nursenatalie

Our hospital closed our surgical floor to admissions on Thursday. The rationale was that they anticipated a decreased census because of the holiday. We joined our Orthopedics wing on Friday afternoon bringing 10 patients with us. Crazy thing is that we now have 15 of our patients and surgical patients are all over the hospital including adults with abdominal pain admitted to the pediatric unit. Anything like this ever happen where you work?

I wear unisex scrubs with only two pockets. One on the left chest and one on the back. I don't put anything in the back but can fit everything I need in the one pocket; two blue pens and one red, scissors, tubex,mini dry erase and permanent marker, alcohol pads and chapstick. Hemostats and tape clipped to my waist. There are times that I may put more in my pocket and it is a running joke that I have the neverending pocket, like a clown car.

I would insist on speaking to doctor. Don't know about this doctor but we frequently have doctors speak to family members before a procedure and they always call. The doctor is the one to speak to you about risks etc. but we do this procedure often. Did your dad have a fem-pop bypass? Or ileofemoral?

I can't imagine that being color blind should affect your ability to start IV's. I think you are looking with your eyes for a vein and that may be the problem. Feel with your hand and finger. The veins you see, unless the person has ropes aren't always the best veins. Make sure your technique is good and practice, it is the only way to get better. See if you can go to day surgery and start IV's.

Please, aspirin is an anti-platelet drug and doesnt significantly increase ptt. Like I said, if the patient is having clinical symptoms that require heparin then best to begin heparin and adjust dose for efficacy. Worrying about a baseline ptt on a pt. who has not been on heparin therapy in an emergency situation instead of beginning treatment would infuriate some.

yes, if the surgeon orders it. Had an order from the medical doc to give suppository via new colostomy and called the surgeon to make sure it was ok and he said no. If the surgeon himself ordered suppository or enema via colostomy then ok.

Our surgeons wouldnt give a rip what the ptt started out they would only want to change rate based on 6 hour ptt. Too late to get a baseline if you've already pushed the bolus. Some docs would be ticked that you took the time to draw a lab for baseline that wasnt ordered when the clinical picture must obviously show this pt is not anti-coagulated enough or else it wouldn't be an emergency to get the heparin going.

We have to witness waste with another nurse. Form comes with patch, we must cut patch in two and put in sharps container.

Funny how things are different, we allow pts to drive after 24 hours. I was back at work in three...would be funny to be able to work but not able to drive yourself there.

As a general rule with only a few exceptions, I would not give a sleeping pill past 2 am. I work on a surgical floor and the day time is reserved for walking and therapy so pts need to be as awake as possible for that. Ambien and other sleep meds are given with the intent to make the pt sleep and this is the only reason they are given. Although they may also make the pt go crazy, disrobe, pull out their IV and run down the hallway naked, that is another story. Other meds are given for nausea, itching or pain and have the side effect of sleepiness. There are few exceptions but generally no reason to give a med to make a pt sleep while the sun is shining.

We rarely have any stay overnight. Usually when pain and nausea are controlled and they can pee they go home. Average 2 hours. I had a lap chole last summer and left after 45 minutes, I met criteria and didnt want to stay a minute longer.

I personally agree with your charge nurse. If the patient is not eating then you are probably giving them sliding scale as well as the lantus, right? I would prefer to manage them on an as needed basis than give a long acting drug that could bottom them out. Face it Lantus lowers blood sugar, did it need to be much lower? Scary thing to know their blood sugar could bottom at 2 am and you may think they are sleeping peacefully while they slip into a diabetic coma. You wont convince me this patient needed lantus. Ultimately clarify order now that pt is npo but dont care who ordered it, the md is not going to be the one monitoring the pt through the night...I would not give it with that blood sugar.

We allow no visitors in PACU. There are no walls between beds, only curtains, and the report between anesthesia and nurse is verbal so I think it would be difficult to maintain patient privacy(you tell the md to lower his voice.) Patients dont need visitation at this time they need to be monitored. Peds are the exception, and only exception to this rule. If a patient is stable enough for visitors then they should be going to the floor. Family gets to talk to surgeon while pt in PACU, and gets update from nurse after 30 minutes so they get their reassurance.

