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  1. Is your job testing serum or hair? If its the latter, heres some scissors, and don't forget your arm hair!!
  2. shiccy

    I refuse to be a punching bag - NO MORE ASSAULT

    I'm a person that is very good (most of the time) of telling a patient what we're going to do so that they can prepare themselves accordingly. I have been hit less times than I have fingers on my one hand, never has it been more than a jab, and MOST of the time unintentional. My response every time is, "I know you didn't just hit me." I stop what we're doing in the position we're in (be it on the patients side, etc), look them straight in the eyes and say WITH authority, "You will NOT hit me again, do you understand?" I've never had a repeat offender. This also works well for those who are beligerantly cussing for no good reason. I had a confused patient that was cussing up a storm while I had a female RN helping do patient care. I let him get a few choice words out, and then finally said, "Look. We don't talk like this here. There's ladies here and they don't appreciate it. Stop cussing right now." He threw a couple more out, and a "who made you the boss" to which I replied, "We're going to go over this again." I had him a few times prior but this was the most lucid night he had had in a long time (pancreatitis r/t EtOH), and after that he had please and than you's coming out left and right.
  3. shiccy

    Colace and Senna BAD drugs???

    Almost every trauma we get is put on Senna-S when taking PO b/c they are almost always on narcs and/or on bedrest (two hits for the ileus train)... Sometimes we enact a neuro-bowel routine (MOM on day 1, Ducolax day 2, Day 3 is bowel rest, repeat) if they haven't gone for a while and the docs are concerned. On a side note, has anybody tried crushing these freaking things for a person that is getting everything per NGT? AFAIK they're not contraindicated for crushing, but holy heck! The Senna A&B (I think) come in liquid, but the S does *NOT*. Such a pain (and waste of 10 minutes at minimum) As far as the "A" drug mentioned before, is that new? I've never even heard of it!
  4. shiccy

    Carry a stethoscope without hanging it on neck

    I take mine off when it gets heavy and place it where I plop for the night for long term charting purposes... We have computerized charting, but it's a pain to log off and log back in b/c it takes >3 minutes each time (multiplied out it becomes ridiculous). We have enough computers for each RN to have their own station on night shift, so sometimes between assessments my stethoscope comes off. Typically, though, it stays around my neck as it really doesn't bother me there. I've been wondering how well those clips for your sides work, but haven't wanted to pay $$ to get one. Unfortunately none of the inservices I've been to have given them away for free that I've been to yet
  5. shiccy

    Wrinkled Ear Lobes means....

    http://www.google.com/images?um=1&hl=en&biw=1333&bih=657&tbs=isch%3A1&sa=1&q=ear+wrinkle+cad&aq=f&aqi=&aql=&oq= I had to google what you were talking about. I had never heard about this before! From what they're talking about, the older gentleman with the crease near where a normal earring on a woman would go is what they're talking about. I'll have to look for that incessantly now! The only thing *I* look for is clubbing of fingers. I'm sure you guys/gals all know what that is, however it's indicative of chronic hypoperfusion, though it's a really late sign. The only problem is that my sister has the start of finger clubbing, has no health problems, and is only in her 30's so obviously both of these signs aren't 100% accurate :)
  6. shiccy

    Heparin Flush for CVC

    It's actually quite rare to find places that use heparin these days. From what I understand case studies have shown that using heparin to hep-lock vs 0.9NS has no advantages and can actually be very bad for a patient if the line is FLUSHED without aspiration, especially in those patients with coagulable states (this is what *I* learned in school). The disadvantage to 0.9NS is that in order to maintain patency you must flush Q12 or Q8 with a predetermined (10ml typically) amount of saline. I have never worked at a heparin-using facility, so I don't know if those people have to flush in the same fashion or not. Finally, all of our dialysis catheters are "locked" with Sodium Citrate now. I am not 100% familiar with this anticoagulant as the dialysis RN's are the ones that dwell the med in the catheters, however from what they have told me is that unlike heparin, when it's disseminated in the blood stream (aka if it was inadvertently flushed through the catheter before aspiration on accident, or if the med was unable to be removed via aspiration), it inactivates nearly instantly so there's little to no bleeding risk. I don't know if this is the truth, but from what they've said this is the reason they've made the switch. ... It keeps the line anti-coag'ed so it remains patent, but also is lower risk than 10k unit dose of heparin. Ps- I'd use your school's CINAHL access to see if you can find the studies I'm referencing. I no longer have CINAHL or I'd try to do it myself.
  7. shiccy

