samiam4

Outpatient Hematologic Oncology pt (pt ANC- 60 [pt is neutropenic], plts - 4, hgb-6) received platelet/PRBC transfusion. Prior to start of platelets baseline vital signs were T-97.9, Hr-94, RR-18, Bp-113/80. Pt received 650mg PO Tylenol premed 30 min prior to platelets transfusion due to hx of reaction. Post platelet vital signs T-99.6, Hr-97, RR-18, BP-112/75. Pt then received 1 unit of PRBC. 15 min VS into PRBC T-98.5, HR-95, RR-18, BP- 114/78. At 30min into PRBC VS were T- 98.3, HR- 95, RR- 18, BP- 117/76. Pt completed transfusion without incident with final VS as T-98.6, HR- 97, RR-18, BP- 107/80. Pt discharged. Curious your thoughts and if you think the blood administration was completed appropriately? Or if you think any intervention should have been done with this scenario? Thank you!

I need some advice from the experienced RN's and the new grads who are in the float pool. Or any advice from anyone would be amazing! I was offered a position in the RN float pool at the hospital I work at. It would involve all the units (sicu, micu, cvicu), ER, and 4 med surg floors. I'm currently a pca float so I'm used to floating. I just graduated nursing school this December and plan to take my NCLEX beg of feb. I am scared to take the position bc I'm not sure if it is a good idea and/or safe for a new grad to start out as a float? I'm also scared this might be the only opportunity coming my way and I don't want to pass it up either...so confused! Help

Yea they can hire you. They would probably want u to get a temporary license to practice in the state of md. After u take your NCLEX you will have to get your md license- which all cost money. What hospital in Baltimore are u interviewing with? Also do u have a BSN or ADN? I'm also a new grad looking for jobs in the bmore area- I'm out of state as well but I'm in Pennsylvania

intermittent peripheral infusion device....I thought it meant the same thing as a saline lock.

I was just wondering when you flush an ipid, administer med, and flush again...does that med mix with the saline that's in the saline lock? Or is the flush a barrier to what may go into the saline lock next? (if you understand what I'm saying) How much can a saline lock tubing hold? Saline, push med, Saline. For example, Lasix is pushed undiluted. Does it dilute in (saline) that was pushed before the med, and then does it get even more diluted by the saline that is pushed behind the med? Thanks!

Hello Everyone, I was just wondering how everyone feels after leaving clinical? Everytime I leave clinical I feel like a total idiot. I also feel like my patient's are going to die after being under my care b/c I don't feel like I do things correct. When I think I'm doing something correct I come home and reflect on my day and retrace my steps and realize I didn't do such and such correct, and I think OMG, that may lead to this, this, and this and ultimately can cause my patient to die, etc. I get severe anxiety just thinking about the patient's I took care of. If I don't have total control over the situation everything falls apart. Such as if I administer a BP medication (IVP) and I don't check the BP before I leave clinical/ or resolve the problem myself I get anxiety, like I need to know what's going on with that pt. at all times. I will get to thinking like "what if I caused my pt. BP to drop so low and pt dies." I'm beginning to think Nursing just isn't for me, but I only have 1.5 semesters to go....I don't like being responsible for other people's live's because if I accidently hurt someone I don't think I could live with myself. I know there are other areas of nursing to get into, and that's what's keeping me going, but I can not do this hospital floor stuff. It makes me sick in the head. I've never experienced so much anxiety and wt. loss in my life and all I do is google things about what I did in clinical (mistakes) and how could it potentially hurt my pt. and I consistently obsess about it in my head. I get to the point to where I look at the obituaries to see if my pt. has died or not...I know crazy right?! HELP :cry:Anyone else feel like this??

Today, I learned more about my patient before he passed away. Apparently he started to complain of chest pain. An EKG was ordered and found that he went into Atrial Fib. Also his lab values were all over the place. I believe it said he had an increase in BUN and creatinine. Also, if I remember correctly, his postassium levels were high. My instructor said that it looked like his body was shutting down- due to his lab values......

Thanks. Is there anything that NaCl isn't compatible with? Just curious

Correct me if I'm wrong but isSaline the same thing as 0.9% NaCl and NSS? Also if someone has an IV with 5% Dextrose in sterile water, is that sterile water 0.9% NaCl? Scenario: if pt has a continuous IV of Sodium Bicarbonate in 5% dextrose in water,and an order for hydralazine IVP, which is incompatible with D5W, I would stop the running IV of sodium bicarbonate in 5% dextrose in water and flush IV with 0.9% NaCl, IVP hydralazine, flush again with 0.9% NaCl. Then, I would hook the sodium bicarbonate in 5% dextrose in water back up and restart the continuous infusion....Am I correct?

