DaydreamerRN

Thanks for all the advise. I might just stay put

Yes, I know the population from the nights, haven't worked with them on days. I do remember a lot of pts antagonizing each other and huge fall risk not related to anything other than frailty and disorganized thoughts. Thanks for your insights.

I did nights 12 hour rotating for 5 years, hence why I floated so much on my off nights. Thanks for the advice.

Hi, I worked inpatient hospice unit 9 years and floated to this Geri psych ward I am applying for a kazillion times cause they were short staffed a lot. I only floated nights, the position I am applying for is days. What are the differences and do you think it is a good fit. I did love it there most nights...the full moon nights were not my favorites. The trouble is they were always glad for me cause I was extra help. Now I would be much more responsible, no cheers daily when I arrive! Tell me, what is the differences in days over nights. I interview Monday, what to ask?

Floated nights on psych while working hospice inpatient. I was torn between home health and psych interviews coming up, reading this I remembered where I left my heart, or was it my mind... Psych it will be if they don't disqualify me for my own psychiatric quirks.

I know of 3 persons dx with terminal neuo diseases 2 months to 2 years post gastric bypass surgery. We were just discussing this a coupke weeks ago at work. None have Creutzfeldt-Jakob disease, one was unspecified aggressive nuero, 2 are/were MS diagnosis. Not sure there is a relationship, but in my small world their appears to be someything.

Love what you do and do what you love! Keep seeking for what you LOVE to do. Our local hospital has a nephrologist who does not handle patients or families well. He is a loner type. He rounds in the wee hours to avoid human contact. He is brilliant and saves lives. He may be autistic or just a genius but cannot handle 'emotional' aspects, just facts and figures, research and such. There is a place for everyone, yours may not be medicine..what do you LOVE? There in lies what you will LOVE to do!

I work in a hospice inpatient facility. Many of our nurses are previous L&D nurses. I think the common bond is we know how 'fragile' the family unit is when faced with life, the beginning or the ending. It is a family experience where everyones feelings and memories they will carry for a lifetime need a loving supporting prescence. The families will not remember our names, but they will remember the love and support they felt during these life changing events. I do not remember the nurses name with my first delivery at 18, but I still remember her love and compassion, her calming prescence in my caos of fear. I not not remember the nurses name when my second child was in ICU, but I remember his compassion for not only my son, but for my husband and I. We do make a difference even when it causes us pain. I am sure God is pleased for all the nurses that offer not only 'nursing' care, but also advocate for families emotions when they are in so very fragile. You sound like a loving nurse and I am glad you were there.

I find that being able to'vent' whether hear or in a journal helps release a lot of my stress and find some kind of perspective.

Your poem was beautiful, heartfelt, and it is also a good release for the stress you are feeling. I have had about 3 difficult weeks, BUT after the school shooting it went from difficult to me stating last Friday was the worst one of my career. I noticed staff, patients and familys were noticably on edge. Families brought all their children with them at all times, increasing everyones stress from the increased noise, but I understood their need to have them close. Patient's families had the news on which did not settle fears but increased them. I wanted to turn all the TV's off and put on some quiet relaxing music. Also we have TV spouting today is the 'end of the world' and this holiday time of year also increases emotions, not just in patients, but in everyone. It will be January and hopefully the tension will relax.

Sorry for the spelling and grammer Just woke up and replied rather quickly.

