FazzDazzle

Remember it's not ABC but CAB in all situations. In the ED we deal with a lot of seizing people, it's scary at first but you soon learn. Check a carotid pulse or radial pulse (it's hard when people are seizing but pulse rates tend to go up, and dead/pulseless people often don't move), then I check their airway. Seizing people often clamp their jaws down far back and so what I do is a hard jaw thrust maneuver if they look like they aren't breathing well. (Not everyone does this but I do. Having worked in surgery I learned this will increase oxygen saturations more than just slapping oxygen on them and you can assess if/when they respond to pain because it kinda hurts.) Then have someone call 911 and grab a nonrebreather mask. Talk to the person and tell them they are okay and it'll be over soon, even if they can't hear you, you are supporting yourself and the staff with calm reassurance. Once the seizure is over people are often scared and hard to difficult to re-orient for a bit (post-dictal). It doesn't sound like you did anything wrong. Seizures are, honestly, one of most intimidating things that you can experience as a nurse. One time I had a girl that had seizures for 40 minutes that after 10mg of ativan, 50mg of benadryl and 1gm of keppra. I felt so bad for this girl until the seizures stopped. After the keppra she began to fake seizures. It turns out she has borderline personality disorder in addition to seizures. She would stop taking her meds so that she would have her seizures. She went to the icu based on her condition, but I'm pretty sure she left ama based on what I heard.

I'm an ER nurse and have attempted to find some articles online but want would appreciate hearing how you or your facility handle sepsis bundles/fluid resuscitation in your hospital for pt's with CHF or renal failure. Recently I've had pts who are "Sepsis Screen Positive" who would automatically receive 2-3L of fluid for possible sepsis but have not due to hx of CHF or renal failure. One case in particular we did not bolus my pt despite his SBP was high 70s to low 90s for hours (good color, no changes in mental status, not super tachy, "provider aware of BP" in all my notes) as he had a hx of severe CHF and had been overloaded with fluid extremely easy in the past. The provider was finally considering putting him on pressors after many hours but he was very complicated, and had received some units of blood, so they held off as long as possible. Less than a week later we had a very similar case with a pt in renal failure who had a hx of hypoTN and syncope. He at least received a 500ml bolus but no more despite being scheduled for dialysis in less than 24 hours. He was more symptomatic than the previously stated pt. Obviously we also have many pt's coming in now with flu and/or pneumonia in addition to their CHF and COPD who meet the "sepsis protocol". I'm just looking for input, even anecdotal, because I always forget to ask providers about these situations during "free time" (hahaha, we all know that doesn't exist). Thanks

I don't generally ask questions about my own health but I worked for two years on an observation unit and never saw a false positive quite like my own and am wondering if this is even normal. As a nurse, this experience has left me quite shaken. I don't really know who else to ask about such a bizarre experience other than a group of nurses.... Two weeks ago I received an albuterol treatment at an urgent care due to a bad case of bronchitis. An hour or two later my heart was pounding while driving and my pulse was about 200. After wasting a bunch of time believing it was not true, I returned to the urgent care casually asking them to take my pulse and reorder my rx they didn't end up sending. My pulse was 214 and my stat EKG showed SVT. I received 6, 12, & 12 of adenosine in the ambulance with my hr only decreasing into the 150s. At the ed I was discharged once my pulse remained in the 110s (I'm tachy normally and was in pain due to recently oral surgery). I followed up with a cardiologist one week later. At my cardiologist appointment my EKG was showing both left and right atrial enlargement, right ventricle strain and an axis deviation. I am 25 and the cardiologist asked me many questions about my support system and care related to my daughter as I am a single mom. He specifically ordered my echo and echo stress to be taken days apart. He also started me on diltiazem (no beta blockers because I have asthma) due to my 100+ resting rate. A week later and my echo and stress were beautiful aside from my hr staying in the 130s post stress (my norm). The cardiologist who read my results didn't believe what that the other cardiologist said those things to me until I showed him the EKG with the md's sig. He was shocked at what the other md interpreted structure wise. The nurses at the practice also were shocked at the difference between my EKG and stress echo. My main question is, has anyone ever seen an EKG shows these sort of findings without there being any issues? Does it seem normal for an MD to break news like this to someone (both your atria are enlarged and your ventricle is strained and we need to find out why) without saying it might be a misreading based solely on an EKG? As a patient, it was horrible and the scariest week of my life....especially being a nurse, it was worse knowing the causes in someone who is healthy and young. Has (I am not looking for health advice or diagnosis. This is based solely on nursing curiosity as I have worked with cardiac pt.s and this is the first real false positive I've seen even though it is in me.)

