regerterb

Just having a bit of trouble getting over a recent death in resus with ongoing guilt. i had a man in his 50's come from acute beds on morning shift....he presented with chest pain, on a background of aortic valve replacement, cardiac disease..smoker etc. the nurse looking after him moved him up the bed lying down..immediately became diaphoretic, pale, grey...moved to resus to me... was hypotensive at 86/56, sa02 95% on nasal prongs when I was able to get a good trace as was so so sweaty and peripherally shut down......heart rate 89...temp 35.5, resps 22. i put him on 6L 02, he had fluids running....monitoring..I even put defibrillator pads on him as he just didn't look good. Cardiac team present at time and did an echo...was all cleared of Stemi or non stemi.....had an echo done...all clear...they were thinking infective endocarditis. Commenced him on antibiotics ? Cold sepsis.....has some frusemide as had small amount of fluids in bases on CXR....clopidogrel loaded, and had digoxin.......had a small non productive cough.....BP best we got was 98/65 systolic.....refused to lie flat.....but was talking with cardiologist etc.....after than remained as above...sa02 96%, Bp as above.....still extremely diaphoretic. For about 45 min...then later on.....dr in room, nurse educator in room.....was getting ready to put a Catheter in...ICU dr reviewing him when he became agitated, pulling leads off..pulling oxygen off.....Doctor notified...put him on 15L 02....was going to commenced him on bipap when he voiced that he couldn't breathe...sat bolt upright.....100% 02 applied..stated he was dying then became cyanotic...into cardiac arrest and died. Struggling with the "did I miss something". What more could I have done...I followed all drs orders...but maybe he should have been on more oxygen initially? I read the echo report later on saying he had a small pericardial effusion....but...I just can't shake feeling guilty that maybe I didn't pick up on something..even though I can think of what. 😩

Hello. Again Tonight I was taking a lady up to the ward that had had intermittent chest heaviness for the past 4 days....she was off to telemetry for overnight monitoring...stable..no pain..etc. all bloods clear and EKG clear. Its about a 2 minute trip to the ward..got in the elevator..and realised i did not attach a mobile telemetry to her....did not want to take her back down and waste more time so took her to the ward where obviously they were not impressed she wasnt on mobile telemetry..clearly.my.mistake..bah! I just cant stop thinking about it and what could have happened..just so stupid 😠i told my.manager who told me not to do it again and just check everyobe that goes up if they need monitoring. I have a hard time letting things like this go any tips??

A pt came in post overdose of Paracetamol..was written up the antedote for 80ml...this was to be put in a bag of 500ml fluid..as per the protocol the dr printed out..for this hospital.so i did this....we.both checked with our in charge that it was correct..she said oh you ha w to remove the 80ml of fluid to make up the 80ml of antedote....then she said oh that should be ok just hang it as we dont have any more stock left...so i hung it...about 40 minutes later i was reading the protocol the dr printed out and on the back (not where the doses are) was written in fineprint about removing the fluid first. I stopped the infusion and re told the in charge nurse who said to ask the dr....so he says no no its fractionally too diluted..just start again. So i tell the in charge and she says oh ok ill just get some.more from pharmacy..to which i said i thought there was none left....as per.previous conversation...otherwise i would not have hung it..... so now i have to put in a report to my manager about how i hung it diluted wrony....i feel like an idiot....iim pretty annoyed and just really dont want to go to work tomorrow. Any wisdom??

I am new to emergency nursing (6 weeks) only just a 3rd year nurse. I was given one day orientation but the nurses I am with are super helpful ans i learn lots off them. Tonight I had a pt with abdo pain...ordered a CT of same and Dr wrote up to give him 2x PO sachets of contrast.half hour apart...so i commenced it at 2100 hrs and the next to be at 2130 hrs. The night shift nurse comes on to shift and says we have to wait until xray call to start the sachets and the patients may be booked in later. I felt like an idiot as I didnt know this i just went off the Drs medication order. I told our manager..and his Dr..the dr called xray and they just ordered an extra sachet..as the CT was for 2230..i even called xray to apologise for what I did..they werent too impressed..i obviously know for next time..and previous times I have given it i have done the same thing with no problem...it must have been timed well. My manager said its not an.issue, no report required no harm was done to the patient and they used to give 3 sachets anyway. I just hate this feeli bf of doing something wrong because...you werent told of the policy..i have looked up the contrast before aswell on how to give it. I just thought the dr knew what time the CTs were before writing up the contrast (lesson learnt!)...any reassurance i always blow these things out more than necessary...

Hello, I am a community nurse currently and had a patient today who required an IDC change-have never had any issues in the previous 11 I have put in for him. Today, removed old catheter, nil issues-inserted fine, he has an enlarged prostate but this has again, never been an issue prior-went in easily, nil resistance, no pain voiced by the client-about 10ml clear urine flowed post insertion (client had emptied bladder 10 minutes prior to visit)-inflated balloon, still-no pain voiced, nil issues. I attached the valve and noticed rose coloured urine had flowed into catheter. He has previously been on Warfarin (anticlot) which has caused some rose return urine before but has cleared up quickly. He is no longer on Warfarin. I advised him to keep any eye on it, drink plenty of water and I would call him to follow up. As I said, I called him at noon-he stated urine flowing fine, clear, nil issues. Then he calls again at 4:30pm-the time we shut and states that he has had no urine flow at all today and catheter completely blocked....I am thinking he may have a UTI as he could not recall that he had called me previously....I advised him to call an ambulance. Does anyone have any ideas as to what could have happened as the catheter went in so nicely as usual....

