GatorRN

Yes, I agree, head to toe assessments and charting have always worked the best for me too, as far as not leaving something out. You can always make yourself a little cheat sheet on the back of a card or something to refer to when you are doing your charting. Such as: Vitals LOC (a&o x3 etc..) Eyes (perrla etc..) Lungs (clear bilaterally etc..) Abd (soft, non-tender, BS active x4 etc..) Pulses MAE (moves all extremities equally etc..) IV's (location, type, size, fluid, rate etc..) Foley/Drains (16F FC draining clear noncloudy etc..) Skin Assessment Sequentials/Teds Safety (bed low, side rails up x2 etc..) This is just a rough example. I'm sure you'll come up with something that may work better for you. Hope this helps a little. The more charting you do over time it will become second nature to you.

I'd say especially as a student to invest in a nicer steth, if your budget allows it. As someone else mentioned, it's hard enough as a student to know what it is your suppose to be hearing. A better scope that you hear clearly with makes different sounds a lot easier to distinquish. I use the Littmann Master Classic II, and absolutely love it! I would suggest getting it engraved and using one of those tubing covers to help it to not walk away so easily. I would also suggest staying away from a black one, they do have a tendency to walk away more often.

Check out: http://www.homestudyce.com. You can do by mail or online. I've been using them for yrs. They have great all in one offers which cover several courses at a very reasonable cost.

congratulations on passing the nclex!!! way to go!! some other questions to think about: what are your strengths and weaknesses? how would your former coworkers describe you? name your 3 favorite and 3 least favorite things about your last job? if you witnessed a coworker being abusive to a pt, what would you do? tell me about a time you had a disagreement with a coworker, and how did you handle it? ___________________________________ go gators!! :yelclap: 1/8/7 ~ 41-14 :w00t: national champions!! :w00t:

i've always found it easier since i'm doing a head to toe assessment, to chart from head to toe. by doin so all systems are covered. such as: vitals loc/a&o eyes/perrla skin/dressings lungs abd pulses mae or not any iv's, o2, ng....etc foley/drains teds/scd safety....bed low, rails up x2 etc... hope this helps...this way has just always been easier to remember for me, rather then breaking down systems. ________________________________ go gators!! :yelclap: 1/8/7 ~ 41-14 :w00t: national champions!! :w00t:

congratulations nurse clee1!!! welcome to the rat race....lol _________________________________ go gators!! :yelclap: 1/8/7 ~ 41-14 :w00t: national champions!! :w00t:

yes, too many to count. i agree she probably didn't want an incident report done because the stick was her fault. i would definately write up an incident report and go see employee health to be checked out. i can't believe she said policy was to watch and wait.....unreal. ________________________________ go gators!! :yelclap: 1/8/7 ~ 41-14 :w00t: 2006 national champions!! :w00t:

you're absolutely correct, we are entitled to our opinions without getting scolded or attacked. ___________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

as i said before, one can't come here and expect 100% agreement from others that respond. i didn't say anything negative, i simply stated my opinion. you stated, "adequate nursing care is taking care of all your patients." if you are blowing off your pts who are suffering in pain due to some preconceived misinterpretation of the pts right to have pain relief, then in your own words, adequate nursing care is not being given. not everyone is drug seeking and all pts have the right to expect adequate care. i have no problem taking care of my critically ill pts right along side of those who need pain meds. so, before you tell me to go work at the pain clinic, how about you get more experience under your belt than the one year that you have, work on your time management skills, maybe take a pain management seminar, and come back and talk to me in about 10 yrs or so. an inpatient bed is the place for all pts who need care. too bad if that statement ruffles a few feathers. it is the truth. not all pain can be managed at home or on an outpatient basis. there are those that come into the er with unexplained abd, chest, head pain etc...that need further diagnostic testing done and pain relief in the meantime. they can't all be kept down in the er until a definitive cause can be found. i never said that i was a better or more caring nurse, those were your words. isimply have empathy for pain sufferers, and believe they have the right to relief without being put on the back burner so to speak. in addition, i'm not one who's quick to label a pt a drug seeker. also, i seriously doubt that a highly educated, experienced physician is going to admit someone with no good cause, just for a "legal fix." i can only deduce that you have no personal experience with severe and/or chronic pain. consider yourself lucky in that aspect. if that day ever comes for you, you better hope that you have a nurse with empathy and a clear understanding of the importance of adequate pain relief. now, if you are finished with your personal attacks and are through hijacking the ops thread, have a nice day. _________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

