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  1. suanna

    Staff Meetings: What Are They Good For?

    i know this was a long quote but i am responding to your example. from my point of view your staff is disfranchised and marginalized. there worth and contribution to your unit is being measured by a scale that they don't respect (pg score) and don't feel they can impact. rather than discuss an obscure number can you identify specific problems within the unit population that you see as an opportunity to improve patient care. have you asked them to rank thier problems in providing optimal patient care. what solutions do they offer for the problems they identify. i'm sure there is no solution that will meet all needs for all people, but if your staff feel they have your support within specific guidelines then they can offer solutions they think may be effective for all concerned. empowering people to change what they feel is important for the better can go a long way to getting them to make the changes you feel are important.
  2. suanna

    2 yr ADN students..question on IV's and blood draws

    WOW- you passed a skill test that would qualify you to be a confused elderly dementia patient. I have never understood the current trend in not educating students to performing venous access. This is going to be a big part of your job in most institutions. Instead you spend a few weeks playing with "Nursing Theory" or "Nursing Research"- good and useful areas of study AFTER YOU GET THE BASIC PATIENT CARE SKILLS DOWN. You will by no means get proficient at venous access as a student, but you won't be proficient at many of the skills required to be a fully competent RN. Does that mean you shouldn't be taught the skill???!!. A HS graduate can work for a home health agency drawing blood on the most difficult patients as a "phlebotomist" with a day or two inservice. I hope Nurses can master this skill with a little more effort. Hospitals that "don't allow" students to learn this as part of thier clinical education shouldn't be used as an acute care rotation for RN programs.
  3. suanna

    I messed up my ppd site

    I don't know if I would work (ice, heat, whatever...) to get the lesion to resolve. What if you are TB positive. It may not be a false positive from your scrubbing but a real one- how would you know? I would rather get a CXR or 2nd PPD rather than struggle to make my injection look negative. TB is pretty easy to treat now-a-days, and still pretty lethal if you don't treat it.
  4. suanna

    forensic nursing

    A friend of mine did this for a while but never finished her certification. All she did was rape kit-rapekit-rape kit.... She got so burnt out in a few mos that she was ready to leave nursing. Not to mention she had a progressively lower and lower opinion of men in general. Talk about a depressing job!
  5. I've never seen an ETCo2 monitor for extubated patients- We frequently use CO2 monitoring on our vented patients to facillitate weaning, but on an extubated patient??? How does it "hook up"?
  6. suanna

    Fired from my med/surg job after almost 3 years

    You got no warning about your charting deficiency? Hourly outputs, Q2hr VS with hemodynamic calculation is the policy where I work. If a nurse skips this charting it is dangerous for our hospitals liability- even if the care provided was exceptional. If some lawyer looked at that chart and can say to a jury "look, no one assessed this patient for over 8 hrs..." we are going to loose that litigation. What I don't understand is why you didn't hear about this before it got to the point of dismissal. Was thier some law suit the hospital lost over your charting gaps? Did some doctor loose big bucks in a malpractice claim over what you didn't chart and is pushing for your termination? Is the hospital under some sort of scrutiny for charting irregularities that you didn't know about? I don't mean to be unkind, but I can't believe there isn't more to this story than an isolated incident one night when you had a gap in you assessment charting.
  7. suanna

    Has anyone ever seen this done before?

    Are we assuming this patient dosen't take a bath/shower with the same water that was used to dampen the swab? Any bug in the water supply would be present on his skin and presumably in the wound. Pathogens that are capable of infecting a wound shouldn't be present in tap water. Any bug that cultures out would most likely be identified as normal flora- present on anyones skin(or perhaps in tap water), or pathogenic/infectious. I would expect the swab would be better off moistened with sterile water or saline, but I am more concerned that the chlorine in treated (city) tap water would inhibit the growth of any pathogens present in the wound.
  8. suanna

    Would you give Lantus without BG check?

    Checking a lab value- any lab value- requires that if it is a certain number, you will do such-and-such. Since all the endo docs I work with say NEVER hold Lantus- no matter what the blood sugar- It dosen't make much sense to me to check it before "giving Lantus". It does make sense to me to check glucoses AC&HS while adjusting a patients insulin routine, or when an acute illness has disrupted thier diet/activity. These checks have nothing to do with the Lantus. Once thier glucose is stable on an established dose, I see no reason to put them through a finger stick when it will make no difference in my care. Most patients can get by with a once a day glucose check- either fasting to eval for hypoglycemia, or 1hr after thier biggest carb meal to eval for hyperglycemia.
  9. suanna

    Mouth to mouth without barrier?

