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2/13/16 What I Learned This Week: Discipline is King

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TheCommuter has 10 years experience as a BSN, RN and specializes in Case mgmt., rehab, (CRRN), LTC & psych.

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Ixchel needed someone to create this week's "What I Learned" thread, so I'll go ahead and attempt to rise to the occasion. I've learned a few things... You are reading page 7 of 2/13/16 What I Learned This Week: Discipline is King. If you want to start from the beginning Go to First Page.

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It sucks if you've ever had MRSA. Not sure about other areas, but here, a Hx of MRSA means contact precautions forever in the hospital.

I'm good at small talk, but when the tears come out, I have the emotional capability of a spoon.

It's supposed to reach mid-50's this Friday. Guess I have to shave my legs *sigh*.

When you learn about CAD and MI's, you jump to the worst conclusion when you start having chest pain.

People are too polite to ask me what my nationality is. I only find it offensive if it's asked in a mocking tone. Otherwise, ask away.

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Farawyn has 25 years experience and specializes in A little bit of everything..

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It sucks if you've ever had MRSA. Not sure about other areas, but here, a Hx of MRSA means contact precautions forever in the hospital.

I'm good at small talk, but when the tears come out, I have the emotional capability of a spoon.

It's supposed to reach mid-50's this Friday. Guess I have to shave my legs *sigh*.

When you learn about CAD and MI's, you jump to the worst conclusion when you start having chest pain.

People are too polite to ask me what my nationality is. I only find it offensive if it's asked in a mocking tone. Otherwise, ask away.

What's your nationality?

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Rose_Queen is a BSN, MSN, RN and specializes in OR, education.

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It sucks if you've ever had MRSA. Not sure about other areas, but here, a Hx of MRSA means contact precautions forever in the hospital.

Really? If someone comes to my facility with a history of MRSA, we do swabs of nares, groin, and axilla. If they come back negative, patient can come out of isolation.

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Farawyn has 25 years experience and specializes in A little bit of everything..

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Really? If someone comes to my facility with a history of MRSA, we do swabs of nares, groin, and axilla. If they come back negative, patient can come out of isolation.

Yes, that's how it is at my hospital as well.

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Really? If someone comes to my facility with a history of MRSA, we do swabs of nares, groin, and axilla. If they come back negative, patient can come out of isolation.

Yes, that does make more sense. But for some reason, the hospitals here keep you on isolation precautions. Same goes with VRE.

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Farawyn has 25 years experience and specializes in A little bit of everything..

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Half white/Caucasian (whatever the PC term is) and half Korean.

:inlove:

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This week I learned:

I'm not going to be an OR nurse. As fascinating as the surgeries are, I got woozy and then later, I got bored.

That the cell-saver does a number on blood cells. Eventually you have to transfuse.

What the term "barrel chest" really means. Saw one for the first time today...whoa!

That I have no sense of direction. I got lost coming back from the bathroom and had to ask for help.

That my capstone project topic has been vetoed. I followed the rubric and PICO format and was told two totally different reasons, by both professors, which contradict each other and the rubric.

And finally, that my first responder teacher (he's an EMT who teaches a class) is a total jack***

He actually told a student that "the problem with nurses is that they all have an overinflated sense of worth." Right after he finished explaining the morphine is a benzo. Ugh!!

Is it May yet??

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calivianya is a BSN, RN and specializes in ICU.

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Haha, well I'm in my Critical Care class. So yes, usually what I learn for the week pertains to Critical Care. It does interest me, but I also find neuro, ER, and OR to be quite appealing.

No offense to anyone who does neuro, but neuro to me was one of those things that was absolutely fascinating to learn/read about, but then when I encountered them in inpatient rehab, I said nope, nope, nope, all the nope. Half paralyzed strokes we had to get up to the bedside commode, half of them thinking they were just fine and could walk unassisted and the other half so scared it was a 30 minute ordeal to even get them to try to get up, traumatic brain injuries who were violent and inappropriate... all the nope ever. The brain is interesting as long as all I have to do with it is study it in a classroom.

