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xmilkncookiesx RN

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xmilkncookiesx has <1 years experience as a RN.

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  1. xmilkncookiesx

    Please help with my hw assignment!

    Hi all, wow it’s been SO long since I’ve posted her. Brings me so much memories from nursing school days :) I am in a RN-BSN program and it has been tough. I have a project that is a whole semester long. First we are working on picking a topic. The topic is something that interests us within social injustice and health disparities. I choose mental health disparities among minorities. I thought maybe that’s too broad. So I came up with mental health disparities among LGBTQ. Then again, thought that’s too broad as well LOL. I was focusing on mental health because I work in that field and I feel that mental health is so important and to get help! I am stuck, I need help. Any feedback is welcomed.
  2. xmilkncookiesx

    what is the hospital nurses role in organ donation?

    thank you!!! I have a question. I was told to NEVER ask families about organ donation, that you only talk to the OPO about it. I am assuming the families will get offended if asked or offered? Is it the OPOs role to discuss that with the patients family?
  3. I am having a hard time looking for resources that gives a description of what a hospital nurse does in the organ donation process from A to Z. For example, the patient is admitted to the ER or whatever floor they may be on, and is in critical condition. they are sent up to ICU for further care and monitoring. Once that patient is there, what are the next steps? Assessing, monitoring vitals, labs .. what exactly are the typical policy and procedures when a patient is admitted in critical condition? (I know it varies per facility, but just a general description helps). what does the critical care need to assess and monitor for to possibly consider this patient not going to live, brain dead? what exact labs are to be drawn for and monitored? what are the criterias and list that the nurse has to check to see if this patient is a potentially brain dead AND a organ donor? what is the criteria called? I have heard of it but can't remember it. something called "clinical trigger"? once the nurse says hey, this patient meets the criteria of brain death and organ donation .. what happens after this? what is the nurse to do? contact their OPO? from there, what does the OPO have the hospital nurse do? I am having trouble finding sources that list these things, just in chronological order. I found an online powerpoint that lists it but it is from 2009 and I don't know if I can even use that as a reference in my presentation. all of the other sites I've come across, does not have what I need, or they're blogs the powerpoint I found, I really liked because it gives me a general description of what exactly is to be done in order and how it needs to be done, etc. it doesn't list references but it does list the presenters' names. if any of you can help find something for me, thank you so much! I was told to contact a local OPO and ask these questions but someone else told me that they would only know what THEIR nurse is to do, not a hospital nurse. idk!! Im stressing over this
  4. xmilkncookiesx

    What do you do when a patient refuses treatment and wants to go home?

    I am already aware of that. thank you
  5. Hi all. I've only come across this incident once, last week as a nursing student. I had a patient who had a wound that was stitched. 2 different doctors worked with the patient. one said told the patient that they need to stay for further treatment and the other said the wound looks fine and they can go home. eventually we had them sign papers so they could leave. the patient was stabled, wound healed really nice too. my question is, what if a patient is being hospitalized for like a stroke, heart attack, something serious like that, and they refuse any further treatment after being hospitalized for days? some may refuse because of financial issues. I would think maybe getting social work involved, PT, OT, dietician, etc. but isn't the cost for home health care MORE than being hospitalized? because its by the hour, who's visiting, how often they're visiting, etc? as an advocate, that is what I would do, get social work involved, PT, OT if they're going to have issues getting around and financial issues. but I don't know much about that stuff (what to do if patients refuse further treatment and just want to go home). I'm not going to convince them, but educate them as much as possible and if they still refuse, they could sign papers and idk what else from there?
  6. xmilkncookiesx

    What to do when pt comes into ER with closed head injury?

    thank you so much!!! this was a great help. I was freaking out on if we need to assess ALL cranial nerves or just specifics like 2,3,4,6,10, you know, PERRLA, can they move them around, and also motor, speech, etc. But the main focus on a heady injury is the GCS along with other neuro?
  7. xmilkncookiesx

    What to do when pt comes into ER with closed head injury?

