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Susie2310's Latest Activity

  1. Susie2310

    9 Types of Manipulative Patients

    Given our ANA Nurses' Code of Ethics and our role as the Patient's Advocate, I think more is expected of us as nurses than to label patients who behave in ways we consider unreasonable. When we label people as a) or b) we objectify them and erroneously think that we are perceiving the whole situation when in actuality we are only seeing a tiny snapshot of their lives during the time we are caring for them. It becomes very difficult to relate to people as individuals once we have conveniently categorized them, and real listening on our part stops. Labelling patients/family members is ultimately unproductive and can actually be harmful for the patient and their family member. Treating a patient (or their family member) as a type a) manipulative problem or a type b) manipulative problem may assuage our ego but the result is that it is actually impossible for the patient or their family member to communicate in a real way with the nurse once this happens. I'll give an example: My family member was admitted to hospital and hadn't eaten since early morning of the prior day. I happen to know that my family member becomes hypoglycemic - this is on their chart - and I could see that they were showing symptoms of low blood sugar, so I went to look for their nurse to ask them if my family member could have something to eat now as they hadn't eaten since yesterday and to let them know that I was concerned that my family member was showing symptoms of hypoglycemia. As I was making my request to the nearest staff member I could find (my family member's nurse was no-where to be seen) and was about to express my concern for my family member, another nurse informed me that a meal had been ordered and that we had to wait. So, case in point, the nurse who told us we had to wait failed to listen to me and had already decided what the situation was as soon as they heard me begin to speak - a demanding, unreasonable family member - and was treating us as though their perception was true when it wasn't. Some family members, being on the receiving end, would have escalated the situation in order to be heard and to try to advocate for the patient's needs, and this would have been due to the nurse's snap judgement and failure to listen and learn what the situation required. While nurses need to be able to set boundaries with patients who are truly unreasonable, it is important to remember that patients who are hospitalized are usually very sick, sometimes lack a good support system, and are often unable to articulate their needs or concerns in the most polite manner even if they would like to. Also, a number of medical problems are known to result in an altered mental status. It is also important to consider the stress of hospitalization, the stress of a patient's particular illness and it's affect on the other medical problems the patient has, and the effects of medications on patients. Labelling patients and their family members negates relationships when in order for a patient and their family member to trust the nurses who provide their care it is important to build relationships with them. Being on the patient/family member end of a nurse who shows no compassion or kindness in dealing with the patient and their family member, who is unwilling to listen to them, and who treats the patient and their family member as a problem, is a truly horrible experience in my experience for the patient and their family member and is one where I will talk to administration and/or request medical records.
  2. A patient's friend or family member is within their rights to report a nurse who makes a medical error that affects their family member to management if they believe the situation warrants this. They have the right to do this without the threat or fear of repercussions from the nurse involved or from the nurse's family members/friends.
  3. Susie2310

    How long to run a code?

    As I read the OP he/she appears to be talking about in-hospital cardiac arrest not out-of-hospital cardiac arrest.
  4. Susie2310

    Code Blue: Just Trying Figure Out What Happened?

    100% agreement; the only problem is that once the elderly patient with decreased physiologic reserves gets there (even when brought in promptly), even with sepsis symptoms - elevated temp, tachycardia, hot, flushed, diaphoretic, blood pressure increasing, tachypnea, new onset of severe weakness, no energy, UTI symptoms - being triaged as an ESI 2 can still mean a significant wait of around an hour (in an empty waiting room) while the patient continues to deteriorate whilst using up their last ounces of strength.
  5. Susie2310

    Let me hear your perspective...

    We don't know all the facts of the situation and I agree that a review is appropriate. Unfortunately it is possible that the patient received inappropriate care. The care pathway for acute ischemic stroke, if this is what the patient had, includes admission to a stroke unit or ICU.
  6. Susie2310

    Let me hear your perspective...

    We are not told that a neurology consult took place in the ED; it appears to me that this was warranted. If the patient had had an embolic stroke there is a care pathway. If the patient was being assessed/monitored regularly/frequently one would expect signs of deterioration to be detected promptly and that the patient would be timely admitted to the appropriate level of care (I agree that we don't know what assessments/monitoring were done in the ED or at what point in the patient's ED stay the patient's deterioration that the OP believes happened there took place).
  7. Susie2310

    Let me hear your perspective...

    Around 1500 a patient with known history of substance abuse presented to the ED. UDS was positive for methamphetamines and cocaine and functional ability at this time was unclear. We are told that at 1751 the head CT was completed and the impression is acute/sub-acute infarct with MRI recommended. Nearly seven hours pass since the head CT and we are not told of any assessments, monitoring, or care provided to the patient. At 0057 the ED RN calls the floor to give report, saying that the patient was going to be discharged but that the patient was unable to walk. When the floor RN asks about the head CT the ED RN is reported to have said something along the lines of "her brain is fried with drugs." At 0130 the patient arrived to the floor in the condition described. The CT impression was that the patient had had an embolic stroke. Approximately ten and a half hours passed from the time the patient presented to the ED to the time the patient arrived on the floor. The OP says that no NIHSS was done in the ED and and that he/she knew for a fact that the patient had a decline in function. Regardless of whether TPA was indicated for the patient, patient assessments/monitoring and appropriate interventions would have been appropriate care in the ED, and it would have been appropriate to admit the patient to the appropriate level of care timely.
  8. Susie2310

    Code Blue: Just Trying Figure Out What Happened?

