elnski

hIYA FELLOWS!! now, we're all gOoD!! keep coming those stimulating ideas... i am enjoying this.. 1st courser, 2nd courser, whatever... as long as both will do things right..

ohHhhh, ManNnn!!! i thot ur a real big shot!! enweii, for me ur a boss..u cant change dat.. ive made up my mind...

NYAHAHAHAHAHAHA!! THAT IS A VERY SMART comeback.. Ur ryt, ill fone mum now and see what she says.. twas only payday and im very close using my bank overdraft perhaps next week!! grrrrrr....:angryfire u just stirred me..better take my beta blockers..reaally a4c is drving me ...

OOOooohhh... So ur a big boss eh? Do u want to adopt me? M hard working and Im used to not going for break most of the tym..:) m a bit impatient at times but since im on beta-blockers, ive been asymptomatic.. perhaps my working condition will improve under ur management... THANK U IN ADVANCE....

iM Jus a humble D grade..people who came 6 months to 2 yrs after me are paid more than I do.. We lack staff and Ive been in charge of an acute respiratory ward frequently... today there r only 2 SN's for the whole ward.. at the same tym Im being rotated in our special unit called Non-Invasive unit...6 bedded HDU lyk.. and if the staff is my junior, i have to be in charge again...:uhoh21: please, everybody say "bless".... to keep me going..m gonna be in charge again tomorrow.. chest drains, tracheostomies, even ventilators in the ward ... whew!! the site manager was squeezing me this pm to make a bed for a pt from ITU...i just dont have!! all these hard work lyk the rest of u..then,I think of my pay - it is just frustrating... my mum comforted me and said...do your job as if your doing it for the Lord.. I went speechless...but I felt better..:) but ill see how i feel tomorrow...

NYAHAHAHAHAA!!! :chuckle

:deadhorse:banghead: :selfbonk:

same in our trust..e grade is band 6..whether your in the ward or in a special area... i dont wanna complain nymore!! it hurts!!! and we jus sign forms saying that, under a4c, if we happened to be assimilated in the wrong payscale, we have to pay it back..yeah ryt!! they already underpaid me... what else can happen to me and my likes?!!!

JUS WANNA BE HELPFUL...U KNOW, OUT OF GOOD WILL...

I personally think, this A4C is not going to make our pay and working conditions any better... too early to judge A4C, i know and please dont call me stereotyped... well, i studied my stars and ruling planets and it said, it's not promising at all.. i think ill go to middle east and be a servant of a princess instead....or to libya, and become a florist..:flowersfo:flowersfo or start my business in bermuda triangle..

well, hi there colleague, if in case ur already in america, u want me to keep ur back pay for you? it'll be in good hands.. i hope its gonna be this november cuz the tax will build up.. i want to have a merry kwizmazzz....:wink2:

WELL, there is no way i can sort my pay..the A4C people are the ones who decided my scale..and since our trust is in wobbly state of finances (just like most of the other trusts), it's going to be a while they said..well, none of us nrsg staff is back paid yet..perhaps next, next xmas... hmm..shall I start applyin in oZzY? :uhoh21::crying2:

eXACTLY...there are people who are blessed and fortunate to be vindicated w/ a better than before, well deserving increment but a number has been on the other end of it.. I just cant understand why its difficult for them to analyze it... :angryfire jerks..aren't they?:angryfire

I cant believe it..It is just so frustrating, nurses who came 3 months to 2yrs after me are paid more than I do!! wELl, i cant imagine the angst of those who are in service for the last 20 years and are paid behind, their counterparts who got qualified 10 years and earlier were paid more.. I rang salaries and wages and I begged to be explained why...and the last line? "I am just unfortunate and there is nothing they can do aboout it".. What a?... I dont think this is gonna get better...u know newly qualified staffs who cant even insert a cannula, handle CVPs, perform and interpret blood gases are paid more than me.. SOrry to channel my frustrations here..I have colleagues who are experiencing the same.. the more our working condition is not inspiring as it shld be.. went to my union, and they cant dp anything about it yet, as the assimilation is MAD.. well, no doubt about it IT IS REALLY MAD>> :angryfire:angryfire:angryfire:angryfire:angryfire:angryfire:angryfire i think, therefore, i will think again!!!

1st sign of pneumonia: dyspnea, tachypnea, use of accessory muscles, sputum production, cough, etc... So you would auscultate, crackles, rhonchi pleural friction rub... bloods: raised WCC and CRP, ESR..

Oh by d way..my mistake..they are charging 3 Grand!! My friend told me that is the price not 2k.. WHOAAA!!! my friend didnt buy it.. thick..thick.thick..

ONP...An adaptation placement is being entertained in one of the nursing homes here in Stafford -- for a certain price.. That is, the overseas nurse shld pay 2000 bux, deductuble from his salary in 4-6 months once he got his pin number... I wonder if the government is aware of this and shld this be allowed at all? I am not sure of the other nursing home but definitely Im sure, this nursing home has been doing this adaptation placement for a (whew!!) price, for a awhile...

