belle87RN

Thought of another one... If you've ever said, "This patient's history reads like a textbook."

When you can change your dust ruffle on a full size bed using the same technique as doing a bed change on a total care patient. You have night mares of taking care of 8-9 patients after a night of chaos and getting 4 admissions. You know for a fact that if anyone wanted to torture you for information, that all they need to do is stick you in a room with a beeping IV pump that you couldn't turn off. You can watch shows like Bones, CSI, NCIS, Body of Proof, etc. while eating a meal that just might include spaghetti sauce and feel perfectly normal.

Why was he giving in and giving her Dilaudid, if he knew that she is a drug seeker?

You guys all have great stories. Mine is from when I did a shadow day in the ER as part of my new nursing orientation. I had previously worked in the ER as an aide before I graduated nursing school so to be honest I didn't expect to see much else than the usual. Boy was I wrong! We had a patient collapse outside the ER doors, diaphoretic, bad color...looked like the typical MI patient. So we get him into probably one of the smallest rooms our ED has because it was the only one available and hook him up to BP cuffs and an EKG. The EKG was normal, BP was low though (I forget what it was). We then get the story that this guy was drunk the night before and took a tumble down the stairs (and even broke the railing). He got himself up and just went to bed to sleep it off. That morning he really didn't feel great so he drove to the ED, while in the parking lot he coughed or did something and felt a 'pop' in his chest and felt slightly better so he turned around and went to work. He comes back in a couple hours later feeling worse and we pick up again with him collapsing outside of the ED. Chest x-ray shows huge hemo-pneumotorax. We are not a trauma hospital so we start the process of getting him ready for transfer. It just so happened that one of the pulmonary docs was in the room next door, they did an emergency Chest tube. The doc didn't hook him up to the drainage canister before unclamping the tube, blood went EVERYWHERE! They finally got him connected, started blood and called for transfer. In about 15 of being in the ED with the CT in place he put out 2 liters and the canister had to be changed before he was transferred to the other hospital. The whole time he was in this room there was about 5-10 nurses and staff, and this room was tiny! Not t

Ouch! That had to hurt. Nubain and I are not friends. In my OB rotation in nursing school I went it to my patient. It was my ever REAL experience with an ampule and was supposed to be my first ever IVP med. Well I broke the top of the ampule off the wrong way, a small spike was left on the edge that sliced my finger. I ended up having to go to the ER and got 3 or 4 stitches. I was so embarrassed, my nursing instructor had to give the nubain. And before I left to go get my finger stitched up she (my instructor) was doing her best to patch it up with gauze and tape to which she exclaimed "I can deal with women pushing out babies, not with cut fingers!" It made me laugh so hard!

I'm sure this topic has gone around this place a few time, but I have yet to really find a pair of shoes I love. When I worked in a college kitchen for a year I had a pair of shoe called Klogs, they were the best shoes I ever owned, not pretty but definitely practical. We aren't allowed to wear that type of shoe, so I can't get them. I've tried Nike Air, Nike AirMax, and Adidas. We can't wear crocs, we can wear Dansko's but I recently tried on a pair and wasn't impressed at all, they were heavy and hard on my feet. What are your suggestions?

It frustrates me that we don't have a little more leeway. If I'm sick, I don't think I should be taking care of any patient, let alone the surgical patients that I was supposed to take care of. I was sick for 3 weeks and kept working, my body just couldn't do it any more. But we are almost forced to work when we are sick because we don't want to get any warnings. And I've been in the process of a possible transfer and we can't have any written warnings if we want to transfer and that includes after the interview and before the transfer takes place.

It probably wasn't the best idea to call off, although I don't blame you. No nurse, no matter how experienced you are should ever have to deal with that kind of mess. The charge nurse was definitely wrong in telling you flat out that she was calling off because of the staffing. I can't really say anything though, I called off today too. I have been sick with a wicked sore throat and cough. I knew that our staffing stunk tonight, we were supposed to get 13 post ops on the floor I was to work on. But I just couldn't fathom working again sick. We have a stupid call off policy, you can only call of 3 times in a rounding year. I felt bad about calling off but I didn't think it would be the best idea for me or my patients to work while sick.

