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oncrnpa's Latest Activity

  1. oncrnpa


    Good little known site: www.highwire.stanford.edu Look for the box under the pic of the journal that says this article is free :)
  2. oncrnpa

    Interview left me speechless

    I've come to realize that interviews can leave only 1 of 3 impressions on me: 1: "The really good place" - people and place seem to be a really cool and its a fabulous place to work. These places make me nervous because I'm always waiting for the facade to fall and the truth to come out. It always does it just sometimes takes a while. Institutions are like people no one is perfect. 2:"The OK place" - People seem for the most part honest, something isn't usually ideal whether it be the pay, benefits, hours, some cultural thing or "little problems" they are currently working on. But they are real and overall try. 3: "The H*** no place" - The place you described that you need to be exposed to (clarify: but NOT work at) so you can truely appreciate the other places. Even if its only to tell yourself on your worst day at least Im not at XYZ today. I understand how frustrating this encounter is. You probably feel it was a waste of your time and its a big emotional toll when you psyche yourself up going into it but please keep your hopes up and KEEP SEARCHING!
  3. oncrnpa

    Question regarding heparinized ports

    Curiosity question: Can LPN's in your state access a mediport?
  4. oncrnpa

    How often do pain meds cause vomitting?

    As with most Pancreatic pts sounds like he's got multiple issues.If he continues with the hiccups (hiccoughs) and the reglan is not working Ive seen them use Baclofen (? possible recommendation to the MD?) As others have said he needs an antiemetic asap... may need to cycle through a few before you get the right mix that work. Nausea and vomiting is caused by a few different pathways (ie chemical : from the cancer and the drugs, mechanical from the cancer etc...) Check and see if your area and his providers have a palliative care team (which is different then the hospice team) but they are an outstanding addition to the care team for these patients... Unfortunately this patients presentation is typical for pancreatic patients and more often then not it does not get better than this without aggressive symptom management.
  5. oncrnpa

    Audio Recordings and Patient Abuse

    TOS prohibit any genuinely helpful advice here outside the general phrase get a lawyer. Despite how poorly the patient behavior is on a daily basis the CNA used a verbal threat on this patient and would also be in violation of HIPAA and possibly other laws if any recordings were actually made. If you were told this and did not report it you are also at fault. The question I would have for a lawyer would be does my professional reporting requirements change as this patient is not a child or elderly per your post and as such does not fall under the special protection categories, the key may lie in if the patient is there as a "ward of the state". Look into it with a professional and good luck!
  6. oncrnpa

    Gave a patient someone else's unwasted dilaudid

    It sounds like there are 2 issues here... 1) There appears to be a cultural issue amongst nurses of not "wanting to waste meds". I myself am stingy and love to save a buck (even if its not mine) however the mentality of keeping it around just in case opens you up to too many issues of liability. In addition to continuously having to worry about the paper trail that dose has and whether or not it is correct, who else has access to it if its at the bedside or in your pocket (ever take your jacket off), petentially giving it in error when your storing 2 patients meds for similar purpose in your pocket, what about the stability of the medication once its been opened keep in mind that one reason why it usually is a single dose unit is because it has no preservatives. Always use a new unit for every dose and waste the remaining immediately. Get your pharmacy to stock in the lowest available unit. I'm actually surprised the hospital pharmacy isn't having a "bird" about this practice. 2) You writing is expressing feelings of being overwhelmed "numb" and not caring about the place that you work for or the professional job that you are doing. PLEASE STOP WORKING AND SEEK PROFESSIONAL HELP NOW! You are placing your patients IN JEOPARDY. If I were your manager and you had been employed for a few years this would be an immediate dismissal offense. IMHO, however you are newly off orientation and obviously overwhelmed (I'm making the assumption here that you know this practice is WRONG and will NEVER save or split doses of narcs again and that if you weren't so overwhelmed you would not have done this to begin with) I may give you another chance. But giving you another chance isnt going to correct you feeling overwhelmed or making poor judgements because of it..... Please think about your health, your patients right to safe competent care, your license, and how this job helps or hinders all of those.
  7. oncrnpa

    Pick your battles with your LNA.....

