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questionsforall's Latest Activity

  1. questionsforall

    Some Nurses too Almighty?

    In my ICU the nurses complete all patient care. This includes bathing patients, getting them out of bed, helping them onto bedpans, cleaning them when they are done. The nurse does everything. The nursing assistant just stocks rooms and take blood sugars. It is rare to find an nursing assistant that will help with patient care. Usually the nurses have to help each other.
  2. questionsforall

    Dialysis, HIV and terminal Pts. Abuse?

    I understand what the OP is saying and I think some people are misunderstanding the post. Some people hit it right on the mark. I don't think she is talking about taking a decision away from the patient or their family. She is saying that maybe dialysis should not be offered to everyone and there comes a point were doctors should be having palliative care discussions with families and patients instead of just doing everything possible to keep them alive. Palliative care is often underused. With some patients, we should be concentrating on reducing the severity of their disease symptoms rather than working to stop, delay or reverse the progression ot the disease. We should instead be trying to improve the quality of life. Working in a MICU, I see dialysis offered far too often and quickly. If every organ has failed and now the kidneys follow, I don't think we should offer dialysis. We will at this point not cure the patient or make their lives better by offering dialysis. I think dialysis should be used as a bridge, a means to an end and just not a means for keeping people alive with no end. Would you offer a VAD or artificial heart to everyone in heart failure who fails medical intervention? I think most people would say no. However, dialysis is the same issue. A VAD is an artificial machine that acts like the failed ventricle. Dialysis is an artificial machine that acts like a failed nephron. So, they are both artificial means of keeping people alive. The US uses dialysis more than an other country. I think this is partially because it is paid for through Medicare. It is also in part because of our health care system being driven by the consumer. But, I think it is mostly due to the beliefs and cultures in the US. We as a culture will take life regardless of quality over life dependent on quality.
  3. questionsforall

    Things you'd LOVE to be able to tell patients, and get away with it.

    To family members who think your only job is to give them updates: You were on hold for 15 minutes. Well this is an ICU, there are sick people here. Actually, I was in your mother's room taking care of her when you called. She is having trouble breathing and we are trying to prevent her from getting re-intubated. I didn't think answering the phone was priority over that, but I know for next time that I should stop taking care of her, come to answer the phone and chit-chat with you for 15 minutes while she goes into respiratory failure and arrests. I now know what is important here, thank you for reminding me. Oh you called 15 min before and your were put on hold then as well. Don't worry, that patient I was taking care of at the time doesn't matter either. Next time I will know better. To the patient who is constantly on the bell: Ringing that call bell faster or harder will not make me get to your room any quicker. It will actually slow things down to the point that I make never make it into your room. To the picky patients: sorry, we only have orange jello. this is not a restaurant, it is a hospital. Take it or leave t
  4. questionsforall

    What do you do when you can't do it all?

    Haha, this is only funny because I was thinking the same thing you posted after I got off of work today, "What can you do when you can't do it all?" I hear you, you are preaching to the choir. I work in the ICU and I still feel the way you do (but I only have two patients and you have many more). Today, I wish I could have been split in two. I can't be. So, while I was with one of my patients, everone else had to wait (including the doctors, patient and phone since we did not have a secretary or an aide). I loved it when my patient's daughter called me and was on hold for 15 minutes got upset with me because I did not run to the phone when she called (because the nurses are the only ones that can update families). However, I was in the room with her mother who could not breath, was completely fluid overloaded and headed on her way to intubation. I should have known that answering her call was a priority. What was I thinking? I got out late and missed my lunch. So, I filled out an overtime slip for my missed lunch and for the time I was late in hopes that maybe they will get tired of paying overtime and give us some more help.
  5. questionsforall

    Just wondering... what would you want your kids to do for a living?

    I want my children to find something they would be happy with and where they would feel like they were making a difference. However, I wish for them something I feel I did not have growing up. That is, I want them to know about all their options. There are so many careers that I did not know about when I was in high school deciding what I was going to study in college that I wish I had known about. My mother said that even knowing all those options i probably would have found nursing anyway. Whatever they choose, I will be there to support them like she did for me.
  6. questionsforall

    Ideas from nurses who've been around awhile!

    The nurses I worked with that were around in the 70's and 80's said that they remember when HIV/AIDS didn't have a name and that these patients would come in the hospital with the diagnosis: Fever of unknown origin. Also, many antiobiotics were given IM.
  7. questionsforall

    question about acidotic pts and labs

    Need more info, (like maybe the complete blood gas). However, you said he was a renal patient with phos of 12. I would need more labs like BUN, creatinine to say this, but maye he needed dialysis. It sounds like his CO2 was low, maybe he was compensating for a metabolic acidosis by breathing fast (since you said he was SOB) and blowing off CO2.
  8. questionsforall

    How much lorazepam have you given....