if by chance this was directed at me, i don't need anyone to speak for me. i can and do speak quite well for myself, thanks. also, just for the record, i, personally, was not "judging" the op for her comment. i was simply stating my opinion regarding the subject. when a person comes to a forum such as this they can't and shouldn't expect every other person to agree wholeheartedly with their statements. nor was i "lying" when i said i had never been enraged at a pt who requested their prescribed pain meds. sure we all get stressed out from time to time when we have too much going on, but "enraged," not me. pts who are in the hospital "who have no other problem except unresolved pain" have just as much right to expect adequate nursing care as the next person. their physician likely admitted them to determine the root cause of their unresolved pain and attempt to relieve it, that's where we nurses come into play. my post was also to point out that many ppl don't wear their pain on their sleeve, and may not display visible outward signs of pain. while at the same time my have vitals wnl and still be very painful. not everyone is going to curl up in the corner writhing from pain. people in general have varied levels of pain/pain medication tolerances. the whole concept of pain management is to find a therapeutic level of meds, along with treatment modalities to allow the pt to function, and have some sense of normalcy in their lives. someone else said it's sad that pts feel they need to act a certain way in order to get their prescribed pain meds, i definately agree. it's very sad, indeed, that people have been programmed per se to display certain actions to make their pain appear believable. as far as others who may be talking to people, watching tv, walking around, doing puzzles, or whatever, perhaps they are doing such things to distract themselves from their pain. distraction can be a very good coping technique to many. as i said before, pain is what the pt says it is, plain and simple. it is not our job to pass judgement on our pts. it is our job to give good nursing care and comfort our pts with whatever means we have available to us. if that involves giving them prescribed pain meds when they request them, so be it. ________________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

no, i have never been enraged by a pt asking for their pain meds that have been prescribed by a qualified physician. a pts pain is what they say it is, plain and simple. i am a huge advocate for adequate pain management. i would never withhold or judge a pt for requesting a pain med. i suffer with chronic pain myself, and can be experiencing mind numbing pain and most ppl wouldn't even know it. over time you adjust to it being a normal part of your every day life, and show no outward obvious signs. if my pts ask for their pain meds, i give it to them promptly without judgement. it's our job as nurses to care for and comfort our pts with whatever means available to us. if they need a bedpan, they get it. if they need a blanket to warm them, they get it, same difference in my eyes. not everyone is "drug seeking." who are we as nurses to make such a declaration? i have taken many pain mgmt classes. i think every nurse should be required to take a class in pain mgmt. many of us suffer from a lack of knowledge and training in this very important area of our job. in addition, i have a very clear understanding, from personal experience, what suffering needlessly can do to a person. if the pts physician has given you an order to medicate his pt for pain, why let a pt suffer needlessly if we have the means to give them relief? it's no skin off my nose to give a prescribed pain med to assist the pt to be more comfortable. ok, i'll step down off my soap box now. :) _________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

I'm very sorry to hear about your situation. What an awful thing to have to go through. I'm glad you got out safely. As others have already said, your things can be replaced, you can't. You're in my prayers.