    2. Again, it is about perception. I don't perceive the term "honey" to be bad and you do. Different strokes for different folks. If it is that much of an issue, make a policy and stick it in the employee handbook. What you seem to be missing is the point that your perception and that of the other workers is irrelevant in this consumer driven healthcare culture. The only opinion that matters is that of the patient which since some are unable to communicate we have to set a blanket rule for every one. Do you realize how thick the handbook would be if EVERY conceivable policy was created.....I can hear forests being felled as I type.
  8. oncrnpa


    From what you have written you seem not to acknowlege the significance of the legal tar pit which you have potentially placed the hospital in. Your review is not about the actions of others its about you. As a potential person your panel given what you have posted especially the last statement I would NOT allow you to get your job back as the hospital is being used as your stepping stone to your MD/DO role and as such your continued employment and access to other opportunities "to learn" given the questionable judgement you are showing by not acknowleging the seriousness of the situation creates too much liability to the hospital. You are better off balancing your approach to the review panel with support of your peers and remorse/groveling to demonstrate your willingness learn from this and not be in this position again.
  9. oncrnpa

    Supervisor Pay Roll Fraud - Help Me!!!

    Please investigate your need to be involved in this situation beyond bringing it to your superior and HR's attention. If you are not a representitive of HR or in the direct management of this individual you are not entitled to be involved in this individuals disciplinary action. While the situation has created an awkwardness at your workplace please turn your attention to your own actions and the work that you were hired to do. We as nurses need to reduce the drama in the workplace it benefits no one.
  10. The OP asked a community of nurses for a 3rd party situation analysis of a clinical situation. The OP asked for constructive opinions... she mentioned the patient had a heparin drip and active bleeding... While I cant speak for nerd2nurse I will say that even as a second semester student there should be some sort of connection between these two facts even if the correlation between PTT and titration/protocol is well beyond the scope and current educational level. I am surprised by many comments in this thread that are just supportive pats on the back while they make the OP feel better I dont see how they are useful in the longterm. If the OP just wanted moral support then please put it in your post so that others that will spend time explaining clinical things can find another post. We are quick to judge the Instructor and blame it on "eating younger nurses" but fail to recognize that the OP was reportedly upset and interpreting the situation as such in her view. There are 3 sides to every story yours, mine and reality. OP did nothing wrong however did appear to need some assistance determining clinically what could have been done differently or additionally because it was not outlined in the clinical description. Nothing that I have read has been anything but supportive from the other posters. I think it is responses like yours that keep clinically intelligent dialogue (which everyone benefits from) from occuring. Its too bad.
  11. As a SN you did correctly in calling the RN who is responsible for the patient period thats why your partner RN said you did the right thing. Given the info you have provided lets work through it. Your instructor may be trying to get you to connect the dots. Your vent seems to be focused on being reamed out/prejudicing the rest of your interactions with this instructor/ blaming the Dr for not really caring about the patient's bleeding and that the patient should not have left the CCU please put all those thoughts aside for a minute and focus on the patient and what you saw. On a basic subconscious level you knew that something was serously wrong well before the 9am meds... she was "anxious" and SOB you were concerned and checked on her frequently. You have prob researched this patient's history to death prior to taking care of her so things that I would have thought about would be 1: does she have a history of anxiety? 2: If no, did she exhibit any anxiety while in the hospital... If you dont know when you are with the patient ask her... 'have you ever felt like this before'. Rarely in my experiance do people have anxiety to 'panic attack' level for the first time in their life in the hospital they either have a history or something is brewing. Your assessment showed crackles and thready pulses x4...Did she have edema? How does this compare to her last assessment or a known baseline. How do the VS compare to previous ones. She has a HX of HTN and Renal insufficiency and is getting IVF how does her I+O from the previous shifts total up is her intake ahead of the output... many times the fluid goes to the lungs first. By this time she said that her anxiety was decreased but she still felt SOB the question is Why... Following the the bedpan event and during your 9am meds she became teary and upset the question is why.. in her case you discovered it with the pulse ox machine number but lets play devils advocate and say you didn't have access to one what information do you have: 1) SOB, 2) Bleeding 3) cognitive change (teary) 4) thready pulses and a boat load of anticlotting medications... heparin, plavix and aspirin I would have called a RR at this point because the patient is either bleeding internally or not getting enough oxygen either way she needs intervention in the unit. What you missed was what interventions the RN did after you left... what did she tell the patient and the family, how did she utilize peers and UAP's in getting the patient to the unit while managing the other patients on her load. What conversation did she have with the Dr, what questions did s/he ask about the patient. Were their any STAT interventions that happened. How about the transfer report what occured then. As you said hindsight is always so much clearer and you were freaking out on two levels 1: generally as a student and 2: your patient was tanking. This probably impeded your hearing what your instructer was really saying to you. Her job is to ready you to be a nurse and to help connect the dots. Her statement about the abandonment and putting the patient in jeopardy was probably in terms of IF you were the nurse ultimately responsible for this patient by going and giving the others meds would have been exactly correct. Your instructors have the difficult job of assessing students "fitness" for nursing based on their actions as a student. People respond to stress in different situations I've worked with licensed personel who after many years of being a fabulous nurse the only useful thing they can do in a code is bring the crash cart then get out of the way....as a second semester student you just need to keep looking inside yourself to know how much you can handle. Now get into your instructors shoes and think about the situation. Based on your interaction with your instructor after the incident from what you reported the only things that you could demonstrate verbally of your assessment of the patient in obvious respiratory distress was an oxygen saturation number... You admitted that know that you didn't count RR and do lung sounds but what other respiratory assessments could you have done quickly in the meantime. When you put the pulse ox on her finger how cool was her hand (temperature can affect pulse ox measurement) was her nailbeds discolored? How about her lips were they discolored? Was she using accessory muscles to breath? Could you hear wheezing while standing next to her? Was she able to speak if so how many words togeather before taking a breath? Having said all this I DO NOT EXPECT A 2nd SEMESTER STUDENT to be able to connect the dots during a situation such as what this patient had and thus you did the right thing for this patient but I do expect that after the fact you should be able to process through the situation using your critical thinking skills and come up with some assessments and things that you could have done more than mimicking what your instructor told you should have done. Being a student is about learning .... get used to it because you will be a student for the rest of your career. Every day I think about things I could have done sooner, assessment questions I should have asked and responses that could have been different Its the only way I can become a better nurse. Good luck and work hard in the rest of your schooling.
  12. I think UKstudent hit the nail on the head with the following statement "Although you are only a student your clinical instructor wants you to practice as if "you are THE nurse" while staying within your scope of practice." I can agree with your instructors annoyance but think of the situation in terms of what physical assessments / questions to the patient/ critical thinking and triage think patient stablization and transfer processes you missed because you were tending to a skill which in your last day of clinicals you probably have under your belt. The annoyance is less about what you did than what quality clinical experiance that you could have learned from that you missed.
  13. oncrnpa

