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I agree with Whispera about going to a family doctor. I was diagnosed with ADHD in high school and have been taking Adderall since then, and to this day I have never been treated for it by a psychiatrist. There are a lot of family practice doctors in my area that specialize in or treat ADHD. If something were to happen and you had to take a drug test you would definitely need a current prescription. I would probably take it anyways because YOLO, but that's probably not the best idea when it comes to protecting your license.

Our spinal drains are placed by anesthesia or neurosurg in OR and managed by vascular surgery post-op. We also level and zero at 4th ICS midaxillary line per our protocol.

I also work at a large teaching hospital and come across this occasionally. We have a doc on call on our unit, so I just page them to come suture it.

I agree with the PP, and would like to add that if you have questions, you need to ask them! Even if she is going too fast. Pull her aside and tell her she is going too fast for you to learn, and then ask the questions you need to ask. She might not even be aware she is going too fast for you, and she will never know if you don't tell her. Unless you are going so slow that it creates a problem with time management, she will most likely make adjustments for your learning style. However, it's not acceptable to have been there for a month and still be afraid to touch a patient because you have no idea what you're supposed to be doing. I don't mean to sound harsh, but preceptors on my unit would start questioning their preceptees' abilities to be assertive and a safe nurse (if they hadn't started questioning that already).

I don't know what I would have said to him, but I definitely would have notified my charge RN, who would have then called the police (my hospital has its own police department) and notified management.

This EXACT same thing happened to me when I was in my ICU internship as a new grad. All I remember reading on that vial was 50 mcg/ml…completely ignored the "2 ml vial" part. And I definitely pushed all 2 mls when the order was for 50 mcg. Thankfully nothing happened to my patient! Definitely a learning experience though!

YES!! I hate having to travel with my patient. Even if it's a quick and easy CT head (takes less than 20 min to get there and back). Don't even get me started on MRI and IR. Having to leave the unit to get anything besides food/coffee makes me want to die.

Intubated patients tapping on the bed rails to get your attention ...and the doc won't give you any more PRNs for sedation/pain. I. Can't.

What was the rate of the fentanyl?

I work in the ICU, and have bags of fentanyl, versed, etc. hanging "unsecured" when a patient is on a continuous gtt for pain/sedation. The only pumps that require a key to access are the PCAs and epidurals. All other narc infusions hang on the pole just like NS and IVPBs. I've never thought about the security of that before now, but as far as I know there haven't been any incidences of someone grabbing a bag of fentanyl off the IV pole and running out (at least at my hospital).

If a patient is alert and able to state their name, date, where they are, and why they're at the hospital then they're A&Ox4. This is assessing their neuro status, not their mental status.

I work in an ICU and we hang it via gravity and run it wide open.

From the Texas BON website: [h=1]Licensure Eligibility[/h]To check your eligibility for renewing your license, please review the following: Been convicted of a misdemeanor? Been convicted of a felony? Pled nolo contendere, no contest, or guilty? Received deferred adjudication? Been placed on community supervision or court-ordered probation, whether or not adjudicated guilty? Been sentenced to serve jail or prison time or court-ordered confinement? Been granted pre-trial diversion? Been arrested or have any pending criminal charges? Been cited or charged with any violation of the law? Been subject of a court-martial; Article 15 violation; or received any form of military judgment, punishment, or action? NOTE: You may only exclude Class C misdemeanor traffic violations Source: https://www.bon.state.tx.us/licensure_eligibility.asp

We also do this in the ICU I work in, minus the code meds (don't get me started on that one ). All patients are hooked up to the portable monitor and VS are continuously monitored by the RN when transporting patients to a procedure off the unit or to a med/surg floor if they have tele orders. We also can't travel alone - either a tech, RT, another RN, or MD must travel with us. A patient going to the floor that doesn't have tele orders isn't hooked up to the portable monitor and a tech can transport them without an RN. Our RN to patient ratio is 2:1, so when I leave the unit with one of my patients I give report to another RN on my other patient, and I try to give report to a nurse who's patients are relatively stable. When tele patients are transported to the ICU they are disconnected from their tele monitor, connected to the lifepak monitor from the floor's crash carts, and transported to the ICU being continuously monitored by the rapid response RN. The primary population in our ICU is surgery/trauma, so many of our patients are younger and often without extensive cardiac history or other comorbidities. However, I have never thought twice about putting any of my patients on the monitor when leaving the unit.

This right here says to me that this unit/facility doesn't value their employees. Maybe I'm "spoiled" by working in a large hospital that has a lot of resources, but I think it's ridiculous for you to have to find a replacement for your shift under these circumstances. Especially because you notified your boss of the situation as early as you possibly could - like, you could have just called in sick, but you let them know what was going on like I'm sure you're encouraged to do. Don't go to work and go see your grandmother. You made an effort to find someone to cover your shift, but you couldn't. Like a PP said, take the write up and keep your head down for a couple months. Family comes first. It sucks that this unit/facility isn't more understanding of situations like this, but I would rather get written up than miss being with my dying family member. I don't know what the job market is like in your area or if this type of behavior is typical of hospitals/etc. in your area, but I would start looking for a new job.

