hjwdancer

Has anyone here used a bullzeyemedical.com Mark-9 or other stethoscope? What do you think about it? How does it compare to others used in the past? Also, what about the ultrascope brand? I'm getting a new stethoscope soon but I'd like some information before purchase. I'll check out the GRZ mentioned :)

Make an appointment with the ER Managers in the area and ask them if you are on the right track for their facility and what things they want you to do to get back in. Make friends with them- sounds corny, I know, but I wouldn't have my current ER position if one of the ER staff docs hadn't put in a good word for me from a previous work experience. There are several CEN review courses out there- ask the ER managers what they found helpful or if they can recommend a good one. At our facility, experience and training seem to matter less than "knowing" someone- I guess they figure they can train you if you're likable and if someone in the ER will vouch for you. Good luck!

Valium IV turns a beautiful white color when mixed with NS. I tried to dilute it ala morphine before taking it to the bedside. I was taught to give it at the hub of the IV (with a cap or vicra attached of course) NOT through a line or tubing and slowly pushed, then flush with NS. Are there any that we can't flush NS behind?

I'm a fairly new RN and I now work in a Medsurg setting. Please set me on the right path here but where I am at "we"- the nurses on the medsurg floor- could write for a consultation for a patients case as the pt's nurse. The consultation- for woundcare, nutrition or PT, etc- would review the pt info with us, pt, chart and/or doc if available and then leave a note in progress notes with recommendations for the physician... who would then choose to write or not write orders based on that info. My basic question: Is this OK? After reading this thread, I am starting to become a little more paranoid. (As if I weren't paranoid enough as a new nurse...) I would think it helps the physicians to have other professionals involved in helping with pt care. My rationale follows that I am not "ordering" treatment, medications, etc. My facility also has several admission flags that tell me if pt answers yes to certain questions then to immediately refer the case to the coresponding department (ex: nutrition for tube feedings, wound care for stage 3, etc). None of our docs has ever objected and it seems to be accepted as the norm. Do other facilities also have these flags and methods? Thanks! H

I'm sure the other poster meant to include the ABC emergencies, broken bones, GSW's (covered by hemorrhage, right?) Now, let's get back to the fun of this post. The ER I worked was located directly between two homeless shelters, each merely blocks away. 911 from shelter- didn't like what they were serving and thought they'd come to the hospital to eat. Then complained that our food was even worse! 911 New in town from Chicago, c/o knee pain from arthritis x5yrs- wanted to be admitted because she "didn't like the shelter". (While I understand her c/o- I can't justify giving her a hospital bed) 911 ETOH on board. period- no LOC, falls, ABC prob. ETOH on board is not an emergency- it's a condition I pay good money for! (We had a memorable night with over 21- 911 calls with ETOH on board c/o- some were twofers) Want your kid drug tested, kid denies taking anything. BTW you can get these drug testing kits at Walmart now. (these are mostly reffered to counseling centers). We also triaged a lot of 911's. If the c/o was something nonemergent you were triaged then sent to the waiting room. We would also get a lot of 911's in with mystery c/o that cleared up just as mysteriously and then the pt requests cab voucher to someplace other than original pickup spot. Ahhh, the ER transport system... forget those other truly sick patients (I'd rather have pt's with a c/o that a PCP could handle if I could put a stop to the ER transport people). :angryfire

As a new grad, just off of orientation: I had a great preceptor who provided me with a fount of knowledge, including resource people for certain areas. Ex: one of the er nurses had a heavy psych background- I knew where to turn with psych questions. She is such a great preceptor. Provide feedback on performance: That is my only complaint about my orientation. At the end of my time, I couldn't tell if I was performing as expected. Each week tell your new person/orientee: our goals were/weren't met this week and why and how to fix them. Also: Your person may be new to the hospital; don't forget to show them around. I also was at a loss my first few weeks on "what" to ask- the ER is a fluid, everchanging environment. Help your person by pointing out protocols, frequently used meds, and helping them deal with difficult patients. Good luck- It must be very tough to be a preceptor!

http://www.microbelibrary.org/ Has lab result pictures. Micro is a class you'll have to take notes on yourself- It is a class that you'll either find hard or easy. Search lab results to help make identifying organisms in lab easier. It may also help to make a short form lab guide: Ex: Gram stain: positive = purple, red= neg This will help you in lab (each test has a fairly simple observable rxn). For class, just do your best and get help from your classmates in study groups or from the professor. Hope this helps.

