JessicaSN

A guy came in last night because he ate a piece of moldy bread. Wasn't having any symptoms, just "wanted to get checked out". YIKES.

Oh, by the way, the ER physician did not believe MULTIPLE registered nurses who re-checked the manual blood pressure. We used different size cuffs, both arms, etc and the physician still wanted different people to re-check.

I work in the ER. An older lady came in complaining of nausea, headache, and upper back pain. She had not had her Clonidine (0.2mg TID) in over a week, along with her other daily meds. Her blood pressure was over 300 systolic (that is the highest our sphygmomanometer went). Her diastolic was around 170. :uhoh21: Got it down to around 230ish with some Nipride before she went upstairs.

A young woman, 7 months pregnant, came into the ER because the skin on her breasts itched due to NORMAL swelling/growth from pregnancy. AAAAAAAND what are we supposed to do about that?

Our ER has a 2 hour wait time after someone is discharge before we will CONSIDER calling a taxi for them if the bus is not running. And am I a big ole meanie if I say I kind of enjoy telling the "abdominal pain x 4 months, came in by squad, btw I need a pregnancy test" patient that? :) Of course we make exceptions for for elderly people, non-FF with legitimate transportation problems, patients who have somehow melted my cold heart with their story, etc. BTW, *most* of the patients who throw a fit about not getting an immediate taxi end up finding a ride home. Who knew!

Yes, the CCRN is for ICU nurses. I think studying for the test and eventually passing would be beneficial for ER nurses though. It is a goal of mine to pass the test :)

I'm assuming you already have your ACLS certification. TNCC - Trauma Nursing Core Course CPEN - Certified Pediatric Emergeny Nurse CCRN - Critical Care Registered Nurse Certification

Part of our triage is getting a height and weight on everyone. I weigh all children; I don't trust the parents to know how much their kid weighs. We get estimates from the adults.

If someone refuses the gown or blood work I flat out ask them, "Why don't you want to put on a gown? Why don't you want blood work/an IV?" Sometimes it's because they don't want to be cold (so I get them plenty of warm blankets, pts loooove them). Sometimes it's because the pt is obese and has always been given regular sized gowns that don't fit (so I go get them our XXL gown). If they say they are afraid of needles or have "bad/rolling/small veins" I assure them I will only poke if I feel very confident I will get the IV or blood work. Most normal people I can convince to do what I want with a little explanation. If they refuse after that, I chart it and tell the doc the pt refused if the physician asks why this or that wasn't done. On another note, how about when we ask them to take off their clothes and put on a gown, and you return a little later and they put the gown over their shirt, jackets, pants, etc? :)

We don't do gastric lavage very often in my ER, but the doc wanted it done on a young lady recently (swallowed multiple types of meds 30 minutes before arrival). We tried out the "garden hose" tubes without success and ended up placing an 18 French. Unfortunately our ER doesn't have a wide variety of choices - we go from 32 to 28 to 18 and smaller. So my question is.... What is the largest size NG tube you have placed for the specific purpose of doing gastric lavage on an overdose? I'm not talking about NG tubes for suctioning bleeds or bowel obstructions. When you need to lavage to suction out large pieces of pills, what size NG do you use? I'm not taking about OG either Thanks

There is no way this *hasn't* been said in this thread, but it bears repeating: We don't get any kicks out of calling report before/during/after shift change. When a patient is assigned a bed is totally out of my control. It happens at all times of the day, just like how the ER gets squads, traumas, and codes all times during the day or night. Do we get angry at the medics when they bring in a Level 1 Trauma at 06:50 or 18:50? No, because that is ridiculous and out of their control. It is the same situation when transferring a patient from ET to ICU. I wish the ICU nurses would do what the ER sometimes does. When the ER gets a code or trauma alert within 10-15 minutes before shift change, the next shift will clock in early and take care of it. If I took care of an ER patient for the past 5 hours and now they are going to the ICU, wouldn't you rather get report from me and not a second hand report? And this is only concerning those patient who are assigned a bed right before shift change. I wish the ICU nurse would clock in early, take report from me, and then get report for his/her other patient. This is assuming a lot of things (ICU nurse is at work early, charge nurse knows who is going to get pt, etc) but I think it would be best for the patient. *phew* :)

I don't have much foot or leg pain after working (thank goodness) but I can definitely tell the difference between the nights I wear my compression socks and when I don't. My feet feel much heavier and my lower back hurts more when I don't wear them, the back pain could be a coincidence though :) I believe I have these: http://www.allheart.com/nm9153.html They stop just below my knee and those suckers are tight! Hopefully they will prevent varicose veins too. I began wearing them in nursing school because I wanted to keep my legs good looking.

Emergency RN: Oh, they got you good :) I have made many embarrassing mistakes during the whole 1.5 years I've been a nurse. I guess the funniest one was I had just come back from taking a lunch and I had a new patient (I work ER). I was told in the brief report she was here for a headache. She put on the call light and I went into the room. She was in her 40's, sitting up in bed watching TV, alert and oriented x 3. She asked me to help her on a bedpan. Well, I paused for a second and pointed to the restroom that was attached to her room and said, "The bathroom is right there" (in a nice way). Then she pulled back the covers and showed me that she was a bilateral above the knee amputee. Oops. So I of course then helped her on a bed pain. I went back to the desk to tell everyone my goof up and everyone laughed because she is a frequent flier in our ER.

