angelique777

I liked all these great answers!!! It had me thinking. Thanks for sharing, wish there where more like this !!!!!

[color=#363636]bipap or bilevel positive airway pressure, keeps the airways open by providing a flow of air delivered through a face mask. with bipap the pressures that the doc prescribes alternate, a higher pressure is used to breathe in, called ipap, and a lower pressure is used when breathing out, called epap. bipap is the preferred method for severe, obstructive sleep apnea and copd medically necessary: the use of non-invasive positive pressure respiratory assist devices (bipap) for the treatment of severe copd is considered medically necessary when all of the following are met: an arterial blood gas paco2, done while awake and breathing the individual's usual fio2, is greater than or equal to 52 mm hg; and sleep oximetry demonstrates oxygen saturation less than or equal to 88% for at least five continuous minutes, done while breathing oxygen at 2 l/min. or the individual's usual fio2(whichever is higher); and prior to initiating therapy, obstructive sleep apnea and treatment with cpap has been considered and ruled out. note: when the above medical necessity criteria for individuals with the indication of severe copd are met, a non-invasive positive pressure bi-level respiratory assist device, without back-up rate feature, will be considered medically necessary. for central sleep apnea, (i.e., apnea not due to airway obstruction) medically necessary: the use of a non-invasive positive pressure respiratory assist device (bipap) for the treatment of central sleep apnea is considered medically necessary when, prior to initiating therapy, a complete, facility-based, attended polysomnography has been performed and the test results have revealed all of the following: the diagnosis of central sleep apnea (csa) has been confirmed; and the presence of obstructive sleep apnea (osa) has been excluded, as the predominant cause of the sleep-associated hypoventilation; and if osa is a component of the sleep-associated hypoventilation, cpap has been ruled out as an effective therapy; and oxygen saturation level is less than or equal to 88% for at least five continuous minutes, done while breathing the individual's usual fio2; and significant clinical improvement of the sleep-associated hypoventilation has been demonstrated with the use of a bi-level positive pressure device, either with or without the back-up rate feature, adjusted to the settings that will be prescribed for initial home use, while breathing the individual's usual fio2. note: when the above medical necessity criteria for individuals with the indication of csa are met, a non-invasive positive pressure bi-level device, either with or without the back-up rate feature, will be considered medically necessary. basically yes copd and osa patients very often placed on bipap also when pt on this device and nebulizer treatments are order respiratory therapy can hook it up so nebs can be given while on machine which i find much more effective.

Thanks WonderRN In response to my previous post. However, I dont allow myself to be bullied and always let the bullyies know that there behaving like bullies so they don't try it again with me cause I speak the truth directly to the bully. I like working on my unit and in relatively short time understand the people on my unit and adapt appropriately to there personalities I think bullying is a specific behavior. Some people particular younger nurses think that senior nurses are bullies. A senior nurse teaching a younger nurse how to avoid a medication error, or why missing an assessment is important is not bullying and too many younger nurses make this mistake. I haven't always like the tone of senior nurses or seriousness but have always instead respected the content of what they told me because it has greatly helped me help my patients and I don't feel these nurses fall into category of bullies. A senior nurse will teach sometimes firmly but often will help a nurse save a life. I am one of those younger nurses who appreciate the experience a senior nurse shares and wanted to post the difference between a bully and a senior who tries to teach a younger nurse how to save a life or least keep patient from harm. In generally its mentally exhausting dealing with a bully:eek: but I make the effort since it really annoys me and won't allow myself to be subjected to the behavior. However it not like when we where in school because then it was easier to deal with bullyies .........so in school someone who always try to skip ahead on line or try to take your books etc...........kicking there butts after school solved the problem:yeah: ....however, at work it takes some level confrontation with out reaching full out fight which is quite a challenge but I managed to get by and hold my own.......I don't get involved with gossip I tell the person directly about any rotten behavior. Again this is my jest of work place bully ....most definitely escalating to senior staff is important at times as well......However, A lot of time such behavior exsist because senior staff does not confront it.

