tewdles RN

PICU, NICU, L&D, Public Health, Hospice

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All Content by tewdles

  1. tewdles

    Brain herniation and eye movement

    wow esme, that was a nice comprehensive
  2. tewdles

    acyclovir

    I sometimes get herpetic lesions in my mouth after chemo. Viscous Lidocaine helps me to control the pain so that I can eat and
  3. tewdles

    National average for pt caseload

    At my agency the field case managers carry 12-15 pts, depending upon location and LOC. The RN case managers who work strictly in a facility carry 15-20 pts solo, more than that and we permanently...
  4. I agree, discuss this in IDT and develop a plan of action. Schedule regular family meetings, say every two weeks before or after IDT. Create an agenda for the meeting so that it is controlled. Invite...
  5. tewdles

    this is do-able, right?

    You have to decide what is doable for you and then set clear boundaries with your employer. Do they have a back-up plan for you if you have a really busy night? Good
  6. tewdles

    Flu Shot Reaction, anyone??

    I had the vaccination just before my last chemo and had no reaction...other than to the
  7. tewdles

    My friend is dying..you gotta read this update!!!

    I am so sorry to hear this...tragic in yet another
  8. tewdles

    Treatment for uncontrolled N/V post chemo

    I am thinking about scop patches, the oxali makes me so dizzy that I wonder if it would work for some of that nausea. I just don't relish the thought of the dry mouth that will come with
  9. tewdles

    Send a nurse now or we will call 911.

    If families threaten to change hospices I make sure that the MSW has provided them with a comprehensive list of agencies and discusses it with them. If a family is that unhappy we are glad to let them...
  10. Yes, the drive by thing is a good idea...I did a drive by once at night and drove right into a group of young people who were having a bad disagreement, seconds later I heard gunshots and called the...
  11. tewdles

    Send a nurse now or we will call 911.

    The POC can include supporting the patient in different palliative treatments or anticipated emergent care. If we have an end stage cardiac patient, for instance, who is not a DNR, has an implanted...
  12. tewdles

    Treatment for uncontrolled N/V post chemo

    I get aloxi and will receive emend on Saturday when my chemo is disconnected. I think both work pretty well, at least for me and I am having a good deal of N/V/D side effects from the prescribed...
  13. tewdles

    Don't you hate secrets?

    Definitely difficult....you are correct that people get stuck in the denial part of their grief. And we cannot change that. I try to remember that my relationships with the patient and family MUST be...
  14. tewdles

    Calling EMS to pronounce

    Different states and counties have different rules. If one of our patients in Detroit dies in his home, we (nurses) visit, pronounce, call the local PD (county rules) AND the ME to qualify the death...
  15. tewdles

    Intraosseous Infusions- anyone using it yet?

    I learned how to do this in the mid 80's, it is a life saver for pedi trauma
  16. ...you do post mortem care? Are you wondering if the pain medicine caused the
  17. tewdles

    Calling EMS to pronounce

    Not a problem in Michigan, nurses
  18. tewdles

    Every visit, pain is 7?

    yep, these patients can be difficult and time consuming. You are doing all the right things. Make sure you document her pain, a good pain assessment, her level of acceptable pain, and her preferences...
  19. tewdles

    No hospital bed?

    I have had many patients who prefer a recliner to a bed...as suggested above, they are often patients with dyspnea as one of their primary symptoms. I try to acquire appropriate pressure relief...
  20. tewdles

    Don't you hate secrets?

    Yeah, that is what I was saying, Leslie. People who know, but their families are emotionally paralyzed by their anticipatory grief and fears...so they never allow, much less encourage those important...
  21. tewdles

    Don't you hate secrets?

    I agree that this is very frustrating! Too often, the patient that the family doesn't want to tell about their terminal disease, knows that they are dying but have no family permission to speak about...
  22. tewdles

    Cardioverting A Nurse Coworker?

    Gosh, it was more than 15 years ago...we shocked her more than once, but I think only twice. The weirdest part for me was doing CPR on a co-worker while waiting for our team...I was happy to step...
  23. tewdles

    Cardioverting A Nurse Coworker?

    Geesh...that is quite a story! Jan (not her real name) was sitting right next to me, with one of our Medical Directors on the other side. As I said, there was quite a diverse group of us present...
  24. Okay, so if gas is a big problem get him an appliance with a valve. Why not palliate the gas with something easy? Talk with the doc and see if that would be possible. Dependent upon the situation,...
  25. tewdles

    daVinci robotic surgery

    Each procedure is practice,