unsaint77

I work at a nursing home, hence the calling oncall doc and waiting for return call. It took about 15 min for the doc to call back. It is true that I wasn't as freaked out since the death was expected. Probably not related to her impending death, but her legs were mottled and dusky blue when I first met her two days before. I didn't think of the NRB. We proabably have one in the crash cart. My biggest question is this.. If she was not expected to expire and her sat dropped to 68, would you have raised the O2 beyond the 4L as the protocol says? At what level of O2 is usually dangerously risking losing one's own ability to breath? Or does that even apply in an emergency, unexpected situation? Should I have at least change the NC to mask? Perhaps I should have. Thanks for all your input.

I had a DNR/DNI pt, but was not hospice. She was incoherent and lethargic. She was not opening her eyes. We were expecting her to expire soon. Her sat was 80 with 3L via NC in the morning. Doctor was notified of the o2sat and the pt condition. When I took over the shift, her sat was 68. I raised the O2 to 4L. She is not COPD. Our standing order is up to 4L. Pt expired before the on-call doc called me back. Did I kill her by not raising the O2 higher right away? At what O2 level, do I worry about too much O2 suppressing pt's own ability to breathe?

2ml flush???? A teaspoon is 5ml. Can 2ml of water flush anything?

I didn't know a NG tube is not the same as a feeding tube. can you tell me how they are different?

I was administering med through NG Fr 10. The NG was patent and in the right place; I got 15cc residual, heard air woosh through sthethoscope, the catheter length checked out. The HOB was at least 30 deg. The pt was fine when I flushed/pushed 50cc water. But she gagged when I let liquid Ranitidine 10cc drain down from the open syringe. The pt thought the medication reflux is causing her to gag. I asked myself, "If so, why didn't she gag when I pushed 50cc of water a minute ago?" After the med, I again flush with 50cc of water by pushing it. The pt is fine. I let the tube feeding run at 80cc/hr. The pt is fine all night. I had the pt for two nights and same thing happened every time. First of all, why would anything draining down the NG cause one to gag? Can somebody explain this to me? Thanks

[h=2]http://www.healthcare.uiowa.edu/pharmacy/rxupdate/2004/04rxu.html Medications That Should Not Be Crushed Due to Fragility: Mirtazapine (Remeron SolTab®) and olanzapine (Zyprexa Zydis®)[/h] Not all of these come in rapid dissolve form and sometimes has to be given to pts with g-tube when the rapid dissolve form is not available. So, what is fragility? Or why these should not be crushed? Zyprexa I had to give through gtube was NOT enteric coated, or sustained release.

Thanks for the comments. Would TPN have any effect on clotting time one way or the other?

I thought INR would increase since platelet would be more diluted by TPN. But I want to make sure. thanks.

I didn't know this. It's amazing. So, a bladder gets fuller at night. Thanks Skindigo. ADH: The Test | Antidiuretic Hormone ADH secretion increases when a person is standing, at night, and with pain, stress and exercise. Secretion decreases with hypertension and when someone is lying down.

I get it now. thank you.

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Thank you so much for educating me. As you probably notice, i am a new nurse. If you had recognized my recent postings, you would know that my unit is poorly run and has so many things to upgrade. So, I will use kelly clamp. My one concern is the pointy end of the clamp possibly hurting the pt when the pt moves around or confused pt tries to get up out of bed with the clamp in their groin areas. Some of mini clamps that hardware stores is short enough and has rubber coating (I am including a picture. It's 2" long). They are meant to clamp down hard. So I think that would be better than kelly clamp.

I am trying to understand how urostomy (or ileal conduit) works. ureter is a sterile environment. what keeps bowel content from leaking into the ureter? thanks.

Yes, I forgot to mention that the foley we use don't have the port canesdukegirl is referring to. So, I have to do either of these two. (for the sake of discussion let's use the term "catheter" as the rubber part goes into patient, and "tube" for the clear plastic tubing connected to the collection bag) I disconnect the catheter and tube and collect urine from catheter opening. Or do as I mentioned above (of course I alcohol-clean the scissors and the part of the tube being cut, just like I alcohol-clean the catheter opening after I disconnect the tube from catheter. Same degree of sterility achieved.). SbostonRN, when you say you kelly clamp the tubing, you mean you kelly clamp the catheter, not the clear plastic tubing, right?