Bullying: the act of intimidating a weaker person to make them do something Example: You arrive at work and in order to prepare you get one of the many portable computers, you clean it, charge it by plugging it in the wall, you put your name on it to signal to other nurses you are using it. You get your cups and supplies place it on the computer all in preparation for your work. You turn around and another nurse walks away with the computer. You see her and you indicate you are using it (please note its obvious your using it since it has your name your supplies and thank to your diligence its now fully charged ready to go), however, this other nurse says in a loud and intimidating voice the computer belongs to the hospital and proceeds to walk off with the computer with an attitude as if she dares you to say anything further, however when you do continue to protest the bully nurse continues to walk away from you telling you again with attitude that you can have it when she done. Example: Your at the pixis machine getting you medications and the bully nurse stands behind you, she says hurry up in a loud voice, your so slow she says loudly, she gets in close to you and tell you to move because her patient cant wait a century till you finish. The harassment continues and she is sure she does it every day till some nurses either try to get there meds early or wait till she goes first in order to avoid the verbal abuse. Example: You ask the Patient care technician to watch the monitors on your side of the unit because you have a patient red alarming and the monitor she is watching only has yellow alarms but there is staff present on that side who can watch those alarms...the PCT states she is afraid to leave because the bully nurse will yell at her she already knows the bully does not want to get up to silence the alarms and will start yelling loudly at her and falsely accuse her not doing her work.......so PCT so blind from intimidation cant even see that logically the red alarm on heart monitors more serious than yellow alarms and her choices should be made based on patient safety vs. how loud the bully nurse roars Example: Charge nurse wants to float you instead of the bully nurse because she knows your considerate kind hard working nurse but its clearly the bully turn...... plus you have higher seniority than the bully but still charge insists you should go but you know the real reason is she does not want to experience the yelling and loud complaints and posturing made by the bully nurse Example: Admissions coming to the unit .........the quiet nurses get the admissions first or the worst sickest patients because charge nurse will not want to deal with bully nurses complaints......charge nurse will leave bully nurse for last or give easier assignments because she has to spend so much time battling bully nurses when they don’t get what they want. So charges nurses not wanting to deal with bullies arguments and complaints the charge decide to leave sleeping dogs lie at the expense of the quiet, non-bully nurses, Example: A PCT or Attendant will not help you first but will always help the bully nurse first because she is afraid of her mouth and posturing.....so nice nurses have to work harder and will get assistance less often Example: Bully nurses will make a scene if on report there is anything left undone because they themselves don’t want to do it and will try to make you look bad even when the issue not anything major..... the complaint has simple solution or even if its not rational complaint......the bully nurse just wants to posture cause they don't want to have to do it. Example: You called the tube room to send you a tube so you can use it but the bully nurse grabs it and uses it for herself ...you explain you just called the tube room and that the tube they sent was for you but it does not matter the bully says call again I going to use this one. These are just a few examples of behaviors bully nurses have exhibited on a unit. We all know its wrong but it still goes on. I Believe there are lots lots more examples but its just to mentally exhausting to write down all the ill behavior exhibited by bullies throughout the years as a nurse. Please note there is a big difference between a bully nurse and a nurse who has lots of experience teaching younger staff how to avoid errors and how to avoid your patient suffering an injury or fatality. Sometimes senior nurses can teach in a firm and serious manner, however, I don't list these nurses on my list of bullies that is quiet different circumstance. I respect any scolding a more senior nurse may give to a younger nurse because if what that senior nurse is teaching is correct that may help the younger nurse save a life or assist avoid damaging a patient health. So these nurses are not what I call bullies. Even if how they say things appear arrogant....what does tone matter in these circumstance if the content of what that senior nurse is saying is excellent and will help the younger nurse be better at what she does. That is my take on events.

