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Ddestiny BSN, RN

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  1. Ddestiny

    Air in Line

    I'm going to assume that you're needing to re-prime the tubing around the level of the pump, not just the area immediately below the drip chamber. This method will work for both, but if you're just getting a little air below the drip chamber then you can re-prime with a syringe without having to pull the tubing out of the pump -- just pause it. Below is a longer way, to be used if the bubbles are down below the secondary port in the tubing (the port immediately above the pump). You don't need to unhook the line from the patient to do this. 1. Pause the pump. 2. Clamp the roller clamp immediately below the pump (I'm assuming that all Alaris tubing is the same? Maybe not?) 3. Open the door on the pump channel and pull the tubing out of the channel. There will be a blue clamp that will be active/closed when you pull the tubing out and you will need to re-open it. (Make sure Step 2 is done before Step 3 to keep more fluid/med from running into the pt and bringing your air level lower.) 4. Squeeze and fill your drip chamber. 5. Connect the empty syringe to the port on the tubing that is below the part of the tubing that goes into the pump. It is usually right above the roller clamp. 6. Pull back on the plunger of the syringe. You should see fluid/med dripping into the drip chamber. If it is not, you have missed a step somewhere. Just keep pulling back until you get all of the air out. You will end up with some of the med/fluid in your syringe. No big deal. 7. Put the tubing back into the pump chamber, release the roller clamp below the pump, and restart the infusion. If your secondary tubing goes dry, you can back-prime it with the primary fluid by simply making sure that the clamp on the secondary tubing is open, then lowering the secondary medication below the level of the primary fluid. You'll immediately see the tubing start to backprime. This can be done when the fluid is still running, without pausing the pump. Hope this helps!
  2. Ddestiny

    Difficult conversations in the ICU

    I wanted to hear from my fellow critical care nurses about a common but difficult situation. I'd love to hear your advice and perspective. My mind's been buzzing around some recent scenarios that I've been involved in at work, where I've been part of a team for various patients that have treatment/goal of care options that are ethically a bit grey. By that, I mean the patients where the families want everything done, when it's questionable what outcome the patient can realistically attain. The patients that are acute but stable; may not necessarily be on death's door, but cognitive functioning and independence are extremely limited. One, we were not sure we'd ever be able to live without ventilation support due to an insult to the brain stem. Unfortunately, the family was not hearing that, and insisted that the trach and peg were just a short-term measure before he bounces back. I feel like, in these situations, my greatest struggle was in trying to meet the family where they are and find common ground so that they can understand that, though the conversations are hard, we aren't trying to be dismissive or tell them to let go of their loved one. Rather, we're trying to explain the treatment options and their consequences. Many families don't want to explore the consequences, which doesn't allow them to make informed decisions. These conversations are hard and people's fear at learning that their loved one may not survive or return to a certain quality of life tends to go quickly from fear to anger, and I feel it creates distrust in the treatment team. My personal belief is that if someone truly would want everything done no matter the potential for suffering, I can be okay with that and will suffer no psychological stress from it as long as I know that the decision was made with all of the information available. But I'm starting to find that is now more of an "ideal situation" since so many families of ICU patients are deep in their stages of grief that make it difficult to effectively connect and educate. Finding the "sweet spot" between making sure that the family understands the consequences of the different options (including the more uncomfortable options), and not just absolutely beating a dead horse and causing nothing but further distrust, can sometimes be complicated. If anything, it's like trying to hit a moving target. lol Any stories or tips on how you go about having conversations with a patient's loved ones, when the situation is "stacked against you" and it feels like the family is resentful or dismissive of the information you present? Or even in those situations where family members do NOT get it (or maybe think that they get it, but are totally off base)? Do your doctors tend to be the one doing most of the talking or do you make a point of addressing these issues yourself?
  3. Ddestiny

    Central KS LPN Programs

    Does anyone have any reviews for any of the following schools? Quality of education, criteria to be entered into program (waitlist vs. GPA?), any of the stuff that you're not going to get from the website and the brochures would be greatly appreciated. Kaw Area Technical School (Topeka) Manhattan Area Technical College (Manhattan) Brown Mackie (Salina) Any other programs close to Manhattan that I missed?
  4. Ddestiny

    Burnout before Nursing School?

