kataraang

Wow. That patient should have been started on fluids the second they rolled through that door. We have a DKA/HHS protocol in place. It's really useful.

Baltimore MD. 3 years experience. $34.85; night diff 4.59. Weekend diff 2.50.

I love students! ? I have rarely had a bad experience with one. To see their excitement when they learn a new skill or see something they learned about in "real life" is awesome. I'm actually getting my masters in nursing education.

Hello, I came from a telemetry/intermediate care before I switched to a medical ICU. I stayed at tele for 2 years before applying for ICU. I found that it gave me enough time to really get my assessment/basic nursing skills up to par to handle a critical care environment. I believe it helped me. You don't necessarily have to wait 2 years, but it may be beneficial to wait until you hit 1 year from my experience.

We have monitors along the walls throughout the unit, not just at the desk. Each hallway has 2 monitors at each end. From any computer, you can see monitors. No patient names, just room numbers.

Hello, I was just diagnosed with RA in March. I am a full time ICU nurse. I've been in practice about 2 years now. RA affects individuals very differently so it kind of depends. For me, I was wearing a boot on my ankle and needed PT (while still working full time). It was rough. I have the pain in my fingers too, but I am slowly finding what works for me. Don't let it discourage you from nursing! Not all nursing jobs are super physically demanding. You can find the right fit. RA tends to come in flares so you may feel good for a couple weeks, then like complete crap another week, until meds can stabilize. Message me if you need, good luck.

Altered mental status. He had infected wounds needing debridement and IV antibiotics. He was a little altered during this time, not as responsive as baseline, HR dropping to 40s occasionally. The next day after rewarming he was more interactive.

Patient with C6 spinal injury from 10 years ago with autonomic dysreflexia. MAPs ranging from 40s to 80s, HR as low as 45. His documented temps had been normal but when I came on shift it was 32.7. I tried it oral, axillary, rectal (though he has flexiseal). I had another nurse double check with me, used 2 thermometers. I only went to those lengths to check because this was the first documented temp this low. His skin felt cool/cold. I gave extra blankets and turned his room temp up. My instinct was bair hugger so I asked the resident and he said no. He said it was normal for his autonomic dysfunction and not to treat. Isn't it still necessary to treat, regardless of cause? I'll see if the intensivist had any input from rounds today (since I'm on nights). Just curious of your experiences.

***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.

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.

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!

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!

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.

Personally I say "sit-trate"

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!