danamobile

I think money is a strong motivator for those that thing aspiration is not needed. Its because they KNOW a vein will be hit, its statistically going to happen if you inject enough people, and medication is wasted. Well boo hoo to them, do what you were taught and stick to your guns ALWAYS ASPRIRATE. Its your license after all, shame on them for telling you otherwise!!

That's the best way to think of it-- preload, afterload, contractility-- EXACTLY how things run where I work. Fill it, squeeze it, then pump it more to get what you want... perfect! Glad you said it like that!! :)

GREAT answer!!! Not confusing to me!!! I need to keep you in my back pocket for when I get tough questions

That's awesome... and here during school I was doing homecare pulling up stockings and doing blood sugars for the forgetful :)

I work on a GI unit currently (and casually back in the ICU) and its weird to see people with a normal Hct. I mean, the patients are mostly dehydrated due to their diarrhea/alcoholism of sorts, but many have a GI bleed so we really don't look at it too much... also a lot are in hepatorenal failure and we don't push the fluids too often. I really don't know much about altitude and different levels in the blood. I'm going to read up on that now :) Ok, so it appears that Hct increases with the altitude, and can be quite high for people that live there for a long time to accomodate for the lesser oxygen in the atmosphere, more RBCs are available.. but you said that you see only LOW Hcts?? What exactly is confusing you? Maybe all of your patients are all bleeding out? lol Lets talk about this some more shall we? I'm at a fairly high altitude as well (going to see exactly now) as I live in Alberta, Canada.

sounds like these techs have a wide range of things they do... where I used to work, we had one person doing stocking on day shift mon-fri, and wasn't replaced if they werent there, and also helps with transports, no more. We also have Nursing Aides, scheduled 3 per 30 patients, and often only 2 as also not replaced often, and each one had a section. we have to do all care for the patient, including assist with wash. Like someone else mentioned, you miss things when you aren't included in the wash. I like knowing each aspect of my patient-- if not, I wouldn't be in the ICU!!! Its nice to have help, if its consistent and actually helpful. I haven't had a lot of help, so maybe I'm naive!! :)

I have use vasopressin a lot to decrease the amount of levophed used, successfully in a lot of patients. I knowthe doctors I work with don't like using high doses of levophed to potential SURVIVORS because of the peripheral damage it can cause.. but is ok with a last stitched attempt for survival. I also agree that more fluids should have been tried-- even though they are a cardiac patient, increasing pressors with no positive change to BP is a good reason to try more, fill the tank like another said. Its really no hurt at that stage of the game. I also question the lasix. Its always hard to see someone die especially when you aren't confident with what happened, you did the right thing and are talking about it.. keep talking about it, too. You did what you were asked, you cannot do any more than your best, remember that!!

1) Full vitals would be good to know. You're asking if the crappy waveform can be from the hematocrit? Hematocrit is a number that is reflecting the % of RBCs in the blood. If its low, you have less cells=hypovolemia. If his BP low, HR up, and we can identify he's in any form of shock with poor perfusion, (specifically hypovolemic shock) then there could be an association with the hematocrit and the Sp02, more of a relationship (poor perfusion due to shock, caused by hypovolemia) 2) the sp02 is the saturation of oyxgen to the hemoglobin, if the saturation measurement is low, there is more room for more 02, therefore give it. There is no shame in giving a patient a few more liters 02, especially if they are having dyspnea, or are symptomatic. I've always been taught that if someone has a very low hemoglobin, even if they are showing high sp02 measurement, always place them on 02 for comfort and to ensure that there is as much oxygen as possible for every hemoglobin they absolutely have!!!

oh man that is not good nursing practice... lazy if you ask me!! I honestly hope she didn't know better, better to not know and do than know and ignore, although both serious I hate hearing this kind of stuff! I'm glad you know your reasoning...

I worked in a toxic ICU environment for a year and it was pure heck. If there are many bad apples where you are, consider changing units, YES. Don't let what they say get to you, I let it get to me and I ended up leaving the ICU altogether, and it honestly made me very sad, I felt I let myself down, but I couldn't take the anxiety that the nurses around me made me feel!!! It was out of my control, setting me up for disaster, RIDICULOUS!! I know how you feel, and hypocrites behind your back... you're a good nurse, and you know it! They are not doing themselves justice treating anyone like that, they'll get their comeuppins for that!! YOU BETCHA!

makes me sick. plainly just very very wrong I'd look into spending the $20 to find a new job...

Stroke volume is like tidal volume, which will always vary because the lungs will expand different with each breath-- and the heart will not contract exactly the same with each beat, and the CO will not be the exact same with each contraction... maybe I need a clue stick too.. :) good luck!!

I think its no one's business but your own why you'd want to try something different, but like someone said, the truth is good, no reason why you should hide from wanting change. Heck, I want change too, and I'm going for it, but nursing related as well (but certainly will be a pay cut starting my own business). Life is about living right? Certainly keeping up with your hours in case changing your mind, would be good to look into though, good luck!! Money isn't everything, and if its not to you, who cares what the other people think!!!

