outsidethebox

Diabulimia Treatment | Center for Change Diabulimia | National Eating Disorders Association Here are two clinics for diabulimia. I am not sure if you need both specialties to work here, but contact them and find out what they look for. I am not sure if this is what you are really looking for, but if it is, you never know until you check it out. On a side note, I do work with a diabetes educator that is a psych nurse practitioner. However, she works with bariatric surgery patients. She is wonderful, very holistic approach. She is very committed and has spent long hours building her career and it has not been easy. Good luck.

So, the ideal answer is indeed not to hold the insulin if the patient is eating. Novolog should be administered to match the carbohydrate intake or to correct hyperglycemia. It is unfortunate that it would be given at any other time. The 6 units is ordered to help with the meal, so if the patient is not eating, there would be no reason to administer 6 units for a FSBG of 75. The doctor should be notified if this was not ordered to match the food intake. Feeding insulin only results in weight gain. If the patient has type 1 Diabetes, not type 2, then not administering scheduled mealtime insulin could put this patient at risk of DKA, especially if they are already ill. At the very least, the insulin prevents hyperglycemia. My son has Type 1 Diabetes, and his glucose levels are rarely over 100. However, if he is eating, he always has to take mealtime boluses. This is how we keep his glucose levels under control. If his glucose levels are less than 60, we do subtract 1 unit from his mealtime dose. That would be contacting the physician in a facility for orders. My son has only been hospitalized for surgeries, and he does get frustrated because nurses do want to hold his insulin. He does not produce insulin. He will get sick, and could die if his insulin is held. It is a very big deal, and he is not afraid to tell his nurses that. Please consider if your patient has type 1 or type 2 before holding insulin. He needs insulin to survive. Additionally, hyperglycemia can be dangerous for both.

Dealing with any disease on a daily basis can become overwhelming. As nurses, we want to jump in, find the problem, and right the wrong that is causing the issue. Although many times this will work, for many chronically ill patients, there is much more involved in "fixing" them. The nurse that cares for this patient while hospitalized, sadly, will likely have little impact on his overall glucose control. You are correct that education is not the answer, but likely motivating the patient to better care for themselves, and make better choices. How would this be possible in a twelve hour shift? It wouldn't. That is why they need follow up care, accountability, and further encouragement on an ongoing basis. Many outpatient diabetes management centers are providing this for patients, and seeing success in some patients. Unfortunately, not all patients are at a point in their lives that they are able to be motivated to care for themselves. Sometimes, their other illnesses, including depression, make the situation unbearable, and they can only do the best they can, even if that means their choices are not the best choices. Do you have an inpatient diabetes educator? These things should be addressed and perhaps, they could be addressed by someone that does not have a horse in the race, so to speak. This educator could make appropriate referrals and have this patient follow up for chronic disease management and weight loss programs that will have a much bigger impact on overall health than simply withholding a cookie.

Strange.

I guess this is not really a mistake, just pretty unbelievable. The most ridiculous I think I have seen is the James Bond movie where James Bond fibrillates himself. I know, we used to get patients in the ED that did CPR on themselves and lived, equally unbelievable, but really. Of course, James Bond lived also. Happened to have access to the defibrillator in the glove compartment of his car or something. No, it was not an AED, but did have pads instead of paddles, so of course he would be able to press the button.

Oh, he is the supernatural part, didn't ya hear? He has superpowers as a nurse like no other.

After actually looking at these pictures, I am not so sure that it is unprofessional. There are actually no nurses seen from the front, only the shoulders. This is really not meant in a sexual way. I am completely ok with these photos, and do not find them offensive at all.

I work nights on a surgical unit, and many of the patients' family members spend the night. Well, one spouse did not sleep (she worked night shift as a nurse), and noticed that the staff was not in the room in about 4 hours. She turned on the call light to request pain medication for her spouse. The staff answered by intercom and she was told the nurse would be in. About half an hour later, she walked to the nearest nurses' station. She found the lights off, and the nurse sitting there was bundled up with a blanket and pillow. She awakened this nurse to inquire where the nurse for her spouse was, and the nurse called the other nurse. As the phone rang, she heard the phone and walked toward it. The nurse walked out of an empty room with her eyes reddened and creases in her face (like she had been lying in one position). Luckily, her husband was not injured, and was fine. However, this family is more than a little upset about what she witnessed, first as a family member, second as a nurse. This is why we don't sleep on the job. Those who do should be fired immediately to prevent situations like this. If you cannot work sleep into your schedule, do not work night shift. This story shows how we look, but what if the patient had died, fell, or been harmed while the nurse slept? Isn't this the reason we have 24 hour staff in hospitals?