In my ER there is a designated person who is the "scribe" on every shift. It is written on a dry erase board that also shows who has what rooms. I am scribe a lot because I apparently do a good job (so I've been told). We have trauma paper work and separate code paper work. Once you do a trauma or a code a few times you get the hang of it. The scribe in my ER is also kind of the "leader" and can tell people to be quiet if it's getting too loud, ask the doctor for clarification if something isn't understood (so you want Morphine 4 mg, is that correct?), and also should be on the ball if the doctor asks a question (How long ago was the last Epi given?). The scribe in a trauma has to pay attention to what all staff are doing the entire time - it can be pretty stressful!

We have an online system called Micromedix that will allow a nurse to enter multiple medicines and see if they are IV compatible. There are only 2 that I regularly mix: Dilaudid and Phenergan. It really doesn't take that much more time to flush in between IV pushes. I would also never taken any one else's word that certain drugs are compatible. Look it up yourself. Call the pharmacy if you still have questions. If I already have an infusion going (not counting 0.9% NS) and need to push something, I pause the infusion, take the tubing off the IV site, flush/push drug/flush, then reconnect the tubing and resume the infusion.

If you still choose to see this doctor as your PCP, I would definitely not bring up work related matters at your appointment. What goes on at work should be dealt with at work.

After you dart the needle into the deltoid muscle, you should pull back a little on the plunger (or aspirate) to see if the needed is in a vein. You can tell because blood will flow into the syringe. This technique is used with all IM injections, not just deltoid.

Following your logic, it wouldn't be a big deal to call a teacher's aid a teacher, or a car mechanic an engineer, or a physician's assistant a physician, and so on and so on. I think it's pretty important to call people their correct title and I expect people to do the same for me. A lot of times the local and national media throw the title "nurse" around to anyone wearing scrubs without doing any research.

You did the right thing. How does the son expect you to "know" about a UTI? If someone cannot tell you where it hurts, and it isn't causing a fever (yet), it's not like you're psychic. Severe UTI's in elderly people can lead to sepsis quickly so you totally did the right thing. You had a feeling in your gut that something wasn't right and you followed it. I don't know what you could have done better.

Isn't this kind of risky? If this is your first time pushing it on a patient, how do you know how they'll tolerate it? I pretty much push everything slow.

Wow. I thought our job was to put "SAFETY FIRST". There would be no way in hell I'm going to dump water into someone's mouth so they can choke down 2 Percocets. Was she already too high to physically push the button on her PCA? Look, next time your patient is too sedated to move her arms and is in 10/10 pain do this: crush up the Percocet, get a small straw (a dollar bill will also do), fill it with her drugs, put your mouth on one end, and blow it directly into the patient's nose. Because being a good nurse means giving the patient whatever they want whenever they want it, not caring about something as silly as BREATHING or ASPIRATING. Duh!

This was directed to someone else but I have some experience with this. My hospital is right in the middle of 2 great children's hospitals (one being Cincinnati Children's) and people still bring in kids for a variety of problems. From sore throat/broken bones to vomiting and diarrhea to kid-not-breathing situations. I probably see 2-3 kids a shift and transfer about 2 kids per month to one of the children's hospitals. Last night I had a suicidal pre-teen with Leukemia. You will see it all in the ER.

Yes, it was in that letter. I renewed mine about a month ago and had to dig out my letter from the backseat of my car.

In nursing school I was pretty afraid of needles. My heart would start beating faster and my hands would shake a little if I were holding one (wouldn't you have loved to be one of my clinical patients? :)). Now as an ER nurse of 1 year, I can draw blood and start IV's with no problems. I still can't look when people draw blood from me though. I have to turn away. So I really don't blame patients who can't look or freak out a little when I have to poke them. Just don't jerk your arm away because that will guarantee another poke

I work in an ER and these are the types of dosage problems I have: 1. A child weighs 58 lbs and the doctor writes for 10 mg of ibuprofen per kg. How much do I give? I then go to the Pyxis and it comes 100 mg per 5 mL. How many mL's do I give? Additional nursing thoughts: Was the child's weight estimated by the parents at triage or did someone weigh him today? Can the child tolerate PO meds or has he been vomiting all day? Is the child allergic to ibuprofen/motrin? Do I need to ask for a 2nd person to come into the room with me to help hold the child or will the parent/s help? Is the child old or well enough to hold the little cup of medicine or do I need to draw it up? 2. A woman is have an AMI and the doctor orders Heparin IV bolus and IV drip based on her weight. She stated she weighs 184 lbs. You quickly find the Weight Based Heparin Orders paperwork. It states to give 5,000 units IVP and 16 units/kg/hour with a max of 2,000 units per hour. You go (more like run) to the Pyxis and find Heparin in 10,000 units per mL. How many mL's do you give for the IV push? Next you take out the bag of Heparin for the drip. How many units are you supposed to give per hour? The bag of Heparin is 25,000 units per 500 mL of D5W. How many mL's are you going to give per hour? Additional nuring thoughts: Is this patient on any other anti-coagulants and does the doctor know this? What is the antidote for Heparin? What labs should I be monitoring and would be the expected results of those labs? What meds are compatible with Heparin and D5W or do I need to start a 2nd line (duh!)? Does the patient understand why she is receiving Heparin? 3. A patient has a K+ level of 3.2 and the doctor orders potassium elixer 40 mEq PO. You go to the Pyxis and it comes in cups of 25 mEq per 5 mL. How many mL's do you give? Additional nursing thoughts: Is this patient on any diuretics? When should the next potassium level be drawn? What are signs and symptoms of hyopkalemia and hyperkalemia? What is causing the patient's potassium to be low? What is the patient's magnesium level? Should this be taken with or without food? I didn't intend for this to be a long, drawn out post but I wanted nursing students to see what goes on in the brain of a nurse when s/he is administering meds.