Birdy2

Well, the patient I most recently had did have a slight pink discoloration to chest and neck and itching there. This was with Zosyn. He also had that reaction to vanc when given earlier.

I have been instructed to give medications, in several situations, that a patient was having a mild reaction to. Every time the doctor will order Benadryl to be given with the Med (mostly antibiotics) and there is only itching and/or a mild rash. Is this common? Some doctors will immediately discontinue a med and then others will knowingly order a med that someone’s allergic to and just give Benadryl. It makes me pretty uncomfortable and seems like it shouldn’t be allowed

I would like to know how other moms are managing breastfeeding while working 7p-7a. I have to work three 12's per week and my son is 4 months old. He typically eats every 2-3 hours. I've been pumping at 10,1, and 4 at work. I feed him at 6 before I leave and at 8 when I get home, so I'm missinghis 8:30 pm, 0300, and 0630 feeding. Can some one of you give me an example of your daily schedules? I'm driving myself crazy trying to set one for him that allows me to feed him before work, have him awake and hungry at that time. He takes medicine three times per day and one of them has to be taken an hour before a meal, so it just makes it even harder. I really wish I could just let him make his own schedule, but i can't always. I kind of do let him do that on my days off, but isn't it better to be consistent every day?

Yes he does. I think it has something to do with him having a rough start so less tone, plus the pediatrician we saw said he had a third degree tongue tie. Unsure if she's right about that causing issuwa because he nurses well, but he does seem to have a hard time latching on a paci and also I have to use a nipple shield for him to be able to latch. He did latch a few times at first but then after getting a bottle from nicu nurses who had to feed him when I wasn't there he stopped trying to even latch and got frustrated quickly.

No clinics are open on Sunday and urgent care clinic had no advice to offer other than what I have already concluded myself. Yes it's my child and yes I'm a general Med-surg nurse...not a nicu nurse or pediatric. My son was discharged Wednesday from nicu and I wasn't given much advice on what to look for with seizures. His neurologist said seizures were hard to identify in infants. In fact he himself didn't think my son was seizing, but an eeg revealed he was. Every move he makes makes me anxious. I did ask them how they gave him the medicine and they acted like he hadn't had a problem with it in a bottle with a small amount of milk, but when I tried that he lost a lot out of the corner of his mouth...plus what if he doesn't finish it? Then his pediatrician said give it in the side of his cheek, so I did and he swallowed it, but with much difficulty and then spit up within a few minutes. I just don't know what to do. It seems like I can't get any good advice from anyone, so that's why I thought I'd try asking some nurses who deal with this all the time. Like I said, tomorrow I'll get the pediatrician to see about switching it to a different form if possible, but other than that I don't know what else I can do.

I will definitely call his doctor Monday and the pharmacist in the morning

Good idea with the nipple alone instead of in a bottle but still he loses a lot while sucking on one so not sure if that would work. That's why I squirt it on the back of his tongue and squeeze his cheeks, so he can't spit any out or it can't fall out.

This is seriously worrying me. I mentioned it to his doctor and she kind of blew me off and acted like I should have no problem giving it. I feel like if it were her child she may be more concerned. It's not a drug to mess around with and isn't something you can just stop taking, plus I'm scared to death my 3 week old is going to have more seizures. I'm not even sure how to know if he is. I've read, been taught, and watched videos on it, but infant seizures just look like normal baby movements to me.

What do you do if a baby spits up within minutes of getting medication? I have a baby on phenobarb and every single time he's given his dose he spits up after and I'm afraid he's losing it all. His level was low last check. Also, the only way to get it down is to lay him flat and slowly squirt a little at a time on the back of his tongue while squeezing his cheeks so he swallows. Otherwise the medicine is running out of his mouth or he's spitting it out. In a bottle there's the risk of him not finishing even a small amount and spitting up is still an issue.

So I usually give heparin in the abdomen, but sometimes have given in the patients arm depending on if they were severely emaciated. I figure if they have no subcutaneous tissue on their abdomen and it's supposed to be injected into fat then choose the next best thing, like their arm...if there is more fat there. However, a nurse I work with who has been nursing for over 15 years says that it is against hospital policy to give heparin anywhere except for the abdomen. The hospital I work at has the most unclear policies I've ever seen, but I have never been told that was a rule. I tried searching new guidelines, but everything is out of date. What is the policy at your facility?

