RYNOBLASTER30

good luck

The system.

B on Ur best behavior.

Of course. The health care system is taxing upon all of us. Especially those times when you get the comatose vent patient from the nursing home with a gazillion pressure sores. I get little satisfaction out of my job. People do get better, but there underlying health problems aren't magically gone. Thank God on my current travel assignment we don't get patients like that.

You know, working in the ICU, these medications change so rapidly. I'm busy getting my patient settled and stabilized. I don't have time to find out why/why not the MD didn't continue certain meds. Let all of us nurses "Get Real!" We can't take responsiility for all of the physicians, they need to be responsible for themselves.

Leave the cleaning to the housekeeper, and the stocking to the stockers. You should be taking care of your patient, not doing every one elses job.

:monkeydance: Please, I work as a ICU nurse, and we don't need these anal retentive, psychotic nurses. They are the ones who don't leave the patients alone so that they can get much needed rest if that is at all possible. To be honest, they bother patients. Having someone on propofol who is wide awake, because they are afraid that they won't be able to assess them neurologically. Constantly petting, talking to, changing linens for no apparent reason. Come on, give me a break.

Don't forget, depending upon where you work. You might get alot of long termers from the nursing home who are trached, pegged, with numerous pressure sores. Not much fun. These patients are draining. If i were you, stick to a SICU, and make sure you check with the manager regarding taking patients like the above as micu overflow.

How about reading the chart. Thanks.

To be honest with you the changes are not that drastic. Overall mortality for a patient that arrests either in or out of a hospital is about 65%, pretty high. I have been to numerous codes in my career and I hate to say it but physicans as well as nurses are very passive when it comes to the protocols. They either don't know them, or they want to check for a pulse every 5 seconds. Don't forget to that they run them entirely to long. By the time a pulse is obtained, his brain has already died. I rarely see physicians run them according to protocols. Alot of physicians are not even ACLS trained.

Maybe all he needed was a DNR order?

Hey, go to a teaching facility. You rarely see that type of inappropriate behavior. The type normally comes from older physicians, not new and younger ones. Just remember, they are made that they are getting older and might die soon. And hopefully, they will be in your care where you can get a little payback.

:monkeydance: :monkeydance: Just another nurse trying to play doctor.

Forget about it. Come one, you did what was best for the patient at that particular time. It appears as if you acted appropriately. Screw the physician. I mean, these old cranky asses. Remember the ABC's. Looking at the chart and reviewing the orders come 2nd. Getting the DIC panel probably wouldn't have changed the emergency treatment of the patient. You did good, and keep up the good work. Remember, you are a nurse, you can go anywhere and be guaranteed a job. We all need to remember that when it comes to unsafe working conditions.

:monkeydance: To be honest with you, i wouldn't have said a thing. That little difference, one time, wasn't going to hurt either of them. Put it behind you and move on. **** happens.

:monkeydance: This will solve the problem: Listen here all of you managers, nursing supervisors, and DON. We are not all and mighty. Get us more ancillary staff to meet the needs of our patients, otherwise care will always be substandard. Thanks for listening.

hey, we should let the physician worry about the diagnosis. to often us nurses try to diagnose, we arent trained 4 that.

:monkeydance: You know statistically that approx. 1 in 5 patients admitted to the ICU will die. That's about 20 %, a relatively high number. You would think that because of that, we would take a more proactive stance in the death/dying situations. I am a traveler who has been at facilities, and when I ask the MD about palliative care, they look at you as if you are an alien in disuguise. Nurses are the same way. Birth is just as real as death. Don't forget that everyone must passs at sometimes. We should be helpding families/patients with the process.

:monkeydance: The patient is dead no matter whay you do. Everything appears to be futile.

Occured the other day. I kept hearing this nurse say that her patients CVP was negative. You can't have negative numbers. If you do, then the set up is incorrect. Remember that normal CVP pressures are 0-8 mmHg. Funny, I took care of that same patient the day after, and come to find out they had the transducer hooked to the proximal port. Always, always, the transducer should be hooked to the distal port.

I think as a general rule it would be 24 hours. That is the amount of time that you aren't suppossed to give any IM injections or draw any blood. I have had patients who received a thrombolytic at another facility for treatment of an MI, then trasnferred to our facility for intervention. Obviously if something went wrong in the cath lab they would be at a greater risk of bleeding.

is the foot warm/dry. Godd cap refill. Then probably not a medical emergency.

:monkeydance: I believe that those eICU are staffed with a physician. So if you disagree with the nurse, you could always ask for the MD to step in.

:monkeydance: hey erika, i don't thing starting out in the icu is a bad thing. although it can be extremely overwhelming. you really would need to get in with a good, young, energetic, knowledgeable nurse who is willing to communicate and tell you why things are happening instead of saying, just do this because that's the way it's done. hate to say it, but the majority of people i have come across with in the icu, even the older ones, don't have any clue as to what the hell is really going on. if you do decide to do cc, you should start with an easy icu patient, and only 1 for at least 4-6 weeks. you really need to learn how to do a physical assessment before you get wrapped up in all of this high-gadgetry stuff. when i used to precept, i'm currently traveling now, we always started out with only 1 patient. my educator on my floor thought that was excessive, but these are people who have gone on to be charge, and precept themselves who are way above average nurses. running into the room after shift change isn't the answer. we always ready through the chart briefly, looked at labs, very important, reading the physican progress notes. then we would go in the room, and before writing anything down, do a completel head to toe assessment. your experience can be good, but the key is to find an excellent preceptor.

:monkeydance: Effectie communication should first begin with the physician whether that be in the ER, ICU, M/S, or Tele. There are to few physicians out there that are honest with the patients and their families. I observe lying on a regular basis. These families buy into it because they are ill informed and don't know any better. Hard for an honest RN to come along after a lying M.D. has already given family false hope. What to do?