got2luvnights

I precept many students during their last rotation in nursing school so here are just a few additional ideas besides the excellent ones that were already posted. 1.Know why your patient is there. 2.Complete head to toe assessment and alert the nurse of any changes that you might witness. Please remember the only dumb question is the one that is not asked. 3.Confirm if applicable ett markings and ng or og placement and residuals. 4.Look at blood sugars and relate why they might be high like steroids, surgery or possibly the need for a diabetic tube feed or maybe this patient needs to be placed on a insulin scale. 5.If you are going to swab the pt's mouth please have suction hooked up espically if they are T/V. Mouth care in the ICU is critical. 6.Know critical lab values and if replacment has occured does it need rechecked and when. 7.Zero all lines if needed and record. 8. Flush all lines and record if no blood return. 9.Find out if anything intresting will occur in the unit that day and let your intructor know,this way you might get to watch. 10.Let your nurse know when you go to lunch or break and what you have not gotten to. This helps build trust. 11.Please ask if pt needs to be bathed so many students seem to over look this important factor. 12.If passing meds be ready and know why they are getting them if you are not sure at least ask. 13.Keep your room clean. 14.Let your nurse know if you are taking the chart somewhere other than the designated area. 15.This is a huge pet pieve of mine let your nurse have her seat when she needs to chart. 16.Enjoy and get the most out of every day I hope this helps.

Levophed is a very potent pressor that literature supports to be the drug of choice in a septic patient. It is critical that you know that your pt's hypotension is not the result of hypovolemia. Trying to clamp down on a dry pt is a recipe for a disaster including risking digits. A swan ganz catheter or a least a CVP can help one gauge this. I also agree that necrotic digits are often dealt with by amputation. Hopes this helps.

:smiley_aa :balloons: :caduceus: :balloons: :balloons: Congratulations R.N. you did it!!!!!!!!!!!!!

You may not of passed the boards on the first try however take some time for yourself, regroup then back to the books. I know that if you made it this far you will get the job done. Good luck

I passed on 75 questions:smiley_aa . I cannot believe it is finally over or should I say just begining. I was able to call the state the very next day after 2p.m. and get my results. I hope this helps many of you waiting because the waiting is just so:lol_hitti crazy..

My daughter got her vaccine at 5yrs old she is now 9. My oldest daughter got a very mild case 6 days after getting her vaccine go figure she was 15yrs old not very fun. I do believe that the vaccine has been useful for many children however I question how many children are now being affected some years later. Thank you for your replies!

My daughter developed chicken pox a few days ago despite her getting the vaccine:o . I took her to the er due to dehydration and severe right abdominal pain. The right sided pain was due to the virus and she was treated with fluids and started on a antiviral drug to shorten the length of this virus. The er reported this to the cdc. They said they are seeing many kids having severe breakthroughs despite the vaccine. Has anyone heard of this and why? She is getting better but gosh is she one sick little girl. Thank you for any replies.