I informed my boss that nobody on our shift had even been in that room, but she said I was still the blame for it. She said she knew it wasn't right, but that's just how it is. Also, when I first started this job a year or so ago i made the goal to see patients after report then pull meds, but after the first few nights of people needing meds as soon as I get there and calling nonstop until I get there with them, it became a time issue. If I don't pull meds when I get there and see my patients first I may not pull meds until 9 and they're due at 9. Yes, we have an hour before/after meds are due to give them, but when you have 6 patients that takes a while. Especially when they all need a million things. So anways, I'm gonna attempt to see patients first and also make a note of every time anyone goes in my patients rooms and what they did for the patient while they're in there. We'll see how this goes. Lord knows i don't even have time to chart my assessments most nights, but I'm gonna try.

I ask this because the other night my 91 year old man fell and broke a hip at shift change. I had gotten there at 8, got report, looked up info that was necessary, and headed to pull meds before 8. I pulled one persons and got a call that my patient fell at exactly 8. The tech was making rounds when another patient came to her and said they heard him fall. She goes in there and the bed alarm is off. We have problems with certain techs turning them off so they don't have to deal with it, but it wasn't that tech. She hadn't been in there and i hadn't heard it go off since I got there. My boss said it was going off all day. So you can believe she was pissed. I agree it's unexcusable, but I don't think it's right for me to be fired when I wasn't the one who turned it off. Next time it happens they are threatening to fire the nurse. I admitted that patient and immediately put on all fall precautions. The only thing that wasn't done is move him closer to the nurses station, but there were no beds. Anyways, I am just trying to figure out a way to track when alarms are activated and inactivated and by who. We have tap and go's on our med carts and the pixis...why not have them there? The only problem is hospitals are spending money on ridiculous things and can't afford to buy things that would help keep patients safe...just like they won't pay for sitters. Im just wondering if any other hospitals have come up with a better system. Have any of you ever seen some kind of tracking system for these things ?

Seriously! 90%???? Yikes! I have never taken care of anyone like this patient before or since she was discharged lol similar, but nothing to that extreme or that manipulative. I'm sorry í ½í¸Ÿ

It seems that a lot of things are not being handled correctly at the facility I work at. Sorry if I gave everyone a headache trying to read this. I really didn't expect that many people to even make it through the post. Clearly I just needed to vent lol btw my mother was diagnosed with bpd years ago, but has always denied it and she isn't quite like this lady. I guess there are different extremes. My mom is manipulative, but doesn't even realize she's being that way. I'm talking complete denial. I truly think she believes she's perfectly normal, but she drives us all crazy

Ok. I spoke with my boss and literally every option I mentioned is not allowed. When it comes to limiting calls she says that we can just not answer all the calls, but eventually it will lead to the patient filing complaints. We are not allowed to take the patients call light because that does not ensure their safety. And as for a behavioral contract, those do not apparently exist where I work. I just don't know anymore. Apparently it has come to a point where nurses really have no rights.

@jadelpn no the patient had no family and I do believe she had munchausens.

Well I am prepared to deal with this kind of situation now. I'll be talking to my boss about this behavioral contract to see if that's a thing we could try.

I had no idea we were allowed to limit number of calls haha that's brilliant. And I think I forgot to mention the patient was found to be recording many of the nurses in and out of the room, so it's a good possibility she recorded me calling her rude and her requests ridiculous. I was polite, but blunt.

Lol I had a headache writing the post and tears in my eyes that were much needed after al long 3 nights at work. I wasn't exactly trying to make it pretty, just trying to get it all out before I lost any details. Thanks to everyone for the advice. I will definitely be trying these things next time I come across this type of patient. I have only been a nurse for a year and was working with even less experienced nurses. I'm not exactly as confident as I'd like to be and was unsure of what I was allowed to limit the patient to. I let her get the best of me and really have to learn not to do that. I was just so frustrated that because of her some of my other patients important care and meds were late .

