stephynic21

--at least five black pens (and I'll be lucky if i end the day with two. I am notorious for leaving them laying around) --Stethoscope around my neck --Badge with 3m tape ran thru my badge clip and ammonia capsule taped to the back --Trauma shears --LIP GLOSS --Eye drops (the dreaded contact dry eye is enough to ruin a day) --alcohol preps and two flushes --cell phone And by the end of the day some patient labels, SL NTG, and the list on the back of a 2x2 that i make first thing in the morning while stocking my rooms usually end up there.

She had unsuccessful intubation attempts prior to arrival in the ER via EMS but successful the first time in the ER by the doc...so i guess stomach contents are possible if there was aspiration. there was no problem with insertion of the NG, tho. It went down easily as it ever has. I would think in order to get passed the ETT it would have to somewhat forced but it slid in easily. And I did ask the doc when he asked for one "NG or OG" and he said NG was fine. I just can't wrap my head around how it became displaced.

Just wanted some advice....recently had a resp arrest come thru the doors....we did all the stuff (intubation, ekg, ivs, meds, blood work, foley, NG)....it was early that morning and there were two of us over there in the critical area. The other nurse was primary and i was tasking all the stuff. I placed the NG tube and we auscultated for placement. I was listening when she pushed the air and didn't hear anything (it was loud with the monitor going off, the coordinator and doctor trying to get ICU bed for this patient, etc) and we tried again. I told the other nurse i still didn't hear anything...she pulled back on the syringe and we got what looked to be gastric contents. She determined that we were in but THANKFULLY, didn't hook the patient up to suction because she was going to CT...never hooked the patient back up because from CT they went straight to the ICU. doc gets a call from the radiologist that the NG is in the trachea. My question is....what could the contents have been?? It was a large amount because we pulled back almost 30 ml of brown yucky "gastric" looking contents. Could the tube have become displaced during the transition from the stretcher to the CT table?? Has anyone ever had something like this happen? What are some tips for apparently placing the tube correctly?? And of course i got called into the coordinators office to discuss with the coordinator and the next in charge and the doc which really made me feel like the biggest crap-ola loser nurse of the world. Advice??

We are not required to fill any orders other than STAT orders. I usually get the antibiotic going if there is one since we have a pharmacy in the ER and will give any meds that are needed IF i have time. If i have a low H&H i usually get blood going and get the first sets of vitals. If the admitting doc has ordered additional radiology, i will TRY to get the patient over to MRI/CT/US etc before they come up. If they can't take them....oh well. As soon as we get a room#, we are given 30 minutes to get the patient to the floor. Within 3 minutes of the room number showing in the computer, our coordinator is asking how long and what else needs to be done to get them to the floor now cause we have 10+ patients in the lobby, 10 just waiting to be triaged, and ambulance after ambulance calling report. I usually am patient while holding to give report (sometimes 5-10 minutes or more) but if my coordinator gets wind of the fact I've been on hold that long then he is on the phone with the nursing supervisor. Its him, not me. I understand why tho....we can't make people stop coming into the ER or tell them to "hold on" cause we are busy with other patients....we just tell them to come on in and find them a stretcher and start treating them in the hall if needed. And as soon as that stretcher rolls to the floor, another one is rolling in with mawmaw clutching her chest and we start the whole process over again (ekg, iv, lab, meds, radiology, etc) and pray that we don't end up having to run up to the cath lab with a STEMI. And honestly, unless blood sugar is an issue, feeding the patient is not priority to me (our cafeteria does not deliver trays to the ER, we have to send staff to pick them up and everyone in our department is usually pretty busy). Its chaos on most days. I've also worked on the floor and been the nurse that really was just too busy to take report from the ER. Thankfully i have come to know the majority of the nurses that i have to call report to. They know that I will do my very best to get things done but if not....it has to be sorted out on the floor. They are grateful for what we do so that when we miss some things its easier to let it go.

