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classicalcat

classicalcat

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  1. classicalcat

    Frequent Blood Draw Question

    Hi All, I am a former pediatric/neonatal nurse who is now working as a nurse clinical research coordinator. I am trying to help a professor put together a research study in which he wants to get frequent blood samples (healthy adult volunteers). We are talking samples which are 5 minutes apart up to an hour apart (total of 12 samples needed over 8 hours). Our hospital's policy is not to obtain blood samples from an IV, but I know it can be done (this research would be under research, so I could bypass the hospital's policy). My question is: do any of you do that and how successful are you? There will not be anything running through the IV--I would have to figure out when to flush it, so as not to mess with the blood sample. Does this sound like a crazy plan?! Any advice would be appreciated. Thanks!
  2. classicalcat

    Side effects vs Adverse Drug Reaction

    Hi all, I am doing preliminary research for a job interview as a Clinical Research Nurse Coordinator. I have experience as a bedside nurse in the hospital. We see people for 1-2 days. If I give a medication (usually a narcotic or antibiotic), it is fairly clear to me if the patient is having a normal "side effect" or something more serious like an allergic reaction. Here is my question: in a clinical research study (esp. with chemo drugs) the side effects can be profound. In Keytruda alone, the side effects can include severe organ damage. So in reporting issues, at what point do you determine if someone is having a normal, expected side effect versus an adverse drug reaction or event? Is it severity? In my research, there seems to be some confusion as to the terms side effect and adverse drug reaction. Thanks!
  3. classicalcat

    I Pads for patient education

    Hi all, Are any of your hospitals handing out I Pads or tablets to patients? We just started this. On one hand, they are nice...patients can send me a message, or know when their meds are due. On the other hand, they are expected to read all of their education topics and mark off that they read and understood it (postpartum unit). I sort of feel like a part of what I do as a nurse has been taken away. The patients don't seem excited about it, but perhaps it's because I am not sold yet. What are your thoughts?
  4. classicalcat

    How does your unit train Level II Nursery Nurses?

