kate1969

We are almost 24 hrs post op with T&A, my daughter is 14 y/o, obese, hypertensive and anxious...what a mix huh? she has been prescribed oxycodone for pain taking 15cc q4hr with amoxicillin q8hr. The pain meds wear off around about the 3 hr mark, she can't cry because of the pain since she's not aloud to blow her nose, anxiety alert!!! I give her plenty of ice water to drink but she complains that she can't swallow, I offer her ice cream cups, popsicles, jello, yogurt...she takes about 2 - 3 bites and says she can't finish....she actually slept last night and I thought that would never happen, but she/we slept 6 hrs this morning from 3:30 to 9:30. So she was late taking her meds by 2 hrs. I gave it to her immediately and told her to drink some of her ice water....boy did she cry...I told her, "Don't cry, you can't blow your nose." Yesterday, she was 2nd to last in line for this T&A and they thought that there was a possibility of keeping her overnoc depending on her BP.. She got out of surgery around 12:15, was in recovery until about 1:00 pm, they took her back to her room, her BP was slightly lower than normal at that time. Within 2 hrs post op, her BP started trending upwards at 180/103. It wasn't quite time for pain meds, we still had to wait about 45 minutes before she could get any. About an hour after her pain meds, she was down to 155/84. The nurse feared that if pain control was going to be an issue, maybe she should call the MD and request that she stay overnoc. About 5:30 pm, her BP was about 142/84, she wasn't due for pain meds again until about 7:30 pm, so I informed the nurse that by the time we get her dressed, loaded into the car and to the pharmacy, it would be about that time to take her meds.. So the nurse released her, but I'm afraid that we made a mistake, maybe we should have stayed the noc. In the meantime, I just bought her some clear gatorade to help rehydrate her and she's due for more meds at 1:30, that's in about an hour... We've had ice packs to the neck, she says that's not helping anymore... What else can I try? I'm really getting worried about her... she's sleeping now, I know she needs her rest, but when she's sleeping, she's not eating/drinking... since she's been home, her BP has been high during the painful times and closer to normal about 1 hr after taking oxycodone... If anyone has any suggestions, I sure would like some advice... katie

try http://www.worldwidelearn.com click on respiratory therapy http://www.rcsw.org, they have some freebies http://www.nellcore.com/educ/onlineed.aspx http://www.ssbinc.com/medway http://www.nurseceu.com/pul.htm start with these, if you need more, just go to http://www.google.com and type in the search bar "free online respiratory ceu's" and read through everything that comes up, but make sure that it reads "free"...

I was pregnant with my oldest child (now 22) and I was toxemic, I was informed my my obstetrician to lay on my left side to control the blood pressure... later in life, a physician told me, if you want to lower BP lay on your left side, if you want to control GERD, lay on your right side....bizarre how all that works, but it does...so maybe if the patient lays on his left side, and his pressures are already sort of low...hmmmm.... the human body is bizarre...yet amazing.... katie

sorry, I live a few states away from you...did you get all the online credits?? there are some sites with free ceu's...I don't know of any right off the bat, but try googling it...my facility provides me with 1 ceu a month and I got 12 for taking ACLS for the first time...in the past though I've taken free ceu courses online and in my state, you are allowed 12 online ceu's...sometimes though the aarc doesn't recognize nursing ceu's...so be careful of the ones you do get... katie RT

albuterol is supposed to be prescribed for wheezing only, if there are secretions in the airway that would tend to cause a wheeze, then albuterol would be in order, if their bronchioles are inflamed and causing a wheeze, then albuterol would be in order. If a patient is coughing, you would want to assess them and find out why, it could be because of the reasons above, but there are other reasons patients cough...as you all know, but still, the RT shouldn't be rude about this, they should want to be helpful anyway they can. I worked in a hospital on the night shift and they always gave me the 7th, 8th, and 9th floor, and the residents were very eager to continue to write for unnecessary neb therapy. they would label a lifetime non-smoker as copd and order them on q4hr nebs, those patients had very clear breath sounds, but the residents would still write for nebs...in that facility I had no authority to d/c the treatments or even consult the residents to contradict their orders...I was powerless, and each night I would have 50 therapies per night...that's a hefty load for 1 RT. I hated that because I could barely assess those patients much less an existing copd'er that needed a PRN treatment.. That job sucked, but as much as I was overloaded, I would never tell a nurse that I couldn't do it unless I was in a code situation...you just have to prioritize..it gets hectic in those situations for all involved, but rudeness is uncalled for in any situation!...especially for a degreed professional....

at my facility there is a policy for nails/nailpolish and no one adheres to it, but it seems as though administration would rather focus on cellphones and their usage in patient rooms, though I hate that too and its another topic on its own, but they focus more on that than on fingernails...not to mention our time clock, you have to punch in your code, then stick your finger there so the clock can scan it to make sure it's you...talk about germy.....I would worry about that one more than cellphones too...hehe, sorry...had to say it though

