jlr820

Wow, let's see. I've been "bizz" for 6 years. Let's see how many "craniorectal inversion" moments (think about it for a second...) I can remember. Forgetting to "pop" the seal on an Add Vantage cartridge after it has been screwed into the top of the diluent bag, so that your patient gets 250 ml of normal saline rather than the vancomycin he/she was supposed to get... Forgetting to unplug the crash cart from the wall outlet before sprinting it toward the room of a coding patient (it's kind of like being a dog that runs until they hit the end of their chain. Kinda jarring...). Charting a BEAUTIFULLY THOROUGH head to toe intake assessment, and dutifully saving it only to realize, just as you click SAVE AND RETURN TO WORKLIST, that you did it on the wrong patient. Suiting up in "full battle rattle" isolation gear for an airborne precautions, negative pressure room (complete with CAPR) to enter and do a complicated dressing change, only to realize once enclosed behind several thick panes of glass and several feet of distance, that you forgot the Medipore tape, or scissors, or whatever other seemingly insignificant piece of equipment needed to do said dressing change. Now, you either have to go through the process of exiting the room and degowning (only to return and do it all over again), or stand inside the glass and play a strange game of charades with your coworkers (who are all sitting at the station pretending not to understand what you need, and doing their best not to laugh). Lowering a bed before checking that none of the wires/cables/tubes/other miscellaneous stuff won't get in the way and be pulled/tugged/shifted or otherwise compromised. Example: Lowering the bed without checking that the, oh say, flush bag for your arterial line isn't in the way of the descending bed such that a side rail catches the bag spike just right and you hear a sudden loud POP followed by the sound of gushing pressurized water striking the tiled floor (followed by the sound of the RN stomping to the supply room to get another 500 ml bag of flush solution, a new art line tubing set, and several towels) :) I'm sure I can recall more given the opportunity, but that should do for now. :)

Hi, First, your prior experience in cardiovascular nursing will serve you well. You already have experience with assessments, rhythm interpretation, etc so that's good. What you have probably noticed is that the pace is different, as is the range of patients that you are dealing with. You will deal with such a range of patient acuities, ages, medical backgrounds, etc that it will sometimes boggle your mind. Thus, I suggest: 1. Assessments in the ED are more or less complaint driven. You don't necessarily need to do complete head to toe assessments on EVERY patient. You will learn who needs more thorough/more frequent assessments with time. You will also discover that you can do a fairly comprehensive assessment in under 3 minutes for most things. You should also become familiar with what some call "doorway" or "across the room assessments"...quick visual appraisals of how a patient "looks" as they are entering the room. Much can be learned about a patient's condition with what I call an "experienced glance." This is handy for those many times when I am in a room doing something for a patient and I can see the triage nurse placing another patient in one of my rooms. A quick visual tells me if I need to go and assess that patient right now, or if it can wait for a bit. 2. What is a priority in the ED changes sometimes minute to minute. Always be asking yourself "Who is the sickest patient? and What do I need to be doing next?" Efficiency is a watchword in emergency nursing. You really can only learn this from experience. That said, however, you are only one person and there's only so much that you can safely do at any given time. Know when to ask for help (and know that teamwork is essential in emergency nursing.) 3. Get used to using protocols to begin orders/treatments/lab tests. Hopefully, your ED has protocols that can be initiated by an RN before the physician sees the patient. This can really help to save time and streamline the care of patients if it will be a bit until the doc gets into the room. Learn what protocols you have and use them appropriately. This will be different from the floor, where you had to get an order for everything you did. 4. Always be wary of pediatric patients, especially infants. Kids compensate quite well, and they can go to hell in an eye blink. So, even if they "look good" right now, keep that healthy index of suspicion and reassess frequently. Also, listen to parents/caregivers. If they are telling you that the kid "isn't acting right" believe it. 5. It's easy to "write off" an intoxicated patient as being "just drunk." Be careful, and assess these patient's appropriately. Many times, these people have underlying medical conditions that are masked by their intoxication. Some also have underlying injuries (including head trauma from falls or assaults). Thus, don't simply leave them to sleep it off. Make sure you have assessed them fully (and this means that you will probably have to undress them to properly assess for any occult injuries.) and monitor them accordingly. 6. Similar to #5....it's also easy to write off what we tend to call "frequent fliers" (those patients who seem to be in the ED more often than the people that work there). I once read in "Emergency Nursing Secrets" that these people need proper assessments each time they present to the ED lest you ignore or miss a possibly life threatening issue. 7. Crazy people get sick too.

I've never heard of the dorsogluteal site being contraindicated for vaccines. As long as you employed proper techniques for locating IM landmarks (as another poster said, upper out quadrant), aseptic technique, etc. there shouldn't be any issue. It's an IM injection, and you used an appropriate IM injection site, so no worries.

Yes it is. The bloodstream is absolutely full of glucose (since it isn't entering cells and being metabolized). This glucose load makes the blood HYPERosmolar and the kidneys respond by trying to remove glucose through urination. They cannot effectively deal with the large glucose load, and that's why glucose "spills" into the urine. The process of excessive urine output secondary to the large glucose load is called osmotic diuresis, and the client loses a HUGE amount of fluid through this diuretic effect, leading to profound dehydration.