    Thanks for the reply! This seems about right to me. Good to know...
  5. Hi All, I am curious what your hospitals do for training this area? When I was trained (years ago), I had 2 months with one-to-one precepting with another nursery nurse. This was after working postpartum for over a year (we do couplet care). Now, it seems that the status quo is to quickly train nursery nurses, with perhaps 3 shifts precepting, and then the new person is acting as the nursery nurse with the experienced nurse "available for back-up." This can be problematic, if the other nurse is not immediately available (i.e., that person has a full team of patients out on the floor). Granted, we are not a level III NICU, but we do get babies on CPAP, drug withdrawal, antibiotics, feeder/growers, and attend high risk deliveries--just not every day. Just curious what other hospitals do! Thanks!
  6. Thanks for sharing your animals stories as well! Looks like we have something in common--I laughed at the possum and sorry, but I laughed at the skunk story--not that you got bit, but that you were treated by a vet. Love it!
  7. I had a flash-back the other day at work. I was cleaning the circumcision board that was covered in poop. Ah, cleaning poop--I was remembering my days as a zookeeper. And, as you can imagine, the job involved lots of poop cleaning. This was another life--I have not been a zookeeper for over twenty years now. As I was applying for my first nursing position, I hit "delete," and like that, this career disappeared from my resume. How can being a zookeeper be applicable to nursing?. But as I reflected while cleaning the circ board, I realized that having been a zookeeper gave me many experiences that were very applicable to nursing. Unlike some of my colleagues who dreamed of being a nurse from an early age, I was the girl who sat spell-bound in class when I saw that first video about Jane Goodall. As I watched this young woman studying chimpanzees in Africa, my path was set--I was going to work with chimps. Quick Reflexes, Determination, and Patience--Or, Catching Monkeys and Toddlers Presently, I work as a pediatric nurse as well as in the nursery and postpartum. Anyone who has worked with peds will understand this: if they aren't that sick and need vital signs and an assessment, and fall somewhere between the ages of 13 months and 4 years, you will be chasing them around the room. Some parents are much better at keeping their kids under control than others. You have to be flexible and willing to move with the child at times. You have to have quick reflexes and lots of patience. These skills I honed 20 years ago in the monkey house. The zoo veterinarian had to examine individual monkeys each year to do labs and to check out the overall health of the animal. Unlike now, when keepers train many animals to present their arms for blood draws or medicines, we had to shoot the animal with a tranquilizer gun (the larger ones) or catch them (the smaller ones). The idea of chasing around a two-year-old for assessment is nothing compared to trying to catch a monkey with a net--a monkey who can climb, leap, and poop all at the same time. Yes, I developed some pretty fast reflexes and learned how to safely hold down a squirming monkey while not getting bit. We learned all kinds of tricks with the monkeys in order to give meds--distraction and bribery being some of the more effective ones. Both of these tools work well with peds. Although, I don't think the tranquilizer dart would go over too well, tempting as it may be! You Called Me for This?! Assessments and When to Call the Doc When folks visit a zoo, they don't see the keepers doing the majority of their work, because they do a lot of it before visiting hours or behind the scenes. (Early hours, weekend shifts, and holidays. Yep, all applicable to nursing!) My first job when I arrived at the monkey house was to perform basic assessments. OK, not the hands-on nursing type, but that first visual observation. Many times as a nurse, I have learned so much before I lay hands or stethoscope on my patient. As a keeper, I had to assess every monkey in the morning--was there food left over in the cage? Did anyone look lethargic? Did I see any evidence of fighting--wounds, blood on the wall, etc.? In order to do this well, you had to know each individual to interpret what was "normal" for them. If we saw something, we had to carefully document it in a log, and know if it was time to call the vet. I began my zookeeping career with elephants and hoofstock--you had to put in your time before you got to work with the primates. Like doctors everywhere, the zoo veterinarian was very busy. He didn't like being bothered unless it was important. Needless to say, there was a certain anxiety involved if you wanted him to come see an animal. One day, when I was working with the elephants, I noticed something red in the poop that I was cleaning. Well, this can't be a good sign, I thought. The elephant seemed fine, but the color of the poop was concerning to me, so I called the vet, and gathered a sample of the poop. As he was assessing the elephant, the main keeper showed up for his shift. I told him what I noticed and that I had called the vet. "Oh crap!" he said, "I think I know what this is about." He then sheepishly told the vet that he discovered yesterday that the elephant really liked red snow cones. "It was a hot day, and I thought to cool her off while she was giving elephant rides." Needless to say, the vet was pretty angry about being called for red-snow cone-tinged poop. I learned that I should probably get a bigger picture and more data before jumping the gun. Fast forward to another day, when, as a new pediatric nurse, I was extremely alarmed to find that one of my patient's SATs had dropped to the mid-70s. He was sleeping--and the monitor was dinging loudly. The waveform looked good. I woke him up and told him to take a deep breath--the SATs continued to stay low. I listened to his lungs--not bad, I thought. I called in another nurse to assist me. She was the one to discover that his SAT probe had fallen off his toe. What the heck, I thought. How was it still reading with a waveform and it wasn't even on his toe?! Thank goodness I didn't call a rapid response...ugh. Ah yes, remember to make sure you have the bigger picture before panicking! The Cranky, Ornery Ones--Or "I Had Her Yesterday, Today it is Your Turn" There was one chimp I took care of named "Giselle." She was an ornery, cranky old thing. No one liked her--not the other chimps, and not the caregivers. She grabbed, scratched, and bit whenever she could. We took turns with her--it wouldn't be fair for one