Thanks in advance if any of you are willing - I don't think it would take much time at all! Angela My kids are 29,23,and 21. For my oldest, born Dec 1982,I was in the hospital from Friday until Thursday. Baby was 7# 11oz, healthy although she had some jauncice and was treated with the light. I had a lady partsl delivery with lots of demerol. The doctor retired shortly after she was born from a long career of gp and delivering babies. I was impatient, not really in full labor Friday night at 7p.m., but I whined so much they kept me. My husband and I had little family support, I had none from my side. The doctor kept telling me babies are born all over the world every day and had been for centuries without a doctor and I would do fine, it was my first baby and they just take time. I knew of epidurals, but he did 'do' them, He gave me demerol, but nothing else until Sunday morning when I was progressing slowly he finally stripped my membranes. I cried and then about a half hour later I thought I wet the bed. I was 18. She was born noon Monday. The nurses told me my water had broke. I was given lots of demerol and finally went to the ER where I labored for an hour or so where I remember grasping the anethesist hand during a contraction and crying and apologising afterwards. I could wave to my husband througha small window in the door, I wasn't doing much waving though. That was my last memory. I do not remember her birth or pushing, just woke up in my room several hours later and told I had a girl. The sex of the baby was a mystery, back then you weren't told, tho I did have an ultrasound at 5 months. I had BCBS insurance and I was required to pay my deductable and co-pay before her birth to the doctor in installments. I think it was around $300 total, the $200 co-pay and the rest was co-pay. I think the hospital bill was less than a thousand, which I paid 20% of the first 1000 abd major medical covered the rest. This was back in the day of great insurnace for $6 a week from my check. I did not breastfeed, I had no support and though the nurses at the hospital encouraged me, I had zero support from relative. My husband was 17,(We have been married 30+ years now). We had WIC from the time I was eight months, that is when the doctor advised me to quit work and rest till the baby was born. He wrote a note stating I was not given enough bathroom breaks at the factory and was suffering from recurrent UTI"s, so I needed to be on leave. I could have kissed him. I hated working at a factory, sewing shirts. Back in those days, they sent you home with everything but the kitchen sink. So many samples of everything. The nurses where awesome, with back rubs and the patience of saints...tho it took me years to realize how frustrating a patient I must have been. We married so young and had no idea what we were doing. It was five years before we had our second child and so much had changed. It was C-sectionand send you home asap by 1988. If you need more, let me know. I was getting nostalgic remembering those starving, poor days of my youth.....I now have 3 grown children and 3 grandsons.

Thanks for the info about your symptoms and what precautions your school is taking.

Can you give us any idea where you picked this up? Do you have any idea of who you may have unknowingly exposed before you knew? I wish you well. I am glad you are feeling better. Thanks for sharing your story! On the bright side you will be protected if this comes back in the fall......sorry....... I know that is not even amusing :sofahider:

I am waiting until October to decide for myself if this one is like the 1918 flu. If this is truly the first wave, then the second wave would be the most deadly if the flu follows the track of 1918-1919. I also wonder if knowing this, the WHO knows the more people who get the first wave, the more people will be immune to the second wave. Do I make any sense? I used to spend hours on-line folowing Henry Niman and bird flu.... Now I am in school, no time for that

This website has been so helpful to me. Sometimes even the nursing humor thread is therapeutic to me. I finally registered so I could post. Thanks for all you do for nursing students. Sometimes I feel like I am drowning. I looked at my last two care plans, I did write more than what the patient said. This is my first care plan for a patient who does not have an H&P and who cannot tell me the onset of symptoms of any disease due to her lack of memory. I just happened to see on the home med sheet a scribble about the leukemia. She is on Gleevec 400mg and hydroyurea 500mg po daily.