    I've been in the healthcare field for 3 years. I started off doing home health for private individuals and agencies, and then moved on to being a CNA and a CMA in a nursing home. For the last couple of years I've been really interested in nursing school. I'd done a few years in college majoring in Psychology and I was really excited at the idea of how different nursing school would be -- feeling like you actually learn things from experience and are challenged by more than deadlines for papers. I've been burning out for a while, mostly due to the fact that I had for 6 months been the only one supporting my boyfriend and me when he lost his job. He was able to start working again in June which has helped a lot but, of course, it takes a while to get back on track financially after that long without working. I did a lot of 60 hour weeks for a while. It's just been in this last month that the frustration has really taken over. I feel so overwhelmed at work. As a Med Aide in Assisted Living, we are treated as the charge nurses. We are expected to step in an help (as we should be) when our CNAs are not able to get things done. Normally this is not a problem, but in the last few months we've lost 5 people, most of which that were FT. Two people we hired less than 2 weeks ago are already either leaving or transferring. It's just getting so hard to keep people so the people that are left behind are so stressed, thus making them want to leave. I'm passing meds to 24 residents so I'm already allocating roughly 6 of my 8 hours a day just to doing that. The other 2 hours are usually divided between getting vitals, helping CNAs serve meals, testing the wanderguard doors, documentation, sometimes a 30 minute break, etc. Though we are assisted living, a lot of our residents require more care than a lot of ALs would allow (at least that's my understanding, I've only ever done healthcare before). We have one gentleman that we get up and dressed every morning, we have some ladies that need help with 45 minute showers, and different things like that, so it's not a rare event for us to be called into a room to give extra assistance. I'm getting so frustrated with myself because...it's like my patience and empathy is just gone. I used to love this business and now it's really hard for me not to get cranky when something puts me behind (which happens pretty often lately). I know that passion waxes and wanes but I'm not even in nursing school yet and I'm already feeling so wiped out. I started doing pre-reqs this semester but I'm so stressed and expected to put in OT at work until we get more people so I am putting it on the back burner. Just 3 months ago I was sooo excited for nursing school (which I was hoping to start Fall 2011) that I could couldn't stand it, now I am really questioning if it's right for me. I know burnout is common in nursing but...how do you come back from it? As you can see, taking time off is not an option. I don't want to quit, though there are days when I would give up a limb for a desk job where I never had to deal with people. I never last long in those jobs, though, because I don't feel needed! But right now I can't even enjoy my time off (this if my first full weekend off in a month and I'm too stressed to enjoy it! It seems like lately all I do is worry, snap at people and cry. How do you get your passion back for helping people?
  5. Ddestiny

    CNA's not completing assignment. Vent.

    Sorry you had to deal with this. Though, as a Med Aide that works in LTC, I have to wonder if either A) the residents didn't want to get up or B) there was genuinely no time to finish everything before the end of the shift. When I worked 2nd shift I know the night shift would be mad with us if we didn't get everyone in bed but if a resident didn't want to, then it's there right to stay up. The few that did occasionally want to stay up usually required either limited help or had dementia and would be violent if an aide encouraged them to lie down. Again, it's their home and their right. Sometimes people forget that, especially if it means they have to do a little more work. And of course there will be those occasional nights that you just can't get everything done. I know every facility (and every hall/house in those facilities) are different in their dynamics and timing but I've always worked on very busy, rush-rush-rush halls. If your aides were sitting around a lot then that's one thing but a lot of places won't let you stay after your shift to "complete your work". Technically, it's everyone's work. The residents shouldn't feel pressured to insure that they are taken care of before the end of X shift. Reporting it was probably a good thing. If they were busy or the residents refused then the aides can defend themselves if they are asked and maybe something could be said to the next shift about *why* those things were not done. If they were being lazy then it lets them know that someone noticed.
  6. Ddestiny

    Alzheimer's unit at assisted living facility

    I work in an AL unit. Our sister "house" is an Alzheimer's/Memory Support unit. A lot of us will work most of our hours in one house but occasionally fill in shifts in the other house if necessary. The Memory Support unit is actually considered to be easier than the other because they have less residents and they staff it in such a way where they have more time to spend with the residents, whereas it's really hard to even fit in time for your 30 minute break in the "regular" house. This is my first AL job I've ever had, I've always ever done home health or LTC, so I don't know if this is a common theme. Memory Support can require more patience but usually I feel that makes it more rewarding. My favorite residents in LTC were usually the ones with Alzheimer's. :)
  7. Ddestiny

    Blindfolding: Is this an intervention or abuse?