I need to quit giving myself such a horrible assignment when I'm in charge. I always have the worst day if I'm charge because I hang myself.

What I have learned about being charge is that it's another NOPE! And I will protest loudly if anyone ever tries to make me be charge. On my unit, the charges just about have to give themselves the worst assignment because of the sheer amount of whinypants I work with. I was strategically positioned to listen to one of the Unit Drama Queens accuse the charge of favoritism because she had another three patient assignment AGAIN!!! (so did I, and I kept my dang mouth shut, thank you very much) and listened to her cry all kinds of fake crocodile tears about it. This girl has been a nurse longer than I have; her behavior is just not cute. She didn't look like she was suffering as she put Pandora on her phone later and walked around the unit singing loudly at 0300. Obviously real suffering happening there. :sour:

Besides, who wants to study electrolytes when their boyfriend proposed to them last night??? I'm too busy admiring my shiny, new ring!!! :yes:

CONGRATULATIONS! That's wonderful. :cat:

2) Nothing sends me faster into a rage than crappy nursing care.

You would have hated following me last shift I worked. Fortunately, day shift was agreeing with me on my logic so I didn't get eaten alive when I gave report, but I let a patient run hypertensive all night long. Like really hypertensive. >180/110 hypertensive. A few 190s and higher sprinkled in there.

Patient had been on a labetalol drip, we weaned it off... and she promptly decided she didn't like swallowing pills. Really. Refused all her BP meds. Every last one of them, over the course of two days. Either she didn't like the coating on them which tasted bad, or they made her nauseous (offered to bring her some Phenergan/Zofran with her pills, which she refused because she'd just rather not take any pills at all, and didn't want IV nausea meds either), or she was tired and didn't feel like sitting up. Patient was YOUNGER THAN I AM and in kidney failure and heart failure due to untreated hypertension. Probably related to her extra-morbid obesity, and her refusal to take any pills at home either.

So what did I do? I made a note of it and left her alone. I snuck in a few IV push labetalol and hydralazine doses (which brought her done from like 188/- to 185/- if that) while she was sleeping because she'd refuse them if she was awake, but that's all I did. Maybe everyone is all shocked that an ICU nurse is going to let her patient run hypertensive (I know I got some side eyes from my coworkers), but restarting the labetalol drip because the patient won't take PO meds is putting a band-aid on a bullet hole when she just needs to be discharged so she can go home and do whatever the heck she wants to do with what couple of years she probably has left, if she even has that long. What's an extra day or two of ICU going to do for someone who refuses to take meds at home anyway? We can't lock her in ICU for the rest of her life and throw away the key, so just let her run hypertensive and send her home. Yep, my filed vitals looked like crap all shift long.

Still can't decide if that's me being a reasonable person or me being a really apathetic nurse.

:blink:

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Wrench Party has 3 years experience and specializes in Cardiology, Cardiothoracic Surgical.

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Calivianya, I guess I need to be more specific. I don't mind when nurses have had total SHTF days with their patient load and didn't get around to the little tasky stuff- that I can deal with. Just let me know in report. Or if the patient is refusing treatment, also relevant.

I do mind the "pass the buck" mentality that occurs, especially on otherwise stable patients. It speaks more to lazy unit culture and lazy than anything else.

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This week I learned that the 52 seconds it can take to dislodge a shoulder from a pelvis during a shoulder dystocia can be the longest 52 seconds ever.

Luckily baby was fine and mom is doing good too.

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StripeyDog specializes in acute rehab.

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My dog's chest is "pristine" on X-ray, she is not obstructed after eating an unmentionable, and I accidentally out myself as a nurse even in the dog ER.

My dog is 10 years old and still eats unmentionables.

The dandelion wine I made back in 2013 has aged very nicely. However, it's not strong enough to counteract all the coffee I drank on the icey-rainy-foggy drive home tonight.

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