Our facility usually collect UC sample from foley catheter prior to discontinuing if UTI is suspected. My question is about a better way to collect the sample. I know I must collect sample from catheter rather than the bag since the urine is old. I disconnect the tubing from the catheter, then I alcohol-wipe the catheter end and put it over collection jar. But usually I have to wait 15 minutes to get 10 ml. I was wondering if I could do the following method to collect instead. 1. empty the urine in the foley tubing into the foley bag. 2. make a "u" shape loop of the tubing so that bottom of the loop is lower than the catheter bag. Fresh urine will be accumulated at the bottom of the tube loop. 3. Once I have enough fresh urine there, I scissor-cut the tubing above the top level of the collected urine. 4. Then the cut end becomes a spout through which I can drain the fresh urine into collection jar. Why wouldn't this work?

I know the following question is a newbie question. I do have a lot of newbie questions and becase of that I get a lot of unkind comments. Please just pass on if you don't feel like answering. I was collecting U/c sample from foley catheter but the flow was minimal. My supervisor told me to lower the head of bed to help the flow. So, is that because when the HOB is lowered, the body is flatter therefore the urethra is straighter?

An employer without AED available 24/7 reflects their regard for their employees as well.

Again, it's me a new grad nurse at a LTC facilility's TCU. (We have pts with iv, picc, ng, nj, o2, cpm, but we have no tracheostomy or EKG capacity) We have two different sets of standing orders due to different admitting doctor groups. They are pretty basic but different. For example, one set has s/s order for hyperglycemia but the other doesn't. One set requires foley cath changed before UA/UC specimen collection, and the other set doesn't specify that (I will post this question separately). Anyone else in a facility with two or more sets of standing orders? I don't think it's a safety issue since there is no contradicting orders on urgent matters such as respiratory distress or chest pain. But it's such a hassle for nurses to handle two sets of standing orders. Thanks.

Yes I am a new grad. There are people like you who like to help, and there are others who have nothing better to do than pounce on newbies with newbie questions. That's why I post it on student section. So your facility do not make you check residual during the feeding? I thought checking residual was important to make sure the feeding is flowing well since the back up can cause serious aspiration. So, if I was told to check for residual, I don't have to wait after holding the pump and before residual check? thanks.

I was helping other nurse so I do NOT know if this pt had NG or NJ. (the head of bed 30 deg up) we stopped the feeding pump and the line flushed fine but when we administer maalox into the open inverted syringe it didn't drain. We must waited for five minutes and there was no draining what so ever. so we carefully disconnected the syringe and pushed the med very gently. It went in fine and flushed with 30 cc of water just fine. His abdomen was soft. we didn't check for residual before we administer the med. Is this normal? Did we do something wrong? why didn't the med drain?

1. After put the feeding pump on hold, how long do I wait before I use syringe to withdraw stomach content for residual? Or do I not have to wait? 2. If someone had NJ (the end of the tube is in the small intestine), do I still need to check for residual? If so, I should expect to see zero residual right? (whereas if it was NG, less than 100cc of residual is an expected norm). thanks.

Our facility does about five lunches a year. If they didn't do that they can afford a decent AED. AED is not the matter of profit margin. Furthermore, which way would the nursing home make more money down the road? when the pt expires? Or when the pt lives and comes back from the hospital to the nursing home? I just cannot understand why no AED? Are nursing homes' managements that ignorant? Applebees without forks will go out of business because customers know it right away. However, Applebees without proper dish sanitation equipment and do poor job of sanitizing dishes will probably stay in business because customers do not see that. The workers at the Applebees have obligation to demand that. "In a study of Public-Access Defibrillation (PAD), communities with volunteers trained in CPR and the use of AEDs had twice as many victims survive compared to communities with volunteers trained only in CPR." 3. Hallstrom, A. and J. Ornato. "Public-Access-Defibrillation and Survival after Out-of-Hospital Cardiac Arrest." New England Journal of Medicine 351.7(2004, August 12): 637-646.

OMG Why is that a harmless question posted can irate so many people? Did I ever say anything about isolating this pt? You don't even know about this pt's coughing spells. Please think about why you guys assumed that I wanted to isolate this pt. Why did you assume that this pt had no problem covering mouth? People just love to pounce on others in the same industry because it gives them a false sense of pride. Nurses are one of the worst I realize. BTW, many of you so knowledgeable about MRSA yet none of you ever quoted what CDC said. Hmmm. So, I guess those of you, who were quick to criticize me, know more than the CDC and the MD who ordered the culture?

So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?