No way. It is unprofessional. Nurses and physicians should act in a professional manner. I would not purchase this either. I am a strong supporter of professionalism, not making a mockery of my profession.

Favorite: Patient sets alarm for prn pain medications "due" time so she does not miss a dose. Calls and complains about the noise of the alarm, very frantic that she was awakened from such a sound sleep. She has no idea what the noise was, so is really chewing out the staff. Finally understands that it is the alarm that she has set, and suddenly remembers how badly she is hurting. Went to get her medications and had to awaken her. She could not even swallow the pills, so this dose was held and she forgot to reset the alarm. Slept like a baby, and amazingly, after the sleep her pain improved.

I think that change is good. However, I feel that orthopedics does include spinal surgeries in many facilities. It will be a little different at first, but then will become easier. The spine unit is much like the orthopedic unit, but is more focused on ambulation than other exercises included in therapy. There are restrictions on bending, lifting or twisting of the spine. Some fusions will require a collar or brace for stabilization. Pain is an issue, just like in joint replacement patients. Of course, many have chronic pain and this may be as challenging. The same risks exist; infection, VTE, pneumonia, urinary retention, constipation and anemia. Therapy is usually limited to ambulation or occupational therapy while in the hospital. Once healing has began, these patients may need additional therapy. Many have lost some function or sensation in extremities, and this sensation or function may take a while to return, months or years if at all. Good luck. I am sure you will do well. We actually had the physical therapist give us a presentation and it made things clearer for us.

Ah, the research and evidence to support us. Now, here is an idea. Obviously, we need more nurses to care for our patients, and we are seeing more male nurses. I say, bring them on. Do research and find out if this is a problem, and how this can be best handled. This should provide the guidance and support needed to change practice.

So sad that this was such a terrible experience for you. But, was it a terrible experience as a nurse, or as a man? I am not sure that this opportunity allowed you to distinguish the two. I think you were hired as a nurse by someone who was looking for a nurse, but unfortunately were discriminated against because you were a male. It is not clear who was uncomfortable with this, you, your co workers, or the patient, or all of you. I truly wish you luck, but feel that, although some patients see you as a male, most simply see you as a nurse.

I have to wonder if you are the one asking for compassion and not your patient. I personally have been a nurse for many years. I am female, but have had only maybe two male patients that chose not to have a female insert a catheter. I never really asked about their comfort level, but feel asking would really bring discomfort and make this more awkward. I believe that it is frustrating whenever female nurses are expected to perform such tasks in addition to their normal duties. I believe if you feel that you should not perform certain care, perhaps you should work in an area where that is not an expectation. I work with a male CNA that constantly says, "I really don't feel comfortable doing an EKG on her, so I will let you do it" or "I don't think it's appropriate for me to walk her to the bathroom, so you will have to do it." These are just examples. So,patient preferences were never discussed. It was about him instead. I am not sure that showing him compassion makes anything better, as while I am performing his duties, no one is able to perform mine and patients are not getting the nursing care that they deserve. I don't mind doing anything, as I was once a CNA. However, I feel by catering to this CNAs needs, my patients' needs are not always met because I can only do so much while he is reading his book.

We also have had a higher number of falls, especially related to nerve blocks. We have been working on this for a while now, but there is something you can do to help. We do not use immobilizer or bed alarms. We do hourly rounding during the day and every two hours at night. We also do not leave men or women alone if their feet are on the floor. We found that most of our falls had nothing to do with walking, but rather toileting. We also were made more conscientious about what we were asking of patients, such as handing them a roll of toilet paper and walking out of the room. Of course, this was when they fell trying to wipe. Also, setting them up for a bath and having clothes nearby, made them think they were capable of dressing themselves and down they went. The staff had to be fully trained and involved, but without immobilizers and alarms, we did it. It is just a matter of making clear what you actually think the patient is capable of. Men cannot re position themselves to the edge of the chair to use the urinal. Women cannot wipe themselves. No one can actually pull their pants up. We used to tell patients not to get up alone, but these are not people that got up alone. They did ask for help. They were not noncompliant. We just did not fully recognize their needs. Also, on bed alarms. Get rid of them. They are demeaning not only to patients, but to staff. It is like being whistled at. There is no place in a hospital for another way to call staff. You have call lights, zone phones, pagers, tele alarms, BP alarms, and pulse ox alarms. Please tell me how this prevents falls. If anything this awful noise triggers fight or flight and only increases falls.