Anoetos

I've had a couple of occasions where all the nurses and techs in a given area of the ER were dudes. We had to reach out for a female chaperone if we had a pelvic exam.

It feels like fighting a bear and beating him.

Let's just say it worked..

I'm not offended, but I think there is a place where things like this come up against necessity and when it comes to saving lives, every one needs to put on their adult trousers and get to work, patient included. Adult female of Orthodox Jewish faith with trauma comes into the ER; guess what? we aren't waiting for an all female staff to start cutting her clothes off. I know that's an extreme example, but it points to the reality that this work is, as has been said, about human anatomy, in all its cold and creamy, mottled and inflamed nastiness. I had an 80 year old obese woman tell me I couldn't give her perineal care because I was a dude. I felt like telling her, 'Good plan, I probably wouldn't be able to control myself..".

I worked in construction years ago... Then sales... Now I'm an RN... It's worked out well for me.

It is reasonable to honor the sensitivities of any patient with regard to gender issues, when they can be accommodated. When they cannot, it should be explained. When they cannot be accommodated, the patient still needs care and will have to deal with it. That said, being a jerk about it, on either side of the question is unhelpful.

Remind me to tell you about the time I gave a constipated colostomy patient an enema...

So many things I thought I couldn't handle when I was a student and when I was just starting out as a nurse... I do all of them pretty regularly now. Poop? Vomit? Urine? Blood? Bronchial secretions? Whaddeya got?

If public health nursing involves teaching, I am very excited to be starting it. I have always loved helping people navigate healthcare and understand things. I've been a nurse for two years. I got a strong bedside foundation by working in critical and emergency care. It would be nice to help people with prevention and education BEFORE they get to the ER.

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.

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.

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 .

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.

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