07302003 the way you were in nursing school sounds exactly like me. Esme12 I actually didnt think that I made any mistakes until I was home and reflecting on my day. I do contact my teacher when I feel like I made a mistake. But, when I found out about his death that's when I started to over analyze my every move and started to realize my day in clinical had more mistakes than I thought...I just recently thought of the O2 incident. I guess I didn't really think about it bc I corrected the problem quickly that day in clinical.

Thanks for sharing your story MyUserName, RN. It feels good to know we can all lean on one another during a tragic event. Even if it's just sharing similar stories. It really does make me feel less alone.. Thank you

Wow, thank you so much for that post AICU RN. It's really nice to know that I'm not alone with this whole situation. I really really appreciate it. This nursing board gives me the strength to carry on with nursing because frankly there are many times I just want to throw my hands up and quit, especially after this episode. I'm so very thankful for you all to take the time to comment about my situation. It really helps!

Thank you all for the comments. The more you all comment about the situation the better I'm feeling!

In report that morning the primary nurse told me he desat's into the 60's overnight...He had pnuemonia, CHF, type 2 diabetes, pulmonary hypertension just to name a few things... Even if he was really sick I don't want to be the one to make him sicker you know? So the whole situation just makes me anxious and drives me crazy thinking about what I should have and shouldn't have done etc....

I was switching my patients nasal cannula over to a nonmask rebreather with a PCA tech. The pt must be on oxygen at all times so I had someone help me. When the PCA switched patient over from nasal cannula to nonmask rebreather I somehow accidently plugged in the wrong O2...Somehow I replugged the nasal cannula tube back into the air supply. After a few seconds I noticed the nonmask rebreather was not inflating with oxygen so I quickly saw my mistake and switched the tube quickly back to the nonmask rebreather. Pt. oxygen went from 85 to 60(when we were switching his oxygen) back up to 88-90. (pt. was on 15L nonmask rebreather and 12L nasal cannula) I feel really bad that I caused his oxygen level to get that low due to my mistake in plugging in the wrong tube. After that mistake pt was fine, he was laughing, joking around, no problems. About 36hrs later, I found out patient had passed away. Could I have caused a problem? I am a nursing student and I feel awful. Since his death I think about everything I did that day from "did I hang the correct IVPB", "did this O2 level cause something bad to happen", he also had gotten insulin (BS 298) and he ended up not eating his lunch except for a few peaches so I think "what if I bottomed pt. out and he went into a coma...." I always think worse case scenario. I keep talking about it and I try to figure out my day and what I did and I keep blaming myself for his death because I feel like I had a horrible day at clinical. I don't want to contact my instructer again about it because I think she'll think I'm crazy. I talked to her and she said "you did nothing to cause this man's death." Though she doesn't know about the O2 instance. My thoughts are becoming very obssessive, and I cry about it. Can someone give me some advice on how to deal? What do you think about my scenario?

Pt.'s BS was 295. I administered insulin, then to find out pt. wasn't hungry. Pt. said though he did want to eat his peaches. So, he did. I administed Sliding Scale insulin according to his sugar level and then there was an additional 2 units of regular scheduled on the emar. So my patient in total recieved 11 Units of Novolin regular insulin. Me being a student I didn't even think about pt. not eating his entire lunch........I feel like a total idiot and awful that I could have possibly caused my pt to bottom out. I do not know what happened after I left. It happened over a week ago and i'm just thinking about it now...I start to over analyze my clinical days and here I am trying to rationale everything........ugh. I feel awful. I know that if a pt. is NPO they say to admin the insulin?....i'm so confused!!! Diabetes and insulin confuse me so much. When I think i'm doing good in clinical I come home and know that I made a mistake!! If I bottomed out my pt. wouldn't my clinical instructor find out by the hospital? and let me know?! I'm so stressed. My biggest fear is really hurting someone...........

It was a sliding scale of 9 units Novolin R and +2 units Novolin R (seperate from the sliding scale). I'm a student so i'm not really familiar with how insulin works. I'm trying to make sense of it all.....

