shellyscorner

Yup ... Don't I feel silly! I actually saw that .. but NOT until AFTER I'd already posted my question! It's a shame too. I sounded like it had some really good information!

Hey nurseprnRN! The link you provided didn't work: "this is a really nice little site with pdf worksheets for different diagnoses..." 404 Error - Page Not Found I'm wondering if there was an error in the link or if the link is just no longer functional... I did a Google search for the link and everything came back to allnurses.com ... so I'm not sure any help? Thanks EDIT: See ... it won't even let me leave the link you gave ... I'm wondering if the site has been removed?

I don't understand HOW you can rate something that you can't OBJECTIVELY measure ... (I've never heard of rating NONpitting edema... which of course does NOT mean that it can't be or isn't done... It just means that I've never heard of it. ) Now, theoretically, if you knew the circumference of the edematous area PRIOR TO becoming edematous, then, yes... I could see how you could rate it. But otherwise? It seems to me that it would be pretty much a useless value. Am I wrong?

Yeah, my observations have been that a male nurse might be able to get away with that, but a female nurse, . . . not as likely. . .

Actually, I think it may have more to do with the "God Complex" that so many of them seem to develop!

I guess a poor excuse is better than none?

HA-HA!!! That's awesome!

Oh MAN! A pop quiz!?! Holy Cow! And not just a pop quiz, but a PUBLIC pop quiz! Okay . . . I'll try to represent . . . (What'cha bet I NEVER forget the answers!?!) I assume (bad thing to be doing!) that you'll send me corrections to my answers . . .!?! 1). What are TWO questions you MUST know answers before giving the patient 4 mg of Ativan IV? (there are more than two of them, actually, but you're just a student :) The first two that come to mind are 1)Current meds, 2)Med allergies, & then 3)Meds taken that day/last time taken, 4)Since patient's in ICU and is having difficulty breathing I'd also like to know when was the last time the patient ate (esp if I'm concerned about a potential intubation) . . . and still, I wonder what I'm missing . . . 2) Which one specific med MUST be immediately available in the unit for a nurse safely administer Ativan? Flumazenil? I admit, that one I didn't/don't know, but I looked it up, and this is what I found for treatment of adverse effects/events in the use of benzodiazepines. And I'm still not positive that that's the one you're looking for. 3). Same as 2) if order says "6 mg of morphine IVP" naloxone 4). What monitors the patient must be on for safely administering this order? telemetry, SaO2, respiratory, & blood pressure monitoring 5). You wrote that the patient had hypoxia. What test you'd like to see to determine if it is "hypoxia" or "hypoxemia"? You know you're correct. I did use the term(s) as though they were interchangeable. I stand corrected . . . She was certainly hypoxemic, as her PAO2 was below normal. She did have some altered mental status as well, as twice when asked what year it was she answered 1932, both times. When asked the second time, she didn't seem to even remember being asked and having answered wrong the first time. So would that not also suggest at least some hypoxia as well? Unfortunately, I don't remember well enough what her labs were to say for sure, so I guess I really can't be sure one way or the other. I know I want ABG's. I'd also like a lactic acid too. But, seems a metabolic panel also be useful as well? Well. Okay then. I guess I'm done. That makes it time to turn in my quiz. But before I do, I'd like to apologize for taking SO long in getting back to you with this! I wasn't ignoring you, or the questions. I knew it was going to take me a bit to to get through with it, so it did take me a few days to actually have the time available to give it it's proper due. Then, I had filled it out, and my computer crashed on me! Fortunately, I realized that the forum has an auto-save feature, and I was able to restore everything I had done . . . WHEW! Looking forward to hearing from you regarding how I did!

Oh! Ouch! That doesn't seem fair. There is a difference between specialty and super-sonic subspecialty. But hey, I'm just a student. What do I know!?!

