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missmiamoore has 6 years experience and specializes in Med-Surg.

6 years experience as a medical surgical nurse with 2 years travel nursing in between.

missmiamoore's Latest Activity

  1. missmiamoore

    Who do you think you are!

    Med aide is such a STRANGE concept to me. I get all territorial and panicky just thinking of someone else pouring and passing my patients their meds. What type of training do these aides have? Do they know how to do the proper assessments and understand the pharmacology behind just giving pills? I personally feel an aide would be better utilized within a PSW role (toileting, turning, ADLs, transfers, boosts). Sounds dangerous overall to have too many cooks in the kitchen and I would refuse to work within that care model.
  2. missmiamoore


    Oh yes, of course we all do that. It's called reflection. The key is not to drive yourself crazy over these things. What I find helps is I try to think of a positive for everything I have missed. For example, I will think, I should of left a note for the doctor about the family's concerns. However, I did successfully advocate for the patient to have their pain medications changed in a timely manner. Just remember, everything you do makes a difference. Those things you think about at night is your way of processing the information and learning. This makes you a better nurse :)
  3. missmiamoore

    What PRN meds do you give a lot?

    Morphine, Gravol, acetaminophen, Atasol 30, Percocet, oxycodone, Dilaudid, Zofran, Stemetil, Maxeran, Bendadryl, Imovane, and Ativan. I work on a post-surgical floor (majority ortho and GI). We always have to call for abnormal labs (potassium, hemoglobin) and get an order for Slow-K or transfusion.
  4. missmiamoore

    Documentation on Total hip replacement

    Hi there.. At our institution we follow hip and knee care paths. On day 1-2, we would be assessing for pain and symptom control, hemodynamic status (hemoglobin and potassium levels), urine output, ambulation (should be 2 assists to sob or chair), bowel sounds and elimination pattern, increasing independence of ADLs, reinforce physio teaching regarding proper use of assistive devices, hip precautions (no crossing legs, flex more than 90 degres, etc), surgical dressing dry and intact. If you look on google under total knee/hip replacement care path, you will find many. Good luck!
  5. missmiamoore

    Orbital skin tear

    Thank you for your thoughtful replies. Shedding some light on this situation. I personally think this patient is "on his way out" he does not look good and I get that gut feeling, but he has not been deemed a terminal patient. As far as TPN, I am in Canada and although there is still the cost issue, we don't really hear about it so closely, as the system absorbs the cost. I think a family-team meeting is in order.
  6. missmiamoore

    Orbital skin tear

    This patient did not eat anything all day. Just kept drinking juice and water. We finally got a Boost into him but only at the end of the day. How do we maximize nutritional status when they don't want to eat anything?
  7. missmiamoore

    Orbital skin tear

    So a scary/strange thing happened today at work. A patient of mine who has chronic edema and very sensitive skin recieved a nasty skin tear under his eye when I was wiping morning mucous out of the corner of his eyes. I didn't put unusual pressure on the face cloth, I just used what I considered normal force. He flinched and when I saw what happened, the skin had torn and rolled away revealing red tissue underneath. I put a saline soaked sterile 2x2 gauze on the site and left it there for about 10 minutes to help soothe the discomfort. He was left with a redened under his eye, which is unsightly and I feel quite bad about it. I consulted with our wound care nurse who said there was nothing really that could be done in terms of dressing it or ointment. Of course, I informed the MD and documented appropriately. I am just really mysified why the skin came away this easily. This poor man is quite ill and has a history of multiple medical conditions, namely cardiac and subsequent edema. He also appeared to have the starting of shingles or chicken pox. He had the typical rash pattern including forming along the dermatome. Have any nurses had patients with this kind of skin before who were edematous? What causes this and how do we care for it best in terms of bathing and pressure sore prevention. Any thoughts would be appreciated. Thanks!
  8. missmiamoore

    Managing Patient Assignments

    Thank you Ericka, I appreciate your response. Another aspect that I find quite stressful is how the other nurses on the floor will expect certain things done by first break. For example, the rehab floor I was on wanted everyone washed before 9 am! I found this extremely hard, as the patients are quite slow in ambulating and need supervision assistance doing their ADLs. Other nurses on the floor seem to be able to get so much done before first break and then tell me to pick up the pace when they see I am struggling. This is one particular nurse I am referring to. It just seems impossible sometimes! Anyone else have this kind of experience?
  9. missmiamoore

    Managing Patient Assignments

    Hello there. I am a new grad RN. I have just gone through three months of orientation where I have been assigned 2-4 patients and had a preceptor as a resource person to turn to. Now I am at the stage where I am being cut loose on my own. I had my first assignment on my own yesterday. It was exciting, but I felt overwhelmed and as if there was not enough time to complete everything I had to do, especially documentation. What I am wondering, is there any advice that can be given on how to manage the work load of having a 4-5 patient assignment while still being new? BTW, I am part of the nursing resource team for the hospital I work for. Therefore, I go to 6 different med/surg units as I am needed. So there is the added aspect of being in still unfamiliar environments. Help!