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Anggelica's Latest Activity

  1. Anggelica

    Failure is an Option: A New Grad Story

    I think what she meant with "no harm done" is the baby and the mother survive. On the next line "In the end neither the mother nor the baby were injured in any way, but that’s not to say this error wasn't damaging." She acknowledges that there was an error and she was questioning if it was damaging.
  2. Anggelica

    Tracheaostomy venting

    I had a pt that had a planned tracheotomy put in 4 days ago. In my nursing opinion he required a lot of suctioning and after I suctioned it. pt still was still feeling SOB, so i would change the inner cannula and the pt would have some relief. He has cuff trach, inflated. My issue was: 1. i have been suctioning him pretty much every 1 or 2 hours with more often changing the cannula too because of SOB and when I changed it the inner canula was pretty much have a lot of secretions that adhered to it. My work got mad at me because I was suctioning and changing the cannula too often. Are they right? they said he needs to learn to cough it out, with I agree but in my nursing opinion, his lungs is still not that strong to cough it out. He is only to the point where where he can cough it out, up until the inner cannula. I have been trying to suction it out as much as I can but to it was very thick. 2. When the next shift came they refused to suction it for him because according to them he needs to learn to cough it out. Which is fine by me because I respect their nursing decision. I felt like they should respect my nursing decision to change it especially if his stats are going down and he looks as pale as a ghost. 3. Mind you when I has him yesterday, he did not have any breathing treatments. right at the change of shift, i was able to beg for breathing treatments. In my opinion, this will increase sections therefore needing for more suction, but before I suction it I try to make him cough first and it doesn't work I suction. 4. I sorry about the rant I just frustrated and I really do not know what is right and wrong now because according to my research and the textbooks if I interpreted them correctly the patient, assuming the pt is alert and orientated, can tell you if he needed suctioning. 5. they told him to use Incentive Spirometer but his cuff is inflated. I did give him one and made him use it but it would not work. To my understanding when the cuff is inflated most are will go in and out of the trach tube and if you block it the pt will not receive air because it pretty much goes in and out of trach tube. 6. I have asthma, so when A pt tells me he is short if breath, I do not ignore it even if this O2 is good. I sympathize with them because it is very anxiety provoking if you cant breath and no one believes you.
  3. Anggelica

    Filipino nurses

    thank you
  4. Anggelica

    December 2013 Caption Contest: Win $100!

    A deer, it's nice to see you again.
  5. Anggelica

    Filipino nurses

    I would like to have a feedback to the all nurses that graduated in the Philippines and is now practicing in the US. 1. How is nursing in the Philippines different than in the US? 2. How do you cope with this changes? 3. What would you have done differently to adapt to the changes? 4. What is your advice to newly immigrated nurses?
  6. Anggelica

    just venting about wound vac

    I was searching how much was a wound vac just for personal knowledge, I found out that wound vacs are only rented. I wish we can buy them because there have been a few cases in my work where people could have used it but cant because they do not have insurance and KCI would not release them if they do not have insurance.
  7. Anggelica

    Resume help

    4 to 1 pt I will keep that job.
  8. Anggelica

    Just being silly

    Does it annoy you when the Doctor just walk out of the patients room and you walk in, the pt is asking you what the doctor's plan is?
  9. Anggelica

    Young, New Nurse with CNA problems

    Look at it on a CNA perspective. 1. You have to earn their respect. I agree thisdoll, it is not about the age. Respect is earn by proving to them your nursing knowledge. They might not went to nursing school but they have been doing this job for a long time. Respect is also earn by showing compassion to the residents. Most of the CNA genuinely care for the residents and they get very hostile if the nurse is just a "pill pusher" type. 2. Since you are a new nurse, your CNA is picking up a lot of your slack. It is very challenging to follow a new nurse because old people do not take change very good. It's one of those personal touch the previous nurse does for them, so the CNA now have to spend extra time with them. 3. Budget cuts. If a home is force to chose between a CNA and a nurse to hire, they will most likely hire a nurse. Most of the time the CNAs are running the behinds off. Put yourself in their shoes. resident Martha, Joe and Betty needs and wants to be toileted, they are all heavy to transfer and a nurse ask you (CNA) to walk Fred. That is too much. they don't exactly teach CNA critical thinking. My advice 1. Know your residents routine. This helps cuts time passing meds and gives that personal touch 2. If a resident ask you to toilet them and you know they are easy transfer do it yourself and instruct them to put the call light on. 3. When you are asking for help make sure you ask them if they have time to help you. 4. When you are delegating make sure the CNAs knows why you are delegating this task instead of you doing it yourself and why that task is more important than what they are currently doing. Example: CNA can you pls give this orange juice to Martha, her blood sugars are low. I have to take this BP meds to Fred because his BP is way to high and he might stroke out. I know you are overwhelmed with everything, but so are CNAs. In time they will respect you.
  10. Anggelica

    Munchausen by Internet: The Lying Disease that Preys on the Heart

    I agree because they are not using resources that can be life saving for other people.
  11. Would you like to have a pt as hostile with you? To me it doesn't matter what is the reason for them for refusing me, If they don't want me i'll find a pt that doesn't mind my care.
  12. Anggelica

    Just being silly

    I probably would get bad ratings about this post but..... Have you ever had a 500 lbs pt that expects you to give them a boost in bed by yourself and if you excuse yourself to get help, they get upset because you can't do it by yourself? Have you ever had a male pt who is so hairy, you can't tape an IV down?
  13. Anggelica

    Dialysis nursing - New graduate

    Lots and lots of compassion.
  14. Anggelica

    Multiple medication errors

    I did the same exact thing and we had computer system. I inadvertently switch antibiotics for patients. Lesson learned. DO NOT EVER HOLD 2 DIFFERENT PATIENTS MEDICATION WITH YOU, including your pockets. If it is an important medication and I do not have room for error, I tell people including pt that I need to get this med a pt. I know that giving meds not on time is a medication error but my first goal is safety. I also went to re-preceptor but this time, our nurse educator followed me. I have reigns to all the decision making for my pt but she gave me advice to be better organize. I agree with everyone. A good brain sheet is important. I could not find a good one, so made one for myself that I can understand and read in a glace. In school, we do a lot of those stupid prioritization questions, when you are overwhelmed, instead of looking at you pt as human beings, think of them as prioritization questions. Example that day i have 4 pt bed 1- hx of CHF, c/o SOB, bed 2- a pt that is a discharge bed 3- pt in pain, bed 4- hang meds. I say it out loud so I can hear myself think and go from there. Just remember safety...it will click
  15. Anggelica

    How to Deal with the Chaos of Med/Surg

    I am also a new grad, what I do if I am seriously overwhelmed, I think of my pt scenario as a prioritization questions and it help me think through who needs help. If that does not help, I just go to the pt that could potentially die, if I don't do anything. IF their acuity is pretty equal and no one is in immediate danger, i go see the pt that i have to do less.
  16. Anggelica

    12 hour shift

    same thing happens on an 8hr shift only shorter. At least on a 12 hour shift there i light at the end of the tunnel. IF I work 4 12 hour shift in a row, I know I get rewarded 4-6 days off, which is awesome. 8 hours shift feels like you will be working for a month straight and not get a day off