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memphispanda RN

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memphispanda is a RN and specializes in Med-Surg.

memphispanda's Latest Activity

  1. memphispanda

    Hurst Online Review...other review courses

    I took Hurst review in person and then online--we got a big discount if we had been to the review in person. It was extremely helpful. I would loved to have taken it prior to my last nursing course--the information and her presentation would have certainly helped improve that grade!
  2. memphispanda

    When to report a classmaste to your clinical instructor.

    We use "insulin" syringes for heparin. We have two sizes--one is a 30 unit syringe, the other is a 100 unit syringe. The 100 unit syringe also has markings for tenths of a cc up to one cc--which is slightly more than 100 units. Obviously these syringes aren't insulin only syringes or the cc markings wouldn't be on there.
  3. memphispanda

    Why do RN's with ASN and BSN make the same?

    You are paid for the job you do. I have a BA in social science. I worked for years teaching preschool in a daycare so I could be near my kids during the day but still make money. I was one of two or three with a degree of any sort working there. We were all paid basically the same money. Education doesn't always = money.
  4. memphispanda

    Multiple morphine orders for pain

    I work on a floor where we often get hospice patients or have patients that are being referred to hospice. We many times have people on multiple pain meds because that's what they require to have any quality of life at all. Usually they have some base long-acting pain med...it varies from patient to patient because each patient is different. The most common we are seeing are Duragesic patches and Oxycontin. The shorter acting are supposed to be for more acute pain that may occur. Such as prior to PT, wound care, etc. Some patients require pain meds prior to eating--especially pancreatic cancer pts. Anyway, I probably haven't been much help at all...it just seems that each patient has to have their own regimen because they are all so different. We recently had a patient on 13mg Dilaudid/hour via PCA because that was what he required to just be able to sit up in the bed/sleep/etc--he was not in the least sedated by that level of medication.
  5. memphispanda

    Reading TB skin test

    I am very very frustrated with my husband's "nurse" at the MDs office right now. We are trying to get him on Remicade for Crohn's, and that involves having the PPD done. First PPD they said was 4mm. I had already been watching it at home--it has a small blue bruise around the insertion site, but there was no redness, no hardness, no swelling. They recorded it at a positive PPD. Second PPD (today) was completely flat, no bruise, just a tiny dot where the needle had gone in. They read this one as 2mm. WTH? They are going to prevent him from being able to get Remicade because they can't read a PPD properly. Or am I just an idiot and I don't know how to read one?
  6. memphispanda

    SCD's and TED hose

    Usually both...I don't particularly like either. The TEDs are so slick they have been the cause of several falls/near falls even though we make sure patients have slippers of some sort to put on. The SCDs make the patients feel "strapped down" and some complain about the sound the machine makes.
  7. memphispanda

    IVPB tubing change

    I backflush. I don't see any reason to dump the tubing and get a new one. That's an additional access to the system that is totally unnecessary.
  8. memphispanda

