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*4!#6's Latest Activity

  1. *4!#6

    Y-site versus Piggyback

    Could you have gotten a new IV site, I would not feel comfortable giving those two meds together? But I am always paranoid about those weird combinations.
  2. *4!#6

    IV infiltrate :(

    I have had so many IV's infiltrate on me it is unbelievable. All of them I caught early, (so far). I always feel the site, ask about pain, and watch for any frequent alarming of the pump. If it's a lock, when I flush I always observe for pain or leaking, or difficulty flushing. If I have any question I will flush again and feel the site, I will also try to check for blood return although there isn't always blood return on a working IV. I think on obese patients it would be hard to see an infiltrate. Also it was only NS, so it was a good thing it wasn't a vesicant.
  3. *4!#6

    How do you handle an admission?

    I am a new nurse and still trying to get my routine and time management down. On orientation, I did not get much of a chance to have admissions. Now that I am off orientation I have had a few. I feel like a train wreck when it happens. All my admissions have either at the very beginning of my shift or at the very end (within the last half an hour). I am just wondering how you handle an admission. First, what are your priorities? Lets say you have a patient in for a pancreatitis. The patient is in a lot of pain, requesting pain medication. What do you do first? I always get a set of vitals, do a quick assessment, check orders, and order supplies. Then address the patient's needs. While doing that, that orient them to their room. Then when I have time, do the admission paperwork. Does this seem correct? I just feel really overwhemled when I have a patient that is in acute distress being dropped off on me. And what about my other patients? How and when do I get a chance to see them? Sometimes admissions can be time-consuming. And what do I do if the admission comes at the very end of the shift? For example, a patient came to me very very late in my shift. I got her comfortable, took her vitals, and gave her some pain medicine. Then I had to give report. Could not act on any orders. Does that seem reasonable?
  4. *4!#6

    Can they fire me?

    I agree, go in person. They can't ignore you if you're standing right there!
  5. *4!#6

    Rough Day

    I am a new nurse just off of orientation too. Trust me, many of my days I feel like that. Especially with an admission or transfer -- that really throws a wrench into things for me. Just a few days ago I had a very difficult admission and I came home crying and was looking up jobs outside of nursing, wishing I could get out. I felt like I wasn't giving good care. The day shift nurses always grill me about my patients and sometimes I feel like an idiot. There are so many things that give me a lot of anxiety or cause me to panic. So I guess I don't have much to say except I can relate!
  6. *4!#6

    Things dying patients say

    None of the people that I have cared for that are actively dying have spoken to me, but I have only cared for people on hospice care. I have cared for dementia patients who are declining and have heard them repeat bizarre phrases over again and again. I was turning one lady who hardly ever spoke, and when I turned her started yelling, "ORANGE! ORANGE! ORANGE!" I wonder if it has to do with the effect of hypoxia on the brain in your case?
  7. *4!#6

    Severe anxiety at work

    Thank you for your awesome article CheesePotato. I actually read it when you originally posted it. It reminds me of what one of my residents said at my previous place of employment. She was in her 90's and liked to pass on wisdom to others. I asked her one day if she had one piece of advice for me about life and she said: "You will be okay." Today I decided to listen to my instinct. One patient was acting a little off and so I checked a quick pulse ox (seen confusion with hypoxia many times) and got in the high 70's! Also got some critical lab values back soon after that. Needless to say on-call was paged after I had her sats better.
  8. *4!#6

    Severe anxiety at work

    Thanks for relating to me. I know this is common for new grads. I tend to be a very cautious and nervous person to begin with. I appreciate what your manager says. And sometimes it isn't our fault it they aren't doing well. I've had to transfer several patients out to a higher level of care. I have made some good observations and judgement calls in the past. I have a pretty good "sixth sense" and tend to get a little on edge when I feel something isn't quite right with a patient. I just wasn't sure what to do with this patient. Now that I look back, my sixth sense was screaming at me. I need to learn to listen to that "sixth sense" and not second guess myself anymore. For example, on another day, I had a patient in pain. I went to check her MAR to see what they had available and what they was receiving. I noticed that they had been getting a fairly high dose of an IV pain medication for someone their age and with their history. However, they had been recieving this dose for the past few shifts and their pain was fairly high. So instead of listening to that little nagging voice, I went ahead and gave the dose. Sure enough the patient was gorked out. Did not need Narcan but felt terrible. Alerted the MD and had the dose changed.
  9. *4!#6

