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  1. kataraang

    Med error and Pyxis

    ***Always check policy, asking a manager would be a good idea. Proper practice vs. what actually happens varies. But in my experience, there are times where I don't return to the pyxis..Like if a patient decides after I have opened the med that they won't take it. There's also no way to document that I dropped a med on the floor. And I have on very rare occasion came home to find a senna in my pocket. Obviously with controlled substances you must always return through Pyxis with a witness.
  2. kataraang

    Who gets the write up?

    That is confusing...most central lines are at least a double if not triple lumen. So you could have levo and vanc running in their own primary lines. There shouldn't be any mixing of them, because while vanc is running as a piggy back, none of the levo is running (for 60-90 minutes I presume). And then I have no idea if these two drugs are even compatible with each other, is the other issue. If it was a single lumen central line, that was a poor judgment call by the provider or PICC team because any patient on pressors is likely needing a bunch of other things at once. And the pressors cannot be interrupted. There are several things wrong here.
  3. kataraang

    Accused of not giving dilaudid

    I had a patient file a formal complaint and threatened legal action because I didn't flush before and after a med (total lie), that I gave his med late (he refused it at the scheduled time), and that I acted "annoyed" at him. It bothered me for a few days. And I was concerned he might try to escalate it...but so far he is discharged and I haven't heard anything. He complained about every nurse that took care of him. It was a blow to my pride but now I don't care. Next case! I understand OP's anxiety though. Some patients can get under your skin try as hard as you might to not let them. Take care of yourself and just do your best with every patient you encounter!
  4. kataraang

    Nurses with SelfHarm Scars

    I have never been asked before, but I have a feeling they have been noticed. Fluorescent light is the WORST for making them visible. I think they are probably worse looking to me than to most others. 99% of people probably don't care. But I notice I do think about it at least once every shift. It really sucks that I had to go through it 15 years ago now...but it's my past and I've overcome many obstacles to be the nurse I am today. I am proud of my progress :) I hope you can be too!
  5. kataraang

    Stepdown / IMU

    I work in the IMCU. It's a 1:4 ratio. Vitals q4. Most patient on tele but occasionally one isn't (usually med-surg overflow, or patients who have stabilized enough and are near discharge). We do some drips (such as nitro, dobutamine, lasix, amio, diltiazem, milrinone) but no pressors. No vents. In my experience the difference between IMCU, stepdown, progressive care, or telemetry isn't usually significant. But at our hospital we only have the IMCU and a cardiovascular stepdown.
  6. kataraang

    How do you pronounce CITRATE?

    Personally I say "sit-trate"
  7. kataraang

    "untestable" on NIHSS

    Thank you everyone! A lot more clarity for me now. I will also ask my unit educator. Seems like I should have scored 4. She had almost no voluntary movement on left (though sensation intact). She at times could wiggle a toe but it wasn't always. Nothing in the arm. Always learning!
  8. kataraang

    "untestable" on NIHSS

    I don't think there's a real debate on this one. NIHSS is standardized for a reason, and there is so much training involved in doing this scale accurately. I'm still a relatively new nurse (1 yr) working in telemetry. I'm only asking because a nurse with many more years of experience than me had documented something that confused me. On patient with L side paralysis following stroke, I am doing NIHSS. Patient must hold arms out to assess for drift over 10 seconds. On her paralytic side, she has a broken humerus in a sling. I documented as untestable. The CCU had documented as a 4 (no movement). I just think that if there's some reason other than stroke that would prevent testing, then it should be skipped (such as reading words when they don't have their glasses, or an amputee). Yes I'm nitpicking but I want to get this right. Did I score that item correctly? Thank you!
  9. kataraang

    Vitals question

    True. BP would probably be a bit excessive for 99% of cases, especially in children with no significant health history. I think I recall when I was using the nurses office in middle school to skip class (yes I did...) I only had my temperature checked. Though one time was legit, I had a 103 fever lol. Maybe only BP/pulse/O2 if the kid is lightheaded or showing changes in level of consciousness.
  10. kataraang

    Vitals question

    Yes it is. Because Katara and Aang are the best couple ever.
  11. kataraang

    Getting yelled at by a doctor for the first time....

    This doctor has a stick up his you-know-what and you handled the situation professionally. You advocated for the patient. I don't know why the doctor would be mad...I'd be happy as the doctor if someone was able to help me out so that the next day I'd have one less thing to do. Don't feel bad! Don't take abuse from doctors. MD doesn't mean they are better than you.
  12. kataraang

    Vitals question

    Scope of practice is a very important topic and it is good to be discussed in this thread. I am not trying to be smart or anything, but why not just take a full set of vitals? It only takes a minute. That eliminates the confusion of what should you be measuring for what symptom. But honestly look into your facility's written protocol. There has to be one.
  13. kataraang

    Does anyone really read all this charting?

    Yep, this!
  14. kataraang

    Heparin drip

    It's okay, that happens sometimes. No harm came to the patient, and you recognized it before you left for the day. Also, my facility uses anti-Xa to titrate heparin, not aPTT. I wonder if either one has benefit over the other.
  15. kataraang

    heparin med error

    You did the right thing by reporting. You let someone know, you monitored your patient, followed their labs, and have now learned an important lesson. I guarantee you won't do it again. Being new is hard! I held lovenox for a stupid reason (in retrospect, there was NO reason to hold it) and I got in trouble with the doctor and had an occurrence report to sign. Patient was fine but I never take DVT prophylaxis lightly anymore. Every time I give a shot of heparin or lovenox I think back to my first mistake. You won't lose your job.