RNDarling

A less likely option, but just for the heck of it, perhaps the Zofran threw her into a fatal rhythm r/t her history of arrythmias/HF.

I’d like to start with a current set of vitals along with an EKG and CBC, BMP, and cardiac enzymes please.

RVs error was definitely egregious, and it goes past just being on some form of autopilot. Just yesterday, I was on autopilot and at the Pyxis to retrieve phenergan for my patient. We give it IM for patients coming out of surgery and complaining of nausea. Typically it comes in ampule form. This time, I looked at the drawer and saw blue vials. I figured I typed the wrong med, closed the drawer and started over only to find the Pyxis opened the same drawer with blue vials. Confused, I grabbed one and it said Phenergan. My idiot self thought long and hard and I doubted myself enough to close the Pyxis, walk back to the EMR and confirm I really wanted Phenergan and wasn’t having some sort of brain melt that had me thinking of giving the wrong drug. Obviously they had just loaded vials into the drawer instead of ampules and I wasn’t aware of the change. My point is that I was on autopilot (yes, I know I shouldn’t be at the Pyxis, but I was), but coming across something unexpected gave me enough pause to double check what I was doing. RV saw something that had to be reconstituted and still didn’t stop and double check. The error is absolutely her fault and in my opinion, her nursing license should be affected in some way. I just don’t know about criminal charges though.

Thanks for the great recommendation!

Thank you!

I'm an ACNP student and was just wondering if anyone has recommendations on good podcasts? I would really love to use my commute to expand my knowledge base. Thanks!

Thank you!

Great article, thank you!

I'm new to PACU and was just wondering why a preOp evaluation inquires specifically about beta blockers? Also, why do or don't you want a patient to have taken their routine beta blocker preoperatively? I'm just trying to better understand the significance of beta blockers in this specific setting. Thanks!

Thank you for the feedback! This really makes me feel so better. To answer the two previous posts, I have 1.5 years of ICU experience and do not have yet have my preceptors lined up as I don't start clinicals for over a year. I will be looking to line those up in about January per the school's suggestion. Thank you again for taking the time to reply!

I currently work nights in an ICU and am in school to become an ACNP. I'm burned on nights but can't work 12 hour days because of child care. I'm considering a change to 8 hour days in a PACU but am worried that leaving the ICU won't look good for my ACNP program (I.e. finding clinical placement will be more difficult and then finding a job after graduation will be more difficult). I don't graduate for another 2 years. Any thoughts/experience with this? Thanks!

I think you're well within your right to apply to any and all positions to find the right fit for you. Due to personal circumstances, I had about a 2 year gap between the time I graduated and started applying for jobs. It took about 2-3 months but I was hired on a med surg floor at a great hospital and I had no issues at all learning the floor. I did refresh my book knowledge prior to starting and looked up everything as I worked, but it comes back quickly. Just have confidence in yourself.

We do not and the justification I've been provided is that you want to use the patient's dry weight (for consistency and accuracy), instead of a weight that may be higher due to fluid volume, for example. Also, if the titration is based on labs, such as would be with heparin, then you risk changing the dose based not on the lab measurement but on the weight.

Agreed, people now get trophies for showing up and we wonder why the newest generations grow up so entitled. To hppy, I am impressed by you and your response to the idiot at the nurses station you referenced. No one deserves to be disrespected at work and we can all do our part to instill a positive culture at work.

Congratulations, you must be very excited!

I read the initial post a few days ago and as a mom to a toddler it was so heart wrenching, I was in tears and could read no more. I'm so glad to have read your updates and feel hope and relief for that young boy and his family. Their story would be so tragic without your help, nursinginchaos; you saved his life. He will have a long road ahead and may suffer long-term consequences, but he a chance at a very happy life because of you.

I'm sorry that you feel so vulnerable and that you don't seem to mesh well with the personality type of your preceptor. While it may be embarrassing that you cried, ultimately that doesn't really matter. What does matter is that you do everything you can to try and learn what is being taught and ask questions when you don't understand something. It may be a scary and intimidating environment for you, but you will be off training in the near future and taking in as much as you can now by way of experiences with your preceptor at your side will only benefit you (and your patients). You don't want to experience some of that for the first time when you're on your own. Give it, and yourself, some time and you may find yourself surprised by what you can do. Don't let fear restrict you. If it's not for you after you give it your all, that's ok too but just give it a fair chance.

Thank you so much, this advice is extremely helpful! There is an educator who is in vacation until next week, but we have a meeting scheduled just prior to my start date. I will definitely ask her for suggestions as well. I'm trying to refresh as much as possible and your suggestions to focus on the diagnosis first is certainly a smarter way to organize the information.

Of course! How could I forget dilaudid í ½í¸€?

Thank you so much, that's so helpful!!

Hi there! I was just hired for my first RN position and it's on a med surg unit, starting in about a month. I have been out of school for over a year though and feel a bit rusty. I thought a good place to start reviewing would be common medications I'd see on the unit. I know that med surg sees a lot of different dx and a lot of different meds, so just thought I'd get your opinions on what you see most and what you recommend reviewing. If you have any other suggestions on books to read or topics to review though please let me know. I really appreciate your help!