3PRN

Twenty years ago, small, rural hospital and new to ICU. Pt. admitted for pain control with epidural drip. All through the night shift I was in the room titrating up and down depending on his level of pain. At one point, there was hardly any medicatio...

Thanks for the update. I'm preparing for my 5 year CWOCN testing in a few months and the continence exam is the most difficult in my opinion.

Check out the web page of the Wound, Ostomy, Continence Nurse Society (WOCN.org). You'll find lots of information on the various programs including WEBWOC, the online program. To sit for the exam(s), you will need a BSN and have completed a program....

It was irritated where the bandage was but how was the wound? I'm guessing it was all healed. You just got a lesson in autolytic debridement! I think you'd make a fine wound care nurse.

When I was told that I must say (to EVERY patient) "I'm going to close the curtain now to ensure your privacy"....I nearly gagged! Of course I'm closing the curtain to ensure their privacy, but I REFUSE to announce it! If you haven't, please refer to...

"can you control evacuation of the bowel with a colostomy." This was the original question. Since we're talking about evacuation through a stoma and not through the rectum, muscle and sphincter control are not the issue. The issue is timing of bowel ...

There is a way to control the timing of colostomy output, and thousands of ostomates do this daily. It is called irrigation. After the abdomen has had plenty of time to heal, irrigation teaching can begin. The stoma must come from no farther up the b...

Odors tell us a lot about our patients, especially the bad ones. You will learn to diagnose a pseudomonas infection without a culture, GI bleed without an CT scan, C.Diff without a stool sample, impending death in a pt. that doesn't look too bad. I d...

Oh the shoulda, woulda, couldas...I've got a million of them. My goal was to graduate from nursing school at 40. Check. BSN by 45. Check. MSN by 50...OOPS! Too expensive. Anyway, feeling behind at the beginning of my career, I made a decision to tran...

I loved working in the hospital. But when I started spending more time writing about the teaching I'd done than the actual teaching and more time writing about my interventions than the actual interventions, I moved to outpatient care. Now I spend my...

If you go with the pre-fab, you should still use extra protection under the tubing now that it's going to be under the compression. Either foam or the cotton layer of your Profore.

I have done this but under hospital supervision, not as outpatient. However, I would consider an outpatient if the person was directly involved with their own care. After the dressing is in place, put a small piece of foam under the tubing near the s...

For her comfort and to decrease time spent on dressing changes you can't go wrong with the wound vac. Drainage won't be an issue as it goes into a throw-away canister. Typically dressing changes are Monday, Weds., Friday, but in this case you can go ...

I took the EMT course while I was on my 4-year waiting list. I did it just for the knowledge gained and it was a great experience.

I would love to teach at the college level. I looked into earning a master's for this and was very disappointed to find that the local state college has an "impacted" program. That leaves me with private universities wanting between 40-60 thousand do...

One time on night shift I was called to a code and left a bag of popcorn in the microwave. At 300 joules I smelled smoke and nearly ****** myself! Then I remembered the popcorn. The fire alarms went off, the fire department crashed through the unit d...

Have you considered that dialysis nursing may be your niche? I know plenty of nurses who have never worked in a hospital and have enjoyed satisfying careers. Just a thought.

VAC VAC VAC! This area can absolutely be vac'd and with excellent results. The one thing that worries me though is your statement, "As much as I can." this tells me that the area continues to be traumatized by friction, shear, and pressure. Tell your...

While treating an outpatient for a pressure ulcer 3 days/week, I removed the dressing one day to find the coccyx was missing in action. I had her go home and look under the couch cushions, her car seat, etc. She did have osteomyelitis in the bone and...

What would we do without foam dressings? I've found that Optifoam, Allevyn, and Safetac (Molnlycke) are great for a lot of wounds but sometimes spread the drainage around the periwound causing problems. I find myself going to the Poly-Mem more freque...

Free range maggots in a necrotic wound...especially if I don't know about them before removing the dressing. I feel a little disturbed just thinking about it.

The foam must be removed before more granulation tissue develops so time is not on your side. The most accurate and least painful way to do this is with a pair of forceps. With wet to dry's you will also be removing the healthy tissue which your pati...