Nurse_AV

It is always helpful to check past medical history as well as current medications. Don't forget to ask your patient about that medication list and how closely they follow their medication regimen (i.e. "When is the last time you used your emergency inhaler? How frequently were you using it before you came into the hospital?"). Auscultate and assess lung sounds, SpO2, respiration quality (including use of accessory muscles or not) and rate. Heart rate and blood pressure are also important here because if they are in respiratory distress, vitals change. Monitor trends. Arterial blood gases, skin turgor and absence or presence of cyanosis (peripherally or centrally - around lips, face, etc.) Long winded but I hope this helps!

right! okay well it concerned me because in the orders for blood cultures it even states "preferred to avoid use of a central line whenever possible". my preceptor is an awesome nurse and has been in ICU for 10 years so i hate to question her, but it just seemed odd to me. at least one of them should be a stick i thought, but i would honestly prefer both of them - unless like britpanda said the suspected source of infection is the line itself. thanks for the replies.

When a physician/practitioner orders blood cultures on a patient who has a central line and an arterial line, do you draw one set from the central and one from the art line? I ask because I am a new ICU nurse (have been a nurse for over 8 years total but just started in critical care a few weeks ago). I have worked in this hospital for over a year and I was taught before that only ONE specimen should come from central/PICC line and not both due to the high risk of contamination of the line. My preceptor disagrees and we drew cultures from a PICC and the second from the art line. Also, I was told not to flush/waste 10mL when doing blood cultures and just to aspirate blood immediately and use that as the specimen. Is this because the flush could wash away potential bloodborne contaminants? My preceptor has been great but she really wasn't sure on both of these questions. Thanks in advance for any help with this!

this is what i was thinking about... it just makes me wonder what the effects might be on hospitals and nursing homes. i work in a nursing home on a rehab unit, it happens to be a very nice facility but we've already had some cuts made plus no raises this year. just causes me concern. weather or not people use obamacare is not my concern, it's the federal funding it takes to make obamacare work on a national scale... i feel like that might affect my job in the future since hospitals and nursing homes depend on medicare money to run. yikes. :/

I've read and heard a lot of things about Obamacare. I'd like to hear what other nurses think the implications, if any, that Obamacare will have on their jobs. And where do you work? Nursing home? Hospital? Dialysis center? Home health? And please explain why you think there may/may not be implications on your job.

I feel your pain! I once had a job where it seemed like I was always getting in trouble for unpredictable things. Better to move on to bigger and better things than keep getting in trouble. Gotta find a place that understands you're one person taking care of multiple people. Big deal some lady called another lady a *****. I would have documented something about inappropriate language and resident was redirected, etc. But a write up over that? Yea, maybe find a facility that will treat their employees with a little more respect.

I think you were right to give the Lantus unless, like Sun0408 said it is a chronic problem. At which point the resident's BGs and insulin therapy should be reviewed by the doc. I am an LPN working in LTC currently, I don't believe I've ever held Lantus. Since there is no peak with Lantus it is not an insulin that would suddenly drop blood sugar. And also I agree with you that we do need more RNs in LTC! I'm going through LPN/RN transition right now. I work with a lot of RNs on a rehab unit and it's wonderful to work with such great nurses. That's what prompted my return to school. :)