mags-rn

Ok, I have to weigh in here. You are walking a fine line when you start to label pts as "drug seekers" Granted, they are out there. Because a person asks what medication they will be receiving does not imply they are a drug seeker. Some pts know what works for their pain. Moreover, some people are allergic to NSAIDs or they are intolerant of these meds. They may be allergic to sulfa nad were told to avoid NSAIDs because of possible cross allergy. Chronic pain is significantly different than acute pain. Persons with exacerbation of chronic do not usually present with the typical S/S of pain i.e., VS changes, writhing/restlessness and agitation etc. I also have to comment on the fact that there may be an inter-relation between MH issues and pain. One must ask "what came first, the pain or the MH issues" So MH patients may have pain issues. There are so many causes of pain and so many reasons people take pain medication to begin with and some people seeking pain meds are so manipulative. I do think significant ethical issues exist when pts are labeled as "drug seeker", or their pain is not adequately treated.

In the Glasgow coma scale they get a 1 or T for tubed, as it is impossible to assess neurological function accurately without guessing, which defeats the purpose!

1. The hospital is the only place that Panadol or Asprin can be obtained 2.I've learned that the first thing a person wants to do after vomiting is "reload the cannon" by eating or drinking and that no pain, bleeding, distress, or illness is too great to want a tray. 3. I've learned that ALL nurses absolutely know the names of every visitor and family member that has or MIGHT walk through the door with every patient. You know, the phone calls I'm talking about,"Can I talk to Mary Johnson?" There is no patient named Mary Johnson and it is the patients cousin twice removed. Or the visitor/family member will come through the door and ask "Can I see my Mum?" Like I don't have 8 Mums in the ED right now. Telepathy is a good lesson. 4. Patients truly believe that there is just one pill out there that is "the little white (blue, pink, etc.,) pill" and that you as the nurse should know what they mean. 5. Patients waiting in the waiting room for 3 hours before they are seen are miraculously better once they get a bed in the ER. This is especially true for dramatic patients who have had chest pain for 6 months, and need to get back ahead of everyone else, because they are way sicker. 6. Patients are sometimes too honest. To tell a triage nurse, "I just want a note for work because I called off today, can't you just write me one and let me go home?" is not a good idea! 7. When you hear, "You won't believe how this happened to me!" and the patient has a towel stuffed down the back of their pants, and a blood soaked bottom, walking with mincing steps, the patient is probably right!! I love this thread, It's great to know these lessons are universal.

Ah, you have dealt with stressed parents. But ICU is a different kind of stress. Its one stress to see your child acting out , its a whole other stress to see your child hooked up to machines and drips that are keeping them alive. Parents are stressed about that fact along with being very intimidated by all the thing hooked to their child, it is really a life or death situation that makes parents very very scared and withdrawn. They usually are very timid at first and then they reach a boiling point. Its good that you have the background you do.

I'd give it in a HEARTBEAT - and in fact have done so MANY times over my many years as a nurse. WHAT IF it's the last injection that helps the patient relax and die comfortably?? To me, THEN you are the ultimate Nurse. Nurses CAN'T change the outcome of a terminally pt. We CAN change the quality of life they LIVE through till they die.

I have heard many people take the matter of fact attitude including myself telling the patient that language like that will not be accepted here we have other patients that do not need to be subjected to it as well as ourselves. Also, you have to remember, pts strike out for many reasons, probably none due to the nurse. May have received bad diagnosis, may have family who do not care, may be scared. The nurse must keep herself in check. It has nothing to due with you, most of the time. I know when I was a pt, the nurses I am sure wanted to strangle me. But, I was tired of tests, tired of saying I can not help you, tired of being sick and tired of surgery after surgery. Not once did I have a nurse yell back at me. Not once did I have a nurse teach me either about what to expect .I just swore I would be a better nurse. Teaching and holding a hand are not beneath me. I also do not need a doctor nor the pt to validate my worth. If someone does not respect you, its their problem.