    Baptist, Memphis, Nurses

    Let's see... As a new nurse, I am VERY glad we have the MRT. I trust myself to see when a pt is having problems, but sometimes there are easy fixes that I am not yet totally aware of. Chart reviews--sometimes all I get to (and the other members of the staff as well) is reviewing the orders for the past 24 hours. In depth reviews may or may not occur depending on how the night goes and how well we are staffed. Prior to the MRT, it was each person for themself. I found that since I was new usually I could get a more seasoned nurse to come give me their opinion, but they didn't always have time. So it ended up being call respiratory if appropriate, call the doc for orders, etc. Of course we still call the doc for orders if needed, call the code if needed, etc. I work nights, and we don't have a charge nurse to turn to--not really. Someone takes responsibility for making the assignment, but beyond that, we all take care of our own things. We have around 250 beds--I don't know the actual number. At night the nursing sup assigns beds, takes care of any "situations" that arise, is present for all codes (unless there are multiple at once which is very rare), keeps up with staffing levels, takes care of TB skin tests for night shifters, gets supplies from storage when necessary, and probably 10,000 things that I don't know about. We usually see the supervisor once a night when she makes her rounds, and then maybe a couple of other times depending on the way the night is going. I am not really sure how things work in the ICU as far as who is assigned to the MRT that night. I think they rotated the assignment for a while, but lately we have seen the same nurse for both MRT calls and codes, so I think she enjoys that and has taken that responsibility. I don't know if she has a pt assignment, a lighter pt assignment, or what. From time to time there will be a comment like "I can't believe they called us for this" from an ICU nurse, but I really think that is because they don't realize that what may not be serious enough to be an ICU problem still may be more than what we can safely handle on the regular floor. Anyway, when the MRT shows up the ICU nurse asks for a brief history/problem and starts assessing, also may work on getting additional IV access if needed. Respiratory is doing what they do--checking sats, starting treatments, changing from one O2 delivery system to another, etc. Primary nurse is calling the doc with info, taking orders, dealing with the rest of the assignment, etc. The supervisor usually is the last to show up unless she just happened to be on the floor at that time anyway, and she starts working out how to move the pt to a higher level of care if needed (our hospital is always packed, so moving a pt usually involves moving multiple patients around). Also because she has a LOT of experience she sometimes says "well did you try _______" (insert something that no one else thought of or has heard of) and sometimes that thing alleviates the problem. It really works well. We tend to get problems taken care of much more quickly. When the system first started that was a lot of grumbling about it, but that really has died down quite a bit. I think we use the MRT more often on nights than on days, but it isn't very often that we have to call them--maybe once a week average.
  9. memphispanda

    Blood culture techniques???

    Uhh...I think the "lowly med tech" comment was directed at the attitude the MDs have towards the med techs and others--as in they aren't even important enough to bother remembering their names, etc. Not that the OP of that comment thought the med techs were less important.
  10. memphispanda

    Baptist, Memphis, Nurses

    I don't work at Baptist, but we do have a "Medical Response Team" that we call when we have a pt who is going bad but not ready to code yet. We have a pager number we call, and that gets us a respiratory therapist, the house supervisor, and an ICU nurse who come rapidly (at least ideally). The more experienced nurses don't like to call the MRT, but newer nurses like myself really appreciate their input.
  11. memphispanda

    What does "up ad lib" mean?

    The pt is able to have activity as he desires. If he wants to wander the halls all day and night, that's fine. That's all it means.
  12. memphispanda

    Night Shift...............

    I'm a new RN and I love nights. Staffing is the only real problem for me--we have more patients than other shifts, and there aren't many people who want to work nights. The good things: more $, less dealing with the "big wigs", the night staff members are great. I haven't had problems sleeping during the day at all. I work 3 12s and have had no problems switching back and forth from sleeping days and nights. I think it's very individual though.
  13. memphispanda

    Waiting for cord to stop pulsating before clamped & cut

    missnurse-- My understanding is that it would depend on the cause of the anemia and jaundice. If it was an rh or ABO problem, the additional blood could quite possibly have caused those to be worse--more of the blood would have been available to be attacked, and that would cause additional work for the liver. That is the situation we had with my children--ABO incompatibility caused jaundice in my first two, so the third was at risk for having it even worse. It turned out he had my blood type unlike the other two, so had we let the cord stop pulsating with him it probably wouldn't have mattered.
  14. memphispanda

    Waiting for cord to stop pulsating before clamped & cut

    I did a lot of reading up on this when I was prego with my last (it's been 5 years...) At that time it seemed to be a great "natural" thing to do. However, I also found info that the extra blood (usually 30-90cc) can cause problems in infants who are already prone to jaundice. We made an informed decision to NOT wait to clamp the cord. In my opinion, it puts a lot of stress on a not quite mature liver.
  15. memphispanda

    Help Feels like ice water

    What about Reynauds? That can cause color changes, and can feel strange. I have it in my hands, and they turn colors...usually red, but from time to time they will get quite purple.
  16. memphispanda

    Night-shift in ICU

    oops...wrong thread!

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