marsy82

Just a quick question regarding the use of IV pumps...i'm a new grad and during my time in ED I did all IV infusions without the use of a pump....I'm now about to start on a ward which uses pumps. If I make up an antibiotic which is to be infused over 20mins do I really need to use a pump? Also, if I reconstitute an antibiotic with 20mL saline, does that extra 20mL need to be programmed into the pump when I hang the bag to ensure all the fluid is administered? Hope that makes sense

Not interested in theatre/OR or mental health. Although I love children, I would not want to work in Paeds, it would be too distressing. My main interests are coronary care and ED, although with ED I do not see myself sticking around longer than 2 years, too much unplanned craziness.

Thanks for the reply. I will take it as a positive experience, ED was great but exhausting so maybe day surg will be a breath of fresh air for me xx

Thanks for the reply brownbook.... So do you think it is a place I will learn anything other than time management? I have previously worked in ED so this seems a bit like a step down for me?

Hi... I am a graduate RN and have a 6 month rotation in a day surgery unit of a large metropolitan hospital, I have not worked in one before and therefore am not sure what to expect. Can anyone offer me any insight into the things I might be doing/seeing/experiencing on a daily basis? Thanks for any replies :)

I found it was good to spend the first few days observing and getting a feel for the place. Offer to check vital signs, do ecgs and basic assessments. When comfortable ask for a patient (start with an easy one, my first ED patient had constipation)....do a full assessment on them don't be afraid to inspect/percuss/auscultate/palpate...document all findings and what you did for the pt...you can then speak with the doctor and inform them of what you found. If the doc prescribes meds ask to administer them, do ECGs or other non invasive tasks. ED is a great place to learn assessment skills and they will be valuable no matter where you work. Most of all try to do as much as you can, you will be surprised at how much you will learn and everyday brings something new....enjoy

Thanks Esme, It is a busy country ED. I'm sure as the days go on I will feel more confident but right now i'm definitely feeling like a fish out of water.

I am a final year nursing student, I have been placed in the ED for the next 4 weeks. The only other nursing work I have done prior to this is aged care. Yesterday was my first day and I felt so under prepared it wasn't funny. The nurses were great and I spent most of the day observing and asking questions. I enjoyed the day but felt like I could never imagine myself being as knowledgable and experienced as those nurses, I felt like the only thing I knew how to do was take vital signs (and even then I became a nervous wreck and it seemed to take me forever to complete). I guess nerves are getting the better of me and i'm definitely feeling a bit lost. What is your advice for somebody new to ED, I really want to make the most of these 4 weeks and learn as much as I can.

I work in residential aged care, we have an elderly Vietnamese lady with special privileges because her family are very wealthy and are constantly emailing and voicing their concerns about their mother's care. She is physically ok despite random episodes of hypotension, she requires minimal assistance and can mobilize independently. We have been instructed by management that this woman's call bell is answered promptly (within minutes), she is to be informed of our name and position each time we enter her room, her family are allowed access to the kitchen to prepare food that they bring in and we are to stay with her while she uses the bathroom (which is often and can take up to 15mins each time). There are other chronically ill residents with debilitating health conditions that need our attention yet this woman is put before them because her family is difficult ?? Is this a normal practice?

The one thing i found most helpful when I first started was getting to know which residents needed the most care. I then got a handover sheet and jotted down as much relevant info next to each resident's name and kept it in my pocket for the first few shifts. When the call bell went off I would pull out the sheet, look at the room number, identify the resident calling and have a quick read of my notes to prepare me - some have catheters that need emptying, some require creams applied or stockings removed, some need the toilet every 15mins (you will get very well acquainted with these residents very quickly) - make sure you know which residents are 2x assist, which need to turned every 2 hours and it helps to know which residents wake frequently during the night - some have nightmares, some will become scared/anxious in the middle of the night some experience sundowning - if you know which residents do these things you will feel more prepared when you go to see them. Keep in mind that not all residents will call the bell, so regular 30min checks on these residents is recommended. It won't take long and you will be in the full swing of things, the hardest part is the first couple of weeks, if you can handle that you will be fine, goodluck.

Unfortunately sometimes you just have to do as the patient/resident wishes despite it not being in their best interest. No matter how hard you try, you will always come across people who will refuse help/medication/intervention - just as long as you explain the consequences of refusing the intervention and document their refusal, you are doing all that you can. I have had residents refuse food and water insisting they just want to die, obviously you cannot force feed somebody but once they refuse something essential to life, it is out of our hands and needs to be referred to a doctor.

Thanks everyone! I had to work with her again last night, she didn't say a word to me except to ask me to help reposition a resident, you could cut the tension with a knife. I will be mentioning her when I see my manager next as she is nothing but rude, lazy and thinks she has it over everyone. I don't like the way she treats the residents either, she bellows at them when she speaks assuming they are all deaf and when they question her about anything she rolls her eyes as if to say 'what an idiotic question' She reminds me of Rosy o'Donnell!

