sara_ky

I actually read the book on my own, LOL. I was in a development psychology/nursing theory class, and our textbook said that "On Death and Dying" should be a "must read" for any nurse. I have always had a difficult time dealing with my thoughts and feelings with regard to death, and wanted to gain some new perspective. Boy, did I, LOL. Prior to reading that book, if you had asked if I would ever be interested in hospice work, I would have said, heck no. But I feel like I gained new insight not only into hospice care, but my own feelings and fears about death and the dying process. It sounds strange, but it seems to me that once you understand your own thoughts about it, it helps to put caring for those who are dying (and dealing with their families) into perspective, which is one of the points of the book. I really appreciated Dr. Kubler-Ross's perspective on patient care; like I said before, her philosophies are really adaptable and applicable to any healthcare setting, not just hospice or palliative. Good luck to you, too! I've got a ways to go in my studies (I'm an evening SPN, only in my second of 7 quarters, then on from there to ASN, I hope), but I'm really looking forward to delving deeper into the profession! :) Sara

I'm a nursing student, too. :) Last quarter, I read Kubler-Ross' "On Death and Dying" and found it to be a fascinating, informative read - enough so that it piqued my personal interest in palliative and hospice nursing for a possible long-term career choice, once my education is completed. The book provided wonderful insight not just into the care of the dying patient and their families, but foundations for empathetic, compassionate, respectful patient care in general that I personally have taken to heart. It even gave me the insight and inspiration to have a heartfelt, cogent conversation with my critically ill grandfather about his thoughts, feelings and fears about death -- something that I wouldn't have done in a million years had I not read this book. If you have never read it, I cannot recommend it highly enough. I hope you have a rewarding rotation and learn a lot!

My advice would be to alert your manager, as well as consult or refer to your facility's employee handbook and/or code of conduct to see what additional or further action you can take, such as reporting your coworker to Human Resources. Whether your coworker meant his threat idly or not, it intimidated you. If the threat involved or implied bodily harm to you, in my place of employment, that would be grounds for immediate dismissal. A threat in general would result in written reprimand. I am willing to bet your employer has similar policies in place, if only to protect themselves against any legal liability. Good luck to you. It sounds like you feel very anxious now because of this situation, and I certainly empathize.

It sounds like you're feeling very discouraged and overwhelmed. Maybe instead of questioning whether nursing is right for you or not, you should reconsider whether ICU nursing is, at least at this time. From what you have described above, you sound like a good nurse, one who cares about her patients and keeping her patient's families informed. But it also sounds like the ICU is an extremely stressful place to work. I'm a nursing student and one of the aspects of nursing that is so appealing to me -- and which I've observed firsthand from my mother, who is an 25+ year RN, is that there is a wealth of opportunities in all different fields of care within the profession. You're not married to one area, and can explore different environments and options to find those that best interest and suit you. I'm sure that as a new nurse, you're still very much building your professional confidence, no matter what kind of unit you're with. Maybe your best bet would be for now to find a position with responsibilities that allow your confidence to bolster, not wither; one where you feel comfortable and are able to provide competent care while honing your professional instincts and abilities. In the future, your experience as an ICU unit secretary may serve you well if you decide to try your hand nursing there again -- this time with more nursing experience and greater confidence in your skills beneath your belt. Please don't give up. :)

As a student myself, I have enjoyed following this post, learning from the different thoughts and opinions posted. I am still very much in the beginning quarters of my program, and among other topics we are learning the basics of pain and pain management in my current unit of study. Some of the pain management approaches our instructor discussed included nonpharmacological, such as massage, guided imagery, therapeutic touch, etc. I realize that these measures can't realistically hold a candle to morphine, especially with pain as severe as post-op, but could they still be applied in this case, if the RN was unwilling to administer the breakthrough dose? Do you think these might have helped, in this circumstance - if not in fully alleviating the pt's pain (which I know would have been unlikely), but if nothing else, in comforting the pt?

You mean ETOH? I would think there would be any number of contraindications you could cite. Most obvious to me would be that there is no medical or nursing intervention which would require the administration of ETOH. (Right?) Additionally, ETOH has numerous possible side effects and negative drug interactions that would contraindicate its administration. ETOH is also linked to more potential health problems, particularly r/t liver functioning than any perceived benefits. Someone on an NG tube may have decreased or depressed respiratory function or mental cognition, which would be further impaired by the use of ETOH. These would be my initial thoughts. Sounds like an interesting presentation! Would you mind to post the answer that you presented for your class? I would be curious to find out what your instructors were looking for in a response. :)

It sounds like you're pretty frustrated. Where does your course syllabus or curriculum outline state you should be in terms of progress to this point in the class? You may not feel you're gaining the quantity of information to date you'd like, but in terms of quality, how would you rate the level of instruction you've received in pharmacology? At my school, we have lots of different liaisons between students and staff, including a student success coordinator, quarter liaison, etc. Are there similar resources at yours that you could turn to?

