Vespertinas

Ixchel, your understanding of my assignment and responsibilities is inaccurate. Your answers have been not only not helpful but condescending. Whether this was my fault for not conveying the problem clearly or yours for reading too far into it is beside the point- I'd rather not hear any more input you have to share on the matter.

The case challenge is fictitious and we've been given less than two weeks to present a budget, timeline, short and long term solutions, identify stakeholders, read 81 pages of background data, identify community resources, and do our own fact-based research where necessary. etc etc etc I'm just polling on something that's not really pivotal to the process so give me a break. With that kind of paranoia, I could walk into the ED, ask a receptionist myself and suspect she's lying to me too.

I'm working on an interdisciplinary case challenge being given by the IOM. We're trying to find a comprehensive solution to support the mental health of aging veterans. Our approach will start in the ED but I have 2 questions that I need your help with because I've never actually worked in the intake part of the ED... 1) Does everybody get asked whether they're a veteran? 2) Is intake done by paper form, Q&A with the RN by a computer, both together, either depending on the hospital? I'd really appreciate your input!

Right. I agree with both of you. Ohiobobcat you made me think that if I can measure a consistent QT interval, then it's likely a T wave. I think my problem was stemming from a patient who was in afib/flutter so the whole thing was unclear as waves kept presenting and disappearing. I appreciate both of your help.

Based on what you said, it sounds like I should measure the T-wave if I suspect that's what it is. But it's entirely possible that I won't find T-waves in which case it's okay to say it's unmeasurable. Yes?

1st year of nursing moment: Agreed to take on an extra 4 hours after my 12 hour shift. Of course someone codes at hour 15. I'm hypoglycemic and full of adrenaline, pumping this patient so hard. When it's time to transfer him to ICU, I offer to grab the emergency medicine kit for the trip. Doctors and RT wheel patient into elevator and it looks pretty crowded in there to me so I figure I'll be kind and grab the next one down. As the doors close, I stand on the opposite side, grinning and waving. Everyone in the elevator looks puzzled. The doors close. I realize I am about to take the next elevator, alone, carrying emergency meds for no one.

Win Miss State for the Miss America pageant while in nursing school. Use "I want to be a nurse" as your platform. Quit nursing school immediately after.

Can I or can't I positively identify T-waves in afib? Sometimes I think I can see them and want to measure but then it could always be a P-wave, right? Should I not even bother once I recognize the rhythm is afib?

Mechanical hiccups

Nah. I've had trouble getting treatment for autonomous patients with MR. No lorazepam for that. It's so sad seeing them walk out AMA knowing the trouble they'll have ahead.

LOL "The power of Christ compels you!" with your stethoscope on her forehead

Remember, you said "a lot of psych issues" You'll hate me for preaching but please try to still be compassionate to people like this. They're not trying to make life difficult for you and ultimately, they're making life even more difficult for themselves so you understand they're not thinking rationally.

My first emergency.... a renal transplant patient who experienced a transfusion-related acute lung injury (TRALI) which is basically an immune-mediated flash pulmonary edema. Uh yeah I totally panicked. I mean within a few minutes she went from talking to me, to having an itch in her throat (which I incorrectly was addressing as reflux), to being unable to breathe, to being intubated. It all happened so fast and being that it was a respiratory code and not a cardiac I wasn't even sure how to operate. My educator took me aside after pt was shipped out and started to debrief me. My lip started quivering and she warned, "oh no you don't." That pretty much did it; I was such a ball of nerves and I let it all out right there in front of my hard-as-nails smokers-voice ICU-worn twice-divorced educator. Gold.

Love this story but I wanna ask are you sure it was actually asystole? (sorry to ruin it with nitpicking)

Having a bad attitude about management and pulling off the two-faced routine must be exhausting too. I don't even see how this relates to the original topic but I love tangents!

NurseDirtyBird, lets make us triplets. My husband and I practically divorced because he doesn't believe I'm a compassionate person. I wasn't... to him. He was too needy. I'm learning to transfer my work personality to my regular life. It's amazing how hard that can actually be! I found it much easier with a recent relationship but it was greatly helped by the bf's lack of self-centeredness. Suddenly I didn't cringe about complaints as if he were a patient who sits on his call bell all day. But yes, I am a true Jekyll and Hyde. For someone so obnoxious, it's odd how I'm bursting with daisies on the job. I think staying cheery is what gets me through the day and convinces me that I love my job. It might be a mind trick.

This is true. I wanted to make this point but for a potassium of 2, it is recommended to supplement with BOTH PO and IV

No, not sarcasm. It seems I have a tendency to confuse board members with my communication. It's not you, it's me. When you said "push out" the hematoma I was envisioning you're squeezing it out like a pimple!! Now an intervention like THAT I've never heard of but I was curious to hear about it. But yeah...reapplying pressure is pretty standard.

I should develop a drinking habit so at least I'd have a sensible excuse for where it all comes from.

Oh here's one! This patient needs some "pillow love"

Best post on this thread. I disagree. I think it's unfair to insist that OP should martyr herself to prove that she's a good, compassionate nurse. It's like saying that mothers shouldn't be bothered by their infant's cries if they REALLY loved their child. And telling OP that putting herself in the patient's shoes will help her feel better about the task is also absurd. It's like telling someone who divorced their husband to not to be sad because he's the one who has to look for a new apartment. Am I losing everyone yet?

Really, I was hoping someone would remind me of the one I'm thinking of but can't remember. It was another HIV one. If you think high-five is unprofessional wait until I ask an old co-worker what it was... it was like a three-word phrase whose acronym would spell out HIV. Something like Happy in Vegas... lol. If it ruffles your feathers, I won't take it that personally because I didn't come up with these myself, I didn't use them myself, and I worked at this place for 6 months. The point is, I'm just sharing a quirk that I found interesting. If you're upset by it, I'll take that to mean that you've found it "interesting" too!

This is why I don't like when I see techs doing BPs on the forearm unnecessarily. Sure, do it if you don't have an option but... don't give me inaccurate numbers for no reason. Against what could you check the accuracy of manual pressures?