DreamingTree

It's true that some homes are beyond cluttered & dirty. The odd thing is that it rarely bothers me. Don't get me wrong -- I'd love it if all of my patients' homes are clean, safe, & smell good. That's just not reality, so to make it in home health, you have to have a great poker face. People don't want to be judged, and unless it's a safety concern for the patient, I just do my thing without mention of the environment. You honestly learn to block it out. If you like to educate patients, are good at working independently, and can manage unexpected challenges, then you'll love home health. Some days unfold smoothly, while others are chaotic. I've found that I learn so much more about a patient from being in the home. For example, medication errors are so much easier to catch because you can look at the bottles and have them show you how they are taking them. I haven't regretted making the switch to home health.

I agree wholeheartedly with this comment! Your manager has set unrealistic expectations for you. It's great to be a strong advocate for your patient, but you did that by trying to communicate by phone, and by following up with written documentation. In addition, you provided education to the patient on the need for a follow-up MD appt. As much as we care for our patients, we can't be solely responsible for their health. Be thorough in your assessments, document carefully, provide good education, and communicate with all health care providers. At the end of the day, realize you did the best you could do, and let it go. It's the only way to remain sane. :-)

I have a MS in psychology, and then went back to school to become an RN (ADN). In order to hone my nsg skills, I worked in med-surg for awhile (very valuable). My plan was to become a psych NP, but being married w/kids, I'm limited to where I can further my education (& found there aren't a lot of online options). I work as a psych RN in home health and absolutely love it. Although I'm on the road a lot, I learn so much from going into homes. Having education in both nsg & psych enables me to assess the whole person.

Yep - it really does get easier with time. When you are first starting out, every little step of the process is new to you. You have to think your way through each task, which takes time. With practice, many of those steps become automatic until you can do them in your sleep. You also get better at prioritizing, problem-solving, and remembering details (more cognitive space due to many tasks becoming automatic). Trust us...we've been there.

Maybe you need a new system for keeping track of pt info. I use a very detailed "brain" sheet. It has boxes for the following: info I receive in report, kardex info (name, age, code, dr, dx, allergies, IV, diet, ACT), assessment findings, labs/tests, & meds (I put times + any PRNs I give). It's the only way I can keep track of things -- especially when it's busy. Keep in mind that everyone makes mistakes; how you handle it is what makes the difference. Figure out what you can do to rectify the problem & you'll grow as a nurse. Don't beat yourself up -- that rarely works. MERRY CHRISTMAS!!

Everyone is right about you needing to learn how to do these problems & do your own work. However, I'll try to give you a few suggestions because you need help getting started. Pitocin was ordered 2milliunits/min IV. The solution is 9 units in 150 mL NS. What is the pump setting?This type of problem can be very confusing at first glance. Tackle it by doing the following: Pumps are programmed with the hourly rate. The order is for the amount to be given per minute. There are 60 minutes in an hour, so adjust the dose by multiplying by 60. Important rule: whatever you do to one side of the equation, you need to do to the other side. You can't adjust the minutes to hours without also adjusting the dose. The solution is stocked in units, but the order is for milliunits. You need to adjust the order so that they are both in units. Another important rule: keep your measurements consist. Milliunits do not equal units, but can easily be converted. Same for liters versus milliliters, grams versus milligrams, etc. You are now ready to plug your information into an equation. There are two choices:Desired/Have x Quantity -- For this equation, you'll divide the amount ordered by the amount supplied and multiply that number by the volume. Example: MedX is ordered at a rate of 5 units/hr and comes in a bag of 10 units/200 mL: [Order (5 units/hr) divided by Supply (10 units)] x 200 mL --> 0.5 x 200 = 100 mL/hour Ratio -- plug in the units/mL of the order and it will equal the units/mL of the supply. Cross multiply and you will have your answer. Example: 5 units/x mL = 10 units/200 mL --> Crossmultiply (rewrite these as traditional fractions -- I couldn't do that here) --- [5 x 200] 1,000 = 10x --- divide both sides by 10 --- x = 100 mL/hr When I would take a dosage calc test, I used both methods to check my work. The key to using ratios is to always place the same unit of measurement in the same place (numerator or denominator). Think of it this way: 1/2 = 2/4 = 8/16 -- you are just working with real life examples in dosage calc. Give the problems a try, show your work, and I'll try to help you out (if you want...).

I'll keep my fingers crossed for you. I remember those darn dosage calc tests -- very anxiety provoking. The key to doing those problems is to: 1-- keep your units straight 2-- always use your formulas 3-- ALWAYS check your work Good luck!!

This is the type of diagram I always followed, but it's probably the same as in your book: http://medicalcenter.osu.edu/pdfs/PatientEd/Materials/PDFDocs/medicatn/geninfo/intrainj.pdf What gauge & length needle are you using? Maybe that's the problem. How quickly do you insert it? Did you hit a bone? I've given mostly deltoid injections (flu & pneumo vacs), so I could get away with a 23 gauge, 1 inch needle. No complaints with that. I try to make my injections quick & steady (avoid lots of movement when it's in), but not so fast & hard that it freaks the pt out. Hard to explain... Wish I had more suggestions to help you out!!