I haven't been on here in a while, but today I just have to share the experience I have had as a nurse this week. I work on a med-surg floor at a small hospital with 29 patients on the floor. We usually have 5-6 nurses, but often have had 4 and even 3 occasionally. We are the floor you dump all the miscellaneous crap on, which often includes your chf'ers, copd'ers, gib's, dialysis patients, surgery patients, Alzheimer's, and just about anything you can think of. Not to mention all the people who were brought from the local mental hospitals or rehab centers who are just absolutely nuts. I was told when I was hired by the staff and my boss that it was a very challenging floor and that I would learn a lot, but be very stressed. Well she wasn't lying. It's practically like an ICU sometimes with how critical my patients are and I don't just have 2. I have 6 and that's being in charge on night shift. Anyways, let me tell you about the patient who has sucked the life right out of me within 12 hours of taking care of her. I had a better night the time my first patient died sudden and unexpectedly after s 55 minute code. This is a 41 yo female who is a frequent flyer and usually comes in with abd pain, diarrhea, and N/V. She has been denied at 5 different hospitals for accusing male nurses of sexually assaulting her and reported at least 4 doctors for not giving her the pain medicine she demands and the diagnostic tests she believes she needs. She comes I with different names all the time. She states she has had cdiff for 5 years and treatment doesn't work. And she thinks she has SMA, but we're just not properly diagnosing her and not doing the right tests. So my night started with a call that lasted 7 minutes. She first explained how unprofessional we were when answering the call light and stated that several people have hung up on her. Then she went on to say her scheduled pain meds were due 30 minutes ago, followed by requests for 5 ice creams and 3 apple juices, and many other questions about tests, pain meds, diet, how pretty much everyone has mistreated her. I was very polite, said I would definitely let her nurse know and the issues would be addressed. I was in charge that night. Her nurse was slammed like the rest of us, but managed to get her pain meds to her not late. She received a total of 16 ice creams within 7 hours and wanted more. She was told that we were out and that we could not take the other floors supplies when we use all of ours. Well, that was it. She wanted to speak with the charge nurse. At the time I had a patient who was q1h bg, total care, agitated, no sitter, tube feeds, ativan q4 or she would climb out of bed and that would just be a whole other issue. Also, taking care of a women who demand dialaudid 2mg q4 on the dot and extremely sick with critical labs, admitted by nephrology. My third was a man who we got to know about a year ago when he came in and refused all care, but had nowhere to have dialysis because every place had kicked him out for being verbally abusive to staff and refusing assessments/care. Nephrology wouldn't discharge him because he was so sick. The man yells at everyone and demands everything he wants, meanwhile not taking any meds you have for him or cooperating with what the Drs want him to do. I guess he wasn't actually hard to take care of, until he started calling and yelling because he hasn't got his chocolate Icecream and coffee and then crapping all over the floor and refusing to let anyone clean it. We call him Mr. Personality. Patient #4 is not bad, but wants me to come at different times for her prn meds, like one at 9, then the other at 10, and so on. My other two were new admits. I got one at the beginning of my shift and another by 0300 even though the next one was supposed to go to someone else and it was my 6th patient. The other nurse is older and just refuses to take anymore. She was busy and if I had given the patient to her she would have complained so much that the rest of us might have gone crazy....or crazier. Anyways, my one admit came up on bipap with critical abgs, total care, >400 lbs and the one at 0300 was a GIB. So that was my group. I had enough to do without this women demanding things and making everyone crazy. She wanted to speak to the charge nurse because they wouldn't give her anymore Icecream. She had had 16! When I went into her room I introduced myself and asked how I could help her. She started off by saying there's a real issue with the way we are answering her calls and hanging up on her without listening to her 25 complaints and that they weren't telling her nurse what she needed. Then that she needed Icecream because she could only have full liquids and she was being denied it. The next problem was not getting paid meds on time, not getting what she ordered for dinner (3 puddings, 3 soups, 4 ice creams), not getting a ct with contrast, which would diagnose her SMA. So far the ct w/o contrast hadn't shown a thing. She never really did shut up and just moved from one thing to the next. I had to interrupt to tell her that I would see to it that her nurse was being notified of all her needs and that I had witnessed her calls being answered and then the message given to the nurse. She argued with me and said that was not true and I explained that they may be listening to her need/complaint, saying they'll let her nurse know, and hanging up because they think she's done. Also told her that I had answered a call from her earlier that night and i was very polite but shocked at how rude she was. I listened and i told her nurse, but there is a list of callers waiting behind her that could be having trouble breathing or chest pain. I explained that we had to answer everyone's calls and could not spend 5 minutes on the call light. All of her needs can be addressed once the nurse knows to go down there and she did. Then I moved on to the issue about Icecream and this is where I got hot. I've never been nauseated by how mad I am, but I swear I almost threw up all over this lady. I told her we have 72 ice creams stocked at beginning of each week and that she had 16 already, so she could not have anymore and even apologized for heavens sakes. First of all she denied she had that many. I had seen them take at least that many down to her room. So I told her of every one had that many there would only be enough for 4 patients and we can't use all of our supplies and then go take another floors, unless it is a need and that is by no means a need. The women had breakfast, lunch, and dinner and snacks! She needed no more. I then asked her why she would want to eat that much if she was in pain and having diarrhea and nausea, plus a diabetic. She just redirected to another thing, such as getting s soft diet order. I explained that Drs do not allow people to eat when they are that nauseated and in pain and that if she was able to tolerate food that would mean she wasn't in pain or sick from it. It's common sense. She then said I was calling her a liar. Well yes I was. I told her I would be glad to page her dr and request a ct with contrast and a soft diet. She argued and said I wasn't listening to her and that that's not what the problem was and neither was the Icecream. I'm thinking well what the hell is the problem lady? I think IBS caused by a good ole case of crazy. Any ways, when she complained about meds being late I apologized and explained that if any meds are late it is because there is a patient that is in more critical condition who we must treat before treating her pain. If someone's having cp the nurse can't give her pain meds before taking care of the cp. she said I was making her problems out to be fake. She said she was told by a "nurse helper or whatever they're called" that her nurse wasn't busy and sitting down when her meds were due. I immediately asked which nurse she had and what tech. She backed out saying she didn't want anyone to get in trouble. I told her nobody would be in trouble, but that I had to go to each source to figure out at what point she misunderstood what the tech said because none of our techs would ever say a thing like that. First of all the nurses hardly ever sit and the techs are smarter than that and know her well. She then went on to say I know you guys get breaks, it's a law that you have to have a 30 minute break and youfe not allowed to work 24 hours. Oh I was getting so mad. I told her that I hadn't taken a lunch and had been up for 36 hours. Clearly we are all proof that what she was saying was ideal, but impossible sometimes. She asked if I was calling her a liar about that and what the tech said and I just said yes ma'am I am because you have now lied to me about at least 4 things that I have proof are not true. At that point I walked out and paged the dr who said no to the ct. I let her know and she said she was gonna report the dr and the hospital for not treating her and trying to find out what's wrong with her. I just apologized and advised her to do so if she felt hat was necessary and walked out. I told my boss when she got there the next morning and she was not surprised. Even she can't stand lady. My concern with this is that this women is dangerous! She is going to get someone fired and nobody who I work with deserves that! I thought about that the whole way home. What if I actually got fired because of this women when I was working so so hard to make sure all of my patients were taken care of, dealing with everyone's issues as charge, putting out fires all night long, and not ever stopping to eat or pee. I had to stay until 10 to chart. And I continued to work during that time on/off, helping my patients who would come to the desk and catching up with patients I used to have, crying with ones who just break my heart with how amazingly positive and grateful they are even considering they're terrible situation. It just kills me to think I could lose my job over a women like that when I am a good nurse...I may not be perfect or held it together as much as I should have, but I survived hell. And I didn't deserve the way she was wasting time I needed for other patients who were critically ill. Neither did any other nurse or tech. I literally want to report this women to the police. Pretty sure she's got 4 or 5 different identities. Ugh. I guess I just need to get over it. It sure does help to get it off my chest though. I'm wondering if any of you have ever experienced something similar to this and did you get just as frustrated? What would you have done? Although there really is no advice that could help a person deal with this particular patient. Even the dr and nursing supervisor couldn't win with her. The dr was actually requesting someone go with her to see the patient so that she couldn't manipulate the rest of the staff and say things that weren't true or accuse one of them for mistreating her. Just a ridiculous situation. Anyways, thanks for letting me get this out there lol I realize not s lot of people will probably read this, but at least it's off my chest. You guys know how it is. Nobody cares about your nurse problems. They just don't understand. I wish everyone good patients and hope you never ever have to deal with a dreadful person such as this evil women I had the pleasure of taking care of. Thanks for listening.