Yeah I said that to him as it deflates within 4-8 hours of me seeing him..according to him....we'll see, I have already put an anchoring device to his leg so not sure I will follow it up this week

Hi Guys, I am having trouble with a patient I have on home health with his indwelling urethral catheter. Twice he has rung stating he presented to the ED as his catheter "fell out" post insertion-first time he said it was because it wasn't in far enough and second time was about 4 hours post insertion he said that there was only 2ml in the balloon the ED nurse deflated. I have read the ED nurses notes which state that he has pulled on the catheter both times accidentally...I just feel like he is giving me half the story... I check the balloon prior to insertion with 10ml sterile water and both times have put the same amount in. Is it possible for it to deflate in such a short period of time or is it possibly him tugging/fiddling with it has caused the valve to fail that holds the water in place? Both balloons inflated perfectly pre-insertion and both held the full 10ml post insertion. He recently suffered a stroke, has problems with his gait and speech. The catheter goes in perfectly each time, clear urine, about 250ml drains freely. Any ideas??

I am not new to this concept whatsoever, however continually find myself trying to stand up for my specialty. I am a 3rd year RN currently employed within District Nursing. I can not count the amount of times where nurses at my previous employment stated that: -"You will loose all your skills" -"You will be bored" -"That's not real nursing" -"That's the easy route". It just baffles me that there is such fierce competition between wards, specialties, what is counted as "easy" nursing or "hard" nursing. Yes, some of my skills have gone to the wayside-however I have gained SO much. I am now finding myself second guessing the reason I went in to District Nursing--that perhaps because I am younger I need to "do my time". I have 2 previous years on very very busy ortho/surgical wards and was previously a paramedic. It is starting to make me feel like my next job needs to be in an emergency department to somehow "prove" to other nurses that I am worthy?? Where did this come from?-it makes me sick. I feel like you get judged as your quality as a nurse as to what department you are employed in. Has any one else had experience like this? I would love to get in to preventative health, immunisation etc however that is also seen as "an easy out".

Thanks, he does have enlarged prostate aswell so that could have been a factor too.

I currently work in community nursing and had a male urethral catheter to change. Have previously done many male ones before, no issues-however this was a new patient. All was fine (clear urine return) until I started inflating the balloon (which was checked prior to insertion) when the patient stated he felt "stinging", i immediately deflated the balloon and waited 5 or so minutes to try again-urine still flowing freely during this time. I advanced the catheter another inch (there was about 10-15cm until Y section) and tried again-still slight stinging however 8.5ml on water went into balloon. I inserted the catheter at about 8am...called him about 3pm to see if all was ok-stated felt stinging at tip of member however urine still flowing fine-he said this has happened before when his bowels were not open. I called him again the next day to check and he stated at about 4:30pm no urine coming/increased pain to abdo so called an ambulance to take him to ED. He stated they said it was either in too far or not in far enough-he couldn't remember. I am not sure what could have caused this...if it was not in far enough, the balloon would not have inflated and he would have been in immense pain whilst inflating it...any ideas?? I feel horrible and am dreading going back to change it again---i am sure he is too.

I got the job!:)

I went for an interview yesterday for a community nurse position 2 hours away. It is a job I would really really like to obtain. I left 4 hours in advance of my allocated time, however the main road to get to the location was shut due to a 3 car accident, so I had to drive around and through the city which took about 3 hours.......it took 4 hours exactly to get there and I got there on time however had called in advance to say that I may be late. Once I got there I did my paperwork and the nurse manager had just finished with a patients dressing. She came and told me one of the panel members wasn't there yet as she thought I would arrive later than I had and hadn't left yet....there was only one other interviewee there and they left the building once she was finished so there wasnt a ton of people waiting to be interviewed. The interview went extremely well and they joked about themselves being late.... I had called in advance and apologised profusely but ultimately the situation was out of my hands. I am not sure whether I should just give up on the interview or remain hopeful..argh. I thought leaving 4 hours in advance of the interview would be enough for somewhere that usually takes 2 hours max in traffic.... im so dissapointed. Is all hope lost?

I actually spoke to my manager, she told me that the head of the hospital has discussed with them about staffing and that they are not actually employing any more full time staff next year (it is a private hospital). So that means no job for me. She actually said to have as many balls in the air as possible. So, in that case, the other job manager has said I do not need to finish my graduate year to transition into the community nurse job as it is much like an extension of a grad year.....i might just apply on the down low and make a decision IF i receive an offer. Would you take it if say it was to commence 2-3weeks before I am due to finish my grad year?

hmm very good point! my manager knows i wont be staying on as I live 2 hours away and drive each day, sometimes taking 3 hours to get home (where that job is). I mean its 2 weeks difference, 10 working days....has anyone else had this dilemma before?

hi guys, I have completed 10 out of my 12 months in my new grad program. A job has come up recently that I applied for for next year, a 2nd year nurse graduate program within the community-pretty much a dream job for me. The thing is..it commences one month before I am due to finish my new grad. I have reached all my goals for the year that have been set out and the manager of the community program has said i would be able to transfer over to that job without completing my grad year as it is somewhat an extension of a grad year. Do I pass on the job if I obtain it, im just not sure what to do. Do i let my current manager know I am considering it...im just not sure to even go to the interview?. It is the only program of its kind in the state I am in and only advertised once every 2 years. What to do?? Thanks for the advice!