    How to handle my father's possible elder abuse

    First off, as someone else posted, Haldol is *NOT* contraindicated in the elderly, as with *all* antipsychotics/anxiolytics/narcotics/etc it should be used under extreme caution and with strict monitoring. It's better to have a closely monitored patient WITH Haldol than a person without that is throwing punches, abusing staff, and possibly hurting themselves/loved ones. To be quite honest, many if not all practitioners will use Haldol hands down first choice over any other benzo's. The main reason is it just plain works for those that you can't get calmed down. The other is that benzo's actually can INCREASE anxiety/restlessness in those that have dementia. As for the original poster, I'm sorry but I'm not going to be any help in this circumstance other than saying that I'm sorry this happened to your loved one. It's hard to go through the mental anguish on BOTH sides with dementia/etc. This being said, this is kind of a "medical advice / legal advice" thing I wouldn't touch/comment on with a ten foot pole (and quite honestly dances on the lines of violating the TOS asking "what you should do" about possible "abuse" or "negligence" of a loved one.) I'm honestly quite surprised the topic is still open, because I've seen many other topics closed for much less, but all done appropriately so. I guess the only thing I can suggest is to ask questions. Also an INR of 2.3 is therapeutic for most patients. This said, please look at the common side effects for medications he's taking. Trauma doesn't have to be very much when you're talking about altered coag times. Hope his condition improves!
  8. shiccy

    How I miss my beloved text-paging

    We have text paging as well. We don't have computerized ordering yet in our hospital, so when we text page, what *I* would do is put a room number and the reason for the page. The PA's in house would make a decision on whether it was important or not to call back immediately or "asap". It creates less aggravation for them when they call back for something unimportant between stitches. A room number alone is not a violation. Name, room, and MRN/DOB *is*, though IIRC txting is encrypted so unless the pager is lost it shouldn't matter.
  9. shiccy

    Why apologize to doctor when calling?

    This is kind of random, but this is the reason *I* do it. When I talk on the phone, I talk fast. I don't call to bullsh*t with anybody (unless they're already up). This is for multiple reasons, but one of many is a lot of docs don't WANT to listen to you ramble / talk slowly, but another is that I've had a few docs fall asleep, so by talking quicker gets your point across when they're still "with it". Since I talk quickly, I give them that "sorry" because it orients them to MY voice and MY way of speaking. Every person is different, but those few extra words will get them into the 'know' of how you speak (accent/no accent/pronunciations of certain things, etc.) Finally, if you were to wake ME up at 2am because your patient hasn't moved his bowels, I'd be FURIOUS, but perhaps a little less than that if you said, "I know, I'm sorry, they insisted".
  10. shiccy

    Do Nurses Still Make *Real* Beds?

    Coming from not only ICU but also vascular unit, it would be simply unrealistic to do this for our patients. We look at feet/use dopplers every 30 minutes and then every two hours until transfer to the floor. It's just not feasible to do hospital corners with these checks.
  11. shiccy

    What do you do if your friend is "THAT patient?"