my post that you quoted, along with the above reply, was the original post that i made when i started this thread. i found your post a little confusing, until i realized that you must not have seen the additional posts that i made to this thread that explained in a little bit more detail about my experience. just to reiterate, i had my surgery done at a reputable teaching hospital by a world renowned surgeon. i only recalled seeing the overhead surgery lights, hearing a banging noise, and feeling excrutiating pain. it was the anestheseologists (sr crna and a resident) themselves who came to my room and informed me that i was trying to pull on things and trying to get up off of the table during my surgery, which i did not recall. they explained that the banging i heard was the surgeon pounding the acetabulum hardware into place during my hip replacement. so, there were definately visible signs that i was awake during the surgery. the anesthesiologists, surgeon, and anybody else in the room, couldn't have missed it and knew long before my follow up appt. so, there is no excuse what-so-ever as to why this incident wasn't noted anywhere in my records. especially considering that both the anesthetists came and talked to me about it. unless they thought i was so out of it on dilaudid at that time, i may not remember our conversation. (my father was visiting when one of them came to see me) who knows....i just thought it odd that it wasn't noted anywhere. i have read this entire thread and have found some very informative information from other posters. as traumatic as it was for me, i'm just greatful that i didn't experience the paralyzes and inability to let anybody know i was aware, like others who posted have experienced. i can only imagine how horrific that must have been. thanks again for your replies everyone. ________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound :w00t:

siri - i wanted to thank you for the article/links that you posted. i finally had the chance to read through all of them. they were all great articles, i found them very informative. mistersister - i wanted to thank you as well. the information you gave was also very informative. i appreciate you sharing your knowledge. i am definately now more informed about what to discuss with my anesthesiologists for future surgeries that i may need. i had no idea that there was such a thing as the consciousness monitor. i have written out a list of questions that i gathered from the resources provided. i will certainly utilize it in the future to better inform myself preop, and hopefully calm the anxieties that i'm sure i'll have. you can learn something new here everyday, that's what i love about this site! :) thanks again as i said before, i am amazed to find out just how many ppl have experienced this type of thing. it can be very traumatizing. some of you had experiences much worse than mine. i truly hope that you have been able to work through everything and will have no lasting effects. thanks for sharing your stories. ______________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

hmmmm, there are many things about this story that sounds fishy to me. first off, i've never worked anywhere where is was protocol to have a male nurse present during my assessment of a male pt. i've not worked with that many male nurses at the places that i have worked at. that being the case, it would make my job very difficult, if not impossible, to treat my pt in a timely manner. but, if it is protocol at your facility, it is what it is. secondly, he had no right to ask you to leave the room, especially considering it was your pt. i wouldn't have left the room. if the idea is that he has to be there to be your witness, then it only makes sense that you should be there to be his witness as well. the fact that your pt "deflected the question 3 times," in regards to his comfort level with the male nurse seems odd to me. in addition, he certainly shouldn't have been doing such a personal assessment without gloves on. on top of that, you mentioned that in the past he was "massaging" a guys butt after an injection. i can see doing a quick circular rub after an im, but a massage?!? what's wrong with this combined picture? i also have to wonder if there is more to the story about his past criminal history that hasn't came out yet. the fact that he's not allowed to be around any children certainly raises a red flag to me; perhaps he has a history of some type of child abuse. i don't see the connection between striking a police officer and not being allowed to legally be around children. i agree with you, it sounds a little off to me too. i don't think your over reacting, given the circumstances. i hope i'm not writing more into things then is really there, it all just sounds real fishy to me. i would ask around discretly, to the co-workers you can trust to not start rumors, and see if anyone else has noticed anything a little off with his conduct. i would be very careful what you document, but i would certainly document this incident and any similar in the future. he is definately, in my opinion, displaying inappropriate behavior. ______________________________________________ go gators!! :yelclap: sec champions!! :w00t: national championship bowl bound!! :w00t:

Just because you've only seen it once doesn't mean that it doesn't happen more frequently, as the 60+ ppl that have posted here can attest to. No, perhaps not all occurences happened during a general, as in my case, but still happened all the same. I was not sick to where the anesthesiologist would have perhaps been inclined to give me a lighter dosage. I remember seeing the surgical lights because I woke up DURING my surgery. I don't "believe" I woke up during surgery, I DID wake up! My anesthesiologists confirmed that it happened. They were the ones, in fact, who told me I was trying to get up off the table, and trying to pull on things, which I did not recall. The surgical lights I seen, the excrutiating pain I felt, the sounds I heard, and the traumatic aftermath were/are also very real!

