Beverage

Slightly off topic but similar... I requested not to be assigned a patient who had a dog with him (not a service animal). Pt was a homeless man with a scruffy dog who barked and growled at anyone walking by pts door or entering the room (I'm sure the dog was frightened) I have a fear of dogs having been bitten as a child. Never understood why administration didn't call animal services to take the dog for safekeeping during patients stay. There was no way to identify if the animal had current vaccinations and its behavior was a huge liability. I believe staff put an ultra sorb pad on the floor to be used for elimination purposes and the pt fed it from his meal tray. A child is not like an animal, but I've encountered visitors children who were unruly, screaming, running in the hall' touching sharps container and playing in the pt restroom sink splashing water everywhere. I would not accept an assignment with a child in tow, social services would be involved.

I passed my NCLEX at question #78 and when the machine shut off, I really had no clue if I had passed or failed. I do remember getting 2 similar questions about crutch walking up and down stairs which I'm sure I missed hence the second question. I don't remember ever reading in my texts or hearing in lecture any crutch walking questions so I was perplexed. My test also had questions about obscure diseases that I read about but didn't memorize because I thought the test would be focused on common diseases one would be likely to see routinely in a hospital setting. I think one was takotsubo syndrome and an endocrine disorder. I can't remember which one it was now.

There was a short unsuccessful trial of faxed SBAR report from ED where I work. We are back to verbal report and I am thankful. Once bed control hands me an admit slip, I have 10 minutes to look up info in EPIC and I make the call to ED for report. If I take too long to call ED, they will call me at minute 11 LOL. If for some reason I can't take report, ED gives it to the charge nurse for me and this avoids delays. I have had a faxed SBAR missing key data like SBP in the 80's that was not filed in EPIC. Had an SBAR fail to mention BG of >500 that hadn't been covered. I had a SBAR pt on a nitro gtt which needed a higher level of care. So for those who have asked, here are 3 instances where faxed SBAR wasn't appropriate and to just send the patient up to the floor wasn't the right thing to do.

Bic Atlantis black medium point retractable. Slim barrel, smooth ink, gel cushioned grip. My favorite plus a 4 color for coding my brains. They stay in my pocket and I rarely lose one. I keep a spare of both in my lunch bag in case I run out of ink. Best pen ever.

I have the Fitbit Zip and keep it in my pocket or clipped to my shirt at home. I average 14K steps for 6 miles on a busy shift though 4-5 miles is average for my day. Hubby and I walk every evening 1-2 miles in addition to what I walk each shift.

1. No, I do not take the vaccine. 2. Yes it is required for work by order of the Public Health Officer in our county and provided at no cost to employees. Staff who refuse have to sign a declaration and wear a mask for the 5 months of flu season. 4. No one that I know of has been fired for refusal. 3. I know the vaccine is a killed virus and cannot give me the "flu", however, I get sick from the vaccine as a result of my immune system fighting off a dead foreign pathogen so I can develop antibodies to the injected virus. I have issues with being forced to vaccinate myself when I am capable of evaluating the evidence and making an informed decision. I wear the mask every shift of flu season. I believe the mask protects me from picking up colds/viruses because patients and visitors can't cough in my face. I actually stay healthier since I've been required to wear a mask. As stated by a PP, I am not anti-vaccine "know (not "believe") that science has proven beyond doubt that vaccines for tetorifice, mumps, measles, chickenpox, diphtheria, polio, pertussis, smallpox, and others..."

A Family members 14 month old grand child choked on a grape at the Los Angeles Zoo 2 weeks ago. Huge delay in care because the child's mother was hysterical and the aunt was occupied with Heimlich maneuver begging someone to call 911 while bystanders were more concerned with taking photos and video of the child choking to death with their phones. The childs' heart stopped for an hour and he was brought back in the ED but not without a severe ABI. The Connor Phoenix Project has more details. 3 weeks ago my DNR patient with mets had just finished lunch, was doing well and scheduled to go home the next day. K+ replaced, Mg infusing and I was in her room with daughter discussing the POC. Her eyes rolled back and she started agonal breathing. My phone rang to say she was in Toursades. Cardiologist was at the nurses station and ran into he room, updated the daughter and per her wishes we stood and watched her die. The daughter took her moms hand and told her what a great mother she had been, how much she was loved and to go be with her dad in heaven. I lost it and had to hang out in the break room for a bit, snot and tears flying.

I work Cardiac Tele, we titrate diltiazem, dopamine and dobutamine. We manage amiodarone, loading, 6 hour and maintenance dosing. We also titrate heparin gtts. We don't take Nitro or insulin gtts because it's too labor intensive with 4 and sometimes 5 Patients when we're short staffed.

I heard a story yesterday at work where the PA ran to a code on a med surg floor, upon arrival there were 5 nurses standing at the bed doing nothing! He started compressions and gave instructions on placing the Zoll while the bedside nurses where paralyzed in shock? And unable to perform CPR. I believe heads are going to roll. The pt was 50's and not a DNR.

Medscape: Medscape Access

Last week I was on day 2 with a POD14 CABG, slow to progress. BUN 2.09, K+5.5, WBC 15 all trending up. Had a PICC extravasation 3 days prior which was d/c'd. LS Clear, no chest tubes, just pacer wires. BP 120's/70's, SB 55-59, 94% on 4L NC. Bipap at bedside for NOC and PRN. I held her AM dose of Coreg, amiodarone and digoxin. Pt had been chronic complainer, moans, pulls off 02, on the call light a lot previous day requesting coffee, jello, bed pan. 10:00 she's being noisy so I check to make sure her NC is in place. It wasn't and she had pulled off her gown and was incontinent. She tells me "I'm going to die". Recheck VS, BP is good, HR is 40's and Sats 84%RA. Replaced NC and cleaned her up, linen change and paged MD to update. Sats remained in the 80's so I put her on the Bipap with improvement to 94% on 40% 02. MD called back with orders to transfer to ICU. There were no beds so I called a RATT which will get the pt a "code" bed in ICU. My thoughts are she was going septic from the PICC issue. I keep wondering if she recovered. I hate it when a pt tells me they're going to die.

God bless you sweet Esme. May you continue to heal and progress. You are a treasured resource to this group and have been missed. Speedy recovery and prayers for complete healing.

I personally would never walk away and leave narcotics in a BD pump or as a piggy back. I have used a BD pump for lasix when I don't want to stand at the bedside to do IVP and if lasix dose is >40 mg of lasix.

https://allnurses.com/general-nursing-discussion/do-you-bladder-243797-page2.html

For me it depends upon the situation. If I'm simply restarting a beeping IV pump no, full assessment and admits always. Male patients who use a urinal, always (they hold their member and don't wash their hands) yuck. Bringing a box of juice, milk or coffee in the room no. Feeding a patient, yes. Changing linens, gowns or chux always. Bringing a towel or warm blanket, no. I always foam in and out of the room.