weezledawg

Drum roll please.... 911 call for "My dog is staring at me." And they brought him in.

I think I must work with you. I am sure I have treated all these people.

I just agreed with Trav, that the forearm is the best ... that being said, I have put IVs in feet, hands, thumbs, necks, fingers, neonates, breasts, chests, shoulders, forearms, wrists, under the upper arm, over the upper arm, bracheocephalic veins, cephalic veins, basilic veins, you name it, I have hit it. If I see a river and you need an IV, it is fair game. No, the chest is not ideal. But neither is an angry surgeon who does not want to place a triple lumen and IV medications that are necessary. Yes, they are harder to secure. But I have seen the best of the best forearm IV sites get infiltrated and ripped out, and the most precarious chest IV or shoulder IV make it three days because the nurse and patient were meticulous.

I agree, the forearm is the best.

When my oldest daughter was 2, she had a bad habit of pulling the foam out of the padding on the sides of her playpen. Well, she developed a nasty-smelling nasal discharge one day, and lo and behold, there was a piece of foam 4x the size of her nostril stuck up there. I pulled it out with a pair of tweezers. Delicious!

Have you checked out the wound care forum on allnurses.com? There should be something there. The care of Stage III ulcers is difficult at best and requires a multidisciplinary approach. In terms of the wound bed itself, it depends on the percentage of eschar, exudate, infection, etc. For less exudating wounds, foam dressings work well (if you can get it to adhere appropriately) and agressive incontinence management needs to be addressed, especially in light of the proximity of wounds like this. For highly exudating or infected? WOUND VAC. If your hospital uses KCI vacs, they should be willing to inservice and are always available by telephone. Recently in our hospital, we formed a wound care team. They sent us to training and we now have a few certified as WCCs. We developed a policy and procedure specific to wound care so everyone is using the same modality for wound care, and there is a resource if nurses like you have questions like this. Sounds like you need a wound care team.

What certification?

Alright, I'll make you a deal. I'll give you this Dilaudid and you agree to keep breathing, OK?

The ones where they let you work the most overtime!

Good job! I keep waiting for something like that to happen to me ... I seem to have that luck. Never by accident.

Wow, OK, coupla things... You said that you had an addiction to painkillers but now you don't. I read through some of your postings later down the thread and the language you use tells me that you have some knowledge of the recovery world. So let me ask you this ... are you an addict? There is a huge difference between tolerance, dependence and addiction. Addiction is the compulsive use of drugs despite negative consequences. If you answered yes to the addict part, then... An addict can be a nurse. BUT, to be successful you must have a strong recovery program, which includes the idea that addiction is not a disease with a cure. It's always there, and the strength of your recovery depends upon the committment and effort you invest. That being said, the statement that you're not addicted anymore was unsettling. It's exactly that type of thinking that gets addicts into trouble. And there's plenty of trouble to be found in the stress and availability of controlled substances if you're not dilligent. I live in a very small community, and this is where I lived in my active addiction and also where I experienced recovery. I am not afforded the same level of anonymity as others who may live in more urban places. And when I was asked on my job application about why I didn't get my interim permit on time with everyone else, I told the simple truth. And good thing, too, because she already knew everything about me. I am, every day, the same person I am ... a recovering addict. There is no shame in that. It keeps me honest and tells others what I'm about.

At our hospital all meds are sent to pharmacy for verification, a note placed on the chart that meds are in pharmacy so at discharge they can be returned. If not on our formulary, then they are labeled by pharmacy, listed on mar as pts own med and placed in pt's med drawer. If controlled, placed on narc list and counted like all the others... but we dont have a good way of accounting for, say, an entire bottle taken from admission that turns out half-empty when sent to pharmacy (not that I've enocuntered thism but its possible). There was one time in my first year of nursing, I found out a pt was taking her own dilaudid on the floor, she told me the past two days' nurses let her keep them. I'll never forget standing with the nursing supervisor counting out a total of 301 4mg pills at the bedside. They went to the pharmacy and a pink form was also filled out.

People always want to ask me these questions and if I believe its harmless, I may answer. But because I am in a same-sex marriage, I believe the marriage question reveals information about myself that may be contraindicated in a care setting. I live in a small rural area, with a large geriatric population, and I always want the focus of care to be about my pts. So I am always trying to think about what's in their best interest when it comes to their care. And I like all the responses that have talked about redirecting the questions back onto the patients... always my method of choice. But I have come right out and told pts their question was inappropriate, especially when I work in the ED. I am also in recovery. There have been times when revealing some of this has been helpful to certain patients seeking the same or suffering from addiction in one way or another. Again, always careful, and always to benefit patient, not myself.

Never masturbate with rapid A Fib and while on telemetry... Never claim "I was walking my dog in the woods, when I slipped on a log and this branch went up my a**," then tell me you are on coumadin and have no correlating scratches or bruises anywhere else but a SIGNIFICANT rectal bleed. I actually asked him, "Were you wearing pants?" "Yes!" He said puzzled. "Those pants?" And I pointed to his Levi's with no hole in the bottom.

I agree with all the responders on this thread. Good for you. This happens to me at work, and all I can do is redirect, redirect, redirect. After all, they are not visiting the ED to talk about me. This is about them today.