emily5547

There absolutely is a stigma! You're a threat to everyone around you (in their eyes,) and cannot be trusted to stay conscious. Just stay on top of your meds, avoid having another seizure, and eventually they'll forget. Maybe it was exciting for some of them to see... I mean, in theory these are fellow nursing students, people who want to help others with variations in health, hopefully they'll be just as professional in this role as they will be with a patient. Keep your head up, best of luck to you. Also, as a cautionary tale, I learned the hard way not to work night shift; the sleep disturbance threw my seizures out of control.

As far as discussing this matter with your DON (which was your ultimate question), I should think expressing that you have concerns about specific patients' treatments, facility protocols, MD orders/lack-thereof/interactions, and you wish to better understand rationale, etc., making sure you're open to feedback and want to work within the scope of your practice and the rules of the facility, while ensuring your patients receive appropriate care, should be a good starting point for a discussion. The only reason I'm actually compelled to comment is to actually implore you to never document a diagnosis. As long as you're not an NP, you should not be diagnosing medical conditions. You are assessing patients. You can document all the s/sx of influenza that you've assessed, but it is not in our scope to develop that diagnosis. I know it's sometimes frightening to work in a tertiary care setting, but I'm not necessarily convinced that the patient with atelectasis requires acute inpatient hospitalization. Are they satting well? Are they in distress? Activity tolerance? Appetite? Have they responded at all to the abx? Are they A&O enough to teach deep breathing techniques, etc.? I would take your concerns to another nurse (charge, DON, experienced colleague) and use it as a possible teaching moment. Of course, patient safety is your very valid concern, and you're there with the patient, you have to go with your gut sometimes and what you're observing - I just get the sense that perhaps you could also be over-reacting and you are definitely going to want to avoid documenting new diagnoses in the future.

You're doing the attacking here - not me. It isn't relevant to your role as Grandma's nurse to know/understand/judge what's going through the minds of your patient's families. There have been a lot of reasons discussed here why people don't see their demented family members because of what the family member did while lucid. Someone also pointed out that for the patient, these visits are sometimes more stressful than the lack thereof. For instance, my grandmother was an adequate provider, she allowed my alcoholic grandfather to abuse my father, but didn't participate in the abuse. My father has no baggage with his mother. He can't drive, due to his own long history with ETOH abuse, so when he sees his mother it's because I've taken him. He doesn't go as often as he should. She doesn't know him. She looks right through him and begs to be left alone to go to sleep. It rips his heart out every single time. There is a fate worse than death, and right now - for my family - it's this limbo. Grandma doesn't *care* if we're there - but it seems you do?

You have no business asking for an explanation, I think that is the point. What will you do with this explanation? Determine the validity of the family's absence? It is irrelevant to your patient care.

I once precepted a nurse completely incapable of med calculations. People here are very helpful if you are stuck on a particular problem, but show your work... this is, what, a quiz? For us? No thanks.

Chronic HD? Routine?? Maybe it was my inner-city experience, but I wouldn't have called it predictable. This one's got chest pain, that one spiked a temp, this one crashed, the other one dislodged a needle, another needs off to poop, another one did it in the chair, that one nodded off in the bathroom with a syringe in her arm... Mad house. What about case management or utilization review?

As the previous poster mentioned, not everyone becomes incontinent after a seizure, but when they do, it's AFTER the seizure, when the muscles relax finally. So, in status, I guess it would make sense that the pt wouldn't void. I never thought about this... I am a dialysis nurse but have a seizure disorder myself... Surely someone with more nursing experience in neurology will chime in.

oops, never mind - post deleted, wrong thread

I don't think I was being sarcastic or rude. You said your admits made you wonder what was happening at those dialysis facilities and I was trying to shed some light on it... My, "duh," comment was not necessarily directed at you it's just the most common complication of dialysis. I mean... really, EVERYONE goes hypotensive at one time or another.

"makes me wonder what is happening in that dialysis facility. " I'll bite. "patient felt week after dialysis and is now unable to ambulate, or they have a fever, or they suddenly had blood pressure drop... then the kicker... Full code." 1) Pt felt weak after dialysis. Pt came into dialysis with 3 kg of fluid on. Fluid was removed. Heart was unable to compensate for decrease in blood volume, fluid shifted slowly from interstitial and intracellular space to vascular system... you'd feel weak too. And pt's CO is probably 30%... 2) Fever. Pt was uremic prior to dialysis, maybe only slightly, which inhibited the inflammatory response of the immune system. Blood was cleaned, fever subsequently spiked. Sick renal pts often don't spike temps until after dialysis. 3) Blood pressure drop. Duh. See #1. Dialysis pts love to go hypotensive. You try pumping 5 extra kilos of fluid, then have it removed (out of necessity) and see how you do. 4) Full code. You mean that's their code status? Or the pt is arresting? Probably potassium here. You know kidneys excrete extra potassium and dialysis pt's kidneys aren't functioning... and surely you also know that what is even more important than the actual level of potassium is the speed in which the potassium level is altered. My pt comes in with a potassium of 7.5 and I put him on a K1 bath... well... it happens that some will arrest.

The above poster is correct; and just to clarify, the initial advice you were given regarding using a sharp fistula needle AWAY from the buttonhole is the appropriate course of action if you aren't equipped to access the buttonhole. The buttonhole is a tract created by the same tech cannulating the same site on the access for about two weeks, at which point the tissues heal much like an ear piercing - once it's established, any experienced cannulator can access the buttonhole with a blunt needle (after carefully removing ALL of the scab from the site). Imagine stabbing through a piercing with a sharp needle... if your needle doesn't go exactly through the hole already created; the subsequent tissue repair where your sharp needle pierced the tract of the piercing may cause scarring and ultimately ruin your piercing - or in this case, the pt's buttonhole.

I laugh internally. The interns are near the bottom of their pecking order, but they've worked hard to get there... it takes time, I think, for them to soothe their tired egos enough to understand the value and role of all members of the health care team. What could possibly more amusing than witnessing a blatant ego-crisis? It's funny!

I understand that it's frustrating, but your tone is frighteningly apocalyptic. Pursuing your nursing career goals in this economy takes determination, persistence, and PATIENCE. A LOT of people are in your same boat right now. Hang in there, the economy will improve, etc, etc, et al, etc. Start looking at nursing homes and clinics, if you haven't already. Most new grads (and even experienced nurses) can't hold out for their ideal dream job right now - get a foot in the door somewhere, anywhere, and in another year you won't be a 'new grad,' and hopefully the job market will be a drastically different environment anyhow. Your degree is only wasted if you make it so.

I started on carbamazepine, but had to switch to Tegretol XR (not available as generic) because of the side-effects of the same med taken without the extended release (lethargy and feeling 'dim'). I've been on it for over five years now and have either mostly entirely adjusted to the side effects of the meds, or they have subsided. I would suggest working closely with your neurologist to find a med that controls your seizures AND has the least amount of side effects. I spent a few months on Dilantin and HATED it. Best of luck to you - it's a hard diagnosis to adjust to. At least it was for me.

Wow. I understand these recruiters are in the business of *selling,* but I find lying to make a sale reprehensible, no matter the product they're peddling. You can, in fact, become an ADRN in Minnesota. St. Kate's Minneapolis campus, for one, offers an AD program - just google Associate Degree RN Minnesota and you'll find other schools as well. Good luck to you.