RN92

hand mittens are wonderful in this situation. it is the least level of restraint (in my opinion). and they cant pick at anything.

dont forget: someone who isnt afraid to ask...when they dont know. Scariest nurses are the ones who know everything.

check with the state board, also.

the pt could have aspirated. i know you probably reported it to the md, right? he should have ordered a chest xray. was the tube secured? and how? just curious.

it depends on the census. if you have a high census and are unable to give the meds 30 min before/after...maybe they need to reconsider staffing. if you start gettin written up for it, i'd be calling the supervisor to let her know if it wasnt going to be possible. at least then you could cover yourself. it figures a pharmacist would make these kinds of decisions without considering the reality of a situation.

wow. in ms new grads start at 19 something.

I agree with everyone. HIPPA is there for a reason and you either follow it for everybody or not at all. I can see where people would think "its not that serious, you can make an exception for me...Im her daughter "(for example). Truth is I dont know you're who you say you are. Family and friends will have to learn that its not personal, its just the law.

Hi. I just started back working at a very small town hospital - you know the one, where everybody knows everybody elses personal lives, the Docs all have the buddy system and meet at the country club on Wed's for golf. I work with a lot of (much) older nurses who still think that if the Doc orders it, they have to do it. (huh?). There is one Doc known for her "euthenasia" efforts. I had an 82 yo nsg home pt who was on his last leg. Diagnosis: aspiration pneumonia, old age, etc.. she writes an order for Morphine 2mg IV q4hrs prn for pain. They guys bp stayed around 84/42 even without morphine. She convinced the family that he needed something for pain so that he could rest better. He was comatose! There was no way I was giving him morphine. the family got upset and I get called into the managers office the next day for refusing to carry out a Dr.'s order. It was just a slap on the wrist, but come on. The week before, she had made one of my elderly pts a no code. In the chart she wrote that she talked to the family and my coworker was present. I asked her about it and she got so upset, she said that she never witnessed that conversation - and when asked, the family knew nothing about it. All she could do was make a note in the chart. I cant believe this stuff still goes on.

I just watched an episode of Smallville. They did shock asystole and guess what? It didnt work - he died. (they also gave NO medications, just shocked):angryfire The patients girlfriend was crying over his body and the nurses grabbed her and told her that she had to leave. Once they pushed her out, they pulled the cover over pts face and all walked out!! So much for allowing family to grieve. We wouldnt want them to touch dead pts, it might be catchy.!? I cant help but get aggravated at that kind of junk.

I work in Memphis TN ER. Every August during "Elvis death week", we get bombarded with Elvis "look-a-likes" - mostly intoxicated, few Diabetics out of control, etc...One in particular, is a regular. Once his blood sugar gets closer to normal, he'll sing for us and other pts (whether we want him to or not).

I've done both, too. You will learn/master different skills in each dept. Personally, I like being in the ER - kind of like solving a mystery....is this pt really sick and if so, what is it? I, also, dont care about having the same pt everyday all day as in the rest of the hospital.

Just curious what his diagnosis is. He obviously has some "mental limitations" (whether its abnormal lab related, mr related, etc..). He needs something stronger to sleep at night...talk with the Doc. Depending on what the cause is...if feasible - you need to set limitations with him. Let him know you cant be at his beck and call and that the call light does not gaurantee "speedy" service. Also, on your end...try and anticipate what his usual requests are ahead of time. I'm sure you've tried some of this - be firm, very firm with him - and get him well so he can go home.

Luckily, cathing a lady parts is (most of the time) not painful. One way I can tell Im in the right place is by the shriek!

In the hospital, we always do it sterile tech... However, when I did home health, pts families were taught clean tech. The theory being that - teaching sterile tech for pts at home - just isnt feasible.

I know this is wandering off of the subject...I took Paxil for over 10yrs - and it worked great. Then over the last year, it just QUIT. I had forgotten how bad my depression could get. Im now on Lexapro (3mo). Not too impressed with it. How long did it take for it to help you.??

Ive had that conversation with my manager. Their response is, they cant make people come in to work when they're supposed to be off. Truth is, they couldnt make me come in on my day off, either. We have CRISIS nurses, but they only want to work 9-5! M-F.!

What Im hearing, is that with negative cvp - i should be looking for fluid volume defecit of one source or another. Thanks guys.

Well, you have ICU experience now. I worked ER for 2yrs and we were always holding ICU pts. Now, Im trying ICU. What I find irritating, is that I have to go through "orientation" (which is understandable), but the ICU nurses act like I should take one ICU pt for a while and get used to that - then maybe take two. Excuse me, but it was ok for me to take care of two icu pts AND 3 ER pts downstairs - and NO, I didnt kill anybody.

Im an old nurse (14yrs), but new to ICU. Hoping someone can answer a question for me. What does it mean or what can it mean when your cvp number goes negative? I know the transducer has to be level with the heart. The number was positive all day and all of a sudden goes negative. Checked the equipment, pressure bag, etc..found no mechanical reasons. Asked my preceptor. He said that if Ive checked everything, then thats all I can do. HUH? Is there any "medical" reason why it would go negative? If not, why dont the monitors stop at zero? I cant handle just saying, "oh well,just wait and see if it fixes itself". Im the type of person that has to know why this is or is not important to know/remember.

Yeah, what she said!! (it sounds better).

I know this may sound "basic", but i have to ask: Were you listening over any clothing? In a hurry, sometimes, i have put the stethoscope over a thin t-shirt or gown and heard what I thought were crackles (of course, I would then go under under the shirt). Also, Ive heard stuff when listening over a very hairy chest. On the other hand, maybe instead of the pt having chest congestion, you had earwax. (just kidding) :rotfl:

Great Idea!! Cant wait to try that one!

Potassium can be soo painful. I have hurt with my pts sometimes - trying different things to make it not hurt so bad.. On a few occassions, I've had pts refuse it - after several minutes or so of painful infusion. The Doc would say, Oh, just give it to them po then. One dose now, and another dose in 30 min. WHAT?? Why wasnt it ordered like that to begin with? If the pts awake enough to complain, why cant it be given po (liquid) form.? I realize IV is faster, but is it really worth the pain?

I need to VENT!! I recently was at the end of a 12hr shift. I got 2 pts from OR within 15min of each other with 2hrs to go (I work in ICU). I busted my butt trying to get them settled in and the paperwork started. At shift change, all the night nurse had to do was complete the careplans and some other trivial paperwork. During report, she wanted to *itch about what WASNT done(?) - HUH? Thats why we have SHIFTS!! First, the night nurses were fussing because they werent getting the same pts they had the night before. So, they were shuffling assignments. Then, they sat at the desk talking while day shift was still taking care of their pts. We (day shift) were 40min late leaving because of their silly, juvenile, very unprofessional conduct. My attitude has always been: The person you are relieving, has been there 8 or 12hrs. They have done their part and they deserve to go home on time. I will go find the nurse to get report (if she's ready). She shouldnt have to find me. If you dont want to WORK, you shouldnt have went into nursing. And, you sure as **** shouldnt work in a critical care area.! :angryfire

I have to deeply admire this woman who knew what she didn't want and commend the caregivers for not giving in to their own discomforts with the situation. thanks. If anything, she was taken great care of - because we knew how miserable being in resp failure would make her. How hard it must have been for her having people dangle a promise of relief (being intubated) in front of her- to say NO.I have all the respect in the world for people like that. She died fairly fast - one minute she's breathing and then all of a sudden she wasnt anymore.I agree that ABG's would have been an empty gesture.!