phoenixrn

1) We don't refer to them as victims unless they're dead. Burn SURVIVOR. 2) The primary focus of the ER should be to stabilize the patient and get them to a Burn Center as quickly as possible. Parkland Formula should be the standard guiding fluid resuscitation, then we often titrate per urine output in the ICB. 3) To explain why your patient was intubated, we'd need to know several factors.... was there any smoke inhalation? Were they burned in the face, neck or chest regions? Are they a very large, very deep burn? All of those are indicators that intubation is necessary to protect the airway. 4) The true damage and illness associated with large burns often doesn't present until hours after the injury. Patients can walk and talk in the ER.... but the next day be intubated, sedated, in pulmonary edema and kidney failure, and unrecognizable because of third-spacing.... sometimes taking months of hospitalization before they can go to rehab. 5) The milky stuff was probably propofol.

Greetings! It's 2017. I'm the primary caregiver for my mother, who is showing s/s of advancing memory loss. She frequently has back pain also, and the two issues are keeping her out of the garden, which has been her true passion. I'm a practicing RN. She lives with me. Research studies are corroborating what countless anecdotal studies have been suggesting: CBD (marijuana cannabinoids with the THC removed) are helpful in neurodegenerative diseases such as Alzheimers and Vascular Dementia. So I'm considering trying to get my mom on some CBD. I'm clean..... would pass any drug test. But I do get concerned if it was found in my household or on my person. I feel safe from legal action, but I worry about the CA BON. Any thoughts, advice, or individual experiences? Thank you.

I was hired as a new grad into a hospital that has an ABA certified ICB. I was hired onto the "ortho/neuro" med surg unit. In addition to ortho/spine patients, we would see cosmetic plastics patients, and step down patients from the ICB. I was probably the ONLY one out of all of my colleagues that didn't ***** and moan about taking care of the burn patients. Also I was one of the only ortho nurses that got along with the burn surgeons, some who actively tried to recruit me. I also got close with several of the ICB charge nurses by frequently soliciting their advice and being receptive to education. Oh..... and the patients..... If I worked a four or five day stretch.... man, we would turn and burn the ortho patients but maybe I'd have one or two burn patients for the whole stretch. I LOVED talking with them, hearing their stories, talking with them through their trauma and experience.... some of my ortho colleagues could barely look them in the eye. Needless to say, once I transferred (after 4 years on ortho), then I got really hooked.

Gosh.... this is a great question. And what if you cut the dressings down but the torso is covered in goopy silvadene and eschar? Burn patients are often slimy and slippery. And we get plenty of patients that are burned almost entirely on their back and chest.

This is also fueled by the fact that there is a PHYSICIAN shortage..... this is why APNs are in demand. Many bright young people considering medical school will also look at the APN pathway and think that it makes more sense for them. Not necessarily a bad thing..... except when they have the attitude that *they* are too good to be wiping butts.

Hero nurse!!! I guarantee you that mom and dad were praying to God/Allah/Jesus/Jehovah and probably Satan as well for any chance to hold their live baby again, deficits or not. You are a hero!!!

Update: I've accepted my admission. It's a State school (hella cheap tuition, and my facility will pay a chunk of it). Mostly online classes, but driving distance for on campus seminars and orientations. Part time track for me to chip away over the next 3 years. Well respected University. I'll be working on my Masters, working on getting my CCRN, and maybe floating around to some new ICU specialities to round out my experience. After the 3 years are up.... I'll probably know more about what direction to go in.

Well hello my fellow burn nurse!! We certainly are in a niche, aren't we? You either love our specialty.... or you don't touch it with a ten foot pole.

Greetings APNs! I could really use your advice. I was just accepted into an FNP program at a well-respected four year university. It will be dirt cheap (subsidized in-state tuition, employer tuition assistance), part time over 3 years so I can continue working and supporting MY kid who is also college bound, and mostly online coursework, although the university is within 30 miles of my home for on campus seminars and such. Sound absolutely perfect, right? Here's the thing.... I'm currently working in an Burn ICU and I absolutely love this specialty. I'm thinking that I'm not ready to leave acute care yet, and might be more inspired by an ACNP track. I'd love to work as an APN in burn care. We don't have PAs or APNs in my burn unit, and I can see the desperate need for them (Surgeons and the facility can't agree on who would pay for them). Other burn units have APNs, and it seems like they'll take any APN who at least has a critical care background of some sort. So an MSN-FNP might be enough to achieve that goal since I have direct experience as a bedside RN in the ICB. ... but then I think about time spent on clinicals, research projects, academic rigor, etc...... and then I wonder again if I should just shoot for the stars and get more critical care and trauma training while pursuing a masters degree. Another option: do the FNP track, then do a post-masters certificate for ACNP. Advice is greatly appreciated!!

So I was just at a "medically supervised" weight loss clinic. The "counselor" gave me a subQ injection in the upper arm. I had to tell her to wash her hands and put on gloves. I asked her if she was a medical assistant and she gave a runaround answer. I asked the receptionist what their "counselors" level of training was.... got a runaround answer like "they all have bachelor's degrees." Another option for these injections is in the hip. I told this girl that was a more dangerous area as there are nerves that can be injured if something goes wrong. So I was "that" client today. I felt terrible about it.... but I really have the heebeejeebies about this. This is in California. Does anyone know the law regarding office staff (without ANY medical training - not even an MA!!) giving injections?

Gotta watch out for pulmonary edema also. If the patient has a good, health strong heart prior to the burn injury, they'll be able to handle the fluids. Patients with weak hearts can get backed up into the lungs pretty quickly.