What are you facilities call off policies? I think my work stinks, if we call of more than 3 times in a rounding year we either get a verbal or written warning, or suspended if it's more than 5. The only exceptions are if you use medical leave or are one of those grandfathered into a previous policy they had. Doctor excuses mean nothing to our hospital. So basically you have to come to work sick so you don't get in trouble, and patients have told me that they don't want sick nurses taking care of them. What are your policies and how would you change them? If I had a say in the matter, if you have a doctor's excuse stating the illness, treatment and when you saw the doctor, it should not be held against you.

Warming up their fingers or a little finger tip massage to get the blood going. Although the later isn't really recommended. Also make sure you aren't too far off to the side. Sometimes the sides of their fingers won't bleed well. Get it right in that middle space between the pad of the finger and the side of their finger.

I CAN NOT stand epistaxis! Ugh, so gross! Especially when they have clots built up in their throats and they are hacking it up. I volunteered to help out in room 7 in our ED (our ENT room, without thinking) The guy had a massive bleed he'd had for a couple of hours. I stood there with a basin as he hacked up blood clots and spat blood in it and everywhere, I swear he got some on me. When I emptied it, I was very close to losing my lunch. GI bleeds are gross too. The smell is awful, I didn't realize this as a nurse aide when a nurse asked me to empty a patients bedside commode. I did and really almost lost it. Then the nurse said "oh I thought you knew it was a GI bleed." I was like "No, I just got here, and I had NO IDEA they smelled that bad."

I can't believe it! I took the NCELX yesterday and only had 75 questions. I was so nervous and didn't know what to think. But I got my results this morning and I passed! I was so excited, one of the nurses I worked with when I was a nurse aide gave me a huge hug when I told him that I passed. He was one of my biggest and best mentors the last two years and it meant so much. Good luck to all of those still looking to take it. I used the kaplan book and remembered to use their strategies as I took the test.

You are able to specialize in emergency medicine here in the states. There is something called a CEN or certified emergency nurse that you can earn (not sure how yet cause I'm still in school). But definitely try out emergency nursing first, some people do find it a little overwhelming, but if you love that type of situation you'll do great. Good luck on passing your exams in the Philippines and here when you come!

I love the patients that come to the ER thinking the have "amonia" One time a patient came in complaining of pain in his "wing muscle" I said to him "you mean your shoulder?", "No my wing muscle, right here." he said as he pointed to his shoulder blade. I went into the ED to hand the chart to the nurses laughing, it was really funny! And one time I had an older gentleman say to me, "You have a pretty smile, are those your real teeth?" It was really funny!

The above two are correct, you will be taught the best ways to give injections in schools and the patient rights. I was scared at first too but there are a lot of ways to reduce pain with injections. One of the best ways to reduce discomfort is to switch your needles. Use one need to draw up the medication from the vial and another to give it. I usually use an 18 gauge (a large bore) needle to draw up a medication cause it's a lot easier, then use a 22-24 gauge to give the med. Those are my suggestions, but don't fret you'll learn everything you need to know in school. And if you can start working at a medical facility now and find a nurse to take you under their wing. I have nurses at my work that have done that for me and have really helped me out through school, their encouragement and support has meant a lot to me and I have learned so much from them.

As much as we scoff at it, it can be an emergency. Twice in one night we had young females come into the ED for stomach pain and N/V for several hours by ambulance. One had a almost if not already ruptured ectopic pregnancy, the other had bleeding into her abdomen from and unknown cause (at least by the time I left the cause was still unknown.) All of the staff groaned at them coming in via BLS but it both their cases it was needed. But then again, these are only 2 examples of legit reasons to come by ambulance amid the numerous non-legit reasons.

Some drug classifications are easy to remember because of there endings. - olol or lol drugs are Beta Blockers - statin's are lipid lowering agents - caine's are usually numbing agents - il's or ril's are ACE inhibitors - sartan's are ARB's Those are some of them that I use to remember. I know that some antibiotics are linked with similar endings like -sporins and what not, you could go through drug classes and write down how they are similar and linked. Figure out your safety parameters for each class and then study that way. (Just in case you aren't familiar with safety parameters they are like HR and BP for the ACEI and such, aka reason you look at when determining if you should give the med.) Hope this helps!

