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!

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!

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.

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

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.

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.

Yep, this!

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.

I work in neither but I imagine it would have a lot of overlapping skills. However, they have very distinct differences. Wouldn't say one is harder than the other. I had an ICU nurse as my nurse when I was in the ED and she was fantastic. I was very ill. It's up to individual facilities how they staff their units.

You could work in an outpatient setting like taking vital signs/doing EKGs/etc. EKGs by the way don't require a separate license. All of our CNAs in our unit can do EKGs. They just had to demonstrate competency and be signed off on it. And it is easy. In an outpatient setting you probably wouldn't experience much EKG or phlebotomy. I'm a nurse on a busy tele floor with a lot of dependent patients. I can handle a lot of transfers especially if I get help from a CNA. With 2 people it's easier. And if you learn the proper technique you can make something that looks difficult pretty simple. I had a severe back injury in 2011 and it flares up now and then. My coworkers understand and don't hesitate to help if it's just one of those days. You kind of have to be the judge. I don't know the extent of your pain or functioning. Best of luck to you!

My badge is always flipping itself backwards inadvertently so it doesn't show anyways. No one hardly looks at it. As previous poster said just look professional, but the picture is SO small that it won't be noticed. I think what's really going on is that you're SUPER excited for this job! And that is wonderful. Keep up the enthusiasm and energy :)