well it isn't a decube...i just didn't know the correct words for wet, red, raw skin. i had erythemic, escoritaed (raw) tissue. i was cleaning her after a bowel movement when i saw her rectum had prolapsed. this has been hard for me to document also. she is on the mental health unit for anxiety, tho i didn't see any. she has no h&p, the teacher said this floor often doesn't have one in the chart. she live in a different town, but their was no mental health unit their. here is what i wrote on the patho part: -major medical diagnoses and pathophysiology of each (not signs and symptoms and not copied from medical disctionary). explain in depth about each disease, even chronic diseases that are not the reason for admission. explain how the disease processes are related to each other when applicable. this must be in the student’s own words and not cut and pasted from the internet. pt has anxiety related to the loss of her husband as caregiver due to his recent hospitalization. her husband has been her primary caregiver since her development of alzheimer’s dementia, onset unknown to me. alzheimer's disease is characterized by loss of neurons and synapses in the brain. this loss results in atrophy of the affected regions. amyloid plaques, deposits of the amyloid-beta protein on the outside of the neuron, and neurofibrillary tangles, twisted fibers of the microtubules in brain cells, are clearly visible by a microscope in brains of those affected post mortem. enzymes act on the amyloid precursor protein (app) and cut the protein forming pieces that make up the plaques, disintegrating the neuron's transport system. this basically is like mice in the walls eating away at the electrical system. at first only small hints of memory loss are noticed, but how to stop the progression or reverse the effects are not known to science at this time. there are drugs, like aricept, that this pt is on which may slow the progression. pt’s feet were assessed by arterial doppler and found biphasic flow bilaterally with calcified plaques. biphasic flow is slower blood flow most commonly caused by peripheral artery disease. this lack of arterial blood flow to the feet would explain why her feet and toes have skin breakdown and cellulitis. also, i checked her shoes in her closet; they are very narrow in the toe area with inside seams protruding. this may be where the pressure points began, and with decreased blood flow and possible neuropathy, why her toes ended up in such a state seemingly without her knowledge. of course, now i am curious as to whether her dementia is of the alzheimer’s type or vascular. without a health history, i can only hypothesize. another cause of the dementia could be resulting from her only actual written diagnosis of a previous medical condition which came via her home med list, resistant chronic myelocytotic leukemia. the resistant stage of this leukemia occurs 3-6 months before the final onset of the blast crisis in which the patient usually dies. she does show a significant increase in bands (immature white blood cells) 9% , decreased wbc less than 3 thousand. with her fever one would hope her body would be mounting a defense of 10-20 thousand wbc, but it is not. her lymphocytes are decreased at 16%. i would suspect the lack sufficient red blood cells, hers are 2.99, would further reduce the oxygen to the brain cells, skin tissues and cells in her feet to promote healing. due to all these factors combined, i think she is at very high risk for infection due to her compromised immune system and that will be my highest priority nursing intervention for her.

This is my first post. I hope I haven't broke a rule. I watched the video?

I am a third semester RN student. I have a big care plan. I cannot decide how to fill out the review of systems since my health assessment book clearly states "Subjective data, positive and negative, that the patient offers--what the patient tells you as stated by the patient." Their is NO H&P in her chart. She has skin breakdown and heberden nodules and disfigured hand, yet she denies arthritis, basically she denies everything. I know this is the section where we use the word 'NO', ex: No fever, chills, malaise. I am confused, if she has a temp and yet denies it...am I reading too much into this? I am unsure! In the physician ROS it is more like our physical assessment of the systems which follows this ROS section. Below is what I have for physical assessment of her skin, hair and nails, I am lost what goes under ROS. Any help with this would be extremely appreciated. :redbeathe Our school is out for spring break and I haven't hear back from any of the instructors on this question. Thanks in advance! Skin, hair, and Nails: Pink, soft, dry, and very warm with poor turgor. Temperature of 100.1. Nails without clubbing, fingernails have raised ridges, and firmly adhered to nail bed. Capillary refill X 6 seconds. Pedal pulses not palpable without Doppler. Skin on feet red and shinny with no edema noted with exception of right great toe. Multiple blisters on both feet distally. Left great toe is swollen and the nail bed is hard but missing any form of a nail, possibly removed. First phalanges bilaterally cross under the second, possibly due to arthritis which also has caused deformities in the joints of her hands. Pt denies any pain or hx of arthritis. Pt. skin is in stage 2 decubitus in the perineum measuring approximately 1.5" each direction from midline laterally, beginning approx 3" above the orifice and continuing to the vulva where the excoriation ends. Hair is gray in color, has wavy soft texture and even female distribution.