I've seen an RN assigned to be aide/PCT once - we had too many RNs scheduled and not enough aides/PCTs. Normally, the charge nurse would ask the RN if they want to go home since they aren't needed, and an aides/PCTs would be called to come in. That day I think the RN wanted to work, so they worked as an aide. It's not a regular thing though. If our unit doesn't have enough techs, either other techs are called in, we get techs from float pool, or we just don't have any techs for that shift. But we don't we don't call in RNs to be techs. I personally wouldn't mind working *a* shift as a tech as long as I was getting my regular RN pay, but it seems like a waste of money to the hospital to do this on the reg.

Chapstick. Tylenol/advil, etc.

Since the question is asking about the infusion rate of the initial dosage of 1 mcg/kg/min, you don't need to worry about the titration part. Just calculate the rate for the initial dose. In an actual order on the MAR there would be titration parameters (like Loo17 said) - for example, titrate by 0.05-0.1 mcg/kg/min every 5 min to keep MAP >60 or SBP >90. So if you start the infusion at 1 mcg/kg/min and the MAP is

IMO, you shouldn't be giving these drugs if you don't know the onset, peak, and duration of action. Especially since it sounds like you give them pretty frequently.

I was a CNA/PCT in nursing school and I would frequently have to sit in 1:1's with patients who had "AMS" (and by AMS I mean "that one dose of dilaudid made them loopy" and now they need a sitter….). We usually had a computer in the room to chart VS and hourly 1:1 rounds, and I would read the notes and assessment flowsheets when I was bored. The nurse would come in the room once or twice at the beginning of the shift to introduce herself, give some meds, and then a couple hours later an entire head to toe assessment would be documented without ever laying a hand on the patient. Now, I never got my acceptance letter to the nursing school of witchcraft and wizardry, so I can't fully attest to what they teach there, but I'm 99.9% sure that touching the patient is required in order to listen to their lung sounds or determine their pulses are a 3+. If there are some magical assessment techniques that allow you to gather assessment data from 3 ft away, I am not aware of them but I would love to learn. But seriously, assessment is what separates RNs from LVNs and CNAs, etc., and if you aren't willing to do at least one head to toe assessment during your shift (preferably at the beginning) then why did you even become an RN in the first place? You can do a quick but thorough head to toe assessment in less than 5 minutes - if you don't know how then you should probably practice at home until you nail it down.

To the OP, you are not being dramatic. We bathe our patients as part of their admission to the ICU, but AFTER they're on the monitor, assessed, labs are drawn, and meds are given.

I'm from the Dallas area, but I graduated Dec. 2013 and received my ATT January 7th

Agreed. On my unit we frequently assist with bedside procedures or travel to another part of the hospital for a procedure (i.e., interventional radiology, cath lab, etc.). While we aren't responsible for obtaining the consent itself for the various procedures, we are responsible for making sure the consent has been completed and that it has been signed by the appropriate person. Since many of our patients are intubated/sedated or otherwise incapable of being consented, and next of kin situations can get a little hairy, I was always taught to verify that the correct person signed the consent. Always look at the signatures just to be sure. I would think this could potentially be a fireable offense, but it seems more likely that you would get some kind of disciplinary action.

I work in a large urban hospital that has completely overhauled their policies on skin prevention/management over the past couple years, and briefs aren't considered "best practice" and aren't used on any unit - ICU or med-surg. The material briefs are made out of don't have "moisture wicking properties," and therefore don't absorb any of the moisture d/t incontinence. The only thing briefs accomplish is increasing the amount of skin in contact with urine/stool, and thus increasing the risk of skin breakdown, UTIs, etc. We have these big blue and white pads that are capable of absorbing large amounts of moisture and are strong enough to be used to pull pts up in bed without tearing. Seriously, they're amazing. And a previous poster mentioned, "if you note skin breakdown on an incontinent patient and your facility allows it per protocol, an order for a foley may be helpful." At my hospital, incontinence is not a indication for a foley even if the pt has skin breakdown. Per the "CAUTI police," the risk of a UTI outweighs the risk for skin breakdown, and that pt's incontinent of urine should have their toileting needs frequently assessed. Also, we have a skin cream that acts as a barrier to prevent urine/stool from just sitting on the skin, and that this cream (along with freq. assessments for incontinence) can be used for incontinent pt's with noted excoriation or other skin breakdown. Not sure if this is practiced everywhere, but it seems to be successful.

Are you studying for NCLEX? If so, be careful - you ASSUMED the patient was taking heparin because of his diagnosis. You actually could have eliminated answer 1 from the get-go because the question never mentioned a drug. Make sure you understand what the question is asking before you answer the question.