I have been working as a carer in aged care for 3 months now. I enjoy the job and the residents but am seeing a side of nursing which is putting me off finishing my bachelors degree. The nurses are rude, snappy and pick on me for any little thing they can find! One nurse in particular has not liked me from the start, I have no idea what her problem is with me but she talks to me like i'm a piece of s*%t. I have held my tongue with her for as long as I can but now i'm ready to explode! What gives these nurses the right to look down on us just because we are carers? I work incredibly hard, have 2 small children, am studying full time to become an RN and still manage to keep a smile on my face and be polite to everyone everyday! It is not hard to treat others with respect, if this is what the nursing profession is really like I don't think I want to continue.

I agree with funtimes! There are also no meal services during night shift either which is a bonus, so you basically wait for Mrs Pee's a lot to call her bell every 20mins, reposition people and do wet checks. It's actually quite boring and the time drags, i'd much rather be kept busy but it is nice to have a break :)

I have an eldery non english speaking patient - he's vomiting, feverish, having constant abdominal pain and BP 90/50. He has his son with him who is acting as an interpreter and is stating that his father is refusing all treatment - How do I base my care plan around this? Obviously I would get a professional interpreter to clarify his refusal and his reasons why but I guess I want to know how I plan care for somebody refusing treatment? What would be the goals?

I forgot to mention that his son is with him and is acting as a translator. Should I consider the falls risk assessment tool considering his BP is low and his son has expressed that he has been confused and forgetful lately

I have an elderly non-english speaking patient that is having constant abdominal pain with unknown cause - in brief he is vomiting and feverish, BP 90/50 and has not had much fluids/solids in the last 48 hours. I'm thinking I should use the numerical pain rating scale as one assessment tool but I need another in order to develop a profile for him. Based on his symptoms what do you think I should use as the second tool? I am not very familiar with many assessment tools so any help will be much appreciated.

No other tests, only obs have been taken. I was also thinking hypovolemia but what would the nursing diagnosis be? Decreased cardiac output r/t hypovolemia secondary to vomiting?

My case study client is 85, has vomited 4 times in the last 12 hours and has had very little to eat and drink - his BP is 90/50, RR 28, HR 110, T 102.7 - this is all I know concerning this issue. Would the diagnosis of fluid volume deficit be actual or potential? If I write it as potential, does it make it less important even though I believe getting fluids into him would be first priority or is this an actual diagnosis based on the data present?

Thanks for the info guys, I will definitely take a notepad with me thanks for the tip. I believe we only have 1 day orientation, does this mean that after this time I will be left on my own or will I still be able to receive help until I know the routine? I really doubt I will learn everything I need to know in one day :-/

It is a care assistant position, I haven't formally trained for the position but i'm a 2nd year RN student - i've only assisted with basic patient care so far.

I'm about to begin working in an aged care complex but have never been exposed to this sort of environment before. What is the usual method of bathing & toileting elderly clients in these facilities? Are residents usually able to take care of themselves or does the nurse usually have to help shower/bathe them? Can you describe a scenario? I'd also like to know what is the most common thing you find yourself doing as a cna, obviously duties vary depending on the client's needs but is there one thing you find yourself doing more than anything else during a typical day? Any other useful information would be much appreciated, I want to be as prepared as possible before beginning thanks :)

Ok, after a bit of research i'm going to attack this a little differently. So I think the first priority should be the hyperthermia - once taken care of can eliminate his temp, fever, HP, RR and possibly his vomiting (by regulating temp, managing fluid intake and treating fever). This leaves his low BP and pain to take care of - as a result of his low BP he is at risk of falls, it can also be contributing to his confusion/nausea. The pain is a tricky one as I don't know what his actual level of pain is, all I know is that it is constant, would I be better taking care of risk of falls first and pain after - is this sounding a bit better, I have found a care plan book to help with diagnosis :)

Thanks for your input Esme. Nope, no care plan book, I might borrow one from the library or download one from the database though.

Thanks for all the help Esme & Grntea I don't have a careplan book, we have not been advised to buy one either I believe we are to use our prescribed texts and academic journal articles as a means of research and evidence. The info provided about the patient is all that I know so I can't determine if he is experiencing other symptoms without doing further tests (which is impossible seeming this is an imaginary scenario, I can't tell if he has dry mucous membranes or decreased skin turgor etc). The first thing that alerted me was the fact he has not had fluids in 2 days, although this is subjective data do you think it is still worth prioritizing first? To me, his vitals are all concerning yet can they all be related to the fact he has not had fluids in 2 days? So assuming I take care of his fluids - would this also take care of his vitals? - What about the vomiting? Could that be due to the pain he is in or could he could in fact have some sort of infection that is related to his fever/HR etc (another possibility, but how do I prove that this is what it could be?) Am I on the right track by taking care of fluids first and vomiting second? Is there even an intervention for vomiting or would I be better to address his pain, hmm critical thinking lol