    Just need some kind words...

    Sorry you are having to deal with this. If she is able to express her feelings and has thought things through now is the time to get the advanced directive done or updated and witnessed/discussed with all interested parties. Why hope not to have the potential of an ugly family thing when it can be potentially avoided? If you personally do not want to discuss this with her and she is still in the hospital how about a call to case management or whichever department deals with it at that institution.
  14. Not to beat a dead horse but I guess what is lacking for me from this clinical situation is the even though the patient "Doesn't want Hospice" per your report. Does she understand her diagnosis and does she really know what she is declining? Most patients especially the older ones do not have a grasp of what hospice is or what services she would be provided... essentially what you are doing for her plus some but instead decline to participate in hospice based on the name or the fear that they would have to pay more etc....
  15. Did I miss something from your post? 98year old woman with questionable orientation ("oriented as a(n) almost 100 years old person could be") and who would probably reflect some cognitive dysfunction from the saturations in the 80's who has "CHF" and "Respiratory failure" requiring 5L of oxygen.... My best over-the-internet clinical outcome assessment would be that this is not a reversible condition. While she may be an outstanding funny LOL who you have been granted the opportunity to care for I will pose these questions to you... 1) Do you want to code her? Why or why not? 2) How long do you suppose the lasix and other meds are going to keep her dying body functioning? Her normal labs are irrelevant to me I prioritize on ABC's if she can't get enough Oxygen and cant circulate the blood her labs will soon tank as well. 3)How was her pre admission community assessment? Is her daughter her primary caretaker? Does she live alone? Is she safe? Is the family able to realistically provide the care she requires... 98 year old would make her children 60-70's? I realize we are in a death denying culture and this post is aggressive and will probably result in me being flamed but you appear to view Hospice as a negative. So you are providing her lasix meds and oxygen which all could be used for her comfort in hospice in the setting of her choice (usually more comfortable than a hospital). And hospice would afford her family other resources to assist her to let her live the rest of her life doing what she would like to do. You interacted with this woman during a chapter in her life... sometimes you need the peices from the whole story before you can interpret a situation. Something to think about: we live in a society willing to push the medicine even if it is futile and not willing to push for someone to die naturally and comfortably... and we call ourselves advanced...
  16. oncrnpa

    Student Loan Repayment for Nursing

    You may want to investigate Perkins loans (if you can get them) 100% forgivable loan for 5 years of service