so we drove to Dallas. He was pumped and chipper that we were coming. His dad and stepmom pulled us aside and gave us a tight hug and thanked us for caring for "their boy". While there we met his whole family, grandmas, uncles, cousins, etc... Dh and my friend went on the Texas Slingshot. basically a double seat attached to two bungee ropes. It goes 60mph in 2 seconds. We got the video- hilarious to her them cursing and screaming like girls. We went to my brothers place. he has a nice pool. we swam all day and jacuzzied all nite. We played electronic monopoly (his 10yo daughter was with us). The Astros were in town playing the Rangers and we got free tickets close to the 3rd base line. Lotta smack talking at that game too! On the drive home, Dh would get teary eyed thinking about them not being at out house. Few miles down the road, I would take my turn. Currently, he is in Minnesota where his girlfriend is from. They are visiting all of her family. The rest of us are happy to see him in the pictures but sure miss having him here. All of us text/talk to him multiple times a day. In a quiet conversation we had early one morning (we were the only ones still up) I asked him where he wanted to be when the end finally came. He hesitated, started to say something and then stopped. I asked him if he would like to be here at our house and he busted out crying. He said he never wanted to ask that of me and my Dh. he realizes that this is a big deal. he told me he didn't want to be all the way up in Dallas away from all his friends. his family has said they can come stay around our area to be close to him. he said, "Boss, i don't want to die in a hospital bed, I want to die right there on your couch in my barefeet".
  8. General E. Speaking, RN

    Nursing shortage in Texas

    I have worked with a few Filipino nurses that were sponsored by some of the hospitals in the Valley in Texas. They are deplorable and dangerous working conditions- too many patient to nurse ration, little or no ancillary staff and minimal equipment. Do a lot of research before committing there. Once their slave contracts are over- they run like hell to get a way from that area.
  9. General E. Speaking, RN

    low urine output high bnp

    Love all the insight. Yall are so smart! Thanks :thankya:
  10. General E. Speaking, RN

    Ativan IVP vs Propofol gtt

    Had a patient on Propofol gtt (and Fentanyl gtt @75mcg/hr). S/P laparotomy. Possible aspiration- he was on a vent (PSV). He was lethargic but calm and arousable and would follow commands. Pulmonologist calls and I update on status. He ordered me to cut back on Fentanyl to 25mcg/hr and wean off Propofol in anticipation of extubating the next morning. Once I had stopped the propofol pt became increasingly more agitated. He nodded "yes" to are you in pain so I called the doc back and got him to up the Fentanyl to 50 mcg/hr. Pt still not settled. HR shoots up from 80s to 150s, A-line b/p goes from SBP of 100-110s and DBP of 60-70s to 200s over 100s. Called doc back and updated. He orders ativan 1-2mg O2hrs prn. I asked if we could turn the propofol back on but he refused stating it would delay extubation. In the mean time, I gave lopressor IV for BP. The 2mg ativan didn't touch him. He con't to be more restless with high bp. Gave vasotec IV. Updated on RR in the 40s wet lungs and 6 liters+. No orders for that. Called the PCP (instead of pulmonary doc) updated and he gave me and order for labatolol. I asked him about restarting the propofol gtt but he refused to 'over ride" the pulmonary doc orders. His lungs were sounding wet and I updated him that he was 6liters + on I&O. 40mg lasix ordered and given. he dumped about 900 ml after that. I called the pulmonary doc back. VS still out of whack and climbing. We put him on A/C. By this time my heart rate is up and I guess I was talking fast. He tells me to "calm down" and to extubate the patient. "Are you kidding me?" was the word vomit that came out. I told him "no way". He ordered Geodon IM and says I can give the Ativan Q1 hr. It was shift change by then and already had another call into him but he wasn't calling back. Geodon given. When I finally left after catching up on my charting, he was still bucking the vent and not following commands. BP did finally come down some. Here's my question: Why wouldn't he want to continue the propofol since it is so short acting. Seems to me that it would be better than pushing 2mg of Ativan Q1 hour thru out the night. Wouldnt it have been better to keep the propofol infusing than wait for who knows how long for the ativan to wear off. Thanks
  11. General E. Speaking, RN

    Things you'd LOVE to be able to tell patients, and get away with it.

    Geez, my dad is bowel-obsessed. My poor mom has to hide the MOM
  12. General E. Speaking, RN

    Things you'd LOVE to be able to tell patients, and get away with it.

    One more: "I'm sorry. Today is a NO FAMILY DAY. Please feel free to return tomorrow because I will be off."
  13. General E. Speaking, RN

    Things you'd LOVE to be able to tell patients, and get away with it.

    With a megaphone in the large waiting area outside ICU: "Attention slobs! Pack up your coolers, bags of chips, 4 dozen kids, empty soda cans, blankets and pillows and get the (profanity) out." We will call you for pick up when the patient is ready for discharge.
  14. General E. Speaking, RN

    enemas and nurses

    I am not discounting the fact that a broken arm is serious. There definitely needs to be an investigation. However, anytime anything happens it always seems to fall back on the nurses. Not to hijack the thread but only NURSING can remove the dietary trays from the patient rooms now because someone lost their dentures once. Only NURSING can strip the beds after a discharge because someone lost something valuable in the sheets. Are nursing aides able to give enemas? I know at the hospital it is the nurses job but not sure about other facilities.
  15. General E. Speaking, RN

    New grad in ICU needing advice

    check out icufaqs.org too. Great resource
  16. General E. Speaking, RN

    Need advice, wisdom from experienced and/or newly hired CVRU/CVICU nurses

    I don't have any advice but wanted to say good luck and way to go for embracing the challenge! There is a lot of wisdom floating around this board so I hope someone chimes in with an answer for you soon.