    Muno, I didn't add the fever part. It's right there on page 3 - a comment by the OP. Here's the OP's quote from page 3 of the thread: "She also had a fever. I'm sorry, I keep leaving details out. Initially when she started sweating, we thought it was either due to her fever breaking or BG being low but it may have a sign of impending cardiac arrest??" So pneumonia/sepsis is a clearly legitimate diagnosis based on the CXR, elevated lactate, elevated WBC, severe hypotension, FEVER, respiratory retractions. We know that elevated lactate by itself is not a specific indication of sepsis. Your explanation about the use of Norepinephrine makes sense if we presume the patient was so fluid overloaded that using Lasix would still leave them somewhat fluid overloaded. Am I correctly understanding you are saying that fluid resuscitation for sepsis/severe sepsis would not be necessary in this situation and that norepinephrine could be given without prior fluid resuscitation? Your last paragraph re the ScVO2 monitoring may be appropriate to the ICU but the patient was in the ED. Also, a patient with serious heart problems is likely to have renal problems also so I don't see that we can say that the kidneys will just get rid of the extra fluid when they deem it appropriate.
  9. Susie2310

    Code Blue: Just Trying Figure Out What Happened?

    The patient's blood pressure at the start of care was 70's systolic and 50's diastolic. This would have been consistent with severe sepsis (hypoperfusion of vital organs, and could also reflect in part the patient's previous apparent history of severe cardiac problems - prior ECHO showed EF of 20 and the patient had a history of A-Fib prior to the sepsis diagnosis). The MD diagnosed pneumonia/sepsis from the CXR (pneumonia has specific visible characteristics on a CXR), the elevated lactate, elevated WBC, patient's symptoms i.e. fever, severe hypotension, respiratory retractions, all of which taken together provide a clear clinical picture of pneumonia/sepsis. The lasix puzzles me also but if there was a need to remove fluid quickly (e.g. symptoms of fluid overload/CHF) it would be an intervention that would rapidly remove fluid and could be given in the ED whereas CRRT would be an ICU intervention (the patient was not in the ICU). It appears that fluid resuscitation was not given to restore the MAP initially but a pressor was used instead - it appears the clinical situation and patient's medical history argued for removing fluids and not adding more fluids i.e. fluid resuscitation; we just don't know the full details. From personal experience, I can't imagine a patient with sepsis/severe sepsis tolerating a CPAP (which requires wearing a tight fitting face mask and can be uncomfortable and unpleasant to wear if the patient is not about to go to sleep) - in sepsis/severe sepsis/septic shock the patient's system is enormously stressed and they are basically fighting to survive. I agree completely with not getting the patient with sepsis/suspected sepsis up. I have seen this done (the physician wanted to see how the patient tolerated standing - answer was they didn't, at all - with the patient becoming even more profusely diaphoretic and dizzy when they were already very weak and very hot/flushed/diaphoretic with abnormal vital signs).
  10. Susie2310

    Code Blue: Just Trying Figure Out What Happened?

    From the information you've given so far I'm not seeing a reason to discount the MD's diagnosis of pneumonia as I recall has been previously suggested (you said the MD had reviewed the CXR and was able to make a determination of pneumonia) and sepsis. You haven't mentioned what the lab values for WBC/differential and lactate were, but I assumed they supported the diagnosis of sepsis. You said the patient had heart problems with a reduced ejection fraction and a history of atrial fibrillation (which can lead to cardiac arrest) and then became hypoglycemic, which can contribute to cardiac arrest. You also mentioned the pressor wasn't being titrated to a specific MAP. As I see it, this entire combination of medical problems on top of pneumonia/sepsis would have been enough to lead to the patient experiencing a lethal arrhythmia and going into cardiac arrest.
  11. Susie2310

    Oh dear . .Audited for proof of CEUs and don't have

    If you take the easiest, least challenging CEU's, you can't expect to learn very much. Or are you saying that there are no courses, nursing or medical, that offer CE contact hours that could challenge you? If the latter, I think you are deluding yourself. If you don't feel challenged by CEU's within your own specialty, try taking CEU's at a challenging level in another specialty. I take 100 contact hours within a four year period and I haven't run out of courses that challenge me to learn new information and improve my practice. Also, nursing and medicine are changing constantly and there is always new information to learn.
  12. This is your comment that I am asking you to explain. Who are "the people?" Who are the qualified persons that they will send?
  13. I have no idea what you meant by your statement about "the people sending qualified persons to replace the CEO etc." Perhaps you would care to explain.
  14. No, you are misrepresenting what I have said. Both industry/facilities AND individual nurses have responsibility/accountability as I said earlier on this thread. Nurses by virtue of their license are held responsible and accountable for their safe practice; my stating this fact does not mean that I think industry/facilities have no responsibility. I have never said that industry/facilities have no responsibility. I also said I believe there is a need for increased government oversight/regulation of industry/facilities and you replied to me that that wouldn't work, to which I told you that that appears to be a contradictory position to hold. Then you told me in reply to my question that you know that industry/facilities won't voluntarily make changes to support nurses safe practice. You mentioned "the people" sending qualified persons to replace the CEO.
  15. Susie2310

    Do Male Nurses Face Gender Bias in Nursing Education?

    Women usually carefully select their MD's (male or female) especially for OB/GYN. They build relationships with their MD's that allow for trust to be developed, usually over time. This is a very different situation from suddenly being expected to receive nursing care from an unknown male nurse in a highly intimate and personal situation such as childbirth or any gynecological problem/situation. Also, some women simply are uncomfortable with having male nurses and don't want to receive care from them. Whatever their reasons for this are (and keep in mind that statistics show that 1 in 5 women are raped at some point in their lives, and that this is just the tip of the iceberg and most rapes/sexual abuse is not reported) they deserve to be respected.

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