AMMLPN

This is kind of a patient question. My step daughter sent me a message last night saying she thinks she has neuropathy. She is 22 and has been an unstable diabetic for about half of her life. She had some major blood sugar drops during pregnancy, has an insulin pump etc. So I ask about the "neuropathy". I ask if it is like pins and needles in her feet. She said, "My chest arms legs i can't really feel...like i can scratch and i know im scratching but it just feels tingly but barely. I can't feel it like i normally would. I responded that neuropathy typically starts in the extremities. She said "I seriously thought at first my brain was like tricking me or something idk what it is then. I don't do drugs i promise lol" She did go see her primary doctor today. He didn't do any labs. She said that he just told her it was from her sugar.... Her a1c is 8.3 as of February. This is not my area of expertise. It just doesn't sound like diabetic neuropathy to me. I told her I would put some feelers out and see what I could come up with, at least some questions to go back and ask her doctor. Of course Google is NOT my friend in this. Googling symptoms never really gets you anywhere good and I don't have any lab values or test to give me any information to begin putting this puzzle together. One thought was a B12 deficiency. She is picking some up since I doubt it could HURT anything even if it isn't the right answer. Any thoughts? Any good questions I can send her back to a doctor with? I am suggesting a second opinion, for sure. Thanks in advance.

I think when bringing us on they said it was a staffing factor. We simply don't have any can't keep enough RNs on the floor at any given time.

It answers quite a few. See, the way it is now, the RN and LPN don't split the 9 patients. The RN does the assessment and the LPN gives the meds. The RN does most of the charting but the LPN will call the doc just as easily on all 9.... It all seems a bit messy but I think that's because it's all still so new.

We do team nursing. On our cardiac/renal floor on nights there are 18 patients split between 2 RNs, 2LPNs and 2 aids. So each team is an R, L, and CNA for 9 patients. On days there are 4 RNs and 3 take 6 patients each but they have a separate charge that does not take patients.

I am new to the hospital setting. We have a NEW team nursing model. The way this is supposed to work is that the hall of 18 patient is split down the middle. This gives 9 patients 1 RN, 1 LPN, and 1 CNA. I am very interested to know how this works in other places since this is the first place I have done it and it is new here as well. What does your normal shift look like? How are the roles divided? How do you make sure everyone is on the same page? Who reviews the chart and when is the best time? Do you do that before you see your patient? Before report doesn't seem like it would work here at all even though I think it would be optimal. However, a lot of times I don't even know who I have until I am handed papers and going to report. I would like to bring some new ideas to my boss, but I don't really know where to begin. Please, my more experienced nurses, please tell me what you do on a typical night or day and how it works for you. I know everything changes and sometimes nothing goes as planned, but if it did, what does it look like? Thanks a ton in advance.

Counting respirations should be easy, right? We learned this in school. You check the patient's radial pulse and switch without telling them. I am a new nurse but I have yet to work in a clinic where I take a radial pulse. We get it from the pulse ox. I tried still playing the radial pulse trick, but then a lot of patients ask me if my PO2 is working. I have seen some nurses that can get it without ME catching on (while I was TRYING to catch on) and I have seen some that put the same thing in for everyone unless they exhibited signs of distress. So, sometimes is feel like I am paused in my noting and staring awkwardly at my patient. I just know they are wondering WHY THIS CRAZY LADY is sending 15 WHOLE SECONDS just looking at them. And of course I am looking at where ever I can see the most movement, so their chest or abdomen. But them there are those that just talk the whole time and can't spend 20 seconds quietly. So, I'm wondering, what tricks do you use? I can count but how do I not get caught?