Surprisingly, we get a lot of pts with VERY high BPs in the ER where I just started. Most just let their Rx's run out, a few days, weeks, etc., ago. 260/140, 189/130 Just a note on BP- I was pregnant with my first child and went to the clinic to start my visits and the nursing student taking my BP tries several times to get my BP and HR then scares the willies out of me by fetching his instructor. The instructor takes my BP and its 58/34 and my HR is 50 and the all important questions are: Are you active? How do you feel? I felt great and I was very active. The instructor explained to me and the student that this was a good thing. Too bad I'm not that active anymore

Here are my tips garnered at the knees of a most-wise and speedy tech while I was a green nursing student: Planning! All the tips mentioned before were very good! If you have no hair washing device then use: * an adult brief (if they're super absorbent- if not, use several towels) * a styrofoam cup * liquid soap (preferably shampoo- but if none available use the liquid soap). * 6-8 wash clothes * 3 towels- depends on hair length * conditioner (if no conditioner use lotion) Have hot water ready in basin- this should be hot but not burn skin hot (as if you could get it that hot from the faucet- I'm sure someone here can, but I can't where I'm at). Place brief under patients head to help absob any stray water rivulets that may run under pt's head or down the neck. (can use towels or a combo of both) Place washcloths in basin. Use one with NO SOAP to get hair damp; for longer hair use the styrofoam cup to pour the water sparingly over hair. Place SMALL AMOUNT of soap/shampoo on new washcloth and towel through hair (this will get the excess oil off and make the hair smell nice without working up a hard-to-rinse lather). Rinse with a new NONsoapy washcloth or if necessary with the cup. If hair needs conditioning, place a very small amount of lotion in your hands and rub it into the pt's hair starting at the ends and working into the scalp (think 1/2 of the amount of conditioner you would use for the pt's hair length). Rinse with a new NON soapy washcloth. Have used consistently with bedfast or acute patients with positive results- conserves patient energy, helps them feel really clean and refreshed. Other tips: Powder in creases of a bed-bound or obese patient can cause irritation and eventually open sores (think granules of sand rubbing in those sensitive areas). Make sure you dry the patient's creases well- even under the abdominal flap, breasts, under arms, and double (okay- triple) chins. Otherwise, yeast infections can form quickly. A quick word about lotion- do not use the whole bottle on your patient and leave it on the skin where it hardens and drys. Lotion was meant to be rubbed onto the skin- you should no longer see it after that. Just pouring lotion on them is not enough :) Just work quickly and keep your patient covered and warm. Tell your patient you are green at this and to let you know if there is anything they would like you to include. I hope you enjoy the new shift!

Wow, digging through the laundry/trash? Nasty! And notice the "no one else ever does"- this is unfortunately true. As a CNA, just keep bothering the nurses with specimens, etc so you know you have done your part! On a separate issue: I can understand the frustrated poster (kurosawa)- there are nurses out there who will try to get you to do their job. I have had numerous requests to change dressings, to stay with a patient until they can take this med, to give these papers to the patient to sign, to do a variety of other things that CNA's really shouldn't be doing and then if there is a problem I have found these awful nurses in empty rooms sleeping, in empty rooms watching TV, in the cafeteria- not on break, on other floors chatting.... Please report these nurses- they give the good ones a bad name!

