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sundowners2

sundowners2

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sundowners2's Latest Activity

  1. sundowners2

    My Lament Over the Decline of Nursing

    ]...it's not the decline of nursing only. It's healthcare in general. Maybe it's that we only view the past through rose-colored lenses, but it seems to me that it hasn't always been this way. In only the four or so years I've worked in healthcare, I've witnessed a slow yet steady sinking of the discipline of nursing into an endless sea of paperwork, checks and double-checks that help shelter from litigation, a useless array of CYA tests and medications, etc. How much easier would our jobs be as nurses if the fear of malpractice litigation wasn't forever hanging over our heads? Seems like it used to be that we felt pressure to provide the best care because someone's life, health, and happiness hung in the balance. Now, however, so many of us are propelled by the fear that our missed assessment or forgotten medication will result in our professional or financial ruin. ]"I'll be right in there with your pain medicine, right after I get all these boxes checked so that you can't sue me later on!" ]Don't misunderstand me: I don't lament the decline of nurses themselves. I work and have worked with wonderful nurses that I still strive to emulate.. nurses with keen eyes that pick up on key assessments, impeccable prioritization and time management, and great technical skills... But what kills me is to see these nurses practically chained to a chart or computer checking an endless amount of boxes that serve only minimize their risk of legal repercussions should the worst happen when they could be at the bedside (where they truly want to be, anyway) curing and comforting their patients. ]I love recovering fresh CABG patients. Usually there are two other nurses in the room helping me to get the patient settled in, drawing stat labs, arranging chest tubes, documenting, etc. But I get to take a step back and, if only for a moment, devote all my attention to that patient. What's the cardiac output? How does that PA waveform look? Are the chest tubes draining ok? What does the patient need? Colloids? Pressors? Inotropes? After all these questions are answered and the patient has stabilized the high tends to wear off quickly. I snap back to reality when I return to the chart and see the mountain of safety checks, restraint documentations, and falls precautions assessments that have accumulated while I worked to keep my patient alive. ]So, what's a young RN to do? Deal with it, I guess. Continue to improve my time management so as to accommodate both patient care and all this documentation. ]Anyone else feel this way? I just needed to decompress, I think. Thanks for reading. ]JP
  2. sundowners2

    Statins and side effects

    Agree w/all above posts. Also, other medications (amiodarone, for example) can drastically increase the risk of statin-assoc. rhabdo.
  3. sundowners2

    Severe Hypoglycemia before Death?

    What would you have done with these things? Would you have stopped the pressors (which would have almost certainly killed the pt)? Would you have stopped the TF? What part of DNR= no tube feeding? Would you stop checking BG? Again, since when does DNR= don't treat diabetes?
  4. sundowners2

    Severe Hypoglycemia before Death?

    Thanks, Blondy, for being the only one who addressed the question at hand rather than criticizing the care we provided for my pt. Can any of you other posters think of a situation in which a full DNR would be on pressors? Like, for example, if he was already on the pressors before the DNR decision was made... In this case, the gtts would have to either be successfully weaned or Withdrawal of Care orders would have to be signed, which are completely different from a DNR order. Also, since when do we not do BG checks on DNR pt.'s? DNR does not = comfort care. Sorry if this post sounds harsh, but it's difficult for me not to take the "mean" and "wasting my time" comments personally.
  5. sundowners2

    Severe Hypoglycemia before Death?

    Not too long ago I took care of a dying patient (DNR). He was severely hypotensive even with norepinephrine and vasopressin (both maxed out) and dobutamine (5mcg/kg/min, set rate). The interesting thing was that for the entire shift he was also severely hypoglycemic. BG's ranged from 12-30's. An amp of D50 would only bring his BG up for a short time. This was especially strange in light of the fact that the day before his BG was very high. He was on continuous TF. He was not tolerating the TF, residuals >200. At first, I attributed this to shunting of blood away from GI system due to the NE. This lack of enteral sugar might have caused the hypoglycemia, but I also wonder if this is part of the dying process... Anyone else have a similar experience with a dying patient?
  6. sundowners2

    CRNA and family life:

    Can't speak to the question about family life and CRNA. But I can suggest that you take the cardiovascular ICU for critical care experience rather than trauma ICU. CVICU RN's work closely with alot of the equipment that CRNA's use (i.e., vents., arterial lines, PA lines, etc.). The CV unit I work on has lost 5-6 RN's to CRNA school in the last 2 yrs. Good luck. JP
  7. sundowners2

    ICU Help!

    I would definitely recommend starting out in the ICU if you are the type of person that is cut out for critical care. Every new grad struggles with time management, but we all find our way. I know nurses who believe a new grad should start out in a lower acuity level of care, but none of these nurses ever once did anything to discourage me or make my job harder. Those who spend more time in med/surg. floors will develop strengths in areas that critical care nurses may struggle with and vice versa. To be a good ICU nurse, I suggest going straight to the unit. I personally feel that the theory that new grads don't belong in the ICU has been discredited by many new nurses who started out in critical care and have done an AWESOME job. And, harsh though it may sound, those who flounder may find that they fit in better elsewhere. My 2 cents =) JP
  8. sundowners2

    Hypochondriac Patient? How to deal with the unknown?

