turquoise

This one piece of advice is what has helped me more than anything else. I asked one of the "never miss" nurses and she said to close my eyes and feel around. Things that were hard were most likely tendons or such and the "springy" things were probably veins. I don't have great feeling in my fingers but i've done much better when I wasn't trying to stick by sight. (I do open my eyes before i actually stick though.)

I'm curious to see what oter institutions have as policy. Where I work, we pull sheaths on the regular floor (not just in cath lab or icu) we do not flush the line before pulling, and we do it manually. If bleeding occurs after the pull and requires pressure for along period of time, we use a femostop. What about you all? Do you pull on the floor, use a c clamp or femostop vs manual , flush or not flush, etc.?

acuity? i've never heard of that (actually i have but i'm pretending) generally 6-8:1 and it does not matter if you have 8 pt with arterial sheaths or 8 fresh open hearts with chest tubes or 8 frequent flyers that sleep all night and set their alarm to wake up every 3 hours for pain med and cookies. Why is it that the more pt safety goals institutions set forth the more dangerous things become??

I work on a floor similar to yours, pre/post op open hearts, pci, etc and we have insulin drips on our pts. We have 23 beds and 3 nurses (2 RNs and an LPN or 2 LPNs and an RN) sometimes we have a tech. You can do the math on how many pts per nurse. (Keep in mind LPNs cannot take or check orders, draw labs, push meds, titrate or even hang any type of drip even heparin-so for the one RN this makes life interesting:uhoh3: :angryfire ) anyways, other than having to check the sugar every hour which is such a PIA the drips really are not that big of a deal. (That is until the cath lab sends you 4 pts with arterial sheaths in their groin and you've already got 2 on dopamine gtts and 1 on ntg gtt and...I digress. Anyway, maybe I don't see it as a big thing because it has been like that where I work since the beginining but once you adjust to the change and the added work it won't be "so" bad. (I won't comment on how unsafe I think it will to have all the pts your talking about as well as adding this though.) One more thing since your not used to it. Remember that insulin helps draw K+ out of cells. I had a pt that was 2.7 and received a k rider and after the rider was 1.7 due to the insulin gtt!! To date the lowest K level I've seen (and with NO compliactions thankfully- though I don't know how she didn't have problems!)

thank you all for your comments and recommendations. It has been reported to the proper people and hopefully, the right thing will be done (whether that right thing is absolutely nothing, or removal from the situation.) Thanks again.

from midnights- doing extra things such as baths (which is a morning shift responsibility) just to be nice and make their day go a little smoother and then getting yelled at because i didn't have enough time to do their work for them. (excuse me? what is more important, Mr. Skank's bath, or the guy that coded in 57?) Nusring instructors that don't believe or get PO'd because a student knows something that they don't- it is not because they're more intelligent, it's because they're learning now- not 20 years ago. Staff nurses who think students are a pain. If students were not here you would have 13 pts not 2 and I don't believe asking how much fluids a CHF pt can have from 7-3 is an inconvience (especially because they wouldn't have to ask if you put the sign in the room that stated that fluids per shift as per hospital policy.) I am a smoker, but I agree with the comments about smokers taking "extended" breaks (although I don't), but I won't limit it just to smokers. Many non-smoking nurses take 50 minutes lunches and when they are on the floor, spend 15 minutes here and 20 minutes there gossiping or calling their boyfriend/ mother/ best friend, etc. If you have things to get done, do it on YOUR time, not when I'm going to have to do your work and mine because you''re lazy and disrespectful. Also, I have a serious issue with people who "nap". I'll be the first to admit, it's sometimes hard to keep your eyes open (especially when it seems you're always on the job!), but please do not expect the rest of us to do your job because you stayed up late watching a movie (3 nights in a row.) And lastly (I think) one particular guy will ask a pt something once and if they refuse (even if it is absolutely necessary and the pt is not of sound mind) he doesn't ask again and just figures the "females will deal with it" GRRRR!