    Severe anxiety at work

    I am a new grad nurse and have been on my own for less then a month after about a month and a half of orientation on a busy medical-surgical unit. My first few weeks went okay, with a few bumps in the road. But today was horrible. I recieved a new admit and the patient was pretty unstable. I'm questioning how I managed the situation, and the nurse I gave report to also questioned some of my decisions. During the shift I have several "freezing up" moments. I asked for a lot of help. The patient was okay when I left my shift. But when I got home I finally broke down. Very upset and anxious. I am second-guessing myself as a nurse. I want to get out while I can, or find something different to do. I get this sick to my stomach feeling during report. I am thinking of holding out for a year and then moving to something different. But I don't know if I can make it for a year. My biggest fear is harming a patient.
  10. *4!#6

    Dear God, Help me

    These dementia stories are cracking me up and bringing back fond memories! I miss LTC and geriatrics so much!
  11. *4!#6

    Patient requests

    I had someone who asked me for an phone charger too!! I'm not even sure what kind of phone! I had to ask them to clarify what they meant, because I can't believe someone would think that we carried all varities of phone chargers on the unit! I directed them to the visitor lounge phone in order to place any calls they needed.
  12. *4!#6

    How much personal info do you share with pts?

    I share nothing. I lie and say I am married to any patient that asks, and if they ask me where my rings are, I tell them I don't wear them at work for infection risk. I also tell them I live in "the city." I side-track the conversation if they ask me about religion or personal beliefs. For example, gay marriage was on the news the other day and my patient was asking me what I thought about it. I just said that there was a lot on the news about it etc etc etc. I will converse with patients but I don't feel comfortable telling them about myself or my personal life. When I am at work, the focus is on them and well-being. That patient asking you where you live is kind of creepy. I would have said "I don' feel comfortable sharing that information." and left it at that.
  13. *4!#6

    Develop a Thick Skin - How?

    I am a new grad nurse, having worked for a couple of months, and only a short while on my own in a busy medical/surgical unit. I am a gentle soul, soft-spoken, and have manners ingrained in me from childhood. I strive to be respectful and professional, particularly at work. As a nurse, I am not surprised to be the "whipping boy." From HUCs sniping at me when I ask to a question, to PCAs rolling their eyes at me when asked to do something, to other nurses being blatantly rude to me if I have a question, to doctors chewing me out on the phone ... I knew this was coming and I know it is something that I need to get used to. My unit is not bad compared to what I have read here. But when working with people, each day, I know that some negative encounters are bound to happen. However I am very sensitive and it effects me. Mostly takes me aback and makes me upset. With the stress of the job, today I was almost in tears after a particularly rough afternoon. I do not want to be a blubbering mess at work. I can't seem to stand up for myself. What can I do to be more assertive in these kinds of situations? Some scenarios -- Ask HUC a question, didn't realize she was on the phone, HUC snaps at me and basically tells me to shut up. PCA tells me she is leaving a patient's tab alarm off because she feels he doesn't need it. I tell her I think it is still necessary and to put it back on, and she walks away rolling her eyes at me and avoids me the rest of the day. Patient's daughter is a zooligist and is ranting on the phone at me because she thinks the patient needs X, Y, and Z treatment. Doctor yells at me because I called and asked for an order that was already placed. (my fault, it was during a rapid response)
  14. *4!#6

    False documentation... more common than you think.

    I do my best to be 100% honest with my charting. Even with the meds. With 4 patients on a busy unit, day shift, all who have fifty bajillion meds due at 8am, at least one of those patients may get their meds after 9 am. My assessments are always done before 9am. But I always chart the correct times for each med and for assessments/treatments. If I realized I forgot something such as examining that skin tear on patient A's right arm, I go back to look at it at another time before I chart on it.
  15. *4!#6

    Healthcare is NOT a basic human right.

    I think the problem is that when you make healthcare a priviledge rather then a right, the health of people who cannot afford care suffers. Wealth and social class are the biggest factors that determine the health of a person in the United States. People should not be sick and dying simply because they are poor.