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HiHoCherry-O

HiHoCherry-O

CVICU, ED
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  1. HiHoCherry-O

    Endoscopy Nurses!!!! Questions for you! :)

    I wont answer all of your questions. . .but a little advice: I would inquire as to what meds you will be expected to administer. Depending on the endoscopy center, you may be the only one administering medications. Know what they are, time it takes to see effects, signs of overdose and what the reversal agents are. I would also recommend knowing a little bit about recovery since sometimes you will be the one recovering the patient after the procedure as well. Hopefully you will receive an orientation that will cover all you need to know (be sure to ask about policies and procedures). I hope you are good at IVs! Good luck
  2. HiHoCherry-O

    Dropping pressures with nitro. Anyone experience this??

    Did either patient have a recent history of taking Viagra or Cialis?
  3. HiHoCherry-O

    Medical Records

    To the OP: You may want to shop around for some EMRs. What kind of program are you using for your med documentation? Is it a software program that allows for other applications to be added such as the ones you listed? The hospital I work for uses Epic. For the most part it suits our needs on a clinical level but I have heard the billing department complain about it not being user friendly. If you have an in-house IT department, they may be able to build a program/application that is specific for your needs (also keeping in mind security issues). However, this in the long run can be quite expensive since it will be unlikely to integrate with any outside software that may be purchased in the future.
  4. HiHoCherry-O

    IV Gauge for CT

    I participated in a study several years ago that measured the rate of fluid administration between a 14 gauge and a 16 gauge. The conclusion was that there was not much difference in how quickly fluid was delivered. So. . . basically what I'm getting at is that a 20 gauge works just as adequately. On another note, I believe it is the amount and type of contrast used (which is determined by the test and radiology) that determines the quality of the picture and not the gauge of the IV. Just my .
  5. HiHoCherry-O

    Prescribing narcotics to drug seekers

    The ED I worked in a few years ago had pain contracts for certain patients who frequently came to the ED requesting narcotics. We were able to track how frequently they came, what resources were provided to them for follow up and what they received (narcotic, RX wise). A care manager would then contact the patient, while in the ED, and present them with a pain contract which would spell out what would and would not be available to them when they come to the ED. This contract would be available to view by anyone in the ED who provided care to the patient. This would help deter some patients from coming to our ER (but not all). To Tencat: yes, I agree, people's pain should be treated despite what our personal interpretation of the situation is. However, these individuals were also provided plenty of resources to establish PCP to manage their pain issues. Individuals would either, never bother to seek a PCP (even if a small to non existent co pay was required--it just took too long to get in), have an existing pain contract with their PCP of which they were now in violation of when coming to the ED seeking Rx for narcotics (and well aware of this) or, as you mentioned use the ED as a Primary care. This is unacceptable, expensive and inappropriate use of resources.
  6. HiHoCherry-O

    wrong order

    It was a mistake. You could ask your CN or NM if there is a way to remove the charge to the patient since it was ordered by mistake.
  7. HiHoCherry-O

    wrong order

    Anything pertinent come out of the tox screen? Otherwise. . .lesson learned.
  8. HiHoCherry-O

    Vent

    Some of the responses I like to use are: For those who tend to monopolize your time: "I need to check on my other patients, their needs are just as important as yours. I will return to check on you in xx minutes/time." "Help me help you." For the chronic 10/10 pain: "What is an acceptable number to be at if zero is not realistic?" "On an average day, where would you rank your pain level?" Some people say they live at a 8. This gives you an idea as to how to go about finding a comparable plan of managing pain. In my experience, I have found it helpful to have frank discussions with individuals about coming up with adequate pain management plans. I explain that I am willing to provide the necessary level of medication so long as it remains within the realm of their safety (not getting overdosed and needing interventions etc). I explain to them what the doctor has ordered, what his plan is (you'll know if you work with the same doctors frequently what their usual course of care is), how I intend to carry out that plan and what the patient's responsibilities are within that plan. For family members who hover: I typically let them know that I appreciate their diligence in being at the bedside, however, there are times when the patient simply needs to rest and not be engaged in interaction after interaction. With regard to management: make sure you cross your "t's" dot your "i's". Document objectively your interactions and education provided. For yourself: You are still learning. Give yourself a break. Ask those you trust and whose opinions/insight you value what they would suggest in handling the situation. Learn how to establish boundaries with your patients (a fine art that comes with time, experience and patience).
  9. HiHoCherry-O

    Pet Peeve: Poor Grammar by Nurses

    LMAO!! Glad to see I'm not the only one irritated by the use of this word!!
  10. HiHoCherry-O

    BSN needed to work in Texas?

    Now children. . .
  11. HiHoCherry-O

    Failing to carry out a stat order in timely manner

    I would have carried out the order. How long of a time frame was it from the time the order was written to the time it was canceled? An ABG can tell you many things. This patient had multiple problems going on, all of which can affect ABGs (high glucose level, CHF etc). The result may or may not have changed the admit destination for this patient. It may have alerted the doctor to keep an eye on another potential problem emerging during the patients hospitalization. It would also be a good baseline to reference should the patients condition change. I am sorry, but I do not buy that by not carrying out the order, this is facilitating the other orders to be started. An ABG takes. . .10 minutes?? Do you have RT's in the ED? Do you as a nurse draw the ABG? RT's draw the blood gasses in my department and have a blood gas analyzer right there in the department. Even so, when drawing a co-ox off a swan (which the RNs do), the results come back from lab in about 10 minutes. Should this order have not been canceled, I predict the patient would have gone to the floor, the receiving nurse would now have to address this issue, arrange for it to happen, amidst the whole addmission process that we all know takes a long time (paperwork, paperwork), still keep up on the other patients she/he has as well as verify all the other orders that need to be done. As a manager, I would expect more out of you with your 28 years of experience, however, I would not terminate you. Just my .02 cents.
  12. HiHoCherry-O

    Just liked it and wanted to share

    Thank you so much for sharing this!! This is what I love the most when I am at the bedside; listening to life stories, places people have been, things people have done, wisdom and advice that they want to share. I love it!!
  13. HiHoCherry-O

    Opinions welcomed

    You mention that "typical RN training is 8 weeks." To me this means that on average most nurses are relatively competent by 8 weeks, some sooner, some later. The next comment is that she is not even close to being competent. In what sense? Practicing safely? Equipment? Patient load? Skills i.e. fistula cannulation etc? Knowledge? Depending on which one of these categories she is incompetent in would lead me to my next action. Some of these categories are more easily rectified than others. How has her progress been measured to show where she currently is in learning/competence? Is it a matter of opinion? In the long run, is she a good investment? Does she have potential? What does she bring to the table for your unit?
  14. HiHoCherry-O

    CRNAs in New Mexico

    The ambulatory surgery center off of University (between Lomas and Menaul) has CRNAs. When I was in school at UNM, I did an OR rotation there. Spent most of my time with the CRNAs vs the OR nurses. They were very pleasant and provided lots of information. I would contact the receptionist there and ask for an appointment.
  15. HiHoCherry-O

    How do you document telemetry in a paperless system?

    Same here as mentioned by the other posters. We document the rhythm in Epic i.e. NSR, ST etc. We also have space below that to chart the measurments. The tele tech prints out a strip on each patient, pastes it to a tele page and puts it in the hard copy chart. There is the abiity to scan the tele strips into Epic which can then be viewed later.
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