I believe you can register a complaint anonymously with APS. If I were you, I would. I don't know what kind of action they can take, but at least you will have done all you're able. This sounds harsh, but you may also consider putting your foot down and refusing to help them. If they know they can count on you to come over in the middle of the night in the event of an emergency, or even to check on them, as you've described, they have no incentive to seek help elsewhere. I would be polite but firm about it. If they call in the middle of the night, explain that you and your husband have to get up for work in the morning, but you would be glad to call an ambulance and then, when it is en route, you could wait with them. (Or omit that last part, even.) If they ask you to come and help get the husband out of bed, etc., you can explain there are home health services and volunteer organizations who can assist them on a regular basis; for liability reasons, you cannot do more than act in a good samaritan role in the event of an emergency. (Even if that's not true, it sounds good, LOL) Someone with more experience than me probably has better advice to offer. (I'm a student nurse.) But I do know that no one can take advantage of you without your permission - so don't let them any longer! :) I know it's hard to say no, but if the man is in no immediate physical danger or harm, then laying down some boundaries as far as the care you and your husband are willing and able to perform for these folks sounds pretty fair to me. Good luck!

In my classes, we were taught to use one nursing Dx per care plan. I checked my Nurses' Pocket Guide, and it defines "ineffective airway clearance" as the "inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway." To me, that primarily involves the physical/mechanical components of breathing. For example, the bronchioles are being affected by increased mucous secretions. The pt's nose is too congested to allow for effective breathing. The pt's HOB isn't elevated enough to help physically facilitate better respirations. That sort of thing. "Breathing pattern" is ventilation itself, the rate/depth/rhythm of respirations. From the Pocket Guide, "breathing pattern - ineffective" is defined as: "inspiration and/or exhalation that does not provide adequate ventilation." Both are definitely affected by the increased mucous production and inflammation secondary to pneumonia and asthma you described but in this case. Both have impaired gas exchange as potential secondary dx. Which need do you think is most immediate and can be best/most expeditiously addressed by nursing interventions? You can definitely takes some quick actions, such as elevating the pt's HOB, increasing pt's fluid intake, etc., that would address "ineffective airway clearance" by helping to clear some of those secretions effectively, so personally, I'd pick that one as my priority. Good luck!

It sounds like you are both concerned for, but frustrated by, your neighbors. Do they have children or other family members with whom you could share your concerns? They may no longer be physically or mentally able to keep up with the necessary ADLs to maintain a safe and clean home. Although one would hope that children/grandchildren/siblings, etc. would be aware if someone in their family lived in such deplorable conditions, if they're not in the immediate vicinity and don't visit often, they may not be -- and they might be willing to take a more active role in the couple's care if they are made aware. Perhaps the couple is on a fixed income, which could contribute to the wife's reluctance to call an ambulance. They may not have any insurance, and their Medicare may not cover all of the expenses. It may have been the wife who refused to have her husband admitted and said that you and your husband would take care of them -- again because of money. She probably feels very fortunate to have you and your husband living right next door, because if there's an emergency, she feels she can count on one or both of you to help. She may not realize she's being an imposition. There are a number of church-based and volunteer-run organizations in my community that offer free meals-on-wheels services for home-bound seniors, as well as light cleaning, errand-running or companion servies at little to no charge. Perhaps your neighbors would be interested in something like this, or benefit from it? As far as their living conditions, have you considered calling your local health department or adult protective services? If the couple is incapable of maintaining a safe, clean home on their own and their family is unable/unwilling to help them, maybe there's some legal recourse that can, at least, protect them. Call Animal Control and report the unsanitary cat feces condition - that may be sufficient enough grounds to have any pets remanded from their custody and care. If they can't take care of themselves, they surely can't take care of dependent animals. (And if you don't feel comfortable calling adult protective services or the health department, at least by alerting Animal Control, you've got one civic agency involved in the matter -- and based on their intervention, they may go on to call in additional resources to help.) It sounds like an unpleasant and unenviable position to be in. Good luck finding a solution!

Coincidentally, I just read about this today in a chapter on assessments. :) If I understand correctly, my text book identifies the sides of the chest beneath the pt's arms (between the right and left anterior and posterior axillary lines) as the area for auscultating vesicular sounds laterally. Posteriorly, it looks like between the scapular and midaxillary lines would be best for auscultating vesicular sounds in the RLL. I scanned the illustration from my book. Hope it helps.