    lol I've always hated SIM, I feel like it is no help. Can you tell me this .. when performing neuro assessment on patients with head injury, would you assess ALL cranial nerves? or will that take too much time and just want to focus on certain cranial nerves such as 2,3,4,6,10 for example?
  8. Hello, I have sim lab in a few days. I reviewed and studied material for ICP. I gathered information on what I learned and put them in the order on how to assess and treat the injury in an emergency. I am looking for help with this. If I did something out of order, please let me know what it is and how it should be. If I missed something, pleas let me know or if you suggest something else. The info below is the pt sim: Pt is a 16 yr old and was riding in the back of a friends pickup truck on a rural dirt road to visit friends. the friend driving had a couple of beers, and swerved to avoid hitting a branch on the road. the teen was standing up in the back of the pickup truck and was ejected, landed about 5 feet away. when his friends got to him, they said he was looking around and seemed ok and that there was no bleeding anywhere. his gf was hysterical and insisted that they'd take him to the ER, and here he is. there are no medications listed (they always list them. so idk why they didn't this time). labs: CT scan of the head (but doesn't tell us what until day of sim) the learning objectives kind of give us the answers away on what to do but not always, which is fine: perform an accurate assessment on there teen who is admitted following a traumatic head injury. identifies nursing interventions for a teen with increased ICP. evaluates the teens response to interventions and responds appropriately. so this is how I would assess and treat the injury: -once we walk into the room, introduce ourselves. ask him for his name, DOB and A&O (this will help me with LOC and airway) -ask him or his friends what happened, what symptoms he presented during the incident and on the way to the hospital -we would simultaneously get continuous vitals on him and administer O2 per orders AND blood glucose? -elevate HOB 20-30 degrees -ask if he is allergic to anything (although it says NKDA on his paper) -assess pupils (PERRLA) -assess cranial nerves (THIS is where I am a little stuck. do I perform all of the cranial nerves or is there only certain cranial nerves to assess in this situation?) -glascow coma scale assessment -administer any meds per order (now .. since there are no meds on the paper, I am assuming we would have to call the doctor for an order once we give an SBAR of the pt.) the meds I remember in the lecture usually given in increased ICP, is mannitol to decrease ICP, decadron to decrease cerebral inflammation, and dilantin if the pt starts seizing, and insulin to prevent elevate glucose levels. I feel like I need more? or I am missing something? or out of order by prioritization. Please let me know if I am out of order and kind of insert where or whatever. Any rationales is perfect too, sometimes I don't know why or have a different rationale to things and thats why I get answers wrong lol. I hate doing neuro and a lot of my classmates are afraid of doing it, just because we get confused or don't know how to do a "focused" neuro assessment, or we forget which cranial nerves and this is and that. I am thinking I would do the PERRLA, have the pt do the cat whisker assessment what are common deficits in closed head injuries?
  9. xmilkncookiesx

    What are the normal CK labs?

    I have used Lippincott, Google, Mayo Clinic, Labtestsonline.com, and they're all different or don't show anything this is my understanding of what each are too: total CK: to accurately localize site of damage CKBB: destruction of brain tissuew CKMB: found in skeletal and heart mm CKMM: found in skeletal and hear mm is this correct? also I know each hospital will have their own range of normal numbers, but I just want a typical range. because on my sim pt, these are their labs: CK: 160 units/L CKBB: 45% CKMB: 0% CKMM: 55% So I'm trying to figure out what the typical normal range is, and compare the sim lab pt values. If you need more info about the sim pt, the pt is a 24 y/o woman that noticed acute facial droop on the right side and weakness on right side, and dysarthria. she has a hx of HTN, arrhythmias, migraines, obesity, asthma, chronic low back pain, smoker (1ppd since 13).
  10. I have sim lab in a few days and I'd like to prepare for it (well I already am, but want to make sure if theres anything I am missing to anything to add onto my assessment). the paper says that the pt was working and noticed acute-onset facial drooping on the right side of her face, right sided weakness, dysarthria, and aphasia at 1000. EMT got alerted and brought the pt to the ER approximately 20min after stroke sx occurred. The pt weighs 190lbs. and is 6'2". She has a hx of HTN, arrhythmias, obesity, asthma, chronic low back pain, and a smoker since 13 (1ppd since). This is how I would go about my assessment: 1. ask the pt if they can tell me their name, date of birth, any allergies (this will also help me in assessing her airway) 2. assessing airway, breathing, circulation (ABCs). get vitals running on her and if O2 is low, I will administer O2 via nasal cannula per doctors order. 3. I would ask when they were last known normal (well, if there is someone with her like employee or something), but I am thinking 1000 since it says thats when she noticed those symptoms. 4. ask them what they were doing prior to, what other symptoms they experienced, any visual changes, etc. 5. I would perform the Cincinnati and NIH stroke screening (according to what my professor said in her lecture, if any of the Cincinnati tests are positive, you move onto the NIH??). So facial drooping (smile, show teeth, frown, stick tongue out and move it up/down and side to side) arm drift (have them hold their arms up for 10sec with their eyes closed), slurred speech (slurring of words or unable to speak). 6. Obtain 2 IV lines (for any BP meds, etc. and the other line for tPA if indicated and because it doesn't mix with any med). I would administer a antihypertensive med PER ORDER if BP is >180/>105 so that way we can give the tPA per order. 7. Obtain labs, CT results with doctor and if the CT comes back negative for no hemorrhaging stroke, and with the positive results from the stroke tests, AND obtaining a history on if she's had UNCONTROLLED hypertension, recent surgeries, recent strokes, basically the tPA protocol .. if she is eligible for tPA, then we can go ahead and go forward with the tPA orders. 8. We would continue monitoring her vitals throughout the therapy. Now .. before I go forward with the tPA, I understand I have to ask the tPA protocol questions to make sure she's eligible for it or else I could cause the pt to bleed. BP has to be So this is how I got my dose for the tPA. PLEASE correct me if I did anything wrong: 190/2.2= 86.36kg MAX dose of tPA is 90mg 0.9mg x 86.36kg = 77.724 x 0.10% = 7.77 over 1min bolus Then the rest, 69.95 over 1 hour I feel like I am missing something in my post, or it is out of order, or incorrect info. PLEASE correct me, I do not mind. Also, on my powerpoint it says all invasive procedures need to be done before tPA (foley, etc.) My question with this is, it says insert foley per MD if unresponsive or consider and ask MD for it. Why would a foley be inserted in someone unresponsive? d/t urinary incontinence? thank you! :)
  11. xmilkncookiesx