Heres a few-- 1. Ambulance ride for a toothache x2 hours. No ride home and hungry/wanted meal tray because they couldn't eat lunch related to the pain. 2. Scratch to left ear. Didn't bleed at the time it happened it just "hurt real bad"....rated 10/10. 3. Abdominal pain after chugging a whole pint of whiskey....I suffered thru all my hangovers and it taught me valuable lessons like say no to chugging and my limits! 4. Minor MVA and comes to get "checked out" but refuses to have any CT/xrays done. 5. 450 lb guy complaining of back pain x10 years. I'm sure there are more....i'll have to think more on this.

I feel everything you are saying! I've been a nurse for about 11 months now...i started working with my preceptor in August and was still working with her after thanksgiving. i'd ask questions and she would tell me i should already know or ask what did they teach in school, I wouldn't be moving fast enough for her, I wasn't able to handle the patient load she thought i should (6 of my own patients plus LPN IV pushes/assessments), she would point out things i missed constantly or just talk to me all the time very snippy. I can't remember the exact situation, but one day i had just had more than i could tolerate. I was so LIVID that i went to the med room and ended up crying my eyes out. She walked in and could tell i was upset and asked what was wrong. I couldn't hold it in any more and told her everything....i felt like she was frustrated with me, i was moving fast enough, didn't know enough, etc. We sat in the med room and discussed at length what we could do in order for me to be able to bring it all together....what she could do to help me learn, things i could do...And honestly? That come to Jesus meeting was exactly what i needed. While i don't claim to be great by any means (yet!), after that particular day things seemed to start clicking. I've been on my own since January 2nd, and i can handle my 6-7 patients with LPN stuff some days more than others. I still have tons of times where i feel like i know nothing, about 30% of the time im not sure what the heck is going on, and everyday i learn something new. I just accepted a job in the Emergency Room at a larger hospital and will be back in this same boat starting on Monday. I just tell myself everyday that it WILL get better. Most nurses tell you it takes 5+ years of experience to feel comfortable, and even then certain situations will change that. Good luck and hope things are getting better! =)

Graduated May 15, 2010 with my BSN, passed boards on June 19, interviewed 10+ times at different hospitals and then interviewed August 18 at the hospital where i currently work. I had to relocate in order to get a job so now i am 2 hours and 15 minutes away from home. I live in central Mississippi.

I relocated as well. I graduated in May and each week of unemployment i expanded my search another 20 miles away from home. I got hired in August at a hospital 2 hours and 15 minutes away. I got an apartment and come home on my days off. I'm hopeful that after 6 months to a year of this i can get a job locally. Good luck!!

Just need to get some nurses opinion on this. We have a new dean at my University and she is bonkers for real. My school is now requiring that we get a Tdap shot within the next two weeks or we will be yanked outta clinical. I went to my local health dept today and the nurse there told me there is no way i should take this shot. I asked why, and she said i had my tetorifice shot like 11 months ago and that it could be too much tetorifice in my body at one time. She said it could lead to severe neuro side effects. In order to get it done, they will require me to sign a waiver releasing them from any responsibility should anything happen to me. I called my school...they said i have to have it! I would much rather have to take antibiotics for pertussis or whatever rather than have lifelong neuro problems from taking two tetorifice shots so close together. I really need some input on this before i go tell my school that its not gonna happen. Does anyone else think its too close and i could cause myself harm? Or should i sign a waiver releasing the health department if anything happens to me, but make the school sign one stating that if something does happen to me i can sue the crap outta them? I don't know what to do! Help?? Thanks, Steph

I'm having some trouble coming up with a nursing dx for my patient. Really quick about her...38 year old female had baby girl on 9/15/09. has two other children, six and four. Vag delivery, no episiotomy with labor, had an epidural. Took care of her yesterday. No trouble or anything. The only thing is that she did report a 7 on a 1-10 pain scale, but it wasn't due to the labor or anything...she just had a headache. Can i still use an acute pain diagnosis?? Acute pain AEB reporting a 7 on a 1-10 pain scale?? WOuld i need to have a related to?? a fellow nursing student says i should say something like acute pain related to reporting 7 on a 1-10 pain scale AEB facial grimace, but that just doesn't sound right to me?? I also thought about doing a risk for infection...but there was no epi, no lacerations. She DID, however, test positive for Group B strep and received two doses of PCN during labor. I really want to use this one, but i have NO idea how i can word it. Also, i was going to use risk for constipation related to perineal discomfort and decreased peristalsis...but she had BMs yesterday so that got blown out. can't use impaired urinary elimination because she is having no problems with that. Please help! any feedback will be greatly appreciated!!!