I am still a student and am in my preceptorship in an ICU. I recently came upon a keyring for small flashcards. I keep it with me at all times and I know I will keep it on me as long as I am a nurse. I keep all my lab values/IV drug values that are important. I also keep basic "drug cards" on there. If its a med i'm not familiar with or not too sure about it makes for a great personal reference about whether a drug is a bb, ccb, ppi, etc and has the values that i need to check before i give (hr, bp, cr, bun, ast, alt, pt, ptt, inr, ect.) I cut down and hole-punch flashcards as needed. It's less bulkier than a the "RN Notes" (highly recommend). The hospital that i am at has an iv compatibility program on the comps but if yours did not than i'd also keep a couple of the cards in there for common meds just to have as a reference. It's less bulkier than a the "RN Notes" (highly recommend). I'd also suggest doing nclex questions for the type of unit you are working on. Just because you may be able to identify with situations and see rationals. This may help you in the critical thinking area.

I'm a nursing student in my last semester and found out today that I will be beginning a mentorship in the ED next week (five weeks of mentorship before graduation). My teachers feel this will be a good fit because I have a strong knowledge base, yet I am a bit nervous. I am posting in this area because I would like some advice from experienced ED nurses as to what to expect and possibly skills areas that I may want to review or work on before going into this mentorship. General advice would also be greatly appreciated as I don't want to be a failure, embarrass myself or, worse, hurt somebody due to lack of experience/clinical judgment. Thank You Nurses!!!

I'm still a nursing student but have been very good about poop, urine, blood, pus, etc. My story is one of an PCT I helped one day.... I walked in the room to find liquid poo all over the floor, the side of the garbage and on the pct's shoes. I guess she spilled the hat that was in the commode. I offered to help her clean it up since i wasn't busy. I almost accepted what she said until she ran into the pt's bathroom and starting gagging and dry heaving into the sink. She still didn't want my help and of course I didn't listen at that point. :)

Thank you!!!! I'm so proud of everyone in my class and everyone else that is out there on their last semester of nursing school. If you made it this far you have worked your but off because I know that I have!!!

The answer is A. Although everyone I've asked has put B. Like I said, we are trying to argue the question.

Question from our final that I don't agree with the answer. I won't post the answer yet to prevent bias. Please tell me what you believe the answer is and possibly a rationale. Your patient is suffering from Post-Traumatic Stress Disorder (PTSD). You know his condition is improving when he states that he: A.) Acknowledges his fault for the event that occurred. B.) has been attending to work and spending time with coworkers. Thank you so much!

I am also in the same boat. I have super easy to find veins but have viens blown on both arms and at one point leaked blood around the the needle (it was a steady flow onto the floor!). I cringe at the health department when I have to get titers, and vaccinations. I have yet to do a blooddraws and I.V. starts also. I have done quite a few injections so far and the only thing I do is concentrate on doing it correctly in front of my instructor. I've had my first patients make fun of me for taking a long time even when i wasn't hesitating. Just make sure to let them know it's happening and then get it done as fast as you can while doing it correctly. Have fun!

I like to take: Fish-oil/omega-3 (food for the brain), B-vitamin complexe (to keep your energy up, especially when you aren't eating right), Calcium (in case i'm not drinking enough milk) Vitamin C (to "boost" my immune system, and help with healing wounds since i have a mean cat) I think the B complexe is the most important. I don't feel rundown when I take it regularly except when I'm deprieved of sleep.

I always give this advice to other students...YOUTUBE!!!! On youtube there are many videos from varying textbook companies, free tutors and medical students who make videos to test themselves. This has always been a great help to me while i'm studying because actually seeing a hormone traveling through the body along with the effects it has on particular systems has always proven very helpful. Good luck!

C.) Albuterol. Since this is fast acting. Although, I'm sure the correct answer would be D. the O2 mask, Simply because I don't need a doctor's order to give a pt O2. It doesn't say if these are MD approved meds. Please share the answer!

People call me a "kiss-ass". I'm not a kiss-ass. I'm a student that enjoys learning. If I don't like how an instructor is doing something usually it is because I'm not used to doing things their way (even if their way is STUPID). Approach him and tell him that you were complaining because yes you don't like how he is doing things because it isn't how you are used to doing things. Tell him he is a good teacher because he is different but since you've had him it's made you struggle but it's made you grow as a critical thinker. Make him realize what you are complaining about is the material content's complexity and not his teaching (even if it is!!!). He will be more willing to help you especially if you appear honest (and are honest) in your willingness to learn. Good-luck!! Be honest and not defensive with him. That will make him have respect for you!!

thelastjanelle, when i started nrn101 i didn't have my a&p2 n micro either. Idk about boyce, but at allegheny campus the bio department set aside a particular classes for nursing students that went around the nursing department's schedule. So, if you are having problems seeing any openings that coincide with your nursing schedule, just email the head of the biology dept. and they will let you know what is up. :)