caregiver to have to deal with her everyday. It was my turn on this day and I found Giselle lying on her bench, with her eyes half closed. She barely lifted her head when I approached--it was obvious that she was sick. It turned out that she had Valley Fever, or coccidioidomycosis. She became very lethargic and stopped eating. As caregivers, we questioned how much intervention there should be, given her old age. She refused all medication. One morning, I came in to see another caregiver sitting in front of Giselle's cage--it was her day off. "I figured out that she will eat grapes!" she said excitedly. "But you have to peel the skin off each one." Wow, I thought. Here was my friend, on her day off, peeling each grape meticulously and passing them one by one through the bars. After all of the fancy treats that we had tried, peeled grapes was all it took. Giselle rallied and actually got better from her illness. She went on to live several more years. I wish I could say that she treated us better, after we peeled all of those grapes, but she didn't. She was still as cranky as ever. I learned that we have to take care of those who are unpleasant to us. We can ask for politeness and respect, but there is no guarantee that the patient will give that to us. We need to take care of them anyway. And I learned that it is sometimes the little things that make a difference. We had a patient come to the floor whom we were all familiar with. She had schizoaffective disorder, bi-polar, anxiety, and suicidal ideation--and she was pregnant. She was disrupting the entire floor with her screaming. Nothing seemed to calm her, nothing worked. She was not my patient, and the nurse taking care of her was busy trying to get ahold of the doc for orders. So I gave it a shot. Several minutes later, the patient was quiet. Everyone breathed a small sigh of relief at the silence. "What did you do to make her quiet?" my friend asked. "Grape popsicle," I said. "That's it?" she asked. "Yep." I wish I could say it fixed her issues--of course it didn't, but for about an hour, we had gained a reprieve and some time to deal with the situation. I love it when the small things help. You Don't Do Dentures?! When I was a new CNA in a long-term care facility, I worked with another CNA who had been there for years. I was in the middle of nursing school and willing and eager. As we were dividing up our work loads for the day, she said to me, "By the way, I don't do dentures, so if you could do that for me, that would be great." "Why don't you do dentures" I asked, puzzled. "I can't stand them--I don't like spit. I can clean up poop, vomit, or blood, but don't ask me to clean dentures." I guess everyone has their substance that makes their toes curl. As nurses, we know that bodily fluids are a part of the job description. I imagine that many nursing students have wondered how they will handle some of these demands. I realized that I was way ahead in this regard. Oh, I can handle gross. Probably the grossest substance that I experienced first hand as a zookeeper was what came out of Gracie's abscess. The lesson I learned that day was when the vet tells you that you will be the one holding a camel's head still while the vet lances a tooth abscess, you should probably be wearing goggles. I had a mask on, but we are talking a veritable explosion of pus. I probably don't have to go into more detail about the monkey house, either. Bored primates like to throw stuff--and they have deadly aim, too. We had showers at work and used them often. Getting Your Work Done with an Audience and Learning to Love Teachable Moments You've been there, I am sure. It is the nursing version of Murphy's Law. The more people who are watching you, the less chance there is of getting the IV on the first try. Or when counting a baby's heart rate with a stethoscope in your ears, a family member is giving you a play-by-play of the birth, which you can't hear at all. We do our jobs with people observing everything that we do. And because they are watching, we can turn many moments into teaching opportunities. Zookeeping was like that. We did a lot of our work before the public got there, but for the rest of the day, you are in the spot-light. Ask any zookeeper and they will agree that people will stand and watch a human being cleaning a cage for more time than they watch the animals. At first, this annoyed me--move on, folks, nothing to observe here, but me hosing down a cage for the umpteenth time. But as I matured and became more comfortable with the public, I began to engage with them. They had loads of questions--what was it like to take care of the monkeys? Why do they do this? Or that? What is their favorite food? My job took on a different dimension for me. I realized that I was playing a small part in the visitors' experience that day and hopefully, they would go home with a greater appreciation of the animals they saw. It is like that with nursing. It is possible to go through your day with pleasant interactions with your patients, and provide good care. But to really engage them and see if there is a knowledge gap about their health or situation--this is a dimension of nursing that I have grown to love. Never Lose Sight of the Quiet, Beautiful Moments I only got to witness one birth as a zookeeper. Animals are subtle about birth and it is a privilege to see. It was early in my career, when I took care of the hoofstock. We were taking turns rotating watch over a pregnant giraffe. The vet couldn't be there 24 hours a day, so we worked alternating shifts. I was doing the night shift when the mama started pacing--giraffes give birth while standing. When I noticed her agitation, I thought briefly that I should call the vet--but I was enthralled--I couldn't have left if I wanted to. When the baby came out and landed--plunk--on the ground, I held my breath. And then, while the mama bent over and began to lick her baby, he struggled and stood immediately, looking dazed. I had tears in my eyes at the wonder of it all. To be a part of that birth in the middle of the quiet of the night was a treasure I will never forget. I still get emotional when I bring a baby over to his mother's chest for the first time and see the family's tears of joy. In the busy-ness of our days as nurses--or as zookeepers--or whatever career life finds us in at the time--it is those small, quiet moments that we should hang on to and cherish. There are no past experiences in life that are irrelevant to our present work. There is always something that we can bring to nursing that we have learned in the past. If I apply for another job, I might just put "Zookeeper" back on my resume.
  8. classicalcat