I agree with what Marienm said... I will add: I would consider eschar to be nonviable tissue that covers a wound bed ... eschar can be yellow, white, or scabby. Eschar doesn't necessarily come off by itself, and in burns we want to get rid of eschar because it impedes tissue healing which needs a clean, pink wound bed to regenerate. We get rid of eschar by surgical debridement, or scrubbing, or sometimes enzyme topicals. If it's sloughing, it's coming off on its own. In burns, we see a lot of sloughing initially when the dead skin is literally sliding off the dermis. Skin graft better not be sloughing!!!

We use silver nitrate to cauterize areas of hypergranulation in healing graft sites. Granulation tissue = pink or red smooth wound bed. Hypergranuation = raised, caviar-like dark red or purplish tissue. Our silver nitrate sticks are in the wound cart and easy access to stop "bleeders...," if a deep burn is bleeding out and a source is located, we may try cauterizing the bleeder with the stick before the surgeon has to suture. Silvadene is just a cream that we apply for presurgical burn care.

I live in earthquake country.... 30 min away from the city where my hospital is at and in a safer earthquake zone than the city. If the "big one" hit and I knew my family was safe, I would do whatever I could to make my way to the city to help out, for as long as necessary. One of the reasons I got into this profession was to feel like I could be of service to my community. Not to judge the OP for not feeling the same way, we don't all have to be the same... but perhaps it would be helpful to reduce your indignation at being required to do what many of us would gladly do.

My routine: I check the MAR, then pull the meds. Then, I chart the meds one by one against the MAR, checking the name and correct dosage again, then opening the package, announcing the medication and its purpose to the patient. Almost fool proof way to double check whilst also doing patient education about their medications.

1) I saved a patient's life by NOT listening to the charge nurse's advice. I got an order for the EKG which concluded a STEMI (Charge wanted to ignore it, because the pt was homeless and yelling out anyway). The patient told ME that the pain in her chest was shooting from one arm to the other, the charge RN just heard yelling. I got the EKG. Remember, YOU (and your CNA) are the nurse that is spending the most time with the patient. Charge nurses, doctors and supervisors pop in for brief moments compared to what you see, hear, smell and sense. Trust your gut. 2) Any person in a place of leadership who chastises you in any way for asking questions is an ineffective and dangerous leader. Ineffective because that kind of behavior does not inspire teamwork or patient safety, dangerous because new nurses should never ever ever be discouraged from getting information clarifying their thoughts. 3) Don't take the laughing personally. Your colleagues could be laughing because they are all remember their first cry as new nurses, or perhaps they are laughing uncomfortably because of the inappropriateness of your charge nurses behavior.

I'm a good test taker. I downloaded NCLEX study questions onto my Itouch. There were 1000, and you could bookmark the ones you got wrong. I studied them until I had 0 wrong. I passed with just a few questions over the minimum required. But I tell you this: after that screen went black, I started crying. I was CERTAIN I had flunked. Within a few minutes of the start of the test, the questions that were coming at me were so strange, specialized and bewildering, I was guessing for the majority of the test. It would repeat questions about specified topics, like pancreatic cancer... really! I did the Pearson Vue trick, which made me feel a little better, then checked the BON site a few days later to find out that I was licensed. But that car ride home after I took the test... one of the worst moments of my life. I felt like I'd let the entire world down. To this day, I have no idea why or how they structure that exam. I guess there are levels of intensity... if you clear the easy levels quickly (and pass!!) they still have to zap you with enough impossible questions to reach the min. number of questions.

I like that most of my patients get better and go home. You see your nursing interventions actually work and patients progress. But don't take it lightly.... when these patient's are fresh post ops they can be pretty sick. You will handle a lot of PCAs, blood transfusions, and nifty gadgets. I also love the collaboration with physical and occupational therapists. It tampers some of the cattiness that seems to be inherent in nursing. Now the neurospine patients.... can't say I care for this specialty too much. This is an area of medicine that needs a serious overhaul. Many of these patients were injured on the job, have been screwed over by workers comp for a decade, have seen their lives and loved ones disintegrate and become replaced by opiate dependence. In the worst cases, their opiate receptors are so shot, after a major spine surgery they are in excruciating pain and don't want to get up. Neurosurgeons are often dumbfounded when their surgery doesn't produce perfect resolution of the symptoms.... perhaps that has something to do with the fact that no one counseled or directed the patient to start stretching and exercising to prevent future back problems. Sorry, didn't mean to turn this into a rant. I LOVE ORTHO, I REALLY DO.

I use the skin prep swabs... gives a sticky surface to grab onto the condom cath so it won't slip off as easily, protects the delicate skin, using a downward motion sweeps any stray hairs out of the way... which also straightens out the shaft. I've never had a member get erect from this, but it really, really helps get the sucker on and STAY on.

The irony of your entire post, OP, is that by singling out a group of people (of whom you have gathered no evidence to support your claims) you are making cruel and degrading generalizations which could, in fact, be categorized as bullying. Sincerely, High school droupout with BA and BSN.

As long as the nurse isn't hosting her Media website DRESSED UP AS A NURSE!!! Wish the BON could go after Media sites that have a "nurse theme." Sorry to get off track here :)

I was at a free clinic once and going through the questions.... thought I'd heard it all at that point and was unimpressed, until I was asked if I regularly came into contact with BLOOD during sexual activity!! I almost jumped out of my seat from disbelief.... I think I asked if there was a vampire cult living in the city!

THIS GUY IS SOOO FUNNY! He's a doc, but a seriously funny one. http://www.youtube.com/user/ZDoggMD

I love making my patients and their families laugh.

"so I said IT'S GONE, IT'S MY FAULT, MOVE ON, WHAT CAN I GET YOU RIGHT NOW..." Beautiful. A metaphor for all relationships :)