I'm not sure how this rumor about NCLEX difficulty varying by state got started, but it's totally incorrect. The NCLEX is a national examination, and there are no differences in difficulty by state. What IS true, however, is that the test is done by computer wherein questions are pulled from a huge test bank. The test is "computer adaptive," meaning that the computer will give you questions that get harder or easier depending on HOW you are doing on the test. So, while the NCLEX is the NCLEX no matter what state you are in, your particular exam might have harder or easier questions and it may be anywhere from 75 to 265 questions. It depends on how YOU, the individual test taker, are answering your questions. No two people will take the same test because everyone is different in thier level of preparation, knowledge, etc. As for "feeling awful afterwards," that describes how nearly everyone feels. It's a difficult, nerve-wracking exam regardless of where you take it.

This is one of those "DOH!" moments. Your risk is probably small. Basically, you would have to have an open wound on your hands and the client's blood would have to have contacted that wound and entered your bloodstream. That said, I'm sure you are aware of the rules about PPE use...giving IVP meds is included since the client's blood can be on the saline lock tubing and/or clave connector from the original venipuncture. In short, you can't be sure that the lock is uncontaminated with the patient's blood, so gloves are in order. Chalk it up to a lesson learned. You might pose this question to your facility infection control nurse (true, might result in a write-up or some other disciplinary action, but oh well...like I said, treat it as one of those "ano-cranial inversion" moments that every one of us has had in our careers at one time or another). We've all done something that we could kick ourselves for after the fact. Learn from it and move forward. Best of luck. I'm sure you are fine.

The risk is likely small, but as others have said the risk is still there. I think the main issue with the anti-retroviral therapy will be the side effects of the drugs. But, for your own peace of mind perhaps that's a small price to pay. Best of luck.

i'd recommend sheehy's emergency nursing: principles and practice as others have done. you can also enroll in an online emergency nursing course through the ena, which is based on the sheehy text. the downside is that it costs about $600. here's the link to enroll if you are interested: http://secure.mcstrategies.com/commerce/productcatalog.aspx?passthrough=v7tftflixrsmt%2ftcida64enwxzsf83vrbwuwnc1e5ck%3d you might also check out emergency nursing secrets by kathleen oman, triage nursing secrets by polly zimmermann and emergency nursing procedures by jean proehl. you won't likely be doing triage for awhile, but the zimmermann text still has a lot of great information in it. best of luck!

You really need to do this in person. I think it would look really bad to do it via e-mail. No need to risk burning a bridge. You never know..you may need to cross back over that same bridge sometime down the road.

Next time I do a pain assessment, I'm gonna ask "Is it like you're actively being mauled by a bear?" with a sidelong, eyebrows raised expression on my face. Prolly draw a complaint...

I certainly wouldn't recommend the "no studying" approach. I know two classmates that took it without studying and managed to pass, but I know many more who took the test cold and failed. So, someone that takes it without doing any organized preparation might get lucky and pass, but the odds are not in their favor. As for me, I took Kaplan, did over 7000 questions and reviewed daily for 2 months before I took it. Some may say that was overkill, but I wasn't about to take that test cold. Doing so is an incredible gamble in my opinion. I passed with 75 questions.

i'm an ed nurse. this is hard to answer with the information given. i'm sure that he was triaged upon arrival by an experienced rn (focused history and neuro exam, vitals, etc). i just have to believe that he was triaged appropriately and had no neuro deficits, stable vitals and probably made a "yellow" level 3. the other issue here is "do we have a room or hall bed to put this patient in?" and "what else is coming through the door right this second that might be a higher priority. sounds like this client had some post-op headache pain, but was otherwise stable. i'm sorry that he waited four hours. i'm sure if there had been any hint of neurological deterioration either upon arrival or during a waiting room reassessment, they would have found a way to get him back immediately. we in ed genuinely do try to do our best for patients...many times, though our "best" and their "best" are not the same thing.

Hi, Yes I did use the Zerwekh book, but as a supplement to my main NCLEX-RN prep book, which was Prentice Hall's Comprehensive Review for NCLEX-RN by Mary Ann Hogan. I did think the Zerwekh text was good, and I used the CD for more NCLEX question practice.

I'm a former army officer, and an OIF veteran. I wasn't an RN when I was in the military (that came later) but it doesn't matter...your recruiter is basically lying to you. An officer IS deployable after they have completed their officer basic course (the training that you are sent through for the specific branch you are in...for you that would be the Army Nurse Corps). Let me be very clear that, once you finish that training, you are deployable...PERIOD! And, let me be even more clear...as the current world situation is (2 wars in progress), you are VERY likely to be deployed to a combat zone as a nurse. Recruiters will say whatever to meet quotas, even if it means bending the truth a little...or a lot. If you wish to join, more power to you...but make sure you understand what military service will mean. It isn't something to enter lightly. PS..it doesn't matter that you would be ARNG-still deployable (not only by the federal government, but also the state you serve in for civil problems, natural disasters, etc).

I've never done it, and won't unless there was a major problem with the care being provided. I don't like it when a patient or family member does it to me, as it is usually stated with an air of superiority. I agree with a previous poster. Usually, it's an indication of insecurity. I recently had a family member do this to me as I was providing discharge instructions for her 13 year old daughter. As I was discussing those instructions, I was told "I know, I've been a CNA for 25 years." I wanted to say "So what...at this point in time you are a parent, and should listen to what I am telling you rather than trying to impress me with your vast knowledge. I might actually say something important to the care of your child." Of course, I didn't say it but found it rude. I applaud the fact that someone is a health care professional, and would never wish to dismiss that, but please don't throw it in my face. I doubt someone would want me throwing my RN credentials at them if the roles were reversed. It isn't helpful. Again, I would only do it if there was a huge problem with the care that was being provided (as in a major deviation from the standard of care).