As to the boundaries, I can't say that you might not have a point. I certainly need to give that some thought. I know I certainly FELT for her. But beyond that, I really hadn't thought through it, except my surprise with the dosage and the doctor's manner with the patient. As I mentioned to someone else, it wasn't the use of the drug in and of itself, I just wasn't familiar with the dosage in a setting like this, or truthfully, I think, just the seriousness of the situation. My other concern was my perception of the doctors response/manner, which was admittedly all my own, but again, admittedly was effected by the patients response to him. I had just never experienced a doctor respond to a patient the way he seemed to, nor a patient respond to a doctor that way. Again, I say seemed, as I don't know the doctor. I'd never met him before. Honestly, yes. It was quite a drama, at least for me. And frankly, I wasn't about to ask the patient's nurse about it AT ALL! That seemed out of line to me. And even if it didn't seem out of line, I'll admit openly, I would have been to big a chicken to ask! While I was surprised at several things, I didn't want to openly appear to be question a physician in a hospital where I don't work. Just seemed like the best plan was to keep my mouth shut. But, when I got home and started thinking about it more, it just ate at me, so I tried to research it out. I couldn't find the sufficient answers, in that I knew they wouldn't be cut and dried, or simple. Then I found this forum/site and thought perhaps I could find some food for thought from people who had already been in the field and might have some helpful thoughts for me. And, I was right. You guys have given me some really good things to think about. Not just in this situation, but in general. I'm really very grateful for everyone's sharing their thoughts. It's been a helpful and a good experience.

"THANKS!!!! I'll check it out for sure! But your right . . . I SHOULD have thought of that . . . after I hit "Post Comment" I promise I WILL check it out! Thanks much for the tip~ I REALLY do appreciate it . . . a LOT!" Weeell, I did do as I promised . . . I guess at some point, I need to get a new phone! It wouldn't let me download it! :banghead: There were several others to choose from. I'm certainly open to other suggestions. I did download a Medscape app but it's a LOT more involved than I probably need or want. I think it's really geared more to doctors. I would truly be interested in an alternative selection from you. ~ Again, thank you for the suggestion! It should have been obvious to me, but yeah, it wasn't.

Wow! Ok, good to know . . . I've just not had much experience with patients on Ativan, at all. In a previous post I commented back to someone and said: ". . . it was the amount that concerned me. It just seemed like so much. Although, when I looked it up, the max suggested dose was 8mg., but I'm not familiar with the circumstances with when that dose would be appropriate. I never dreamed you could give someone 8mg of Ativan! Four surprised me, can't imagine using 8mg, unless the patient used it on a regular basis and at higher does than what I'm familiar with (like .5 to 2mg doses)." I just wanted to clarify that I'm only familiar with patients, using .5mg-2mg. And I'd only seen one patient that occasionally used 2mg. All the other few pts that I'd been involved with used .5mg-1mg. So I guess that's why 4mg seemed to be so much. Again, thanks for sharing with me.

THANKS!!!! I'll check it out for sure! But your right . . . I SHOULD have thought of that . . . after I hit "Post Comment" I promise I WILL check it out! Thanks much for the tip~ I REALLY do appreciate it . . . a LOT!

That's a little scary. Doesn't that put the patient on a pretty slippery slope? It seems to me that in a patient that was having trouble getting diagnosed to begin with, that that could really be damaging to the patient's well being? Not to sound overly judgmental, but just as a human being that seems like an integrity/pride issues that could be really dangerous to a patient. I mean, I'm quite sure that they don't INTEND any harm, and again, I don't mean to overstep my bounds, but that really bothers me. I haven't been around enough yet to have experienced that. As a nurse, HOW DO you handle that? I mean, legally/morally do you have any responsibilities there as a nurse? I don't think I ever thought about being in that position. Again, I say that keeping in mind that nurses don't get to diagnose, so what do you or can you do in situations like that? Where does our patient advocacy go from being appropriate and then crossing the line in situations like that? Or do we even have room to advocate in such a situation, considering again, that we don't diagnose? And how do you handle that when you come across it? That would really bother me if I realized that was what was happening. So I guess what I'm really asking is, even if I wanted to do something, I'm guessing it wouldn't be appropriate, so how do you handle that? Both professionally and personally? I'm sorry if I'm crossing a boundary here, but I rather do it here in a learning environment than to try to address it in a work place environment and end up getting fired over it, thinking I was trying to do the right thing. That's a little confusing for me. Thank you for sharing that with me!

I'm sorry you feel that way. But no,that's not correct. And yes, your right! That would violate the TOS! Frankly, I didn't have a PDR at home.