Congrats to you for making it away from her! i had the same situation with my first semester clinical instructor. She hated me...i'm taking rolling her eyes when i spoke during pre/post conference, huffing and puffing if i asked a question...she did this not only to me, but to another student as well. i'm generally a very smart person. Its not like i was not making sense or anything. she seriously made me doubt if i wanted to continue in nursing. Like your teacher, it was rumored that she always picked one out of her clinical groups and made their lives hell. Lucky us, she picked two. It does get better. i just finished my second semester. It seems that once i moved up, the instructors no longer treat us like we are stupid. We do get more respect. My instructor now is very patient, she is kind and she never makes me feel like i shouldn't be doing what i'm doing. Point is...if its something you want, don't let anybody tell you that you can't do it, or make you feel inferior. You may not be in control of her actions, but you are in control of how you let it affect you. I think there will be nothing more satisfying than for my first semester clinical instructor to see me graduate.

I have a question about a critical thinking assignment that i'm working on. It gives the following information: Three women, a 21year old african american student, a 35 year old hispanic prostitute and a 65 year old white widow need teaching about the importance of screening for cervical cancer. The question i have to answer is: How would you present the screening recommendations for each of these women that would demonstrate age and cultural appropriateness as well was the latest screening guidelines? I'm just really not sure what i'm even being asked to describe here...can someone please just help me get the ball rolling?? Thank you =)

Thanks =) i still hadn't resolved why she had respiratory failure, but when i got to clinical today my instructor told me basically the same thing that you just did. I just couldn't wrap my head around it last night haha. she was intubated but it was removed on monday, they observed her yesterday for complications....and she was discharged right when i got to clinical so i spent the day in the wound care.

While i don't have kids, something that my friends, family and boyfriend have had to get used to is the fact that i dont' always have time to do "the little things" anymore. Me and my best friend would have shopping trips alot of times over the weekend....we still have the occasional one, but most times i'm in the library studying on weekends. Family has "get togethers" and needs to understand that right now school has to come first. I missed my grandmothers surprise party because it just happened to fall during finals last semester, and this semester it looks like i will miss my niece's babyshower cause its during finals as well. It sucks, they hate it, i hate it more, and its so easy to blow off the school work and go but you've gotta keep telling yourself it will all be worth it and to stay focused (trust me, the one and only test in nursing school i bombed BIG time was during a weekend where i put off studying until the day before so i could have a weekend gettaway with the boyfriend). i have no advice on how to explain it to small kids, but the rest of the family needs to know that its gonna be hard for you to do all the things you used to. Oh, and they should also expect you to be stressed out and a bit moody.

i just have a quick question about why my patient had respiratory arrest. It said in her chart that she presented in the ER at one hospital with complications of COPD/pneumonia. She had SOB, weakness, and pain when breathing in. They have her Lasix IV and immediately following that she went into resp arrest and had to be intubated. Lasix is something that she takes at home, so was she most likely already having complications that would eventually lead to that, or was that something that the Lasix did being it was given iv? Her chart was very vague and i just didn't understand. The staff was busy and i didn't want to be a burden. Also, all this happened on 4/3. Is the respiratory arrest the reason why she is still in the hosptial? After she was intubated, she was also put on a PEG tube and foley. They PEG and foley have been DC'd (yesterday).

oh well. just thought i'd ask. I googled it and had no luck and my instructor didn't even know what it meant. Got too busy on the floor and forgot to ask. thanks anyways!

one more quick question if anyone is still around. what is atherosclerosis without mcc mean???

Ahhhhh you are the best! Thank you all for helping me!