My Resume listed it clearly as part of work history but that it was a internship job ( It was work and I listed my duties at that internship: who I worked under and what was my responsibilities etc) I consider it work and the type of work done was specified: Internship: I wrote the duties and responsibilities ( example I did finger sticks, vital signs etc ) I also listed type of unit the internship was done on ex I worked on a vent unit....the fact it was a vent unit it allowed me in my interview discuss what I learned on that unit about vents. When I was a graduate nurse I listed my positiion at the hospital as a graduate nurse and type of unit I worked on : EX oncology and what was my responsibilties there. I never had to write that it was stipend or not a stipend position was never told anything negative about me listing it as work experience because I mention it was internships , what matter was type of units I worked and what was my experiences there, .......................because during the interview we discussed what I learned on those units and why I choose those units to work on. My first job as an RN I requested to work on ICCU before I applied I took and passed the ACLS cert and was hired because I new my medications and new my interventions for particular cardiac problems. Working on the Vent unit it was a critical care floor and I learned a lot about many of the medications given on that unit , I learned a lot about vents, these experiences while still not as an RN still was valid and important for the person interviewing me.

This is not a chief complaint , I would have liked to see the chief complaint the nurse wrote for this problem. In Korea this gentlemen apparently had become very lonely and lied down face first on a metal bench that had circular holes in it and proceeded to make love to the bench:eek: ..:sstrs:...........well this very bright gentlemen obviously got swollen and stuck to the bench .............fire department had to cut the benchs legs off and bring the metal part of the bench with him attached to it to the ER................now I would have loved to see the nurses face who recvd this guy in the ER and would have loved to see his chief complaint written on paper.......... The picture that appeared in the newspapers was this guy face flat against metal grid arms and legs sprawled out to either side being carried by firemen (obviously you know what was sticking out the other side right ):hehe:............I couldnt stop laughing what the heck was he thinking............ Angela

:DNuala thanks so much love :redpinkhethat ..........I learned it the same way except they made it a married comple first the go every where together but later more distant till finally they do there own thing .............so love this explanation because it helps you remember the blocks any way thanks Love little tricks that come with a story to help you remember !!!!!!!!!!!!!:loveya:

I agree with Angel Fire temp too high:eek: I would go straight to ER ....hope he feels better :oI am sure its stressful to see your loved one ill Take Care Angela

Here my report sheet that I use. Have extra space below where I write my labs and I use side margins to write my vital signs through out the shift. Angela NEW SHIFT REPORT SHEET 2008.doc

As far as I know the doctors diactivate it with a magnet ..........

