RNexplorer

I know this is an old thread, but I'd just like to comment. I understand wanting to always follow the doctor's orders, but there are certain situations in which there isn't time to wait for a new order. Susie2310, sometimes you have no choice but to give a nurse's dose or you really risk a central line being pulled, the patient falling, or worse.

What's rude is nurses who make fun of patient's bodies. It is cruel and distasteful. I don't want to hear you criticize someone for the size of their genitals, the shape of their nipples, or anything of this sort. I would never want a loved one to be near you! Have some compassion. Why did you become a nurse anyway?

No, this is not an essay question. I was just curious what people's thoughts are on this.

Regarding interpersonal skills during a code situation, what are your thoughts/opinions on this issue? - What interpersonal skills do you think help or hinder a code? - Do you think respecting your colleagues is important? Why? - Do you think your unit emulates these skills?

I wish I could handle difficult people by being more assertive rather than emotional. Sometimes I just have to shut my mouth because I feel tears welling up inside and don't want other people to see that. But then I get trampled on by bullies/people who take advantage of "nice people."

Thanks for this information. Do you know of any really good resources on CVADs?.. There are so many types and I'm often confused about them... Yes, I assessed the site and checked for blood return. I also tried to get more information from the physician, but his description of it was so vague. I think the nurse was angry because I questioned myself and didn't quite believe that this CVAD site was also the site of the PCI procedure. It seemed strange to me. I think she was mad that I wasn't more certain of what I was reporting. I get that. I just wish she would have been more respectful and listen to me rather than interrupt every 5 seconds. I would never treat anyone the way she treats me during handoff.

Thanks for your response. It has really helped me put things in perspective and create something positive out of the situation. I will definitely find the answer and add it to my knowledge base. Also, I am looking forward to trying your technique with those chronic interrupters.

HeySis, thanks for the encouragement. The problem is I'm not a new grad. I've been working for 3 years as an RN. I don't have this problem on every shift, but it happens once in awhile... There's no excuses for it. I should have asked the cath lab nurse to explain the access site, but for some reason it got missed. I was running around like a chicken with my head cut off all shift, hoping I wouldn't miss anything, and I didn't even think about the access site after asking the doctor the one time. Boy did I feel like a stupid nurse when my relief came in. This relief nurse has a way of making me feel really uncomfortable whenever we get report. She's always interrupting me asking questions and never having the patience to listen to what I'm saying. I lost my confidence and could barely communicate with her. It basically looked like I was a dumb dumb.

At times, I feel worried about my ability to perform adequately in this profession. Patient was admitted from the cath lab. I was confused with the access site description. There was a single lumen central line at the access site, and I had never seen this before. I had wanted to ask the cath lab nurse to explain more about this access, but there were so many other questions I had about the patient. The report was lacking in so many areas... and she was in a rush to transfer the patient. In the hustle and bustle of things, somehow I forgot to ask her more about it. When the patient got to our floor, I asked another nurse about this central line and also asked a doctor. But I was still confused about it. There was so much to do with this patient, and I was running around trying to get it all done. There wasn't a lot of extra help this night, and I had a demanding family and ethical issues to worry about, as well as a ton of new orders, and all the patient had for access was this single lumen catheter at the access site... By the time I had to give report to day shift, I couldn't explain the PCI access site to the oncoming nurse and she was pissed off (for good reason). I just feel so incredibly inadequate. This is basic stuff I should be doing. I feel like a terrible nurse sometimes, and I've been crying since I got home! Just looking for helpful advice/comments/encouragement...

For the following basic question, elite reviews and Barron's are giving different answers: What vent settings would be important to have for a patient with asthma? - Elite reviews: "a longer inspiratory time" or an "inverse I:E ratio" to keep the alveoli inflated... - Barron's: "a longer expiratory time to decrease auto PEEP." I'm really worried because I've been studying a lot of questions from elite reviews, and I'm thinking that if they are wrong on this question they may have been wrong on many others!! Can anyone advise about these resources? Thanks! I'm so nervous because my exam is coming up.

When your patient is on a heparin drip, and aPTT comes back at say 45 and you need to give a bolus... Do you think it's reasonable to bolus at a Y site closest to the patient? Or do you disconnect and bolus directly into the vein? After bolusing at the Y site, I started to wonder whether my next aPTT would be accurate... A "bolus" is not meant to take an hour to infuse to the pt, so wouldn't this affect the end result? i.e. The result at the 6 hour mark might actually be a bit lower than it would be had the bolus been given in one shot?

Thanks for the heads up!! I will try to enjoy the learning process and realize that things will be easier when I start out on my own.

Thanks for your advice mbrookeRN. My experience in the ICU is minimal - less than 6 months, and I received very little orientation at my most recent position. I will definitely use my preceptor and try to benefit from her knowledge and experience. I just want to make sure the unit likes me too.... I'm actually not from Texas, and I've never had a 3 month orientation to a new job so I don't know what to expect. Just feeling nervous because I really want this opportunity to work out positively! I'm very excited about the facility and don't want to screw this up.

I tried to do a search on this topic but was not able to find an answer, so I decided to post the question myself... I'm starting a new position in a MICU with a 3 month orientation. I'm just wondering what I should expect for my first buddy shift? Is there anything that preceptors look for in their preceptees? How can I be helpful and not cause extra work for my preceptor?

In shift change at the start of my shift, I was told that the patient refused to wear the BiPAP because it was really uncomfortable... I'm not sure why he was okay with the non-rebreather.... I really think this patient's pulse oximetry must have been inaccurate... The paO2 was showing an elevated level, I think it was almost 120 mm Hg.. It was not a depressed value. As we are all aware, many things tend to lower the accuracy of pulse oximetry. This is a huge mystery to me. The more we discuss it, the more muddled everything becomes. I don't think we are going to find an answer to all these questions on this forum b/c we don't have access to the actual lab data and clinical history and so on... However, it's been fun chatting about this and I will definitely use this learning in future. Thanks to everyone's comments :)