My house looks like the Munsters house...hehe, I almost never dust and only vaccuum about 2 times per month...haha, there's only 3 of us living here full time and we all agree that life is just too short to be working every day, be it at work or at home....I would dump the vaccuum in a heart beat if the sun is shining and the 4-wheelers are calling...LOL, I live at the end of a gravel road about 1/10 of a mile from a river, I must say that because of all of the dirt outside, my house has more dirt in it than a lot of other homes, and we just all get over that, because if I had to keep my house clean 24/7 I would never have time for anything else... Life is too short, life is too precious and if anything happened to my family members, I would be soooo sorry that I spent more time cleaning my home than I spent with my family members....ASHES TO ASHES, DUST TO DUST...that's where I came from, that's where I live now, and that's where I'll die...in a big pile of dust...hehe, my home's not really that bad, but sometimes I feel like it is...and that's when I clean it...

I'm an RT and I'm very sorry that that happened to you, last noc I was called in to my PRN job and there was a patient there that is a "No code" comfort measures only. I gave him a TX at the scheduled time and he had no PRN orders for nebs, but a nurse, not his nurse, called me and asked if he could have a tx, I looked on my sheets and explained to her that I just gave him a tx 2 hrs prior to the current time in which she called, I also explained to her that he had no prn tx's ordered, but if she could get me an order, I would come and give a tx. Mind you, I was in my office on another floor. She hung up the phone and apparently tried to call the physician. In the meantime, I decided to go up (on my own) and reassess the patient, I was worried about him. I went up there and I could hear him just gurgling on his own secretions..I went to the nurse and explained to her that I could give him a tx, with a prn order however, I truly felt that the patient needed to be suctioned more than anything. Since suctioning is invasive and traumatic for a patient without an artificial airway, I explained to her that I could do that as well for the patient, but I would need an order from the physician. She explained to me, in a very frustrated tone that "nurses could nasally suction patients at their discretion without a physicians order.." I said, "fine, if you can do it that would be great, but for an RT to do this, we have to have an order written in the chart". She proceeded to find the patient's Nurse and have him suction. We were still waiting at this point for the physician to return a call. Anyways, to make a long story short...hehe, the physician called back, gave an order for prn nasal suctioning and for a stat neb tx. The patient however was completely unwilling to be suctioned but he did take the neb tx. I like being an RT, I love my patients and I'm concerned about all of them. I would love to spend every bit of my 12 hrs assessing and treating my patients in a timely manner, however, some of the RT's out there only focus on their current patient workload. I would gladly dump all of that to fix a patient in distress. But sometimes, when your treatments have to be written off because of priority, the RT dept manager likes to write up therapists that write off treatments...(legal issues and all). I feel like saying that they all need to staff enough RT's to perform therapies and staff 1 RT for emergencies, even if that Emergent RT sits at work all noc and does nothing...The safety of the patients in need of emergent care take precidence over the "clear lung sounding" scheduled q4hr tx's...(IN MY OPINION) SORRY FOR THE SOAP BOX and i'm very sorry that an RT treated you in that manner.... Katie

The long term acute care facility I work at weans people off vents that are more difficult than most to wean, if/when we deem a patient unweanable we inform families of other options ie: compassionate weans/terminal weans. In my state however, medicaid will not allow us to terminally wean their recipients, instead, we must pay for an ambulance service to send the patient to a long term care facility so that they may carry out their compassionate weans....the government would rather spend more money in transporting these patients to other facilities so they can "save" money...hehe, generally these patients are over 90 years old...cracks me up!

Please don't lose hope, I'm just a CRT working on my RRT and as you know, we all have to crawl before we walk, walk before we run, soon, you'll be, oh yeah, you already are running your a$$ off....hehe, sorry, but you know what I mean, you're there for patient care and to learn, may the learning never stop..You'll have the glory one day and one day, you'll be a precepter to "just an LVN" and you'll have this very experience to guide that LVN... We ALL are important in the work that we do! and you worked Long and Hard for the education, Please, Please be proud of that!!!

I work in an LTAC and this is my belief "crocs..with holes, without holes, tennis shoes, steel toed boots...what's the diff!" I work in an LTAC and I figure this, I probably have every germ known to man and its not because I don't take every precaution, I do, however, when push comes to shove and there's a nuclear war, the only thing left on this earth alive will be the cockroaches and ME!! hehe we have those plastic needled syringes and they suck, I'm an RT and occasionally I have to use a syringe to draw up Gent for neb therapy, I don't care who y'ar, you can't successfully draw up the second vial...you always end up pushing too hard, pushing the rubber stopper thingy up into the vial and all the Gent leaks out onto your gloved hand and your scrub jacket... so, I guess all the germs on me are now being killed by the Gent I've just poored all over myself...LOL It just doesn't matter...LOL maybe I should just dump that second vial onto my crocks and socks...LOL sorry, I have a warped sense of humor

I think that's what they're trying to turn my place into.... :)