    Ebola in the pregnant patient

    Wow--great questions and lowsy answers from management! I work as a nursery nurse and I don't feel that our hospital has addressed the L/D issue either. We are going to get mandatory training in donning and doffing, but our only Ebola PPE cart (Don't know what is on it) is in the ED. I am not sure that the ED has been told to do with a laboring patient who says she just came from West Africa (not a far-fetched scenario in a college town). I listened in on a conference call the other day with the nursing union and the CDC and they said that they were working on an L/D protocol. Please keep us posted on what you are doing. With L/D, it doesn't matter that there are designated hospitals--we will have to deal with the hemorrhaging patient.
  9. classicalcat

    Ghosts Are All Around Us

    Ah, the questions that our children ask: "Where did I come from?" "How does Santa Claus fly around the world in ONE NIGHT?" or... "Do you believe in ghosts, mommy?" Some questions are easier to answer than others. I have never seen a ghost--that ethereal mist that makes the hair on the back of your neck stand on end. The kind that makes the room suddenly turn bone-chilling cold. But that doesn't make me doubt their existence. As a nurse, I have seen their influence: the ghosts of the past--those shadowy glimpses of those who once lived, who never leave us. The ghosts of the present, who haunt us daily. Those of the future, who we would like to change, but wonder if we can. It was a beautiful summer day, when the sky was so blue that it seemed endless. This outside beauty seemed an unfair contrast to the dark, gloomy room, as I held the hand of my dying patient. "Martha, is that you?" he said as he looked at me. "No, I am not Martha, I am the nursing assistant," I replied. I knew that he had lost his wife a few years ago. "Martha, please stay, "he cried. "I am here," I said. "I am not leaving." He died peacefully, with his wife's name on his lips. On this day, I was the ghost. I had another patient, a new mother who seemed overly concerned about everything that her newborn was doing or not doing. "I think his lips are blue!" she would say. Or... "can you please check his temperature again? He seems too hot." Or... "he just isn't breathing right." It was kind of driving me crazy on a day that was already busy. Near the end of the shift, I finally had some time to go through the rest of her chart. And there it was: She had lost her first baby to SIDS, when he was only two months old. On this day, her first baby was the ghost. When I was a nursing student, I had to do my obligatory four-day rotation in mental health. I had mixed emotions about this. On one hand, I was thinking, this could be a nightmare, and on the other hand--it might just be interesting. It was actually a little of both. I was given a lot of autonomy at the facility, given that I was a nursing student. The nurse in charge basically said: here is a list of "safe" patients--you can give them their meds this morning. Um, OK. As I made my way around the unit, I wasn't sure what I expected, but I encountered patients who seemed very ordinary to me. Until I went into the fifth room. I heard voices from behind the closed door. I thought it was a private room. When I knocked and entered, there was a man sitting on his bed having a conversation. He questioned....and he answered. "Who are you talking to?" I asked. "The Prophet Elijah," he answered. What am I supposed to say now? I dove right in. "Can you tell me your name?" "God," he answered. Oh. I double checked his wristband, and gave him his meds, while he continued his conversation. On this day...the ghosts were within his mind. It was a cold, rainy day in December. I walked into my patient's room, not knowing what to expect. The report on paper didn't look so good. Teenage mother, history of depression, history of abuse. The scene was surprising. A lovely, young mother sat in her bed breastfeeding her baby. "Look, she has latched on this time without help!" she exclaimed with pride in her voice. "Good job!" I replied, sharing her enthusiasm. Then I noticed another woman in the corner of the room. She sat in the rocking chair with a sullen look on her face. She looked unkempt and smelled of cigarette smoke. Her hands were shaking. "I need to get some fresh air," she said and exited the room quickly. My patient looked embarrassed for her mother. The mother didn't return that day. We had an order not to let the stepfather into the unit due to his history of abusing our patient. I got to know my patient throughout the shift. She was tearful at times. "I am so scared that I will end up like her...she has made such bad decisions...bring that %^hole into our house." I realized that the ghost of her future self was haunting her. "You aren't your mother, and the decisions you make will be your own," I said. So many times in my nursing career, I have felt more of a counselor than a nurse. But I have come to realize that nursing is all of that--you can't separate taking care of the physical body from that of the mind and spirit. We have to take care of the patients and their ghosts--they are all around us.
  10. classicalcat

    Do saline locks last as long as a peripheral IV in children

    Our lab and IV team says that you can't get a blood specimen from a peripheral IV...shelbs3...does your lab do this routinely?
  11. classicalcat

    Kids Say the Darndest Things...

    I was taking one of my pediatric patients to her car to discharge. When she got in, she saw a penny sitting on the seat. She picked up the penny and handed it to me...and in the sweetest voice said. "Here you go...now you can by ANYTHING you want!" Then she gave me a huge hug. I love my ped patients!
  12. classicalcat

    Best way to Weigh a hospitalized Ped

    Hi All, Peds have moved to our postpartum floor, so I am new to peds. We don't have bed scales in all of our ped beds. The other day, we had an appy patient who was VERY painful and did not want to get out of bed. The only weight we had was from the ED. When we finally got him up and weighed (with lots of tears), he was 11 pounds lighter than what was recorded! This scared the daylights out of me, because all of the meds are dosed by weight. Luckily, the MD had dosed in the lower range, so with the lower weight, we were still OK. However, this should not have happened. What if we get patients with fractures, or a very painful MVA kiddo? How do you weigh the kids in your hospital? Some are light enough for a parent or the RN to hold and weigh (subtracting the adult's weight, of course). But what about a larger kid? Thanks!
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