memphispanda

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!

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.

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.

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.

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?

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.

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.

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.

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.

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.

PT does our wound vacs. They are trained to do it, we are not, so that's the reasoning behind it at my place of employment!

The gluten free-casein free dite must be followed strictly for up to 6 months in order for changes to be seen in most children who could benefit from the diet. And keep in mind that there aren't that many kids who do actually show a benefit from the diet. It isn't as simple as just stopping the obvious products like milk and ice cream, but you have to go beyond that. It can be VERY difficult to find the needed foods, and then they tend to be quite pricey. It's also more difficult in a multi-child family. Also, depending on the size of the "young adult" and how much physical ability the child has, it may just be easier and safer to leave it alone--maybe they have tried to reduce the milk and been physically threatened or injured--it's certainly possible. Anyway, I would think that's too much milk for a variety of reasons--none to do with the casein free diet. For one thing, large quantities of milk can cause anemia. It's also a LOT of calories and sugar. However, it's ultimately up to that family to do what they have to do. Provide what information you can and let it go.

Keep in mind that it is Sunday morning, many members may be in church or working. Also there probably aren't a huge number of members who have the information you seek so it could take some time for the "right" person to see your post.

We only use Ativan for agitation and DT prevention (my floor is oncology, urology, med/surg). Our chemo patients have had great success with anzemet for nausea.

The title of this thread is really a bit misleading. Let me clear up a bit about tattoos... First, I believe that most people are well aware that there are restrictions on donating blood following getting a tattoo. That alone isn't going to stop many people from having a tattoo done. I have never been able to donate blood because either my hct is too low or they can't get a line in me. So now I don't try. Second, the risk of transmission of a blood borne disease when getting a tattoo from a reputable shop is extremely low. There is no "ink cartrige". A reputable shop will use new needles on each person--and sometimes multiple new needles depending on the size of the tattoo and different types of details of the work. They also will use individual ink wells that are discarded after use. If one chooses to not look into these details prior to getting work done then they may be at a higher risk. I believe that the majority of tattoo transmitted diseases are coming from jailhouse tattoos and garage tattoos--not from your neighborhood tattoo shop.

I would keep my mouth shut, and wait for it to be over. Having just finished nursing school in December 03, I learned from my fellow students mistakes. She who challenges the instructor or tries to "call them out" becomes she who has a "clinical failure". Half of nursing school is leanring to play the game.

I have lived in 2 cities that would be considered larger if you use 100,000 as the cut-off point. One place I lived on the east side of the city, had my child in a home daycare that was about halfway to my workplace that was downtown. The hours were 7:30-5:30 at daycare and only very rarely did I have a problem with time--when I did it was usually on the pickup end of things. Here, there are daycares with many varied hours, but generally for the better centers they are 6:30 or 6:45 to 6:00 or 6:30. A lot of the timing hinges on where exactly you are going and if you will be traveling against the rush hour traffic or with it. I am not currently having to use daycare but I will this summer, and I don't expect any trouble with getting the kids picked up on time. Before they were all in school we never had a problem. I don't think daycare times will be a problem for you.

My first two children had ABO incompatability...it was much more severe with my second than with my first. I do think that there are two issues here--the jaundice and the breastfeeding. They may not be related at all. First the jaundice--I was the breastmilk nazi with my second--her bili level was 28 at the worst. We did small supplemental feeds thru an NG tube for the 2 days in the hospital before my milk came in, then we went home with bililights through home health, she nursed exclusively, and we had no further problems (did have to have bili level checked daily for 3 weeks). Second, the breastfeeding. If there is a latch problem the LC should be able to help. My youngest (who did not have ABO problems because we have the same blood type) had a horrible latch. He became severely dehydrated by day 4--urinating a few brown drops every couple of hours. We went to an LC after the pediatrician (who was most unhelpful). LC took one look at the screaming baby and weepy mom, and said "I can tell you exactly what his problem is--look at his tongue". He was so severely tongue tied that his tongue was heart shaped--he couldn't move much at all, couldn't stick it out at all, couldn't reach the roof of his mouth with it. We did finger feeds for a couple of days while we hunted for a doc to do the frenulectomy. We had that done and he was able to nurse immediately. ANyway, my point is there are things that can be wrong with a latch that can be easily fixed (teaching the baby proper latch, which is disrupted by the bottle attempts), and things that can require a bit more effort. But it is extremely rare that it is an unfixable problem, jaundice or not.

Ahem...I am one of those "over 30" who is apparently too old to be remotely sexual in some people's mind. There are benefits to having it shaved, yes there are.

My very most favorite thing to do--talk to the patients! I also like to start IVs (especially the ones where a couple of others have already tried and missed!), brush out the lol's hair when no one else took the time to (not that I am always able to find the time either), and anything that I haven't done before is a thrill.

I was wondering what other facilities supply for patients beyond the regular meal trays. Also if anything is provided for family members. Do you have coffee, soft drinks, ice cream, sandwiches, soup, etc available for pts to have during non-meal times (say 3am when dietary is closed)?

I don't know what the answer is...I think sometimes they are so desperate for aides (just the warm body) that they let them get away with doing almost nothing. The aide assigned to my hall repeatedly didn't answer pages the last night I worked, until I asked the US to page her "phone call at desk". Guess who showed up? Then she tried to claim she didn't get the other pages.

It would be useful to note that the legislation requiring these updates to the system was passed in 1987. This is not new at all, it is just receiving a lot of press at this time in hopes of fueling fears of the draft being reinstated.

Employees who are involved in "direct patient care" will receive the flu vaccine.

Donmurray-- A question. If you have a serious health problem that requires a specialist or surgery, how long does it take to get that taken care of? I have heard that the waits can be long--sometimes too long. What about cancer treatments and chemotherapy? Are you able to see a specialist right away and get treatment started or do you lose time waiting for an appointment?