I used to work in a nursing home, so i have many strange tales to tell, but i'll just tell you this one. One of the residents on this floor always got up around 2 am and came out to sit in a chair. I was sitting in the lounge on the south floor one night (the lounge is in the middle of the floor) doing my books. I saw one of this resident sit down in the chair beside me. I said good morning and turned to look at him and he wasn't there, of course i went to his room tto see if he was there, which he was and sleeping soundly. This happened multiple times. I didn't say anything because i thought maybe i was nuts or nodding off for a few seconds or something. A few months after this started one of the other emplyees reported the same occurence to me. While on a nother floor one night (where the activity room was) I started looking at some old photo albums during a slow time. Low and behold, i found my guy. I showed the book to the other worker and asked if anyone looked familiar (he picked out the same guy!) I asked someone who had been there longer who the guy was. He had died a few years ago, and in the chair i always saw him sitting in! (Insert Twilight Zone theme song here)

AMPUTATION AMPUTATION AMPUTATION! I've had nightmares since i was a little girl about legs being blown off. It's my biggest (only really) personal fear. Even amputaions from WWII that are healed just gross me out. Arms don't bother me quite as much but legs YUCK! Something that I am not afraid of but just makes my skin crawl is maggots. (I'm convulsing just thinking about them.)

Hi all, I am a nursing student by day and a child care worker by night. This question is related to the child care, but I thought some of you may have delt with a similar situation and could offer some advice. Here's the situation: I work at an elementary school grades Pre-K through 6. One of the younger children ( age 5) has been a cause for concern for myself and my co-workers. He often has bathroom issues, which I know can be a sign of sexual abuse. He very rarely has an injury, but when he does the story constantly changes when ever he tells it and it differs from what his mom says. His mom is almost always the one that picks him up (occasionally his dad) and his parents do seem to care about him. He has mentioned to me a couple of times about how his parents scream a lot at home at each other. The other day, we were making "scary" masks and he said something along the lines of "it would only be scary if it looked like a paddle." I tried to get him to open up a little bit more about it, but he clammed up immediately. My main problem with all of this is that everything can be explained. For instance he had a stomach bug (and his mom said he was taken to the doctor) when he was having daily bowel incontinence. (urinary incontinence has been a problem 3-4 times as well. however, he is young.) His mom said the cut on his face happened at school (although he said otherwise and the cut looked like it had been healing for a day or two- it was monday, it looked like it had to happen over the weekend) The same day as the cut on his face he had a few other bruises which he said happened from a fall down the stairs. Later that day he fell down the stairs right in front of me -maybe he is just a clutz. Not even looking at any of these occurences, I just have had a gut feeling (which is rarely if ever wrong) that something is going on and one of my co-workers feels the same. I don't want to turn someone in on gut feelings and i dont want to turn someone in who is innocent and cause problems that they dont need. At the same time, i just can't let go of the feeling that something, if only a rare occurence, is going on at their house. I guess I just feel that even though things can be explained, medically or otherwise, i just feel that there is too much explaining that needs to be done. Am i just lloking for something to be wrong? I'm sorry that this is such a long post, but i just needed some inputon this, and at the very least how to get rid of the guilt gut i feel if nothing is really going on and i cause problems. Thank you all.

i'm not sure what a fundal plication is (everytime i try to google it i get Mediao sites instead of a definition). My mom had a paraesophageal hernia repaired last May. (Is that what you were asking about?) About 75% of her stomach had slipped up into the thoracic (?) cavity. It took about 4 hours to repair and there is a high risk of damaging the spleen and having to remove it (the surgeon nicked hers but was able to repair it.) She had a 'Y' incision (part under her breast and part straight down her abdomen) (paraesophageal hernias are apparently a rare type of hiatal hernia- from what I found only make up about 4% of hiatal hernias.) She has continually had problems since then with h-pylori infections and her symptoms have now returned. They did x-rays yesterday and found an abnormality; she meets with her surgeon again next week to see if they need to go back in and fix it again. She recovered fairly well from her surgery (considering she is a senior and has diabetes, HTN, etc.) My grandfather had a sliding hernia repair but it was back in the middle ages where he had to be upside to with an NG tube for a month and a half or so. My mom didn't have to have an NG and she wasn't NPO for very long after surgery. I hope I'm talking about what you asked. If not, sorry for the confusion!

I know someone whose ex-girlfriend wrote bad checks on their joint account after they split just to tick him off. His application to sit for the board was denied (after FINISHING nursing school mind you) because of this (even though it was many years ago and the situation had been rectified. (it was still on his record though.) I also know a police officer who had gotten into trouble for "roughing someone up" who also was not aloud to sit for the board. It is my understanding that any offense, no matter how minor, can prevent you from becoming a healthcare professional (even a nursing assistant) My advice is to have your friend talk with someone in the department that regulates nursing and the NCLEX in your state and on a federal level(can't remember for the life of me what the name of these organizations are- it's been a long few days!) . They would be best able to answer the question.