ShyViolet

Phenylephrine is a very dangerous vesicant which can cause severe necrosis of the tissues if it extravasates; therefore, it is always to be administered via central line. That being said, I have had occasions where a patient was crashing and all I had was a peripheral line. In that case, I have given the phenylephrine peripherally, but only until central access could be established.

If you were giving the medication, I don't know of any possible way they could prove that you weren't. It becomes a case of their word against yours, and neither one of them was there for the weekend to observe you giving or not giving it, correct? I don't think there's a whole lot they can do to you.

Congratulations, you're a registered nurse!

I passed in 75. What I hated was that it just shut off. No "Thank you for testing" message to let you know it was over. I sat in front of the computer for about 5 minutes about to cry because I thought something had gone horribly wrong! I got too many pharmacology questions, especially psych meds, so I thought for sure I had failed. Thing is, even if you don't pass the first time, it's not the end of the world. It doesn't mean you won't make a good nurse or that you don't know anything, it just means that you didn't take the NCLEX very well the first time. All a standardized test really measures is how good you are at taking that test. If they had had some EKG questions, I would've kicked tush all over that test.

I used to ask questions before I did pretty much anything! I got teased about some of the things I asked, but now that there have been a few newer batches of nurses coming to me with questions I feel like I'd rather know that they feel comfortable and safe to come to me if they aren't sure. Quality patient care is at stake, and I don't think you should ever feel like you aren't allowed to seek help with that. It was good of you to ask for assistance on the straight cath if you'd never done it; I don't think catheters are hard at all now, but I still remember the days when inserting a Foley seemed like the scariest thing I could possibly have to do!

When I was 6 months in and feeling like I wasn't good enough yet, one of my preceptors gave me this breakdown: 1st year: Task oriented. You are all too aware of the clock ticking and you know that you have to assess your patient, do vitals on schedule and get meds passed on time. Your main question is "What do I need to do to get through my shift?" 2nd year: Numbers oriented. You're starting to understand your assessments a little better, starting to put the numbers together and understand what it all means. Your main question is "What do I need to do to fix these numbers?" 3rd year: You're finally a holistic nurse. You know the numbers, you know the norms, you know what to do in a lot of situations. Now your main question becomes "What does this person need me to do for them?"

Being told that a patient had no TF residuals for day shift, only to get 6 hrs' worth of residuals when I check. When a pt has been intubated for 3 days and nobody has cleaned up the orders to change the PO meds to something else (especially for enteric coated meds that can't go down an OG tube), then the doctors look at me like I'm crazy when I ask them to fix it. When pts get annoyed and start refusing ridiculous things like temperature checks and lung auscultation. Listen, I know you are tired and don't feel good, but when you're in for pneumonia or sepsis I need to know if you're starting to show signs of infection again! When I look at past vital signs and somebody charted the DP and PT pulses as bilaterally present on a patient with BKA. When somebody reports skin breakdown to me, but it's not mentioned anywhere in the charting. If the first time it's mentioned is in my assessment at the beginning of my shift, and I'm the one who got the ET consult and did an incident report (which are both hospital policy), and the patient has a stage 2 decub, then you're going to look pretty negligent if anybody cares to audit the patient's chart.

Anybody who is on an insulin drip needs to be in an ICU, period. Q1h sugars get hard to keep up with even there; when you have 5 other patients to think about then either sugars will get missed or some other patient care will get missed. The patient who still needed a lot of inotropic support with dobutamine needed to be in an ICU; you should never have to take titratable drips on the floor, it's just plain not safe. And the lady with low urine output in possible shock? She at the very least needed to be part of a decreased ratio. Good candidate for an ICU as her vital signs seemed to be deteriorating. That was a very unsafe patient load, and it's not right if the nurses on your floor routinely have loads like that.

When I get a good blood sugar from one of my little grammies, I say "Awww, like I thought. You're perfectly sweet." When DTing patients start yanking their Foleys I say "If you yank that thing out then we'll need a urologist to put a bigger one in" or "If you pull that out then you can kiss goodbye all the good things your member does for you." "If you could sleep at night in an ICU, you might get too content and never want to leave" or "We have to make it miserable. It motivates you to get better and leave." When delirious patients claim they've called the cops (we don't have phones in our ICU rooms) I like to say "That's fine, I'm the judge's favorite niece." "I'm going to put a cool, refreshing stethoscope on your chest and make sure you've got a heart." After having taken care of a man in end-stage liver disease every night for several weeks and only speaking to his wife on the phone, I finally met her one night when she stopped by after work. I introduced myself by saying "I'm the 25-year-old blonde who's been spending the night with your husband." I once introduced myself to a lovely little old man and said "I'm just going to have to give you a little look-over and you can go back to sleep," to which he replied "Fair enough, I'm giving you a look-over right now." When men ask if something will hurt, I say "No more than childbirth, and it'll be a lot quicker."

Could you PM me the information as well? I've recently become interested in the PHRN certification.

Getting into a casual or per diem position might help get you a foot in the door. I would take whatever I could tolerate in the hospital setting just to get in; once you're in-house it's easier to move than it is to get hired in the first place.

In my experience, nurses who are only doing it for their required CC experience don't work out well. It's good to have CRNA school as a goal, but take the ICU experience for what it is. The ones who are only viewing it as a bullet point on a checklist forget what it means to be a nurse and care for a person.

It's definitely OK to change sensitivity and output as needed, because you're not changing the actual settings; you're making the settings work the way they're supposed to. I do check the underlying rhythm, unless I know that there is something deadly underlying. If the patient is able to take the pacer being off for a minute without decompensating, I might take a moment to check the blood pressure and cardiac index with the native rhythm.

Somewhere in your assessment notes it should state that your a-line is giving a dampened wave form, so there is no reason to chart bad data. As another poster stated, lawyers adore charting discrepencies and having two different pressures in the same set of vitals is a heck of a discrepency. If your art line is no good then you should talk to your doctor about either getting a new one (if you still need it) or discontinuing it.

I have seen both heart and lung transplants kept fairly dry for the most part, with inotropic support for MAP and CI. Our surgeons' drug of choice for this is usually either epi or milrinone or some combination thereof.