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al7139 ASN, RN

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al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

al7139's Latest Activity

  1. al7139

    Funniest, Weirdest, Most Unusual Baby Names

    Sha' (say it shapostrophe) Ta, (say it Tacoma) I mean really?
  2. al7139

    Funniest, Weirdest, Most Unusual Baby Names

    I have had La-sha (say Ladasha) Ta, (say Tacoma) and Sha' (say Shapostrophe) I mean, REALLY? what are u thinking? And my fave: a real BAD epileptic that we ALWAYS have to restrain ... De'mon (we say Demon)
  3. al7139

    I am a new agency nurse

    How do you cope with the prejudice?
  4. al7139

    I am a new agency nurse

    Hi All, I am a new agency nurse. I previously worked for four years as a cardiac nurse on a stepdown/tele unit. I took this job so I can be flexible with my school schedule for my BSN/MSN. I consider myself a good nurse, and have lots of experience in my speciality, but I frequently run into other nurses who have prejudices against agency nurses. They think I am a "bad" nurse because I don't have a "real" job with a hospital. I explain that this works while I am in school, but they don't seem to get it. I think it takes a great deal of courage and experience for a nurse to work for an agency because we have to be flexible, able to adapt, and do our jobs, all the while getting the attitude from the "real" nurses, who think we are inferior to them. What is up with that? I feel like nobody appreciates what we give to the profession. Can anyone relate to this? Amy
  5. al7139

    how do you assess for wound dehiscence?

    Hi all, Here is my opinion: If I have a fresh post-op patient, then the site needs to be assessed. Yes most surgeons prefer to do the dressing changes themselves, but unless it is a dressing that is wrapped around an extremity (such as a fracture or a TKR), it is possible to uncover the incision to assess it. There are rarely orders not to touch the dressing (with the POSSIBLE exception of a pressure dressing, and they are usually only for a short period of time). If a patient reports any unusual sensations, such as feeling it give way, or sudden pain, etc., then I will look under the dressing, and report to the surgeron my assessment and the patients concerns. Also remember it is possible for the surface sutures or staples to stay closed, while the inner layers can open up (not a good thing), so it is important to always report your findings to the surgeon. Also if I have to continuously reinforce a dressing due to heavy bleeding, I call the surgeon because this is not normal either. I also make sure I document everything from my assessment to my phone call to the doc, and their orders (or lack of), and I reassess and document that as well. I also will let my charge know what is going on. I would rather look at an incision, and have everything be OK than not look, and have there be a problem, because I was scared to get fussed at by a doc. And, most docs, will not get upset at you doing your job, and if they do, thats on them, just let it roll off your back. Amy
  6. For the most part, I love having students on my unit. Most of the students I work with are in their last semester, and have gained some experience. I am a preceptor, and I love to teach. That being said, there are some things that irk me: 1.Do not carry on loud conversations in the hall/nurses station, etc. This is a hospital, we try to do things quietly. Voices carry and the noise is irritating to the patients, the staff, and the MD's. 2.Be aware of your surroundings. I hate having to say "Excuse me!" to move students that are blocking the hall. This is something you should have learned by now in clinicals. 3. Be aware of what the nurses are doing. Do not rush up to me and start talking without observing what is going on. I am more than willing to teach you, answer your questions, etc., but please wait for an appropriate time, I may be in the middle of something, or going to an emergency. Stop and think. 4. Don't be a know-it-all. I hated those people in school, and I hate them now. Everyone has something to learn. As a nurse, I learn new stuff every time I work. Stay open to every lesson, no matter how trivial. The day you think you know everything is the day you should stop being a nurse. 5. If I am precepting you, please be prepared for questions. It is OK to say you don't know, but I do expect you to then find the answer. I may not be your instructor, but I will still test your basic knowledge. 6. Ask lots of questions, and never turn down an opportunity to do a skill, even if you have already done it. Practice makes perfect. 7. Relax! Enjoy your clinical experience. Even the bad stuff is a learning opportunity. Don't apologize for being an inconvenience, if you show you are really trying. Yes, you are slower than us, but you are learning. Don't be upset if we give you constructive criticism. Learn from it.
  7. al7139

    IV Push Times?

    Here are a few not mentioned: Labetolol Hydralazine Cardizem Digoxin Haldol And don't forget the emergency drugs: Adenosine Amiodarone Bicarb Atropine Epinephrine Lidocaine
  8. al7139

    Jobs for New Grads in Hampton Roads Area

    Hi, I work for Sentara at the Leigh Hospital. I know that right now with the economy, the units like to get experienced RN's but will hire new grads also. You can check the Sentara website, and just post your resume for every job. Something will come up. Also, it wouldnt hurt to visit the hospital and drop off a resume in person at each unit. You can ask to speak to the unit manager and give the resume in person. This helps sometimes. Also there are job fairs held regularly where you can go also just call HR and get the next date. Keep trying! You will find something!
  9. al7139