It looks like it is missing information. Your answer is in mg/mL -- but the information given before that only lists the mL. Does the original problem provide the mg ordered & the mg supplied? If so, then you just plug this information into the following formula: Desired (mg ordered) -------------------- X Volume (mL available) Have (mg available) Here's an example: Desired = 2 mg (lidocaine ordered) ---------------------------------- X 1 mL (volume available) = 0.1 mL Have = 20 mg (lidocain supplied) If this amount has to be diluted to make 10 mL total, then you would take the 0.1 mL lidocaine (from the vial supplied) and add 0.9 mL NSS. You would start with 2 mg/0.1 mL (lidocaine), which is the same ratio of the lidocaine supplied (20 mg/1 mL). Once it's diluted, you have a strength of 2 mg/10 mL. Again, since the original information didn't have mg, I guessed at the values that should have been listed. It was an educated guess, though because lidocaine 2% is available at 20 mg/mL. Hope this makes sense!!

same explanation, but i'll phrase it a bit differently. make a chart: acidosis alkalosis 7.35 ph 7.45 45 co2 35 22 hco3 26 sorry -- the chart won't work on here. i hope you get the idea of how it should look. put all acidotic values on one side, alkalotic on the other. for some reason, the post edits out my spacing. follow these steps: 1. look at ph (using the chart). this is how you determine acidosis versus alkalosis. 2. look at co2 & hco3 (again, chart). which value is out of whack? ----> if your co2 is > 45 and the ph is acidotic, then you have respiratory acidosis. ----> if co2 is ----> if hco3 is ----> if hco3 is > 26 and the ph is alkalotic, then you have metabolic alkalosis. 3. now consider if compensation is taking place. this is a bit trickier to explain, but....here goes: ----> compensated: ph will be away from it's norm (7.40), but within the range (7.35 - 7.45) ----> uncompensated: ph is outside of the range ( 7.45) ----> if ph is on the acidic side, but compensated (w/in range), look at co2 & hco3. choose the value that is out of whack on the acidic side. this will determine if it is resp. acidosis or metabolic acidosis. the other value will be out of whack on the alkalotic side because the body is trying to compensate. hco3 increases to compensate for resp. acidosis. co2 decreases to compensate for metabolic acidosis. make sense? until it becomes second nature, keep making a chart (like i did above), and put checkmarks next to the values that are abnormal. the value matches the ph (hco3 or co2) will give you the final answer. good luck! disclaimer: all info blatantly stolen from a former nsg instructor's lecture. she made it all seem so easy....

Before making your decision, I'd do an old-fashioned "pros/cons" list. The following would be important factors for me to consider: 1. Commute time. I have a 5 min commute now, and little desire to drive 30 - 45 min to the other area hospitals. 2. Nurse -Pt ratio 3. Staff turnover 4. Unit "personality" -- how does everyone get along? Do they help each other? 5. Support staff Those are just a few considerations. A sign-on bonus is a great perk, but if you end up miserable there, the time commitment may seem like a jail sentence.

You'll get plenty of responses in favor of one choice over the other. I can tell you that I reluctantly followed the side that whispered medsurg in my ear. My days have plenty of challenge, and I can't say that I have much time to make tea. Whatever you experienced during your clinical rotations while in school tends to be different than reality. I was one of the top students in my class -- a great test taker, very good at pathophys, and never a problem in the clinical sites. The real world challenges me every shift, and I'm just starting to remember that I have two years worth of knowledge in my brain. So, what will you learn if you go the medsurg route? Time management, prioritization, and refinement of basic nursing skills. Many may tell you that you can pick these skills up in ICU, and some will tell you that they tried going there first and felt overwhelmed. Ultimately, you'll have to decide for yourself. My advice would be old-fashioned: make a pros & cons list. Consider all aspects of your life. Tally the columns, and go with the winner. Just make sure you take reality into consideration, and don't discount the learning involved in medsurg. I haven't regretted my choice. :-)

Is "focus charting" when you only comment on the abnormals? If so, then I usually include mental status & pain in my comments. I'll write something like: "Alert, oriented, resting in bed. Reports no pain." Plus, I throw in a line that relates to the diagnosis -- if pneumonia: "Lung sounds clear; intermittent, productive cough."

This may be a stupid question, but if he didn't want the pt to have dilaudid, then why didn't write the necessary orders? Are you supposed to be a mindreader?

I would have irrigated the same way you did: quickly flush with NSS, then quickly withdraw same amount. The one time I had an irrigation order for a drainage tube, the dr actually wrote out the w/draw instructions -- w/emphasis on the "quick" part. Easiest solution is to call the dr for clarification.