Here goes... 1.Type of nurse? Surgical Nurse 2. How many hours u work per week? 36 one week, 48 the next. 3. How many years of nursing? three 4. What Shift: Day, Evening, nights, or weekend only? nights 5. City and State Western North Carolina 6. Average 2 week gross pay $1900 after insurance, tax, retirement and foundation contribution

yes, definately make sure the earpeices are facing forward. I am embarrassed to say this but it is the truth: I was out of nursing school roughly six months before I realized I had earpeices turned the wrong way! I was very embarrassed, it wasnt that I didnt hear things before but wow I could sure hear them afterward! I usually tell this story to any new grad I am orienting. It makes them a little less timid about asking me questions. I am sure they think if I spent six months with my stethoscope turned the wrong way I am not going to laugh at them!

Don't work in OR or anything so this doesnt affect me as much but seems like a sterile pre-packed syringe of frequently used meds would come in handy. then you could open the package and place it on sterile field? They may not make anything like this at all but it seems like it would work. Next thing you know JCAHO will have us going under a hood to withdraw meds into syringe!

Not specifically for diabetics, but we have some surgeons who will use it for retractable nausea after all other anti-emetics given. It works. Given as one time order usually. We'll use a sliding scale to control blood sugar, lets take care of the n/v first

In real life I program it on a pump and run it as such. In a couple of emergency situations when I had a patient crashing and primary wide open x two lines and need to get abx before OR I have put abx on a primary tubing and piggybacked into primary line and regulated them this way.

Ok, this illustrates how different things are in facilities. We always run TPN and lipids in same port (dedicated) with lipids connected below filter. I would not interrupt TPN. We use mostly triple lumens, dont know why you would reserve these for the very sick...most people have the potential to become very sick.

....AND YOU ARE A NEW GRAD:selfbonk: ???????????????

Ok, if you have a ventilated patient and are titrating dopamine then how is that different from ICU? You are taking a big risk having five other patients too. I don't care how good your NA is, they don't have the license to lose...you do.

Wow, please don't stop TPN. Ok, assuming this is a triple lumen CVL (why do they make any less) I would run TPN and lipids in one port together and dedicate this line for TPN. The second port for abx and the third for blood products. Unless there was an urgent need for abx asap then wait for blood to transfuse.

You are very mistaken if you think that MA's are in no way shape or form a nurse. This is what you said that hit raw nerves...YOU are in fact mistaken for thinking that you are some shape or form a nurse. Not trying to be unfriendly but your training does not qualify you to call yourself a form of a nurse. Good luck in your studies, after you have a license you will see why we are so offended.

Ok, I may not be the one to answer your questions as I am not a L&D nurse. I have, however, precepted many people. Your question "help me manage 2nd stage" seems to be only the tip of the iceberg. I am sure there are many clues that signal different nurses when to prepare for delivery...ask everyone you work with what prompts them to get things rolling. Sounds like no one was in charge when you had the delivery without md on bed. Talk with that preceptor and tell her that you need clear instructions of what is expected. If you had no instruction or hint on when and how to get things rolling or how to do bp cuff then you had no business being in charge of the situation. How far are you into orientation? Sounds like your process could use a little organization. If you are early on then don't give up, and take responsibility for learning what you need to. Keep a notebook and jot down things you learn each day and reference back to it. This is a good place to put things such as Dr. X wears size 7 gloves and prefers this, and really hates this. Don't assume who is doing what, that should be designated early on. It only takes your preceptor a minute to say "this delivery is yours, I'll step in if you need me." Be proactive, ask questions until you get an answer, just be sure you listen and learn from questions answered.

No experience in changing fields personally but have worked with others who have done it. It is definately possible. Just remember when you change specialties (if you decide) to do your research. Nothing irks me more to orient someone who for example only has long term care experience to our surgical floor and find out that they expect me to teach it all. I think someone switching fields should expect to crack open some books and refresh themselves some. This may mean refreshing yourself on lab values, procedures, etc. If you decide to switch and take some accountablility in your learning you will do fine.