i am taking a class where we need to analyze a legal malpractice case. i was just wondering what everyone think of this. sorry for the length but i feel that there is a lot to be learned for this case. thank you for your replies. the patient was a fourteen year old male with multiple medical conditions. specifically, the patient was a quadriplegic, nonverbal and nonambulatory. he had a history of seizure disorder and at the time in question was npo. feedings were given through a gastrostomy tube. the patient was on an apnea monitor due to an obstructive respiratory condition that required a tracheostomy to be placed. there were specific orders from the physician that the sleep apnea monitor be turned on "at all times" that the patient was not directly observed. this would soon present an annoying problem for the nursing staff. under normal conditions, the monitor could "alarm" for no reason, or if the patient held his breath for a moment or two. the patient would frequently use this as a "trick" to get the nurses to come and check on him. at one point, the nurses began to turn the monitor off routinely. this was soon noticed by the physician and prohibited. he pointed out that the monitor was set to alert the nurses to episodes of tachycardia and bradycardia that the patient was at risk for. when the nurses continued to turn the monitor off despite the order documentation of the monitor's status was made a requirement of the nursing staff. in other words, each nurse on during a shift would need to document that it was in fact on and in use. this made the nurses individually accountable for the monitor's proper use. despite these measures, an lpn on duty discovered the patient with his tracheostomy tube displaced and with no pulse or respirations. the patient would be coded, and transported to a nearby emergency department where the pronouncement of death was made. the nurse stated that the alarms had not sounded and when cardiac leads were removed to begin cpr, there were also "no alarms" heard. other testimony would state that lights on the monitor were flashing, the accuracy of this observation was doubtful. when the case went to court, curiously, the "monitor" of that day was "missing" from the chart. the parents of the 14-year-old child would sue the facility for medical malpractice and negligence. the court's verdict found for the plaintiffs and granted a large award. the defendants appealed. questions to be answered: 1. were the nurses responsible for the status of the monitor and documenting that it was working properly. 2. were the nurses responsible for the wellbeing of the patient who was a total care patient and unable to care for himself. 3. were the nurses responsible for documenting that the sleep apnea monitor was working properly and having that documentation available in the chart. the court and jury noted that the nursing staff of the facility had already been reprimanded for "shutting the monitor off" on several occasions. this was with the full knowledge that this action could put the patient at risk of distress. at the time of the incident, the patient clearly was experiencing respiratory and cardiac distress that would otherwise have been picked up by the monitor and sounded an alarm. testimony on the equipment itself stated that it was in perfect working order. it was added that even with normal operation, incessant "false" alarms could not be avoided. it was this "alarming" that prompted the nurses to shut the monitor off in the first place. this had prompted the physician's order to keep it on at all times and that the nursing staff "document" that it was turned on and in use. the responsibility of the nurse to monitor a patient's status and report any changes or distress to a physician is basic to nursing practice. this is mandated in state nurse practice acts and nursing[/url] standards. the nursing documentation of the monitor's use, mandated by a direct and specific physician order, was "missing" from the day in question. this in addition to nursing testimony that "no alarms were heard" and conflicting testimony about "lights flashing" shed considerable doubt on the credibility of the nurses. the appeals court affirmed the judgement of the lower court stating that the evidence against the defendants was grossly in favor of negligence. events in a facility are sometimes beyond the control of the nurse. a patient[/url] can code, or go downhill despite the best intentions and care of the nursing[/url] and medical staff. in this instance however, deliberate negligence on the part of the nurses resulted in a death that was clearly avoidable. had the monitor been used as intended, it is entirely possible that the patient's condition could have been picked up promptly and a tragedy avoided. if the facility or family in this case wished to file formal charges with the state board of nursing, it is likely the nurses involved would lose their licenses. it is likely that a formal complaint could involve not only the nurse on shift during the incident, but all the nurses caring for the patient up until that point. to turn off a potentially life-saving monitor because it "made too much noise" is simply inexcusable. a malpractice insurance policy might offset losses in this case by covering legal expenses and damages to the family. it would not however save the nurses from losing their licenses following a formal board inquiry.

Hello ang75Would this have been a good option for the kiddo we have been talking about?

After this experience I would have to say I wish for this patient that you would of been the one doing this reduction. To answer your question earlier yes I have done extensive research on complex elbow fractures. While I appreciate that most reductions slip back in easily it cannot be overlooked that a elbow fracture is a serious matter and peds patients have growth plates that are not so forgiving. After a first failed attempt bone fragements have to be considered as a source. To condense all other posts this patient was a transfer to our facility for surgery. The patient somehow got thrown into the ER and the treating 2nd year resident in general surgery stated that this child did not need surgery only a simple reduction and should come back in 2-3 weeks for a cast. During this procedure which was unsupervised by the ER doc in charge, anesthesia came down twice asking what the hell was going on, they were waiting for patient in the OR! It was not until stat x-rays had been called 3 times that the anesthisia doc came back in and loaded this kid up and rushed to the OR. This case is being reviewed by risk management for obvious reasons. The parents were raising many questions as to why one minute the child is being transfered to another facility for surgery, then told no surgery was needed only a simple closed reduction, then off to surgery. The final report was devasting. What once was a radial head fracture and dislocation now added a radial neck fracture, injury to the ulna in the cornoid region, avulsion injury to the cornoid, serious damage to growth plates, significant ulnar neuropathy as well as the interosseous membrane was torn. The child spent 3 days in the hospital. While I appreciate your comments and clairifications on the world of nursing vs medicine I find it intresting that all nurses involved in this case have been talked to extensively. If your correct in stating that nurses opinions on such cases do not carry much water then why is risk management so eager. That said, thank you for your response and willingness to share your experience with these matters. You have given me a lot to debate over "that is a good thing". I would still appreciate any comments on this and or other situations in which nurses have found themselves debating over.

ang75 The child had all sensation before reduction 1 day postop child lost feeling in ring and small finger and cast had to be split but did nothing for numbness and little for swelling. The patient was only x-rayed splinted and given pain meds before transported to our ER.

TraumaRUs,I would have to say no because of all the moaning, crying out for mom and raising off the table many times. The whole procedure in the ER was very long and exhausting. Stat x-rays were called in 3x. What a mess!

Yes thank you what has been your experience in the time frame for a NORMAL reduction to take place?

The 9yr child had been put into conscious sedation however he was moaning, tearing up and raising off the table many times. It was not a good scene. This was my first time to see this procedure and hope that any in the future go much easier.