To be specific to what you mention in your post..............if the BP was 190/100 I would think the provider covering that patient would order a medication to lower the BP ( I would look to see if this is a dialysis patient or renal patient, or if there is a provoking cause for the elevated BP (ex pt refused previous BP medications...........pt in pain etc) most of my providers would add something to lower the BP at that range...........regarding pt in Afib with heart rates of 120-140..........while the new onset afib who is not anticoagulated is my biggest worry a patient with a sustained rate of 120-140 should be given medication to lower that rate 120-140 sustained is uncontrolled afib ..........rate should be lower.........note if patient is sustaining 70-80 rate only occassionally going up to 120 maybe the doctor will wait to add a medication but if patient sustaining that rate (120-140)they will often give cardizem........IV push to bring it down at least on my unit both in step down and on the Heart progressive unit............so if your provider is ignoring you for these two things maybe you need to ask another nurse how new is that provider........in my experience sometimes new provider (new residents new PA are hesitant to intervene or add a medication) I have learned which providers judgement I trust and whose I dont ........if my covering person is someone whose judgement I dont trust I will monitor my patient very closely and if I find them at risk and nothing being done I will go over that person head ex charge person or I consult with ADN depending how serious is the problem or consult a more experienced nurse on how to approach the situation first before going over the person head......... I covered a new nurse who let her patient all night at rate of 140-150 she was new to the floor she told new covering PA about her patient rate and covering PA did not intervene she did not do anything about this heart rate....................when I covered that nurse patient I told the PA very confidently she needs to control this patient rate and to tell me what she was going to do cause I couldnt leave patient continue at this rate all night ...........PA called cardiology and they intervened ...........different approach same PA patient rate after treatment 70-80 sustained .............knowing what to do comes with time and talking with nurses on your unit ..........follow your gut .......if something seems wrong and intervention seems to be needed more than likely your right...........observe on your unit who is the most experience nurse working that night/day with you who can be your resource person..........I usually had more than one person and if I told her my situation and she agreed my patient should have an intervention and the doctor /provider was not doing anything I would ask for advise on what to do........I did that my first 2years on my unit and it was a big help ..........and when needed if I dont know something I still will consult those nurses....they have been doing nursing 30yrs some of them and are a great resource to you for specifics of your patient during your shift..........sometimes generalized information from a post cant help you when your patient has specific situation ........but that nurse can review that patient hx with you and tell you if what your thinking is right or wrong........but better to ask and be wrong than to ignore a situation just because the provider not impressed with what you tell them about the patient .......... I had a cardiologist make a bad call on my patient when I was only a year on my unit...........Had a patient with atypical symptoms stomach discomfort general malaise ......headache ...but VS stable...these are the symptoms that brought her to the ER and she ruled in for MI now she on my unit having same symptoms ( I dont know why but everything about her said she was going to code so she arrived @ 8pm at 830pm I tell PA patient needs to go from step down to CCU or cath lab trop through the roof CPK through the roof:eek: no hx of renal ( I say that cause on occassion elevated CPK trop with renal patient can occur and not be MI) , PA agrees pt not stable..............(vital signs where stable but pt symptomatic) , Cardiology does not agree, charge pa notified agreed with me pt should go to CCU .............cardiology disagrees it is now 10pm at night pt still symptomatic so now Cardiology goes in alone with patient (pt spanish speaking cardiologist does not speak spanish) he come out says to me "pt says she is fine pt does not need to go to CCU"..............I am shocked cause since 8pm patietn has been telling me of her symptoms............I go in ask patient in spanish if she told doctor that she was fine she says no .........i tell him doc I was in with patient just now pt does not feel fine...........its now 11pm cardiologist still does not want to move my patient to ccu I call ADN, tell her my situation nows it 12 M she says she will talk to cardiology..............all this time I waiting ............. pt then codes at 1am in morning cardiologist does not get me a bed in CCU until 3am in morning meanwhile my pt coded 3 more time on my unit............now I was new nurse I was covered becaue told every body and there mother since 830pm that this patient was going to crash .........Pt finally was taken to CCU by 330am with a pulse and pressure intubated I find out she died at 4am .........CCU nurses not knowing what I went through with cardiology or that I had requested pt to transfer since 830pm said I brought pt hald dead to them in CCU ..........I was devasted that my patient died:sniff: .............I was upset with cardiologist:angryfire but held my tongue cause it was to late now to change the facts......... at least everything was documented and they couldnt blame the nurse ,........I couldnt stand the sight of that Cardiologist for months .........he was new fellow ............it took a long time for me to forgive him but I finally did realizing he just human and we are all falliable and not perfect I am sure he learned a lot that day and hopefully wont ignore a situation again............I dont know how that patient by passed the cath lab which is where I think she should have went from ER since she ruled in for MI in ER ...............never had a patient like that again..................but I tell the story to new nurses just so they know in the back of there heads that the doctors can be wrong .............second story,.............just today got patient came from having blood drawn and right after she felt sick ..........nausea dizziness, heart rate went up , sudden onset sweating ..... I tell provider(new doctor) the provider says she probably just sick from having blood drawn and probably a vagal response and to make her a regular visit..............I tell doc this is not a vagal response pt got worse on abulation and heart rate is up not down....I insisted she needs EKG because doc was not going to order anything and let her be seen regular visit ( I am triaging in clinic today not on my unit ) I did EKG pt was in afib sustaining a rate of 132-146 .......doctor wanted me to walk her over to her room I told her shouldnt walk this patient her heart was 126 when she was in my room she walked short distance for the EKG went up to 146 ...think you should see her in the room she in .......Doc saw pt had to send her by EMS to hospital and told me later good catch.......... but had I listen to the doc and something happen to patient who fault would you think they will say it was (you got it the nurse)............. she wanted me to sit patient in our waiting area like regular visit and not run any test......I already had marked pt acute cause I triaged her..........the point of the story is that sometimes docs dont know everything and some times they assume things...........and nurse needs to follow her gut and sometimes disagree respectfully ........of course I never go head to head with a doctor but I try within the order of leadership and chain of command address an issue if I think my patient is in danger of a problem being missed I try to advocate for the patient through proper chain of command and seek advise from my senior nurses on the unit or clinic or what ever the setting I am in ............sorry for the long story but hope something I said was of help..................:heartbeat;)

