peaches88

Sorry for the late post. It had turned out to be an ovarian torsion. FAST exam at bedside ruled out bleeding, then she had a CT and ultrasound. I wonder now, is a possible ovarian torsion a level 1? Testicle pain is a level 1 because it can cause loss Of a testicle, but I couldn't ever imagine assigning a level one to every child-bearing female with sharp abdominal pain.

My thought was that her aneurism could have ruptured, which is why I put her as a 1.

Had a pt present to ED... young female with a hx of splenic artery aneurism that had appointment to operate in one week with sudden onset of sharp, tearing abdominal pain that radiated to her back. HR 150 and BP 90/45. Diaphoretic and tachypneic. I triaged her as an ESI-1 and my supervisor changed her to a level 2 because "she is here all the time." Pt still got a high acuity room ASAP, but I'm pissed that my triage level was changed. Was I wrong to put her as a 1?

I listen to metal/hard rock on the way home. Then it's always a hot bubble or epsom salt bath with lavender oil, a glass of wine, and a good book (or just complete silence and nothing to think about).

Having worked PACU and having friends that are L&D nurses, my biggest recommendation would be to study up on cardiac monitoring, airway management, and medications. Try to see if your facility has a PACU med order sheet and then focus on studying those. Get comfortable with OPAs and NPAs. Make sure your orientation includes information over the aforementioned areas, malignant hyperthermia, and invasive hemodynamic monitoring. The majority of facilities require ICU experience before PACU, so don't let them screw you out of a good, thorough orientation. Also, don't be afraid to ask anesthesia providers questions about the medications they gave to put the patient to sleep and the rationales behind their choices.

Most likely cause would be Bell's Palsy... This patient would have likely set out in the waiting room of the ED after being triaged. If you had called an ambulance, they would have complained about the bill. Let me know if you find out what it was, I'm really curious now. I work ER and someone presenting with that one symptom, at that age, with no history, would have probably been treated for the Bell's palsy with no testing done, then sent home.

So, this morning, I was scheduled to orient at a hospital. I signed up with this agency in order to make some extra money, picking up per diem shifts. I show up at the hospital and nobody is in the classroom area. So, I wait around until it was scheduled to start and confirmed with an employee that this is where they usually do orientation. When nobody was there by 0700, I called the agency and the on-call person told me that orientation starts at 0800. Small mistake, no big deal, so I just go grab breakfast and then come back at 0745. Still nobody there. Nobody setting up. Nothing. So, I wait until 0800, then call the agency again. They say they will call and get it figured out. Then they call me back and say that the orientation was cancelled, sorry they missed it, email came in over the weekend. First of all, this excuse sounds like a load of you-know-what (office people emailing over the weekend?). Second, they made no offer to compensate me for my time or lost income. If I had cancelled on them with no notice, I would have been terminated. So, I'm really frustrated right now. I have logged in countless hours on the computer for their testing and testing for several hospitals, with no pay, then this was a huge let-down. So, my question is... is this a common thing to happen? Should I just suck it up? Should I ask them to do SOMETHING to make this up to me?

I rarely have to give a lap chole much for pain. This includes three surgeons that all perform the procedure differently. Typically, we give 0.4mg dilaudid q 5 min, up to 2 mg, if needed. I usually end up giving 0.4-0.8 mg total to a lap chole in phase 1. In phase 2, they get their po med, then go home. As for phenergan, I was taught in my first semester of nursing school that I would NEVER give it IV (lol, right!) because it is so hard on your veins. The policy where I work is that you have to give it diluted or through a running IV line. Sooo... That is why I use it as a last resort, besides the fact that it makes patients drowsy. I try zofran first and if they have a history of PONV, we usually have a scopolamine patch on them anyways (cheap and effective).

Did you go to their test review or were you able to just study on your own?

Also, ASPAN just posted their winter/spring conference dates!

Good collaboration with your anesthesia provider is really important. Depending on the procedure and the patient, maybe have him/her look into doing a spinal or nerve block. If the procedure wouldn't allow for those options, sometimes our anesthesia providers will use ketamine to help control pain.

I'm the second youngest at 23. I think the oldest RN that I regularly work with (on nights) is in her late 30's. It is a med/surg floor though, so the older RNs probably work day shift or in specialty areas. It does sound that you must work in a place with low turn-over though and that is awesome!

Where I worked, if a new admit showed up 5 minutes before your shift ended, too bad, it was yours to do... all of it! It sucked. All paper charting too, so your hand hurt like hell after it was all done and if it didn't, then you probably forgot something, lol! We did, head to toe assessment, fall risk assessment, elopement risk assessment, physician order sheet, MARs, TARs, careplan, notify pharmacy, etc. Usually took around 2 hours. We only had one nurse on shift at a time, so there was no help, except sometimes the QA nurse would put in all the physicians orders. If you asked the DON or MDS coordinator for help, they probably would have just yelled at you. There are reasons that I left...

Well, they would probably be more likely to hire you as a NP if you worked there before...

Thank you for the information! I'm really excited to start this new position!