    How to prioritize 4+ patients?

    First semester we were able to have the whole pt info the night before. But we haven't in the last few semesters. But this semester is really complicated for me since its a big load for me and some of my pt have SO MANY MEDS, I mean its SO frustrating.
  12. xmilkncookiesx

    How to prioritize 4+ patients?

    Thank you, this has given me some relief!
  13. xmilkncookiesx

    How to prioritize 4+ patients?

    Ours was self taught. she taught us based off her experience as a nurse, not the books we bought. so it was definitely hard and especially because no anatomy and physiology review was provided before going straight into the medications .. which they NOW understand why we struggled with pharm.
  14. xmilkncookiesx

    How to prioritize 4+ patients?

    Thank you. And no we can't look at the meds the night before. We aren't given pt info until morning of. But I go home and review the meds I've written down
  15. xmilkncookiesx

    How to prioritize 4+ patients?

    Thanks! She said these past few weeks, the N's didn't matter but these next upcoming weeks (3 weeks because we have 8 week courses) the N's WILL matter. But how do you manage this patient load? What is best to do first? I feel like she was annoyed that I wasn't prepared. But we were never taught how to manage this load. I need some sort of guidance, time management skills, prioritization with 4 patients.
  16. xmilkncookiesx

    How to prioritize 4+ patients?

    Hi. I am in nursing school, my last semester (4th). Right now in clinicals, we are assigned to 3 patients but help the nurse manage 4 patients. All we have been doing is med pass and assessments, and charting head-to-toe assessments on 2 out of the 3 patients. My clinical instructor has barely talked to me during clinicals since she's on another floor with other students or I'm always in a procedure or she is passing meds with another student. This week was the FIRST time I was able to pass meds with my professor (and then we can finally pass meds with our nurse). This is our 5TH WEEK already. So for 4 weeks, she didn't pass meds with me but she did with everyone else and she was aware of it. She gave us our clinical feedback this week individually and I have some N's (Needs Improvement). But I am confused because the other 4 weeks, all she did with me was come see me for 3min or so and ask about my patients and I gave a brief report to her, and said what type of meds they are on, and how they currently are doing. And she kept saying I am going great and that it sounds like I have everything worked out. But when reviewing my feedback, I have N's on "managing 4 patients" and "knowing medications". How can she grade me on these when she JUST passed meds with me THIS week? And she doesn't know my struggle with managing 4 patients UNTIL I told her THIS week since she never had time for me previously. Every time she came around 4 weeks ago, she would just ask if I have the meds ready and I would say no because I JUST got back from procedure and just began to look into them. And she would say okay thats no problem. So that really upset me because she said after this week, the N's will matter if we get a lot. I do struggle handling 4 patients. and ESPECIALLY if they have SO many damn medications. omg idk how to manage it all. its so overwhelming. Here is what I do when I come into clinical: get report from nurse look at admission notes look at labs look at meds (I write them down first and TRY to review them all before seeing my patients but it takes FOREVER because some I have never heard or seen or don't remember. Pharm was horrible for my class). then I go in to see my patients, do my assessment on them get vitals then I go to try and review the medications and THATS when my clinical instructor pops up. She told my clinical group that we are all doing VERY good, and that the other clinical groups instructor is struggling with their students, that they are doing poorly. I even told her I struggle with getting all of the pt info down first before seeing them. and all she said was, "yea you have to figure it out." you know, I'd like some guidance instead of figuring it out myself. I asked my nurses and they said they all struggle still, and they told me their routine and I tried each of theirs and I still struggle. Can someone please help me? I am usually on a cardiac unit, whether its med-surg/tele unit.