As the in above reply - there is very little danger in this myoview. My understanding is that it will dilate the coronary arteries pharmacologically (instead of through physical exertion i.e. exercise). It has been approved for this use longer than any other coronary dilator and its action can be stopped with Aminophylline if need be. Similar to the above reply, it is possible to cause bronchospasm in people with asthma or COPD. There is also a slim chance of inducing arrhythmias. For these reasons, you will be monitored throughout the test and life support equipment will be available. A small amount of radioactive material is given IV that is taken up by the myocardial cells. Basically, you just lie there on a gurney with a gamma camera focused over your chest. It takes a "picture" of the coronaries being dilated and how well they feed the myocardium(myocardial perfusion imaging). It is a useful test of the functioning of the coronaries. The radioactivity is about as much as you would get with a chest x-ray. So even though the word "radioactive" is used, it is such a small amount that no precautions need be taken by you after the test. There is the concern of the IV used to administer the stuff. It should be diluted to prevent phlebitis. Caffeine is not allowed as it is antagonistic to the drug and will give you a non-diagnostic test. The same with some meds so check on what you might need to avoid, including over-the-counter stuff. I too, have not heard of anything terrible happening during this test and it is considered to be safe and useful. Good Luck. Let us know how it goes. Maybe you can give us more information on the test afterwards, teach us something

Steven Johnsons and TENS tend to be partial thickness wounds and really dont require all those extensive and disruptive dressing changes. I forgot to mention, we started using ACTICOAT! This was excellent! It is a silver coated barrier and the dressings only needed to be changed daily if that often. The barriers could be reused up to about 7 days. It really is bothersome that some medical staff do not dialogue with sales representatives who can offer more current wound care products!!

http://www.vh.org/pediatric/provider/pediatrics/PediatricPainMgmt/index.html http://www.wch.org.au/rch_palliative/prof/?doc_id=1686 http://www.medicineau.net.au/clinical/palliative/palliative3.html http://www.medicineau.net.au/clinical/anaesthetics/AcutePain.html

Considering the amount of medication(s) ingested in the western world we are either the sickest bunch that ever lived or the most healthy. While it is true that we are healthier in many respects this is due more to public health and education than pills. Anything that makes us take a long hard look at the amount of pill popping we (not all) do is not necessarily a bad thing. In the fifties Eisenhower warned of the Military/Industrial complex and the way it manipulated the system (people) to make exorbitant profits. Perhaps it is about time to turn the spot light on the Medical/Pharmaceutical complex. The bottom line is that the Drug companies get their profit either way, either from the individual or the society, and what we need to be doing is encouraging people to take control of what ever situation they are in and not to expect a magic pill to "make it all better" because it won't. Just a thought.

Congrats to you! I am a former Paediatric Nurse - hospital ward. I do ICU primarily adults nowadays. The one thing I can honestly tell you is to always, always take care of YOU...burn out comes to fast in those places. But it is also very rewarding most of the time. I would also say that your going to deal with loads of very stressed parents. Stressed parents are scared and mean. Always remember to put yourself in their place and remember that could be YOUR child laying there. If you remember that with passion and respect it, you will do fine. Good luck in your career, it is very rewarding!

There is an old joke. God put a thousand people in one room and filled it 1/2 full of poop. Then sneezed with copius amounts of snot flying. The ones who ducked became nurses, the ones who stayed upright, were RT's/Respiratory physician.

We've had great success with Xigris, but then it's been started early, and we've had little incidence of bleeding. I think it's a keeper. My only problem has been that thus far, patients have had to stay in the ICU until the whole course was completed [that is unless they were doing so well that it was discontinued before the 96 hours was up], but we're working on changing that.

I had to run a search as USA med brands differ to those in Australia. In answer to you questions 1. If the urine in the foley is blue the patient is probably on urised, a medication for bladder spasms usually associated with a UTI. 2. I have been lucky that in the hospitals I have worked in had a bladder scanner. So we would DC the foley. push fluids, wait for up to 8 hours depending on why they originally had the foley and meds they were on, take to the bathroom q2h during the 8h wait. If no void in 8 hours scan bladder, if over 250cc straight cath, repeat x3. If >than 250cc's after three scans then replace foley and contact MD for when to attempt again. If Hope this helps.

Cross my heart the following is factual Now, grab on to something, folks - Last week - adult male arrived heavily intoxicated in A & E (Accident and Emergency) s/p assault. Drunk and acts like a 10 year old, but he's happy. I take said-named-patient to the bathroom to obtain a UA. Patient is shown the location of the benzalkonium pads and instructed to "clean yourself very thoroughly before you pee in the cup". (Getting the picture yet? I didn't) Five minutes later I am concerned about the PT and call him through the door. To my relief he responds immediately and says he's OK. I ask him if he's pee'd yet and he responds "Not yet, I ain't got clean yet..." (Are we any closer to catching on...?) I ask him what's the matter and he responds that he needs more of "them little soapy pads". Now I am REALLY concerned because there was a whole box of them in there 30 minutes ago. Suddenly a light goes on and I open the door, cautiously.. Much to my chagrin, the patient is standing naked in the middle of 200 benzyl packets laying about on the floor. "There ain't enough here for me to get clean with". Folks, it takes one of these Kodak moments to get through some shifts.