Thank you all for the comments! I'm feeling better and better as you all comment and give me your advice, input, and shared experiences. I'm going to talk to my instructor and let her know how I feel. I hope this heaviness in my chest goes away... I ordered the book "Death and Dying" by Elizabeth Kubler-Ross in hopes that it provides me with some insight and learning to this experience. It's very sweet of you all to take the time to share your perspective to a total stranger to make me feel better. I very much appreciate it!

Thank you for the replies!

I ordered lunch for my patient. I administered Novolin (11 units). Blood sugar was 295. Once food came Pt said he wasn't hungry. He just wanted to eat his peaches. So, he ate his peaches. Could the pt. bottom out from only eating peaches? (5 peach slices).

I just wanted to thank you all for your kind words. I really appreciate you taking the time to respond to my post. I feel a little better about the words you all speak. I will definietly talk to my teacher about it. I am still upset about the whole situation being that it was my first death experience. I guess I feel guilty because the patient was under my care at some point during his hospital stay, and I felt like I didn't give my best care to the pt... I talked to my mother who is an LPN and works at a nursing home and experiences death often and she told me not to worry....Although, that's all I can do. I think time will heal, and I will look into the recommendations you all said. Thank you so very much

I'm a nursing student in my 3rd semester and my pt died the other day. I have anxiety, chest pains, and a horrible stomach ache after finding out my patient died. It is my worst nightmare. I had clinical on Tuesday and I found out on Thursday (kind of) that he died. We usually get the same patient's when we go into clinical. My teacher said "you have two new patients today" and my stomach dropped. My instructor didn't say if my pt passed away or not. So I said "ok." So I went on with my day looked up my current patient's info and saw my pt. from tuesday still on the pt. list for the floor. About an hour later his name disappeared. The nurse that had the pt. with me on Tuesday came in to work at 7am and went up to the night nurses on the floor and said "What happend?!" I just had this feeling something happened to MY pt. from tuesday. My pt.'s room from Tuesday was being cleaned by the custodial people. His bed was empty and made. I just knew it was him that something happened. I didn't get to talk to anyone about it and didn't ask what happened b/c I didn't want to be the nosey nursing student. When I had the pt. it was on tuesday and it was a very busy day with med passes. I felt that, on tuesday, I did not provide the best care for him. I know that I'm a student but, I feel like what if it was something that I DID or DID NOT do that contributed to his death early Thursday morning?! I have a hard time prioritizing my care and I'm still learning....I had clinical on Tuesday the pt. died early Thursday morning. I'm guessing something happened in his sleep? When I had him as a pt on tuesday morning he was doing great, in good spirits, laughing and joking. A very happy man in his late 80's. He was in the hospital for Poss. pneumonia, SOB and had an extensive history for CHF, pulmonary hypertension, diabetes etc. When getting report from the nurse on tues she told me his O2 would desat into the 60's overnight but would be better 80's-90's during the day when awake (and it was)... I don't know why I feel like what if it was something I did that caused him to die...I feel like I can't accept him dying and I don't know why my instructor didn't tell me what happend...I feel like I want to throw up. Any advice? Comfort words and experiences people can share? Should I talk to my instructor even though she doesn't know that I know about the patient passing? Help...I feel like I should quit nursing school........

I'm not sure what DAT pos or neg means?

Thanks for the replies! I'm glad they check bilirubin again. I felt like just checking bilirubin @ 24hrs wasnt enough....makes sense to check at 48hrs too. My pt was a lady partsl delivery so she would be there for at least 48hrs b4 going home.

I just finished my postpartum rotation. We had a 36 week old baby with a trancutaneous bilirubin reading of 7.0 @ 24hours (nurse told me 7.0 was higher than they would like to see for a baby at this age). A serum bili was ordered and it came back at 6.3 so the doctor did not order any interventions....Since the baby was a premature baby, and at 6.3 serum bili, would they order another bilirubin reading to make sure it's not rising before the baby leaves the hospital? Or do they only check it at 24hrs? If the baby was bumped, after the 24hr bilirubin was checked, and had gotten a bruise, would that raise baby's bilirubin to a point that it could be very severe/life threatening? The baby was having troubles with breastfeeding as well. Do they check levels a few days after the baby goes home? I'm so confused because jaundice is so common, especially in a premature baby, with breastfeeding issues. I wonder how often they do checks to make sure that the levels are not rising?? Anyone able to fill me in? Thanks!! Lot's of questions.. :) ...