I think its hard to rotate shifts, I've worked on a 6 week schedule, half days half nights and didn't mind it (as a young new nurse) then in the ICU, we had 4-days on, 2 days, 2 nights, then 4-5 days off, rinse repeat. I HATED IT!!! Switching from nights to days every week was the worst thing ever endured!! I know finding staff for evenings/nights is always a problem, but there are always people that just love working straight eve/nights too, as there will be for days-- but there are always more wanting days than the latter, its the mid day 3-11(or similar) range that is hardest to fill. Rotating makes a fairness, instead of having potential employers look elsewhere. Check your union rules, I know where I am, we can ask for a change to our rotations and cannot be unreasonably denied (Unfortunately during our shortage of nursing that is being ignored right now, nothing is legitimate) but I won't get into that. I found in the ICU I was able to trade enough of my day shifts to nearly work permanent nights, which was so much better than switching (and I loved nights then)--wow how things have changed after 5 years of nursing!! (I prefer not working at all now ha ha j/k :))

Very good point, I never thought about the 'exam with someone present'-- I think that's BS anyway. I mean, you don't know what's really going on under the drapes (No pun intended)!!! If there is a will, there is a way to do what negligent people do. Professionalism should count for something!!

Where I work we have 'education pay' where diploma RNs get an extra 0.75/hr and degree RNs get 1.25/hr on top of their base pay--so it might be quite possible there will be a difference in pay depending on where you are! (I'm in Canada though)

I was exposed to blood from my patient into my eyes. I was trying to loosen a bandage wrapped with kling wrap with saline as blood oozed to the outer wrap, and it sprung loose when I tugged and up came the fluid. I can't say I know how you feel but I was very frustrated at myself for what I did and what it could impose on my health. The mouth has a very very low, NIL, transmission rate, it would be like kissing someone with HIV. Although you may experience some grief with the medications, its taking one for the team for the long haul. I know you will be just fine, just hang in there.

The difference is not IM to subQ, its IM to IV---and if you do not aspirate you cannot possibly know where you are injecting, it it hit a blood vessel or not. But you know that its best practice to aspirate before injecting and that's the most important thing. If you see someone doing anything you don't feel comfortable with, ask a charge nurse or supervisor that you're working with and maybe they can give you some insight on the matter, or deal with it appropriately.

I was in a similar situation myself as a student, and I find a lot of the older nurses have not been shown the ventral gluteal landmarking (that I've experienced). Like the other poster said, stick with your guts, and you will have the courage to speak up for what you've learned-- it may be different, but if you have the reasoning behind it, you can judge for yourself-- is this good practice, or is this BEST practice? .. and ALWAYS aspirate, otherwise, how else will you know you are not giving it IV? Don't lose any more sleep over it :) You sound like me.. I lose sleep all the time, and its just not necessary!!!!!

I agree with the writer above me, and have had the same issue with patients not remembering, BUT with a great BUT BUT BUT too... I find that a lot of nurses are cutting corners these days, and I find too, some nurses do 'bare bones' nursing, or some lack education to know what to educate patients on. How can you educate when you don't know yourself? I say-- do what you've learned and do best practice. If a patient tells you something, ok, grain of salt indeed, but if you SEE a nurse practicing poorly, you need to let someone know or address the issue. I think lack of education at discharge is a negligence--and costly for repeated admissions. I hate to say this (I'm not a pessimist by default), but a lot of times the patients are there for a reason (a lot self inflicted abuse), but it doesn't mean we can give up on the patients-- its always our job and our business to tell them how it is!!!! Good luck :)

Maybe just a slip of the fingers (and pardon my pun ;P), but its 'rouses' not 'arouses'. I write something very very similar to this one, as all information is objective, and is observes, not an opinion of judgment. My eyes can be closed and I very well might not be sleeping. I always write if I hear snoring as its a good way of saying "hey, this nurse actually noticed someting with that patient". If everything sounds too generic, I don't feel my butt is covered enough when a picky lawyer is in doubt (its all about saving our butts for the day we go to court, right?)

hey there, i hope you find what you're looking for in edmonton, it's a nice city, but you gotta shop around, so i would recommend you do some major looking before you come... the housing market is "just" starting to fall in prices as they skyrocketed in prices in the last year making housing very unaffordable for many, and the renting availability very small for those that can't buy. i would suggest looking at housing away from the city core, there is more lower income areas in the core (although i live in one area where there are high renters but not as many houses). I'd suggest looking into the new development into the west side of the city, southwest (these are new, lots of families). Even the east, and east central (places like bonnie doon and capilano) are older neighbourhoods with houses made in the 50s-70s, but more reasonable and safe areas. There is a lot of new development in the far north as well, but i am unfamiliar with the north end of the city myself in regards to housing. if you are of a certain cultural decent, there are areas of the city that have more of certain cultures if you would be more comfortable with that and thats what you're looking for as well, as an option to throw that out there too :) hope that helps!! dana

thats a great idea! but i guess if there is going to be longterm venting, they trach a lot quicker now (where i am anyways). but just to clarify, i think when they mean lavage, they mean water straight down the hatch, i think when you clean the tubing *most* of the water goes into the suction equipment.. does anyone know for sure how much doesnt go down the lungs (if at all) and cleans out the apparatus? glad you enjoyed it! :)

if you can inflate the balloon by blowing, then you have mad skillzzzz

if you can inflate the balloon by blowing, then you have mad skillzzzz