    When I was first reading your post I was asking myself, "I wonder if you've made it clear that what she is doing is ridiculous?" I guess the way (if you're interested in furthering the relationship) is to NOT talk online, but on the phone and just give her a, "Here's the deal. This is really bothering me, and I want you to hear me out." The first thing I would do is make sure she knows that what she's doing by video taping / snapping photos is in some places absolutely illegal, but also exceptionally rude. Everybody has the expectation of privacy when they're in the hospital, and *I* have the expectation of not having people come find me at my house after taking care of their loved ones. Posing the question, "If you were at work, would you find it appropriate for people to snap photos of YOUR name badge?" The ultimate finale to your conversation is this: If she refuses to listen to reason, refuses to change her way, and YOU find it unacceptable and not good for your mental health (I wouldn't think it would be), then I would definitely tell her, "I'm sorry, I understand you have health problems, but from what I can see you're trying to blame somebody else for your issues. You need to realize these are people that are trying to help you, and the only reason you're getting the impression that they're being jerks is solely because you're being an a**hole to them first. Very few people are in the nursing or medical profession for reasons other than wanting to help others get better and further their lives. Until you can realize and accept this, and stop being such a horrible person every time you're admitted to the hospital, for my mental health I'm not able to be friends with you. You are the exact reason why some days healthcare professionals have a horrible day at work. If it wasn't for people like you and you're disparaging attitudes towards others and having the mental image that we're there to attempt to hurt you on a daily basis while admitted, then our jobs would be so much more enjoyable. Please revisit your attitude, check it at the door when you get admitted, and maybe realize that being a bit more humble and less of a bi**h is a nice quality to have. Until that time, though, I don't really think I have anything in common with you anymore. I'm sorry that God gave you an illness that you are disabled from, however had you not had treatment from this disease, you would probably be dead right now. If you are thinking this is a proper and amazing alternative to the way you live your life right now, then make yourself a DNR-CC or DNR-CCA and leave it at that, and leave it in God's hands." Alternatively you can ask her to see a psychologist, however I highly doubt she will. I'd never EVER be able to tolerate that. And when I'm confronted by MY friends that DO have disparaging comments about healthcare, I fully listen to their complaints, and then give them both sides to what COULD have been happening. If they refuse to listen to it, I change the subject and move on. Finally, you don't need toxicity in your life. Cut that complaining jerk out of yours. You have to deal with enough of that s**t at work yourself.
  12. I guess maybe it's because I'm obviously in healthcare, myself, but if I didn't understand something CURRENTLY I would say in any language I could muster, "I have no freaking clue what you're saying or what that says." Others said it's prohibitively expensive to employ interpreters for the hospitals for all languages. We have a system at our hospital called that MARTTI (It's either 2 R's or 2 T's) that allows you to "dial up" via VoIP and video/teleconferencing to interpreters via the internet. You can get ANYTHING interpreted. It's actually kinda nice. It costs $x for the machine, and then $x for each minute (I think). There is also an option to pay $x per month. It's a computer on wheels w/ a battery backup and a webcam. Some interpretations are done sans video, some with. Many interpreters live in their native countries and teleconference whenever. Prior to MARTTI we would call an interpreter in the middle of the night, pay a ridiculous fee, and have to wait upwards of 3 hours to communicate effectively to the patient. Huge improvement to wait 20 minutes for the machine to be brought up. When I say *any* language, I mean any. There was an Middle Eastern individual that spoke a SEVERELY remote dialect of their respective language. We had, on staff, four people that spoke her native language, but being separated by the Middle East by a generation or two, the language had changed enough to where nobody could understand. MARTTI booted up, connection was made to the appropriate translation expert, and *bam* good to go. *I* used MARTTI to explain a procedure to a patient. While the procedure was not a pleasant one (bowel prep for colonoscopy), nobody spoke this individuals language. When MARTTI was brought into the room and the translator said, "Hello" in the foreign language, (and after being sans verbal communication with staff for DAYS), the patient smiled for the first time EVER. Until I described what we were going to be done, of course
  13. shiccy

    (RN) Salaries

    There are literally at least 10 different threads on this. Use your google skills to search for your specific area, and/or please please please use the search function on the boards
  14. I'm personally torn on this issue. I agree that people should have to learn the language, but that said *we* aren't trying to learn any new languages in our gradeschools ourselves. Something that is done in EVERY other country. Current stats state that the USA is second in number of Spanish speaking people in the world. If this is the case, we SHOULD be learning Spanish and be able to speak it to near fluency. In order to get a work visa or obtain citizenship, you HAVE to show you are 'fluent' in English. This said, what the testing standards and/or if things are fudged frequently I don't know. I think there needs to be a point in time where we say, "Ok this is ridiculous. If you want these instructions in Spanish, French, Swedish, etc. then you NEED TO TELL SOMEBODY." Silence is NO excuse for stupidity. If you don't voice the need for something in a different format, then it shouldn't be listed as a "healthcare downfall", but more of something that you need to work on yourself.
  15. shiccy

    Tums makes GERD worse?

    Ca++carbonate is well known to give what called reflexive dyspepsia. That's why on the commercials for things like Zantac they tout how the relief comes quick and stays away rather than other "chewable" alternatives. Personally it gives me extremely acrid eructations and then any reflux I had comes back just as bad if not worse a few hours later. Ps - I'm not recommending any medications over any others, but the reflexive dyspepsia was explained to me as such: Your body realizes that the acidity isn't where it wants to be when the Ca++ carbonate starts working, and turns on MORE pumps to return pH back to where it wants to be, sometimes not turning these additional pumps back OFF right away. Hence worse than when you first started.