Can someone explain to me why we check albumin levels when a patient is on phenytoin long term? I know I must've learned this at some point but I have forgotten and can't find anything with a clear answer when googling.

I know that a hematoma is a collection of old blood that can get infected, but how do you tell if it's actually that and not just a bruise? One of the nurses I work with said she was worried a patient might be bleeding because of a large bruise and that she wondered if it might be a hematoma. Well, I thought hematomas were old blood, not a sign of active bleeding. The patient supposedly had an abscess after having hysterectomy, but was severely bruised all the way around her body and in a lot of pain. Also her wbcs were pretty elevated. Anyways, I'm just wondering if there are any ways of telling if it's a hematoma or just bruising, other than a ct.

I'm thinking I should eat breakfast when I wake up, then maybe lunch when I finish first rounds which sometimes is 10 o'clock. Then that would leave dinner for about 4 in the morning. Ugh it just doesn't seem right lol I need some serious help. Plus when am I supposed to workout?? On off days I guess....night shift problems

I am going to start doing the same. THe problem is I just don't know what eating schedule I should be on. Especially since I'm up during the day on my off days. I guess I should be eating when I wake up and then probably around the time i clock in. Lol this is the problem.

I have a 7 year old and have to make time for him. He stays with a sitter so I can get some sleep. I usually pick him up at 2:30. Then have to drop him off again at 6 to make it to work by 6:30. So I'm basically getting an hour and a half with him before I have to make something to eat and get ready for work. Thank goodness it's only 3 days per week, so I can catch up on sleep on my off days. But it's still very hard