Says place foley if patient going for catherization in other words straignt to cath lab like PARREN 20 mentioned earlier but thanks for the protocol post I like reading other agencies polices.

This is my quick reply sorry dont have all the detail you asked for ABC is my explanation ....would like to see what other nurses say though to see if the think IV goes any sooner ABC a.Pulse Oximetry patient already has labored breathing should know how much oxygen is needed b.Cardiac Monitor (having chest pain need to see EKG and rhythm) c. Blood Pressure although you have one its low will need to know if it dropped more Doc need this in order to see patient getting nitro amoung other reasons d. Finger Stick Patient diabetic e. IV line f. Insert urinary catherter __________________________________________ a. Connect the patient to a cardiac monitor b. Apply a pulse oximetry to the patient c. Take a fingerstick to test blood glucose d. Take a non-invasive blood pressure e. Insert an intravenous line f. Insert a urinary catheter

I thought today I post inspirational movies a lot of them about team playing , not quitting , never giving up. The post was bumped. It was a list of movies that inspired that. Some how the staff member felt its not nursing related. Well after being a nurse a while its hard for me to say this but its unfortunate that often in this profession what is consider relevant to nursing is well not edifying or helpful to me as a nurse or person. Like a post that talks about saying saturation correctly. In a 12 hour shift what is relevant to me is that my fellow nurse is a team player and that she would be there to help me out and help the patients out. I would hope she not there to notice if I said Saturation correctly or not while I am all for teaching. I can only hope she there as an encourager beause the job is tough. I can only pray she there to notice any changes in my patient and let me know what she see and we compare our thoughts about it. I can only hope she there to lead, support , and work in conjunction with me. It would not hurt the profession one bit to be inspired by the movie for example "Facing the Giants." Having a co-worker who is there thinking about giving you 110% support is the inspiration that all nurses need in our field of work. So how could that topic be irrelevant is beyond me. Its unfortunate ,as new students will notice , is that nurses can be cranky, difficult , extremely critical , whiny people and although its not all of them its enough to put a strain on the job. Hence a few inspirational movies wouldn't hurt but of course one staff member did not think that's relevant to nursing. Brian Song is about a Football player who although smaller than others on his team had a lot of grit (Enough grit to get him on the Chicago Bears) and an awesome personality in the face of meeting new people , in face of great personal adversity , and a supporter to others when other people needed it or were struggling and in trouble. However, one of the staff from allnurses.com website did not feel that such movies are relevant to nursing. Well I think they are wrong its probably one of the key most important attitudes to have in nursing in order to help others and personally be able to survive the career your self. In order to help others you need to find some inspiration and well if your a nurse you may go to a nursing web site and share that with a fellow nurse. You may want someone to share what they saw and you share what you saw in order to encourage each other to go the extra mile at work. If the source was a movie ...does not mean its not relevant to nursing. One of my professors in nursing had us watch "Remember the Titans" as a class assignment. Therefore, inpirational stuff including movies definitely has its place in nursing because we deal directly with life issues of death and life. Along with major life adjustments and changes and movies are just a form of humans sharing stories that inspire us to do that better. That is extremely relevant to our roles as nurses. Especially since we have to deal with a lot of grief , illness, and pain because that is what the patient is going through and we are there to help them through there stay in the hospital. Now if I list a lot of movies like holloween , Scary movie, Terminator Icould see how it was not relevant but these movies where about people who faced life crises, and how they over came them through not quiting , having a good attitude, etc. this is what being a good nurse is all about. It shocks me some times that things that inspire are often knocked down but ranting and criticicing is reward with a post. I thought that posting inspirational movies about team playing , not quitting , never giving up would be one avenue we could encourage each other through another story. The post was bumped it was a list of movies that inspired that. Some how the staff member felt its not nursing related. I wont re-post the movie list but I think the staff may try to consider that I don't have to talk about puke and pee , sex on the nursing unit as some post have in order for a topic to be nursing related . Motivational movies are definitely nursing related subject since in our very limited free time a movie can re-energized a nurse to come to her next shift in a mind set to help , encourage , help another especially after a work week of 12hrs shifts where most people come in to complain and critique. Its gotten so bad that I heard of a manager who had to send staff to a class on how to be nicer and caring. So motivational inspired movies are important and relevant to nursing since they portray issues in life and you cant get any closer to issues in life than nursing a sick person back to health under the stress of short staffing and surrounded by cranky people.. Just my two cents for the staff who felt Motivational movies shouldn't be a part of nursing . Seeing Brian Song and his attitude while being sick was definitely something a nurse should see. Again just my two cents..................!!!!!!!!!!!!!!! Angela