    I'm not so concerned about a valid defence in court, but a valid defence in my own self-judgement if a person died and I wasn't sure I did everything in my power to prevent that loss. I can see not stopping at accidents, and avoiding the decision, but when it jumps up in your face, I don't know how many of us could really not provide airway support- reguardless of the current position of the AHA. I still think having a little more O2 floating around in my bloodstream can't hurt if someone is in a full arrest.
  10. suanna

    LPN or RN help!!

    I think you would be nuts to turn down a position in an RN program. People wait years getting into an RN program. The employment picture in most of the country is bad for all new grads- but hopeless for new grad LPNs. Your LPN education may offer little that transfers officially to an RN program, so you are paying twice for going to nursing school. Just my 2cents.
  11. suanna

    How powerful are hospital unions?

    As a rule hospital/nursing unions ensure equal treatment- not good treatment. I work in one of the strongest nursing unions in the eastern USA and we have never been able to negotiate hard ratio numbers. That always falls under "management rights" and is non-negotiable. What you can expect from a union is backing and support if you have a manager or supervisor making unfair complaints about your care, or scheduling you in a manner that is inconsistant with established protocals. The union should be ensuring you are given a position for which you are qualified and have seniority. Usually unions establish wages, benefit costs, paid time off rules, anad job mobility rules. Anything beyond that is unusual.
  12. suanna

    Lost very important paperwork. Am I in trouble?

    It will probably turn up somewhere- stuck in the wrong chart, in the "out box" for interoffice mail- somewhere. In the mean time tell your unit manager you were unable to locate the blood form to complete the charting. Odds are they will have lab send up a copy of the form for you to "late entry" document on. If it happens every day I would expect you to get some flack, but only once- things happen. That is why there are policys to back us up when they do. The worst thing you could do is ignore it and hope it goes away. Blood administration needs documentation, and it is your responsibility to see that it is done- even if it is "late entry" charting. Knowingly ignoring the fact that you know the blood admin form was missing is a serious offence and is likely to come back to bite you.
  13. suanna

    Mouth to mouth without barrier?

    Our atmosphere is around 21% oxygen. Exhaled breath is around 17% oxygen- more than enough to oxygenate a person in need of ventillation. The question still remains- is there a significant risk to the CPR provider if mouth-to-mouth is done without a barrier? For me, I have done mouth to mouth on a drunk face trauma I stoped to help at the side of the road. There is a risk- but there is a risk just driving to work. For me, the hope of having a greater possibility of a good outcome far outweighs any personal risk. We work around dangerously sick patients all day for our pay. Unless you are wearing a space suit you are taking your life into your hands every time you punch the clock. That's what we get the "big bucks" for! If I thought I could save a life by giving MtoM I wouldn't hesitate for a moment. The life saved would be worth more than any salery I earn on the job.
  14. suanna

    off duty nursing?

    Yep, I've done CPR on an motorcycle accident - and got a pulsless, breathless person back (with a lot of his blood and teeth in my mouth). Anywhere I am, I try to stay open to helping someone in need - not only since I've been a nurse, but throughout my life. I don't think I could have ignored a child in distress, especialy since I am the parent of 2 and grandparent of 9. There isn't much you could have done as a "nurse" in that situation - whether it was a trauma with broken bones, or a bee sting - the most important intervention is to comfort a child in distress and keep them calm while you locate her guardian. That dosn't take nursing - just not being a "horrible person".
  15. suanna

    How do you induce passing gas post-op?

    X-Ray shows active ileus?! No nursing intervention is going to do much at this stage. I would be very cautious of anything PO- even sipps&chips. I've had patients with an ileus rapidly distend with very little intake. Before you know it you have an aspiration pneumonia or post portem care to add to your list of duties. With a current ileus I am surprised the docs haven't ordered an NG tube of some sort to relieve the upper GI tract. Until the ileus pattern resolves in the bowel you are playing with fire to put anything in from above. Reglan( metoclopramide ) has been used but with little sucess in my experience. It can also make an elderly patient (and my wife) NUTS!!! Dulcolax RS may be more helpful since it stimulates action in the gut distal to the ileus. As for walking, it can't hurt but recent studies showed no improvement in GI motility with patients that participated in a regular postoperative walking program and those who were on restricted activity of bed&chair. Pneumonia improves but not pooping. Keep in mind, if you increase your patients activity you are going to need to increase thise fluid intake (IV?)to compensate for insensible loss through perspiration and the like. Daily weights, mucous membrane assessment and good mouth care become VERY important for this patient. A parched cracked mouth is a great place for Candida(Thrush) to set up shop, A Candida pneumonia or even oral thrush isn't going to make your patient any happier. SORRY for the long post from a simple question about the gasses we pass. I'm a surgical intensive care nurse and I can get carried away in my care planning.