You all are sooooo Awsome!!! I want to thank you all for your responses, I'm so happy to know that I'm not alone, not only in what I'm seeing/experiencing but in how I feel as well. 1 issue I would really like to address first and foremost was the "Consider leaving and going elsewhere" issue. I have to say, I didn't have time to really get a lengthy education, I got a great education don't get me wrong but I needed an education and needed it fast, but it was good and one of the best parts about it was the time spent in Clinicals, but when you do clinicals as you all know, not only do you get to browse in your prospective field, you also get to eliminate all the "not so great" places to work. I live in a large city, I don't really want to post where for fear the "higher ups" are "watching" but for this large of a city, I've seen some bad places in clinicals, like so bad that if they were the last hospitals standing, I still wouldn't work for them, and there are a couple of hospitals that are 1st rate, but they don't pay well and there are a couple that only employ RRT's...I'm waiting for my check to be cashed by the NBRC and then I will be Registry eligible and I'm studying for the exam diligently so that I can expand my opportunities.... however, I walked into this LTC a couple of years ago right after they opened and it was wonderful, I didn't think they would hire me because I was so green, but to my surprise, that's exactly how they wanted me! I was so greatful, my first job was horrible, I worked there just under a year and I did more there in clinicals than I ever did as an employee, I never got to touch a ventilator and I can honestly tell you that I am a pro at giving neb treatments...hehe isn't that sad!! Anyways, the pay here is so depressing even at the top hospitals and I still have a 14 year old at home which takes me out of the possibility of becoming a travelling therapist, at least for 4 more years.... How come they don't tell you all this IMPORTANT information in school? Hey, all you nurses to be, rt's to be, cna's to be, did you know that when you get out there on the job, you'll be short staffed, running your a@# off, lose 40 lbs in less than 6 months, never get breaks, put your hard-earned license on the line, all for a couple of pennies a day because the bulk of your new salary will go to taxes and outrageously expensive insurance with prescription coverage eating away your food money and you have to go in every day, never call off sick, cause if you do you'll be written up, work every one of your off days, and every six weeks your schedule will change, you'll work nights, days, weekends, EVERY HOLIDAY, and instead of getting double time for your holidays worked, you'll only get time and a half.... HAPPY JOB HUNTING GRADS!!! Oh Dear Lord up in Heaven, Please Bless me and The patient's I don't kill today.... Thank you all for listening/reading my rampaging ramblings... I sincerely appreciate you all!! I'm almost 40 years old, I've raised 4 daughters, I have 1 grandchild and believe it or not, I've lead quite the sheltered life!!! I have so much to learn.... uggggghhhh, life is so exhausting... thanks again, you have all made me feel so much better....

My name is Kate and I'm a Respiratory Therapist, though I am not a nurse and I hope that you don't think I'm intruding in your space here, I just have a problem and I would like to know if Nurses are feeling the same way. I work in an LTAC facility and we are facing what I call outrageous cutbacks in staffing, with RN's, LPN's, CNA's and RT's and we're all pretty sick and tired of this issue. I love my nursing staff, all of them, they're all pretty important to me and I'm just sick to death of all the cutbacks, I think we're all pretty tired of it. Our facility does wound care and ventilator weaning, etc. We were supposed to be staffing per acuity level, granted, I'm new to the healthcare field, I've been an RT for only a couple of years now and this is my first time ever being in an LTAC. I was a nurse aid for a few years way back when in a nursing home, actually a couple of them, but when someone called out sick, the nurses were very helpful, we did all we could for each other, anyways not to get off track, we now are no longer staffing RT's per acuity, the nurses and cna's are still being staffed that way, but they don't do our work at all, we do all the RT work but we help the nurses and cna's a great deal. The nurses on the floor are very upset about this as are the cna's and the RT's obviously, but nothing we say gets through to administration and nothing is changing. We are all very fearful of the "sentinel events" to come from this "short staffing". We are all about ready to take a "leap" . Is this happening every where, or is it just happening to us? They are trying to staff 2 RT's per 30 patients and they still expect us to do admits, discharges, weans, therapies, trach care, run codes when necessary, do abgs etc..., I think the nurses feel lucky having only 4 patients, but most times they have 5 or 6, and the cna's are lucky to have 5 per 30 patients but most times they have 10. I think that's horrible patient care and its very dangerous. Our licenses are on the line, and I'm quite sure that this company wouldn't back us if anything tragic ever happened. I think they would drop us like rocks to avoid liability...and of course to cover their butts...I went to RT school because I don't have the stomach for nursing but I wanted to care for people. I admire nurses, they have to know so much about so much and I think they have enough on their plates. My nurses and cna's know me and they know I'm always willing to help, but the last thing I ever want to do is tell them, "No, I can't help you boost a patient, or clean a patient because I have to get 10 treatments done in the next hour, start 3 trach collar weans, start three cpap weans and do 10 trach care's".....uuuuggggghhhhh somebody help me...just go ahead, tell me that before I retire I'll be weaning 30 patients, doing 30 trach cares, 30 treatments, running 2 codes at once all by my little old self!!! or instead, maybe you should tell me to just go back to my little desk in Accounts Payables...hehe, I'm trying to find humor...sorry this is so long, but as upset as I am, its actually pretty short... Thanks for listening Katie