A pt called for nurse for another pt who happens to have STM loss and has been endlessly searching for her upper set of denture..We searched hi and low, in her bag, insyd her shoes, insyd and out of her cabinet, bed, sheets, blankets,pillows..toilet..in the vase..EVERYWHERE... then I give up cuz its first thing on my shift and i have to give medications. When i was abt to put down my meds for the second pt's bedsyd, i noticed her little glass has sumthing soaked in it.... EEEeeeEEEeeWWwwww!!!!!! u guessed it ryt.. that's hers cuz that pt of mine whom i gave the tabs doesnt wear dentures.. it happened again, the next tym she got it mixd w/ somebody else's denture box who happens to be confused as well..Darn, have to figure out wc is wc..cuz one wld have a whole set and the other has a few missing..glad i figured them out in the first try i made them wear it... ULK!!!

[quote= Another memorable was the dearest little confused lady who was using her call bell to play jeopardy on TV and was annoyed that 'the other fella' was winning. Even after being re-oriented, the bell was still ringing every 5 seconds. :chuckle Harrr!!! Harrr!!! Harrr!!!! Ouch! m having lock jaw now....

Good grief!!! That is funny!!! chuckle* chuckle*

A COPD pt, would normally thrive w/ low pO2 anyway.. It 'swhat we call the hypoxic drive.unlyk us normal peeps. Chronically evidenced w/ and elevated HCO3 and BE most of the tym to compensate their pH. I wouldnt worry if they have a pO2 of 8, cuz a lot of them have been hypoxic all their lives anyway. More accurate delivery of FiO2 is without a doubt via a venturi, cuz when theyr acutely exacerbated and when distressed they become mouth breathers in an attempt to blow off CO2.. A good SpO2 doesnt all the tym indicate the pts ventilation is well..they may have sats of >95%, but guess what? the CO2 is already on the ceiling..thus they become drowsy and unresponsive.. due to acidosis.. the more O2 we deliver, the more they will retain CO2..when CO2 reacts w/ water it will form carbonic acid, thus the ph goes down.. acidosis occurs... Tho there are COPD who are not chronic retainers.. as much as possible keep pt from receiving too much O2 ..just enough to perfuse and maintain their respi drive active.. too much 02 is toxic as we all know, careful Px of it shld be monitored.. we give Hi FiO2 if only if it is a lyf threatening situation...

your welcome... by the way, i just made them all up.... naaaahhh... just kiddin..

hmm...what sort of mask.. if a pt is a mouth breather, go for a venturi mask..but also,ther's nothing wrong w/ using a nasal cannula to COPD pts(esp. those who doesnt fancy keeping a mask on their faces)..as long as u know how to convert into LPM via nasal cannula ur venturi O2.. so basically, on air, our FiO2 is 21%..1 LPM n/c wld be 24%, 2LPM = 28%..just add 4% for every 1LPM..and so forth ...BUT..not more than 4 LPM please, as much as possible..wc is 32%..if its just while the neb is going through and pt is on 40% venturi,it shld be fyn to use 5LPM n/c.. just sharing...

i KNOW this is an old thread but i just wanted to share what i think is worth sharing.. If a patient goes type 2 respiratory failure..w/ acidosis..(hi pCO2, w/ normal or low O2), what we normally do is place pt on bilevel ventilation.. Type I respi failure, a hi flow CPAP or jus a CPap w/ titrated O2, depending on gases will help. Let's say a patient, becomes extremely hypercapneic...but also extremely hypoxic, we always treat for the hypoxia first, then the hypercapnia bec. the former will kill the latter first. lets say a pO2 of 4kpa..the hell, whack the O2, inmrpove the pO2, then work on the CO2 hitting the ceiling..I work in an area called, Non-invasive ventilation unit and we have saved a lot of ICU beds ever since... ANother option is an IV drug called doxapram...wc may increase respiratory drive knocked off by hypercapnia (preacautions as well).. If a pt is obese, other co-morbidities shld be considered. Any elements of heart failure, OSA, etc.. shld be treated as well or else ventilation/lung perfusion will never improve despite non-invasive ventilation..Hope this helps.. A known COPD saturating less than 85% for more than 5 mins, despite back to back nebs and repositioning deserves an ABG.. and series of ABGs, for every adjustment of O2..Pulse ox, maybe misleading most of the time esp. if a pt goes cold and clammy due to respiratory distress, poor peripheral perfusion will reflect an inaccurate reading, therefore ABG shld be performed..In our case, we do CBG (capillary blood gases, only to chronic CO2 retainers, OSA, and MND)..may my late reply be of help for those dropping by... amen..

Oh yeah, we do so! and that make us like work together closer, we realize each effort exerted.. believe me, wer havin' fun.. cuz the people m workin w/ are open minded.. well, Not all of 'em, but at least things are not taken seriously unless sarcasm and ridicule are present.. PEACE!!