Hello all! I'm trying to get some information to help me figure out what is going on with my patient. We have clinical tomorrow and i was at the hospital getting her info from her chart when she was taken down to surgery...and so was her chart! She is a 61 year old obese female with history of HTN, DM and CAD. Anyways, she had a heart cath on 2/26/09 which "showed a 3 vessle CAD but stenosis appeared critical ( 50-60% stenosis in obtuse marginal and 30 % stenosis in circumflex) and stent was placed into RCA." What does stenosis appeared critical mean?? I know i should probably know this, but the way it is worded is also throwing me off. Also, she went home after the surgery and came back in on 3/7/09 with severe chest pain. She was being taken down to surgery when i was at the hospital, which is why i have hardly any info on this patient. What would be a reason she is going back to surgery?? Complications or failure of the procedure the first time, or is there some type of procedure that follows this up? I've googled this for the past few hours and i know why she went to surgery the first time, but i really don't understand why she is back there now. Any help would be fantastic and greatly appreciated.

I'm having a bit of trouble getting the wording right on my diagnosis. I know what i WANT to say, but i'm not sure how to say it. Mine are: Acute pain related to inflammation and painful abdominal cramps AEB reporting 7 on 1-10 pain scale. Constipation related to decreased motility of GI tract. Imbalanced nutrition: less than body requirements related to impaired absorption secondary to clear liquid diet. Here's some info on why i chose them. My pt has IBS and was admitted for acute ischemic colitis. She actually constipation now (not a risk for), but it also said in her chart that since she was admitted (2/14) that she has had bloody stools. She was also hypokalemic and dehydrated and had 0.9 NS with 20meq KCL/L 125cc/hr but that has been resolved because her IV is now heplocked. There was infection but that seems to be cleared up because labs came back normal (after abnormals). I'm not sure why she is still there (we have clinicals tomorrow, i just picked up info today). I looked it up on the internet and it said that with dehydratiion and hypokalemia that she would be admitted to provide fluids and electrolytes. Do those diagonsis make sense? And should i level pain or constipation as my priority. I was thinking constipation, but the pain scale number is really high. Any help will be greatly appreciated.

okay, took your advice on the second and it sounds alot better (thank you!), but i'm still not sure how to word this first one. i do see what you are saying tho....she isn't at risk if i'm saying there is evidence. glad i posted it on here or my teacher would have killed me lol. anyways, every other diagnoses that i'm tossing around in my head doesn't sound good to me. could it be risk for infection related to inadequate primary defense (broken skin), secondary to surgical wound on left lower extremity??? or do i just stop it at broken skin? that doesn't seem right to me either..i feel like i need to include what broken skin i'm talking about in there somewhere. i can work up the rest of the careplan fine but i always have trouble getting the wording right on these lol. any help is always greatly appreciated :heartbeat

My pt is a 48 year old morbidly obese pt with type II diabetes, CHF, PVD, hypertension who just had surgery for a left occulded distal femoral artery below knee popliteal bypass with reverse saphienous vein graft. I've came up with a few diagnosis, but i really don't know if they are right and i have clinicals in the morning. Risk for infection related to inadequate primary defense (broken skin) as evidenced by surgical wound on left lower extremity. Risk for Delayed surgical recovery related to surgical wound on left lower extremity, secondary to decreased circulation and effects of chronic disease. are these worded right? and will they work?? Any input would be GREATLY appreciated. Thank you! :heartbeat

sounds lots better than mine! =) Another one that i came up with was risk for imbalanced fluid volume related to intake in excess of output. Does that one work? I thought about it since his I&O is 1350/500. You've been a big help! Thank you!

ok, can i use diarrhea as my nursing dx? Diarrhea related to inflammation as evidenced by urgency and hyperactive bowel sounds??

I'm not sure if he actually has problems in that area. I know that his wife is there to help him at all times, but he may be able to do all those things. I only went in and introduced myself to him today so i didn't really get a chance to see what all he can do by himself. I also forgot to mention that his I&O is 1350/500. is that within normal ranges??