Guest 360983

A nurse who is much smarter than me told me that the elderly are like babies--neither group compensates well and both have initial presentations that are very different from the healthy young adult. If you had a neonate who was hypothermic, hypotensi...

Ischemia takes hours to show up after the initial infarct. The initial CT may show no abnormalities.

I want others to explain. I'm that annoying nurse who asks students for rationale.

Why are we doing the labs ya'll suggested?

That's a fairly tough assignment for a pre nursing student. When you mention a nurse cleaning wounds as a provider, I think you're on track. To me, providers do stuff. Nurses do a variety of things, from cleaning wounds to assessing patients to admi...

My initial instinct is yes, but what's preventing management from slowly inching back to the (sub) standard conditions?

Good! Now grab your NANDA book and make sure your diagnoses are in it. I know risk for PE isn't one. I imagine there's a nursing way to say it. Make sure to look at the defining characteristics for the diagnoses so you can determine if they are the m...

Use Maslow's hierarchy to help you prioritize. In the ER you get the highest priority if you have a life or limb threat. EDIT: I think you're missing some important risk diagnoses. I don't have a NANDA book handy but what are the defining characteris...

I don't chart care plans. I chart my initial assessment, reassessments per floor policy, reassessments when change in condition is noted, interventions and discharge instructions. This could be simple and fast on a benign belly pain or one nurse's so...

Tell me about what you think of when you read provider. Next, tell me what you think of when you read manager. Seriously, write this down before you go futher. Now think about what you have seen nurses do in clinicals and what you've learned about nu...

I'm lazy so I count the number of complete QRS complexes in a 6 second strip and multiply by 10. You can measure the number of large boxes between the same part of consecutive complexes (say between the start of one P and the start of the next P) and...

So this might be part of the care plan :)

What did your assessment show? What did the nurse spend most of her time doing with the patient? Why is the patient hospitalized and not getting antibiotics via PICC at home?

If you like sick kiddos, don't underestimate the value of an ICU or ER rotation. The ER sees every age group, including pediatrics (unless you have a children's hospital in the area, which I doubt because of the lack of NICUs). The ICU will teach you...

When my MIL had cardiac surgery, the hospital she was in had a cardiac surgery ICU and a separate cardiac ICU. One took all the surgical patients (CABG, valve replacements) and the other took nonsurgical patients (MI, CHF). And that's not counting th...

I'm an ER nurse, not an OB nurse. I have a few accidental catches and several late miscarriages under my belt, however. I would be VERY concerned about hypotension in a postpartum mom as she should be able to compensate for a typical amount of blood ...

I think you're doing a fantastic job with this case. He may well have only vomited once, especially with the NSAID use. Most of the Mallory Weiss tears I've seen as a ER nurse have been in pregnant women with hyperemesis--I share this as a reference ...

His WBC was likely elevated from gastritis (vomiting that causes a tear is rarely a one time thing) and/or stress response/inflammatory changes from the body reparing the tear. It's not the bleed so much as the cause of the bleed. GI bleeders run th...

What are you concerned about in the postpartum patient? What assessment findings are consistent with this concern? How do those assessment findings compare to the information provided in the question? 110/60 is a typical BP for a young, healthy pati...

I know this is probably late but for future students: So tell us more about your patient. I see he is diaphoretic, tachycardic and tachypenic. What did your abdominal assessment reveal? What did the rest of your skin assessment show? What were his la...

How is her interaction with baby? How is her interaction with family?

A doc once told me viral illnesses raise WBCs higher than most bacterial infections. I don't have any evidence for this, so take it with a grain (or a shaker) of salt. Like Esme said, don't underestimate the body's stress response.

I think you need to shadow some nurses and midlevels in the ER. Even at the busy trauma hospitals, trauma is VERY far from the majority of patients. I've heard the busiest trauma ER in the country is 20% trauma--more on weekend nights, less on Wednes...

In the two hospitals I've worked at, the NPs and PAs are used the same. At the trauma center, the midlevels weren't allowed out of urgent care. At the community hospital, they see non dying patients first to order the labs and meds. They also do some...

New York City Severe Sepsis Project I'm assuming you are in the ICU based on previous posts? I used this site to help revamp our ER sepsis screening protocol. Definitely check out the Surviving Sepsis campaign. Also, check out the recently publishef...