    Maybe I'm wrong here, but I thought it wasn't considered to be a restraint as long as it is something the resident can reasonably remove? So many things can be considered restraints (putting the feet up on a recliner so that they have to be put down in order for a resident to stand, having "seatbelts" in wheelchairs so they don't slide out, etc) but they're still used for resident safety. Maybe all of these residents had signed something in order to have it care planned, I'm not sure.
  8. Ddestiny

    Have you ever seen a seizure for hypoglycemia?

    I'm not a nurse yet but as a Med aide working in LTC, I've taken care of a resident that was a brittle diabetic. He was also deaf and there were a few times where I would come in on shift and hear him "barking". You quickly learned that mean you needed to be in his room -- NOW! -- because his sugar was so low he was hallucinating and trying to crawl out of bed. It's amazing how fast the Glucagon brings them around. Since his sugar was used to being all over the place (bottoming out one day and 300+ a day or two later) it could handle going disturbingly low. We'd test him and at least once he was below 20. It's sad that it was such a frequent event, even when we were doing accuchecks 4x a day....
  9. Ddestiny

    The most comfortable Nursing Shoes

    Asics, definitely. I never spent more than $30 on a pair of shoes until I got into LTC. My boyfriend introduced me to Asics a couple years ago and I will never go back, they're amazingly comfortable for those long shifts! I just started work at a new facility and a lot of people there swear by them, too.
  10. Ddestiny

    Wedding Band Tattoo

    Thanks for all of the replies! I think infection control is another great reason for this. In my CNA and CMA classes they really encouraged us not to wear rings with stones for the combined issue of infection control and the potential of tearing the residents' sensitive skin. I'm also very diligent about keeping my nails short for these reasons. I will be getting my RN before I get this tattoo but I would eventually like to go back for a BSN after I have a few years of experience in the field (at which time, we will be married....just waiting for me to get my RN and him to get his Master's :) ). That being said, most of my worry is stemming from the fact that I don't know where I will be, and I don't know which school I will be attending (or what facility I'll be working for). Otherwise I could just ask them directly. I'm glad that most of the responses are positive. I've seen some nurses with tattoos but all of them are able to be covered by long sleeves or a small band-aid on the arm. The idea of putting a band-aid around my finger sounds rather....counter-productive, especially with all of the hand washing. Getting a cheapie little band, as some of you have suggested, sounds like a more acceptable answer if it comes to that.
  11. Ddestiny

    Wedding Band Tattoo

    I'm not exactly asking for acceptance, just experience. I would ask my facility, but as I said....I don't have one. I'm not yet at a point where I can even pick a nursing school (about a year down the line). And I don't know what state I will practice in, nonetheless what facility, so I have nowhere to get a firm answer. If it was that easy, then I WOULD have gone there... This idea of mine is important to me, but so is becoming a nurse. If I was told that it would have a great potential of interfering in my future, then a career is more important than a symbol.
  12. Ddestiny

    Wedding Band Tattoo

    Hey all, this is my first post. Been lurking for a while and have learned a lot so far! Anyway, my question.... I decided a while back that I would rather have a tattoo wedding band instead of a regular ring. My reason for this stems from the fact that all of the rings I've ever had, ended up horribly bent or lost. I still want to have something to symbolize the marriage, but not something that would eventually get completely messed up. lol And since I'm interested in eventually going into Psych nursing, I wouldn't want to wear it on a chain around my neck so as not to make the chain a makeshift weapon for an agitated patient. I know a tattoo is not everyone's preference, but it is mine. I know that hand tattoos are generally frowned upon in most areas of work, but I was wondering if this situation would be a bit different. It would just be something that looks like a ring, not "love" and "hate" across my knuckles. Is this something that would hut my chances of getting into nursing school or eventually getting hired?