A $5.00 weekly fee automatically deducted from our pay for staff parking. Hospital parking is free in the wee hr of the morn. - no one patrols the boom gates at this time.

A venturi mask delivers a more precise FIO2 which can be important in COPD patients who are oxygen sensitive ( those that have a compensated respiratory acidosis on ABGs). FIO2s range from .28 to .60 on a venturi mask system and is regulated by the color coded air entrainment devices. Simple O2 masks need to be run at a liter flow of al least 5- 6 lpm and deliver anywhere from .30 - .60 or above depending on the patient's own inspiratory flow and tidal volume making it a less desirable system for COPD patients who need a specific lower FIO2. Hope this helps

I no longer work in burns either, but over the past couple of years, there has been an increase in SJS and TENS. I believe it was/has been related to the increased combination of medications used to successfully treat HIV. The main culprits are medications based with sulfa like Dilantin and Bactrim. Pain management is important, so most of our patients were managed on continuous morphine drips. Also, Biobrane or any similar type of bio-synthetic dressing was successful in wound healing and pain management as those dressings remained intact for about 7 days, long enough for superficial injuries to heal. Silver nitrate may be great, but I like to see those patients placed on homograft and iobrane. Daily dressing changes is concerning.

There is one thing to keep in mind - A.P.R.V ventilation, and that ventilation is not curative form of science, but only a means of relief.

Referring to this specific question whether a line in the jugular vein could be used, the answer is no for the reasons given below. There may not be evidence in the literature about such things where common sense is needed! I would say that a check X-ray is mandatory for all central lines inclusive of peripherally inserted lines. Apart from recognising complications like pneumothorax, you do not want to rely on pressure measured outside thoracic cavity or infuse vasoactive or hypertonic solutions like TPN elsewhere than the desired site. There may be situations where you cannot wait or cannot do a check X-ray (for example perioperative period). In these situations as long as one is able to aspirate blood in all the lumens and there is a convincing pressure trace with appropriate pressures, I do not see any reason to start using the line without an x-ray. If these criteria are not met, I would have a high suspicion and hope a check X-ray was done at the earliest. Regarding line tips migrating to the jugular veins, pressure on the jugulars would cause distortion of the wave form and pressure. We recently had a patient who sustained head injury and admitted under the neurosurgeons. On the third day patient had features of acute abdomen. Patient also had left sided pleural effusion. Differential diagnosis including pancreatitis were considered. Before using the central line inserted through the femoral route, the registrar tried to aspirate the line only to get some clear fluid. The line was not used and another access was secured. On reviewing the abdominal X-ray, it was found that the line was coiled in the same side (left) iliac fossa. Patient also had some 3 litre fluid in her pleural space which was of the same colour wh8ch was aspirated out. This patient had received all drugs including Mannitol and fluid through the line inserted in the femoral region for three days. All she needed was removal of the line and throracocentesis!

Working PT in ICU - I am rostered on as FT in a 25 bed ICU dept. where I know of 2 staff who are scheduled on PT basis.

Because this is an issue all throughout nursing, and not exclusively Australia. I stand strong in saying this - nurses should NOT have to put up with abuse whether it be verbal or physical. Spend a day in Accident & Emergency that will change your mind. Thank-you for bringing this up. Cheers!

The hospital I work at written physician order, or a verbal order to dc or continue meds is a must for discharge, a duration of script is also a must with indicated refills. If an RN or pharmacy has a question, physician needs to be contacted, and date and time of such communication documented. Nursing/hospital policies are only a backup tool in case of nonavailability of the physician or his designee praveen.

Nurses are playing increasingly important roles in the ICU/CCU. It is not uncommon to see nurses remove central lines or arterial lines or endotracheal/ trach tubes. Therefore I see no reason why they cannot remove Intercostal tubes. Like any procedure, it is important that the RN are properly oriented to the relevant issues and initially supervised by previously trained RNs.

Here - Generally speaking, no - no drains. Rarely they may come out with a T-tube, but again that is very rare. The only real consideration is to watch for bleeding from the clipped artery. A rare potential complication is a missed stone in the common bile duct. This can be corrected either with surgery or an ERCP to grab the stone. Of course, a patient might go into surgery expecting laparoscopic surgery, and come out with an open chole. Diet is something to counsel the patient about. The body needs time to adjust to a reduced amount of bile released when fatty foods are eaten. Food tolerances might be changed. Go slow when introducing fatty foods (of course, this is an opportunity to change one's diet for the better!). Hope this helps.