Its really something you have to decide. Only you know if this is going to interfer with your work. I can tell you that nursing is a tough profession and a nurse is subject to a lot of abuse at times,although not always, depending where you work. I can say as a floor nurse the abuse has been heavy. From co-workers who personalities are extremely demanding at times ( you can see post by other nurses who discuss bullying at the work place) , some nurses say from providers (In that area I have not experienced to much abuse I have a good rappor with my providers there is always one or too who I could live with out) (see post from nurses about being yelled at by doctors ) abuse from patients who sometimes from being sick are abusive and some times because they are addicts and have abusive manipulative behaviors and then there is always from management who you want to believe or supportive but who can hang you out to dry. If you feel your past medical problems of depression and paranoia can withstand the on slaught from all these area than you know if you can pursue the career or not. You have to have a clear seperation as to when your own personal weakness are kicking in and when your are on target about what your are perceiving I think this is a key point. Conducting your self as a professional and being a safe practitioner also key to nursing and key to your choices that you make. If you become a nurse the work environment you choose can also be important. Some times working enviroment makes a difference. In another job I have as a nurse I work in a clinic setting and although at times people can become difficult it not half as bad as a hospital setting. Therefore more tolerable and I definitely feel in the clinic setting I am helping others as well. The clinic setting is my happy place while my hospital job is the place I go to challenge my self. So, if you can endure nursing professors that is your first hurdle( you can read what nursing students have to say about them and how nurses eat there young lol) this is something you have to know about so you dont develop paranoia so to speak because I believe its just part of a culture and process you have to endure to make it through school.(see nursing student forums so you can see what they experience) It unfortunate that other nurses can be tough on you but reading about what others experience is key to knowing negative stuff exist and that with alot of patience , perserverance and not taking stuff to heart many of us has survived it to live and tell about it lol So why not you. You can one day tell us of your over coming it too. So to answer you question why not only you know your self and know what you want to subject your self too. However you and only you know if you have over come your own personal problems in order for you to safely help others and be clear enough to know when you would have to step away. Now a days who has not suffered from some depression or paranoia. Todays society full of consipiracy theories etc. The key here is patient safety and if you can function as a safe practioner and not take to heart all the abuse that occurs in this profession and if you can also not internalize it so that it does not take a toll on you emotionally then this is the hurdle you need to ask your self if you can do. The past is the past how are you today how much can you handle today. This is the key question for you. Look always for an work situation that can maintain quality of living for your self and still allow you the energy to help others in a safe manageable way. I wish you the best I think your right a career that takes you away from your self and helping others is always a great direction to go. I wish you the best in your search Angela