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Anoetos BSN, RN

Emergency Nursing
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Anoetos has 2 years experience as a BSN, RN and specializes in Emergency Nursing.

Anoetos's Latest Activity

  1. Anoetos

    PICC line blood draw

    I usually waste more than I flush. Flushing is for line clearing and patency, so I can't really see the point of a policy of flushing with 10 or more, but I am certainly willing to be educated on it. Other than that, after you flush you can move the pts arm around...lol.
  2. Anoetos

    Antibiotic initiation/effectiveness

    There's no way to have known this was coming. Sepsis can "gallop" on an elderly patient, but it doesn't usually. There doesn't seem to have been any indication that she was moribund. She came from the ED with abx started, right? I think that's pretty much procedure anywhere. I'm currently in the ED (having transferred from medical step-down) and we start abx on all elderly pts of whom we suspect UTI/Urosepsis/Pneumonia, also waiting 0:45 for a reaction. Additionally, with pna we're now doing blood cultures first. No pt gets abx without cx being drawn The point above about flash edema is also well-made. Other questions: I am assuming that since she clearly went into shock her BP was tanking, did you bolus her fluids (if she could tolerate them)? Did you start pressors upon adequate hydration (this is posted in critical care so I am assuming you can start pressors where you work, I could be wrong). This may be something they would have done once they got her to the unit, I don't know how your facility works. All of this said, we need better education in the elderly population about the dangers of UTIs.
  3. Had a girl come in the other night with a tooth ache. No big deal, I get it...the likelihood of getting an oral surgeon on a Sunday morning is nil, but we can give ABX and pain control. Tooth aches hurt like hell, I get that. So, I start a line, infuse clinda, etc. She gets 5-325 Norco. Doc tells her he'll write a scrip for Norco and let her go if she's going to see her dentist/oral surgeon on Monday, but that she should take Motrin 600 regularly for additional pain control and swelling. Before we discharge her, her mom, who is with her, asks the doc to write a once order for Motrin 600 before they leave so she doesn't have to stop at a drug store. So, she got a dose of NSAID for a couple hundred bucks to her insurance that she could have gotten by making a five minute stop for several doses at $8 or $9 .
  4. Anoetos

    Question about IV therapy

    All giving them a hypertonic solution would do is draw fluid back into the intravascular space, possibly correcting a hypovolemic state, but it would do nothing for their hemoglobin and in fact might reduce it further due to hemodilution. The best and fastest way to correct hypohemoglobinemia is to transfuse packed red blood cells.
  5. Anoetos

    Medication tidbits an ER nurse should always know

    But I feel like I've derailed the thread with my rant. Sorry about that folks. I yield.
  6. Anoetos

    Medication tidbits an ER nurse should always know

  7. Anoetos

    Medication tidbits an ER nurse should always know

    But more directly to your case, why deny the pt what they want? If they have a high tolerance to opioids it's unlikely that 1mg of dilaudid is going to do much for them. Certainly not as much as for the naive. The likelihood that you'll do them harm is very small also. Again it comes down to judging our pts and while it's certainly true that we use our judgment to assess them, that's not the same thing. I guess I just don't understand the gatekeeper mentality many nurses have about opioid pain meds. They are actually metabolically, very benign and only a hazard to a pt who is already severely hypotensive or in respiratory distress.
  8. Anoetos

    Medication tidbits an ER nurse should always know

    I think sometimes patients get caught up in a cycle which ends up generating narcotic dependency and we are as at fault for this as they are. Let's say they get a spinal fusion which never really takes, sure, their spinal cord is now protected and intact, but they still are dealing with chronic pain. They get scrips for Vicodin and Oxy which they never really get off of and they require higher and higher doses just to manage the pain and they don't really have anything for breakthrough. So they come to the ED, where we call them "seekers" and deny or at best dilute their pain control measures. CP I am NOT saying this is the case with the pt you're talking about. I am just pointing out that we, just because we're nurses, don't necessarily always know what is best for every patient. Frankly, if it's ordered, I give it. If the pt isn't opiate naive, I don't cheat them just because I have moral qualms about the choices they may have had to make due to a medical condition.
  9. Anoetos

    Medication tidbits an ER nurse should always know

    I read up on the hypotensive effects of dilaudid and they're actually negligible except with chronic use. I did this after a patient died on me.
  10. Anoetos

    Medication tidbits an ER nurse should always know

    I only dilute dilaudid for opioid naive patients. For those with chronic pain and high tolerance I push it hard and fast and I always flush. They appreciate it.
  11. Anoetos

    Medication tidbits an ER nurse should always know

    The problem with hydralazine, Brainkandy, is that it's unpredictable, for every ten patients it works for, there are two or three for whom is either does very little or does too much. That said, I love beta blockers, especially Lopressor for heart rate control in tachycardic pts. I always question it for BP control, it's only mildly effective and even then usually in conjunction with HCTZ or some other diuretic.
  12. Had a guy come in, said he had a fever of 99 degrees F, but what really made him come in was that he was having bad dreams.
  13. Anoetos

    Emergency Room Skills

    Pretty new to the ED but so far I've had a lot of success in calming patients down. Usually all it takes is an open handed explanation of what's going on.
  14. Anoetos

    Any good "nurse" shows on tv? Netflix?

    Grey's Anatomy is ridiculous. Not only do they degrade RNs, the RNs don't do anything. Pt needs to be ambulated? A doc does it. Pt needs meds, a doc gives them. Basically, everything RNs do every day is done at that hospital by doctors. Their nurses are either so horrible that they deserve to be degraded or that show is absolutely asinine. I think the latter.
  15. I worked for a year in a medical stepdown, basically a MICU overflow. I recently accepted a position in our ED. I think already being ACLS certified and used to intubation and codes helped me, not to mention familiarity with the elderly CHF/COPD/PNA/HHNC/DKA/GIB/ETOH/Drug/psych population.
  16. Anoetos

    "I don't want him as my nurse"

    Back on page one I think, it was noted that the value of any pain scale is that it allows you to reassess after your intervention. Since this is a Joint Commission evaluable activity, it's even more important