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Tomorrow I have a patient who is on telemetry. This will be my first patient on a cardiac monitor and I was wondering what I need to know. They use a 5 lead system and I think I will have to replace the leads after AM care. Also, what do I need to look for? I am confident I will notice Afib, Vfib, Vtach and G*d forbid- asystole, but what else should I know to look for. Is there something about a u wave indicating a prior heart attach? How do I document telemetry? Do I just include it in my new patient assessment then just document problems? Any advice you could give would be great!!! Thanks!!!:heartbeat

That's it! Thanks so much and that is a terrific website!!!!!

I think it was something like mosselles? She said it was used to stop the bleeding- does Mercurochrome or benzoin do that? I thought they were just to kill bacteria? It definitely had a strong chemical smell and had an iodine metallic sheen to the golden brown.

I was at an OB clinical rotation watching colposcopy procedures. What is the name of the thick golden brown liquid (begins with M) that the physician put on the biopsy site with a cotton swab to stop bleeding? I wrote it down on my clipboard, but it got wet and now I can't read it. Help!

No worries, Mate! I have Lewis as well, but maybe they consider that information more "diagnosis" and out of our sphere of practice, but it seems like that is the type of questions patients would ask a nurse "in the room". The only ones I have seen that are to be reattached later are the double ostomy cases, but I have only seen one and that was for a gun shot victim, not due to a disease process. That is why the lewis comments seemed very atypical to me. I was wondering if in the real world- disease is full removal, but trauma is reversible? I don't know.

Not to be judgemental, but if you can build a pouch for urine that doesn't leak, why can't you build a pouch for feces that doesn't leak? Just by the viscosity of the two samples you would think that it would be harder to keep a liquid from seeping than a runny or semi-formed solid. And no, my text book does not cover it that is why I asked. The text book makes it sound like the majority of patients would not have ostomies. It implies the only patient who would get an ostomy is someone who had rectal cancer or diseased rectal tissue, but I have seen so far that many patients without cancer, or highly placed UC or Crohns still get ostomies. The book says ""Patients with UC may also need to have a total proctocolectomy. In both situations the surgeon will form an ileal pouch anal anastomosis. If the anal sphincters are not diseased they can be left intact, if not the person will need to have a permanent ileostomy." I was just wondering why the book (which I know is highly theoretical) is so different from what I see in practice. I was wondering if EBP showed that leaving any portion of the intestine makes relapes more likely? pointed to the n is that the disease will spread anyway so might as well remove it all? Thanks for you help, you make me feel so welcome.

We are just starting our section on ostomies, but I have seen several in clinical settings. I have so many questions. First- why does a urinary diversion not drain out continually, but a fecal ostomy does? I think patients would much rather have to go to the bathroom every hour than have to strap on a bag of poo all day. I had a 22 year old guy with ulcerative colitis who refused the ostomy despite all the drs pushing for that option. I didn't say anything, but I can't say I didn't agree with him. I know I could not deal. Also, why is their so much variations between ostomies. Some are huge and protude, others are much smaller and only slightly humped. Is that surgical skill or what accounts for the difference? Also placement. I know that placement depends on which area of the intestine is damaged, but does placement site make some ostomies better or easier for patients? Thanks for any help!

This is what makes me nervous. At our school we are taught that you 1. Must always use Y tubing with normal saline. 2. You have 30 minutes to start a transfusion (not 15) 3. that the blood should transfuse slowly 3-4 hours. 4. use at least an 18 gauge needle to avoid RBC trauma 5. if you have any type of reaction to stop the transfusion and send the tubing and blood back to blood back and start a new bag of saline to dilute irritant. We also have a different schedule of vitals- before you get the blood, before you start transfusion, +15, +30, + 1 hour, +2 hour, +3 hour and after transfusion finishes. I am worried when we take the NCLEX that someone is going to get something wrong because we are all taught something slightly different!

Can "dying" be an abnormal "assessment? I am really confused because when he reviewed my concept map he made it sound like comfort care/ hospice was an actual ND. So I went home with my NANDA and nothing. My patient is mentally altered by the HEncephalopathy so I don't think I can put Grieving, Impaired spirtuality, of Ineffective coping. I was thinking "Disabled family coping" but I have pretty thin evidence to support it. All I have as a D-i-L coming by to say that her husband was really sensitive and she wanted to come by to see how her F-i-L looked before she would bring the older grandchild to see him. I asked her if she wanted to speak with a physician or a minister (at an Adventist hospital) and she declined both, but I don't know if that relates to any spirituality issues or she just was in a hurry with a toddler in tow. Any suggestions?

I have a pt with end stage liver and kidney failure. During the week they changed his treatment plan to that of comfort measures only. They pulled the NG Tube, stopped all meds other than for pain and stopped all blood tests. I have to do my concept map- what types of ND's would show that change?

I don't get how you go to nursing school online? If you just get your prereqs then have to transfer you might as well go to your closest cheapest community college. How do you take clinicals? This is a hands on profession. I worry you would spend all that money and not be able to get a job because hospitals wont want to train you.

The patient is in end stage liver disease, renal failure, hepatic encephalopathy, anemia, jaundice, hepatic portal hypertension causing E + G Varices all due to cirrhosis/ Chronic Hep C. He has SO many problems, but only a few that we are still treating so that limits what I can do for NDs because I have to have outcomes and interventions. For example, they are giving him lactulose to cause diarrhea to help waste base and get him closer to balance. Can I use diarrhea as a ND if it is something his treatment plan is actually trying to cause? This stuff is so confusing!!

As a newbie I appreciate the color system. I always feel like a perv trying to read nametags! I don't see the point of only nurses wearing a color. The only hospital I have clinic-ed at had everyone in uniforms- DRs were green scrubs (only if they were operating that day) or long white lab coats over street clothes. Nurses were in navy blue, Resp in red, radiology in black, speech and psych wore short white lab coats over street clothes. Physical therapy in "salmon" (totally pink!!) and I cant remember seeing anyone from OT. The only people I felt really bad for were the PCTs that had to wear these G-d awful smocks over navy blue pants. Yikes. But they were free, so that was good with what they get paid. We would always tell the patients- Remember we're all Navy Nurses! Except us student nurses that were dressed in so much white you could make a patient snow blind!

Can I put risk of aspiration? The patient was given an NG Tube for feeding because he was at risk for aspiration. Can I put that he is at risk for aspiration due to mechanical irritation of Esophageal Varices?

Does Maslow have sub-levels? In our school they teach us the Hierarchy of Needs, but it seems very general. Physiological, Safety, love Self esteem, self actualization- we never went into what goes on within a level. So I know you don't talk about relationship issues with a patient who is in physical pain, but how do you prioritize between needs in the same category?