    She may be addicted to the ATTENTION she gets when you bring her a Tylenol. A sugar pill would probably have the same therapeutic effect. Or hey, she may truly be in pain. Often times chronic pain has no identifiable cause and poorly correlates with objective indicators like vital signs.
  9. sundowners2

    ?'s about Med Rec

    Hello all, I have some quick questions about med rec: I haven't been a RN for long, but I've admitted enough ICU pt.'s who came in through the ER to notice that medication reconciliation is a process with which hospitals struggle. Several times I have seen the scenario play out where a pt. has been in the hospital 2,3,4 days before we realize that they were on lithium/dilantin/lasix/[insert important med here] at home and it has not been continued in the hospital. It's not hard to imagine how failing to reconcile meds like dilantin can and has caused major adverse events and lengthened the pt.'s LOS in the hospital. So, from an inexperienced RN who has never worked ED, here are some questions: How do we reconcile meds for patient's who come in with CVA's or some other mental status change? How do we get home meds from pt.'s who are poor historians? How can we be sure that the PMH that the pt. reports is 100% accurate? What's to stop a pt. from saying that he/she has chronic back pain and takes scheduled morphine at home? In other words, how do we know a pt. isn't just making these dx's and meds up? Many pt.'s go to multiple docs and multiple pharmacies. So, basically, what I'm wondering is how do we verify the accuracy of these so-called prescribed meds.? Thanks, JP
  10. sundowners2

    Hep C Diagnosis --- Now What???!!!

    Even if the HCV result was positive AND it was not a false positive, about 1/3 of those who acquire HCV are able to clear the virus from their systems without medical tx. It sounds like you have the right attitude. Keep your head up, and I'll say a prayer for ya =)
  11. sundowners2

    Hep C Diagnosis --- Now What???!!!

    If I were you, I'd wait for someone to explain the results to me. I did the EXACT same thing once. I had an exposure at work and had to have a Hepatitis profile done. Same situation with me: I was able to peek at my labs and saw that the Heb B surface antibody was positive. At the time, I didn't realize that this indicates immunity and that you WANT this result to be positive. Maybe that's what you saw. I had a panic attack over it and didn't sleep well for 2 weeks until a MD explained it to me.
  12. sundowners2

    For a hypochondriac RN

    I know that it is not uncommon for health care professionals to have hypochondriac tendencies, but I'm beginning to think that I am taking it to the extreme. Self-diagnosed ailments to date: abdominal aortic aneurysm (on the verge of rupture, of course), kaposi's sarcoma and HIV encephalopathy (I'm HIV negative), Hep B (I'm immune), various other hepatic diseases and symptoms (ascites; jaundice; abd. pain must be onset of acute Hep C), various cancers, and the list literally goes on and on.. all the way back to when I started patho... I currently think I have either an appendicitis brewing or an abd. hernia. Every little symptom is simply the onset of a life-altering disease. It all sounds kinda funny when I think back on some of them, but they cause legitimate anxiety and stress. Each of those diseases mentioned above represents a couple months of worrying about my health, even though I have no PMH. It causes me to become a "germ-o-phobe." My wife and my primary doc are probably sick of me by now. Can anyone relate? If so, do you have any (preferably non-pharm.) ways of dealing with it?
  13. sundowners2

    care plans

    Yea, get a Nsg care-plan text book that lists NANDA approved nsg diagnoses. First you need to come up with a nsg diagnosis statement. Match your pt's problems to one of the nsg dx's listed (e.g., acute pain for a pt. status post hip surgery or decreased cardiac output for a pt. w/heart failure...). The next part is the "related to." This is where you put the cause of your pt's problem (nsg dx). This is the etiology of the nsg dx, the reason it's going on (e.g., tissue trauma secondary to surgery or a fall). The last part is the "as evidenced by". This is where you put the signs and symptoms that let you know that you problem (nsg dx) is actually going on (e.g., pt. complains of pain; dependent edema; crackles). So, in the end, you should come out with a 3-part statement: Acute Pain related to tissue trauma secondary to surgery as evidenced by the patient's complaints of pain, facial grimacing, increased resp. rate. Then also use your textbooks to find nsg interventions to help "fix" the nsg dx. Set goals to measure whether or not your interventions worked. Be sure to include a specific time interval and a specific way to measure (e.g., pain rating scale). For example, "Pt. will state that pain is at an acceptable level [4/10 per pain scale] by end of shift." Also, be sure not to use any medical diagnoses like congestive heart failure, hip fracture, or pneumonia. Hope this helps, good luck!
  14. sundowners2

    The difference between Med-Surg nurses and ICU nurses

    My experience has been that ICU RN's tend to encounter alarming situations on a daily, even hourly basis. If my pt. had a low sbp on the floor when I was an intern, my first thought might have been "tx to the unit." Now that I work as an ICU RN, my first thought is "MAP of 65? Gravy."
  15. sundowners2

    Night shift nursing

    Night shift in the ICU can be very exciting.. especially when there's a full moon out...
  16. sundowners2

    Should I call the mgr?

    Quick question: I got a call from a nurse recruiter about a position in CVICU that sounds like it could be the perfect job for me. I was really excited when I heard about it, but I haven't heard back from the mgr. in almost 2 weeks. Do you think it would be inappropriate to call the mgr directly and ask if the position is still available? Thanks, JP