eukaryote

I think you did the right thing. You assessed the pt's vital signs and found he had a high blood pressure and increased pain. You gave the blood pressure medication that was scheduled *at that time* and gave appropriate pain medication per the order. His blood pressure could have been elevated because of pain, or because he was due for a blood pressure med, or some other reason. I would have done the same thing, and then rechecked the blood pressure in 30 minutes, and then an hour. If it was still elevated, then I would have initiated the protocol. If I had called the doctor right away, the conversation would go something like this. "Hi doc, my pt's blood pressure is 188 systolic. They are in pain and have a blood pressure med scheduled." Doc: "Did you give the med?" "No, not yet, I'm instituting the hypertensive protocol." Doc: "Well give the med and call me if it's still high in an hour if it's still elevated. Click."

Like the previous poster said, it is a core measure for stroke patients to be on ASA, antithrombotic and a statin by day 2 of admission. There is a risk of conversion, like you said, but it is small. I also work in a stroke center, and I've only seen it once. This isn't research based, just my opinion, but I would say the risk of the pt. throwing a secondary clot would be greater, particularly if they are in a-fib and/or immobilized d/t the stroke.

Our floor also accepts these types of medical patients as our hospital doesn't have a step down. The floor I work on hyponatremia is often managed (SIADH, etc..) I admitted a patient this weekend with a Na+ of 113, K and low Mag...can't remember what it was. These patients have to be managed closely, but as long as they are otherwise stable and assigned to an experienced RN, I would not send to the unit.

It's really important for floor nurses to understand the way the ER functions. It's literally crazy down there. I've had to float there a few times, and yeah, I can understand the need to get ppl outta there! When they call report, we usually do a short SBAR, I view the appropriate info in the computer that I need, labs, radiology, ect and just need the absolute skinny. Also, I make sure they know I just need the basics - anything critical pls address since it could be awhile before I have orders. ABX, blood, whatever - just send it with the pt. and I will complete it. That stuff doesn't need to be completed in the ER.

Does the ER have an admissions RN? We had a similar issue to this at our ER, and they hired an admissions RN which has been immensly helpful. The problem I have with quick throughput times and not getting report on ER patients, is that often patients come to our floor and the attending will see them upstairs/when they are ready. This could mean we have patient on the floor for an hour or sometimes more with no orders (we cannot implement or view the ER orders). If we receive an unstable patient, or a patient with no report, this is a huge patient safety issue. I recently got an ER patient - in report they told me she was stable, BG was 73. On a hunch I checked the BG when she came up to the floor - it was 23!! I had to page the attending 3x and had to override the system to push d50 - THREE times because it took the attending 45 minutes to get back to me (which we are allowed to do with d50 on my unit). I was about to call a rapid. This is an extreme example, but a good reason floor nurses need a good report. If that patient had just been sent up to the floor without a report, in the middle of something crazy or at shift change and had just been left sitting in the room, there could have been a very poor outcome for that person.

The problem is that if it's stocked and labeled in that patient's med cart, they are being charged for those meds one they are deposited by pharmacy. That is why you should not give them to another patient (other than that it violates the 5 rights). Ask for pharmacy to stock those meds in the accudose for single use, or unfortunately, you will need to return the discharged patient's medications to the pharmacy so they are not charged for unused and unopened medications. Then, have pharmacy stock the correct meds for the correct patient (if you can't do the accudose thing above).

Seriously. My daughter has epilepsy and I have witnessed hundreds upon hundreds of seizures of any and all types. Never once has she injured anyone and/or herself for that matter. If she ever wanted to be a nurse I would be thrilled because of all her experiences and empathy for others with health issues or disabilities.

How could she hurt someone during a seizure? By falling on them? I know plenty of nurses w epilepsy, and even met an NP w epilepsy the other day. Epilepsy has a spectrum of effects on a person, however, most people who are well controlled live normal lives and function just like the rest of us.

Being a CNA is much more physical toll on the body then being a nurse. Nurses endure other kinds of stress, at higher rates than CNA. I have been both. Being a CNA can be backbreaking work. I had shifts where I cared for 14 pt without sitting down the entire 13 hours. As a nurse at least I get to sit down once in a while to chart or make phone calls. However, I'm much more stressed out as a nurse. Just my .02.

Need to understand more about what was going on. Why was she asking you for help with a bed change? Was it a code brown? Bariatric pt. about to fall off the bed? Did patient vomit? Was pt. agitated? Confused with tons of lines? Was it a patient with a hip fx lying in a puddle of stool? While she had no right to yell at you, I can think of a lot of reasons why someone would ask for help and be frustrated when they were told "no" for whatever reason. In my experience most CNAs are completely capable of handling a bed change on their own and don't ask for help unless they REALLY need it. I would be mad if a CNA yelled at me too, but I'm a grown-up and having been in both roles, I understand the frustration on both sides. Instead of being angry at each other, try to see things from the other person's perspective for a moment. You are a team, and bottom line, need to work together and help each other out. I just don't see someone flying off the handle for no reason. I think there is more to the story like something might have been going on with the patient that put her at risk. Was there someone else that was able to help her?

If you're a military spouse, you can work as a Red Cross volunteer nurse at Tripler. It's unpaid, but it counts as experience and I know of a few people who've eventually been hired that way. Otherwise, you need to have 3 years as a civilian nurse to work there as an RN. I know some nurses have gotten in working as a contractor. Otherwise, the job situation for new grads is very grim. I am local and worked as a CNA after graduating, but ended up moving away for my first RN job. Please take the advice people give you very seriously. Of my graduating class, only a few local people had jobs within the year after graduating while everyone who went to the mainland pretty much got a job right away.

I would say that it depends on the area you live in and the facility's policy. In my area, it's common for new grad RN's to work as a PCT for up to a year after licensing before securing a new grad position - it's a very competitive area. I did this in fact. I wouldn't recommend it though. Working as a PCT has a different set of priorities. It's a good way to get used to the floor and to handling a busy acute care patient load, but you will lose your critical thinking skills quickly. So, if you do it - do it for only a short period (3 months or so) or not at all. It's also difficult not to cross boundaries, because as a trained nurse you will still think like a nurse and want to act accordingly.

No it wasn't offered online when I took it. And honestly I don't recommend taking pharm online. It's a really crucial class to understand for nursing. The Maui one is the notorious online one.

I took pharm at Windward. I won't lie, it's a tough class...but she offers tutoring. I found that I knew my drugs way better than the students who took the Maui or Leeward pharm. so if you want to learn, take Windward.

Thank you, I did mention it. It was not a big deal. :)