I understand that philosophy, BSNtobe 2009. I also do not understand these mothers who choose the boyfriend over their children. If you'll forgive me for a short diversion: My Mom used to work as a social worker for child protective services (CPS). One family had two girls and one boy all under 10 with the mom's boyfriend sexually abusing them. The kids were removed from the home but mom was allowed to have the kids back by pressing charges against the creep and having him removed from the home. So mom gets the kids back and decides she really loves the creep and drops the charges. My Mom stopped in for a follow up, sees the bf there and takes the kids into custody. Only CPS tells her to take them back because paperwork, etc. My Mom refused and took them home with her. CPS retrieved them a few days later and my Mom quit social work completely. (At times, my Mom and I have our differences but she will always be my hero for at least trying to fix a huge injustice.) Now back on topic, My cousin worked ER- she had a case with a holiday-traveling family come in because an older kid (6 or 7) sleeping in the back had put their legs over the corificeat of an infant and had smothered him. There was nothing they could do. Her advice to me was to try to remember that we are there to make the situation better by taking immediately. We can only do our best in each situation.

++6 month old girl who was RAPED by her step dad.... ended up with a colostomy and cystectomy after incredible surgeries How do you deal with this and cases like this? Is this a high frequency happening? I feel rage and deep sorrow for this and other cases of abuse and maltreatment but how do you handle this? I have always wanted to be in the ER but I know I need to prepare for the horrors as well as the accidents and I would appreciate any advice you have for me.

I am a nursing student (grad- Dec 2006-hooray) who has worked for the past 11 months as nurse extern- which covers training and working as CNA, unit secretary, and telemetry monitor tech. My tips that I have learned from my experiences are: Before starting your shift, have a routine or schedule mapped out for the day. Always find and speak with your nurses for the day within the first hour and ask them if there are any specials things to watch for or need to be done today. Organization is the key to a smooth day. Ex: 0700, get ice bags filled, get linen cart or washcloths prepared with extra soap/toothpaste/etc, do VS, toilet, wash hands face, FSBS and distribute ice bags. Turn Q2 pts. Chart VS/FSBS/Q2 and tell nurse/conference. If possible fit in one bath. 0800 Distribute breakfast trays. If no pts need feeding assistance and you have an NPO pt or two then bathe them. Pick up trays. 0900 Turn Q2s and chart brkft%/turn. More baths and take your first 15 min break-recharge your batteries and let your feet rest. Stick your head in pts rooms as you walk past for a quick check- this will help reduce your running time and will help you stay alert to pts. If you notice something new with a patient, tell the nurse even if it seems small. I always call for the nurse when I notice a red spot or a new wound, etc. This saves the patient the aggravation of rolling again in 15 min and helps the nurse assess the area. If a finger stick blood sugar is sky high or really low, stick the patient again using a new site (preferably fingers of the other arm). For low bloodsugar, get juice and a pack of crackers to patient immediately then find nurse (if this is acceptable at your agency and obviously if pt is not npo or confused, etc). Roll with the nurses- some act as if you are an idiot, some treat you with respect. Don't let this affect the attentive care you provide for your patient and whether or not you will report an abnormal value. If you don't know how to do something, get help. You should never fly solo on a maiden voyage. :smilecoffeecup: Good Luck!

A good website for a meth project: http://www.montanameth.org/ads_television.aspx#

I am a student in an LTAC/MedSurg setting. I am uncertain of the terminology and technical names so I'll do my best to describe the situation. Just an example I witnessed of a true to life patient that could not be cleaned: Male with old AVF in both arms, critically ill. Any movement dislodged the needles and tubing. He HD'd in his room in bed and if it occured during meal time he was fed. If he was incontinent during Tx, he had to wait because of his complications. It was not a situation that the Tx could just be stopped and restarted. I knew an approximate time that HD would begin so I could place extra pads and ointments before Tx to help my patient. At the end or close to the end of Tx, the dialysis nurse would call me to let me know the patient needed attention if needed. Our HD nurses remind us or call us down to floor to take patient to bathroom before Tx get underway to avoid incontinence. If incontinence occurs, it can't be taken care of in the HD Tx center- no space, no personnel, no supplies.