    IV pump help---all help appreciated

    Hi, We use the same pumps at my hospital. If the pump says "occlusion" it will specify the patient side (below the pump to the patient) or above the pump between the bag and the pump. Most often, the occlusion is one of two things if it is on the patient side: The patients IV is in a place where the arm can bend such as the AC (elbow), wrist, or even a finger (if pt is a hard stick). The occlusion occurs when the pt bends that area and blocks flow. Unfortunately, it doesnt just turn off or reset when the joint is unbent so we have to go check it. I HATE having IV's in the AC area especially since it happens so often. It is impossible not to bend your elbow and the confused LOL/LOM's forget all the time. I try never to use the AC unless it is a last resort when I place an IV, and lots of times the alet pts request it to be moved to keep down the annoyance factor. The other main reason is that something is clamped off (and yes, even us experienced nurses forget to unclamp the line sometimes if we are in a hurry). Also another reason is that the IV may have a small clot in it or it is infiltrated. This is why you should ALWAYS flush the IV first before hanging something (the exception would be if you are hanging a piggyback with fluids already running, then you would just check the IV site to make sure it is still good). Pt laying on lines or tangled lines are also a possibility. If the occlusion occurs above the pump, it is usually because the line is incorrectly placed into the pump, or there is a clamp above the pump that is not open (this is rare, usually lines don't have clamps above the pump with Alaris, except on the transfusion lines). If the infusion is complete, simply turn off the pump or channel (depending on single or multiple infusions) and disconnect the line and flush the IV. Don't forget to cap the end of the line to avoid contamination so it can be reused in the event the same drug must be administered again in the future. For air in the line this is usually either because the line was not primed, or when the piggyback was hung there was a tiny air bubble at the connection (this can be avoided by back filling the line). Sometimes if you have an infusion in a glass bottle, air bubbles occur more frequently. Also it helps if when the line is primed, the drip chamber is filled at least 2/3 full. Small air bubbles can be tapped out, with the larger ones the line needs to be reprimed. You should get all this training in school or in clinical. Alaris also has a training website. Hope this helps you! Don't be nervous! It takes time to learn all the "tricks" Amy
  10. al7139

    breakin down

    I think it happens to alot of students. I cried after my second clinical. I had a lol with contractures in all 4 extremities, we had to assess and clean her up after an incontinence episode. It was really the first time I had seen a really debilitated patient who was a total care. I am a very empathetic person, and all I could think of was how hard it would be to be like that. I broke down afterwards in our wrap up session with the instructor and other students. Luckily, they all understood, so it was OK. Heck, even after 3 + years as a nurse, I still cry sometimes. I can't help it. I just take 5, go to the lounge, and give myself some time to get it together. It doesn't make you a bad nurse. It's normal to experience strong emotion in our jobs. Hang in there you are fine!
  11. al7139

    Cardiac NURSES advice?

    Before I hang any cardiac drip, I check vitals. I also check the order, and make sure I review the drug side effects and if labs are necessary to assess electrolytes or renal function and when to get them. I also make sure I have a good IV, and evaluate the possible need for another IV site if there are other drugs to give that are not compatible, since cardiac drips cannot be interrupted to give another med. Hope this helps. Amy
  12. I am unable to convince my SO that you can't get the flu from a flu shot. Last year he got a severe pain in his toe. I knew it was probably gout, but when I told him he needed to see a Doctor, he wondered why he spent all that money to put me through school if I couldn't help him...Needless to say that was a huge fight!
  13. al7139

    Fluid restrictions vs Patient rights

    Hi, Heres my two cents: I work on a tele unit where we see lots of patients with CHF and abnormal labs that would benefit from fluid restriction to correct the problem. If the patient is A&O, I discuss with them the MD order, educate them on why it is important and how it can help them, and explain how we measure and ration their fluid intake. Most of the time (as far as I can tell) this works to keep patients and family compliant (I have never caught anyone drinking from the sink). However, there are those few, who, no matter how much you educate and explain will do it their way and will not listen to us or the MD's. In these cases, I document my education, the patients response to the teaching, and I note every time they exceed the FR in spite of teaching. I also let the Dr. know that the patient is non compliant and note that I have informed the MD. Most of the time, the doctors understand, and these patients usually are discharged sooner since they are uninterested in helping themselves. If the patient is confused, I have to say it is easier to restrict them, unless a "well meaning" family member decides to "help." I don't know if it is abuse or not. IMHO, I do my best to follow the order, but I can't stop a patient or their family from making the wrong decision, so I just document everything. Amy
  14. al7139

    Med-Surg Certification Question

    Hi all, I am interested in getting my certification, and I was wondering if anyone can help with good books to study, and what to focus on, etc. I will be taking a review course, but I want to be well prepared for the test. Thanks
  15. al7139

    Scrub Stores in Norfolk/ VA Beach??

    Yeah, Their A/C was broken for a while, but they do have the best selection.
  16. al7139

    New Onset AFIB..Is it an emergency?

    Heres my 2 cents: I work on a tele unit and we get lots of new onset A-Fib. They are usually admitted 2 ways; either they went to their PCP who found it on a routine exam and want it worked up (the patient may be asymptomatic, but they may need coumadin and a sotalol load, which can require close monitoring for side effects and INR level), or the patient comes to the ER with C/O sob, weakness, and mabye syncope and/or palpitations. These pts are usually in what is called uncontrolled a-fib (hr >100) or in RVR (rapid ventricular response) which is a potential emergency and usually they are put on a cardizem drip and may need cardioversion if they don't get better. Some people never convert back and stay in a-fib, and some flip flop. Either way the posters here are right. Your patients symptoms will tell you if it is an emergency. Amy