I'm an not familiar with the second two drugs but I am familiar with morphine, and we had a representative from our local hospice care in our nursing class last week. She talked about a lot of times these patients that are in end stage disease often are agitated and restless because they are in pain and are unable to tell us for some reason or another so they do have standing orders to give morphine to their patients. So from what she said and not really being familiar with the other two, I would lean toward the morphine.

I work in the ED and I do agree it's up to the doc really. We have docs that would just do the basics and docs that will give them an entire work up "just in case". I will venture to say that the answer is a combination of option 1 and option 2. The docs will want an x-ray to r/o any possible fracture, then observe him for a few hours then send him home if all seems fine with his neuro. assessment. But there are a lot of times, the docs order a head CT to be on the safe side, since it shows soft tissue, so option is a possibility though we wouldn't start an IV until we knew it was necessary.

Okay so this is more for myself than anything else. I know that lots of people can have idiosyncratic reactions to medications. In my case, I've taken Levaquin, Biaxin and a Medrol dose pack in the past and all of caused me to have I guess you would call it generalized pain. I thought my doc called it faciitis one time but I honestly don't remember. Usually it is my upper body, arms, chest, upper back, neck and sometime my thighs, they will be super tender to the touch. And one time hurt enough that putting on a shirt and just the slight pressure from it rubbing against my skin would cause pain. Each time this has happened to me it had been on one of these medications. The last time was recently with Biaxin which also make me feel jittery or like you would with a low BG level. Before that I thought it was the Levaquin, but I had always been on a Medrol pack with it and the last time I had a Medrol pack I didn't get the Levaquin cause I couldn't afford it and it happened that time too, and badly too. I was really sore. I'm on Avelox now and may be starting to get that sore feeling again, but it could be just being tired and stressed from nursing school. My question is, has anyone ever heard of this before????? As a nursing student I have access to med books, and online med resources and have not come across this at all and wondered if anyone else had. I'd be interested in your thoughts. Do you thinks it's an allergic reaction where I shouldn't take these meds again or just an idiosyncratic reaction that it's okay to take it. I mean it bothers me but it will subside within a week of stopping the med. Just curious as to what your thoughts are...please respond if you can!

What camp did you work at? It sounds like a camp in NY that I go to called Word of Life. But I would imagine you would have seen a few fractures and sprains there given all the activities that they do.

To answer your question regarding the L sided heart failure causing R sided heart failure. In this case you need to think about your patho. What is going on in L sided heart failure and where is the blood going. In L sided heart failure, the heart usually increases it's afterload which means that when the blood returns from the lungs it can't fill the L ventricle as it normally does. So blood eventually backs up into the lungs, now that blood is backed up into the lungs, the right side of the heart has to work harder to pump blood out to the lungs. Eventually blood can't fill the right side of the heart either so it causes hepatomegally and splenomegally. So definitely not a good situation. I hope I explained that well, and correctly :). But yes that basically is what happens.

I would go with what the book says or what the hospital your school is affiliated with says. If they wanted you to buy the book, that means they are probable using the values and info from those books.

These are the med-surg text books we use and they are helpful. This one even comes along with a study guide with really helpful study questions on each chapter. Then you can go online and look up the answers to the questions. Check it out on amazon at: http://www.amazon.com/Medical-Surgical-Nursing-Critical-Thinking-Collaborative/dp/1416066330/ref=sr_1_1?ie=UTF8&s=books&qid=1256169010&sr=8-1

So, I'm sure that I will be able to figure out some on my own but I just thought I'd ask for your thoughts on nursing diagnoses for a patient who is 65 years old, with a recent tracheostomy and PEG tube. He was has bibasilar atelectasis and had a barium swallow study and was shown to silently aspirate on honey thick liquids. He also has diabetes, hypertension, and his BUN/Cr were slightly elevated. Let me know your thoughts, Thanks!