    We switched over to valium IV for ETOH withdrawal and we even sometimes use ketamine drips (like they do with burn patients).
  9. questionsforall

    Gave up in ACLS class

    I will tell you that even doctors have problems in ACLS class. In my experience, the nurses know more :)
  10. questionsforall

    Signing out meds you do NOT administer yourself?

    This whole process seems to defeat the purpose of the 5 rights and the 3 checks and should be re-evaluated.
  11. questionsforall

    The Problem with Nursing

    1. I had a BS in neuroscience before I became a nurse and I will say that nursing school was harder. Once you actually become a nurse you will see that everything always falls on the nurse. If a change needs to be made, it all falls on the nurse. Doctors are not filling in time in/time out sheets, oh the nurse should be on top of it (now they fill them out). Oh, there is an increase in central line infections (So now the nurse must fill out a quality assurance document for every incersion on top of their regular charting). Patient and family is not satisfied with explainations or updates they are receiving, must be the nurses fault. Doctor ordered medicaiton wrong, pharmacy must call nurse, so nurse can deal with the issue. Again, I like how the person who said that you don't hear a family member come in and say, can I talk to the CNA, EKG tech, radiologist about my mother. We have a lot on our shoulders. We can whine a little if we want because all day we have to listen to patient's, families, administration, doctors whine to us. 2) I do not think that the other professions do not have to deal with the patient's at their worst. They may spend two minutes with the patient as opposed to twelve hours. They are not always so caring. The other day, my patient, who was 1 day post heart transplant in a tremendous amount of pain, and constipated. He finally had the urge to make a BM and I just placed him on the bedpan when the ECHO tech came to do a bedside ECHO. I told her the patient was on the bedpan, she said she needed to get the ECHO done now because she was going home in an hour and he was her last patient (ECHO may take 30 min max). So threatened me with the oh I can't wait forever, could you do something about it. I should have told the patient he had to hold it for 30 min until the ECHO was done (even though he already feels like crap). She waited 5 minutes. I went to answer my other patient's call light and she went in the room to do the ECHO while the patient was on the bedpan. I just hope someone shows her the same courtesy if she is a patient. 3) I will admit, the crazy scrubs can be a bit much, but as a patient I would rather my nurse be competent than wear solid scrubs. 4) Nursing diagnosis help nurses with their assessment of situations. A nurses assesment is his/her most valuable asset. Doctors rely on nurses assesments. In the ICU doctors make clinical decisions based on the nurses assessment every minute. 5) I don't see how #5 has anything to do with making nurses look like they do not have a brain. 6) Again, not one person knows everything. Even doctors don't know everything (except for you apparently you know everything). I am a CTICU nurse and I couldn't tell you more than a handful of material related to maternity nursing. And an OB/GYN physician could probably not tell me how to titrate my ICU drips.
  12. questionsforall


    I was thinking of buying a new labtop for CRNA school. I was wondering if anyone had opinions on what type of computer to buy. I was wanting to buy a MAC but I was wondering if it is necessary to buy such an expensive computer or if I should just keep the one I have until school is over (granted it lasts that long). To the students that will be starting soon: What type of computer do you use or did you purchase for school? To the students already in programs: Did you even use your computer in the program? What type of computer did you use? Also, to change the subject but keep it close to topic, do you need a PDA for school and clinicals or can you get by without one?
  13. questionsforall

    everyone is stumped

    Also, why are they not starting a beta blocker?
  14. questionsforall

    everyone is stumped

    What about pheochromocytoma? This tumor can secrete excessive amount of epi and norepi. Besides the physical symptoms of elevated BP and HR they can get crazy too. Did you guys check her urine for catecholamine metabolites? Maybe the poison is an unrelated coincedence. But, antifreeze poisoning sounds pretty good too, especially since you said she was in Kussmal's breathing (due to a metabolic acidosis probably) and that she was in renal failure (kidneys's compensating for metabolic acidosis?). I agree with the others BP and Heart rate need to be controlled with something other than hydralazine.
  15. questionsforall

    What is the highest temp you have seen?

    106.7 neuroleptic malignant syndrome, patient survived episode. Surprisingly cooling and treating with dantrolene worked (we treated it like malignant hyperthermia). Patient died a week later, but from whatever caused the syndrome and not because of the fever.
  16. questionsforall

    A BSN or just a Bachelor of Nursing degree for becoming a CRNA?

    I believe as an undergrad there you either get a BA (Bachelor of Arts), or BS (Bachelor of Science). Nursing is a BS degree. You get a BSN degree, which stands for Bachelor of Science in Nursing. I don't think there is a BN degree, or Bachelor of Nursing. If you were getting your Associate's degree there is are a whole other mess of degrees. I got an AAS for my Associates in Nursing (Associates in Applied Science). You will be going for a Bachelor in Nursing, not a Bachelor of Nursing.