no, i sure didn't experience hair loss from my hep b vaccinations. i've not heard of it happening with anybody else either. you really might want to talk w/your physician about your concerns. ____________________________________ go gators!! :yelclap: #2 in the nation!! :w00t: national championship bowl bound!! :w00t:

thanks rnlou, i stand corrected. :) _______________________________ go gators!! :yelclap: #2 in the nation!! :w00t: national championship bowl bound!! :w00t:

glad to know i'm not the only one who has done this..lol. i felt lost until i got all my lines and pump chambers labeled accordingly. we didn't have the pre-made labels though, i wrote them all up, all different colors, of course. to the original question: all bags changed q 24h. all tubing changed q 72h. with the exception of tpn/ppn, lipids and diprivan which was changed q 24hours. _________________________________________________ go gators!! :yelclap: #2 in the nation!! :w00t: national championship bowl bound!! :w00t:

when i was a new grad, many moons ago, i had a choice of days or nights, whichever i wanted. i think it probably varies with location and facility. i chose nights, i guess i'm a sucker for the "rotten shifts." i'm also a sucker for the nice 29% differential. :) although, i'd work nights even without it, but it sure makes for a puuuuurty check. ________________________________________________ go gators!! #2 in the nation!! :w00t: bcs national championship bowl bound!! :w00t:

i prefer 12h shifts personally. once your there the time flys by, so what's 4 more hours to get 4 days off a week. working 12's i feel like i have more time off then i'm working, as opposed to working 8's five days a wk and only having two days off a wk. ______________________________________ go gators!! #2 in the nation!! :w00t: bcs bowl championship bound :w00t:

I love it!! Thanks for sharing...too funny

You have got to be kidding me? OMG, that mans doc needs to straighten those ppl out. I can't believe the trouble this nurse has caused, seeing as how she was WRONG from the get go!!! Unreal!! How very inappropriate for her to have placed unwarranted doubt in your pts mind about your nursing abilities, when she was the one that jumped the gun..totally unacceptable. Please tell me somebody, anybody has tried to get through to them that Narcan is definately not the answer. This poor man is now sleep deprived, painful, dehydrated, and not treating his sleep apnea, all because this nurse can't/won't admit to her mistake...instead of learning from it. I sure hope this nightmare ends for you soon. Hang in there. Good luck with your inservice.

What would I do? I'd write her lil butt up, but fast! I'd also suggest to all the other nurses to do the same when she throws her fits. When the mgrs collect enough write-ups, they'll have no choice but to correct the situation, or find a replacment for her. That type of conduct, especially in front of pts, should not be tolerated, for any reason. I can't believe they allow her to throw childish tantrums like that. Unreal

I understand that the anesthesiologist controls the anesthesia. What I meant was, did the surgeon even acknowledge that it happened after the fact. Both the anesthesiologists came to my room and discussed it with me. They said I was crying out in pain, trying to pull on things, and trying to get up off the table. I didn't recall all that, but I did recall seeing the overhead lights and hearing/feeling the surgeon pounding the acetabulum hardware (hip replacement) into place, and feeling excruciating pain. They must have quickly loaded me up with Versed or something. When I saw the surgeon, in the hospital, and at my follow up appt, he never brought it up until after I asked him about it, then he downplayed it alltogether. He told me simply that it's not unusual for pts to wake up confused, and that he hoped I understood that they weren't trying to hurt me, they were trying to keep me from hurting myself, explaining the reason for the restraints, I suppose. And, the fact, that he didn't document anything in his surgical notes about it. Someone else mentioned that they may have woke me up intentionally. I don't believe that was the case in my situation. It wasn't the type of surgery that involved anything neuro or reflex related. It was a total hip replacement. To any of you CRNA's out there: Is it, or is it not, standard to administer a paralyzant to pts receiving general anesthesia? I always thought it was standard procedure during a general. Either they didn't use it on me, or it wore off, otherwise I wouldn't have been able to do the things they told me I did. I'm not seeking advice for medical or legal purposes, I'm just curious. I'm really surprised to hear about so many others that have also had such an experience! Thankfully, my situation wasn't like many have mentioned, about being awake, but paralysed, and unable to communicate what you were going through. That had to have been absolutely horrifying for you. I can only imagine. I'm sorry to hear so many ppl have gone through a situation similiar to mine. It's obviously more common of an occurence then I thought it was.