OFFICIAL: Health Care Thread. Health Care Crew Unite!

[DatMurse]

Nobody in this thread is talking about hanging a 3 liter bag of saline and walking off. I've never even seen a 3 liter bolus ordered, and cant see myself ever doing so. Typically it is "1L bolus, repeat x2 for SBP <80/CVP <5/etc". Most fleas think a 250 or 500ml bolus is huge, good luck getting more than a liter of volume from them.

I get the 2 3 port lines and start attaching them to each other so I have 5 ports(2 spikes and 3 running secondary). I therefore spike bags and have a 5L bolus gravity and walk away

[iBrooklyn]

Anyone here get into the nursing program with a B? Dont think I will get an A in anatomy and physiology brahs. Also...is nursing classes harder or just as hard as a&p1?

[veggie530]

Did you start out in the ICU as a new grad?

No. I worked the floor for 6 months with no CNA's and no RT's. Just RN's. It was a respiratory step down/tele that gave us 4 pts each. **** the floor.

I felt like a waitress at Hooters during the Superbowl but without the tips.

Anyone here get into the nursing program with a B? Dont think I will get an A in anatomy and physiology brahs. Also...is nursing classes harder or just as hard as a&p1?

Yes you can, but it won't help like an A will. I say that nursing classes were easier, tbh.

[guyman123]

Anyone here get into the nursing program with a B? Dont think I will get an A in anatomy and physiology brahs. Also...is nursing classes harder or just as hard as a&p1?

B in A&P 1 crew.
RN crew.

[J_dazzle23]

I certainly hope not all of nursing school is harder. I took evert bit of my phys and anatomy, both one and two in one semester and it dang near killed me.

BRB learning clot ting factors, hepatic veins and brachial plexus all in the same weekend

Even the pathophys class I'm in now seems like a cinch.

[JeffyDOS]

Anyone here get into the nursing program with a B? Dont think I will get an A in anatomy and physiology brahs. Also...is nursing classes harder or just as hard as a&p1?

Lol, yes. I got a C in microbio. Aced A&P though. But you'll be fine man.

No. I worked the floor for 6 months with no CNA's and no RT's. Just RN's. It was a respiratory step down/tele that gave us 4 pts each. **** the floor.

I felt like a waitress at Hooters during the Superbowl but without the tips.



Yes you can, but it won't help like an A will. I say that nursing classes were easier, tbh.

Jeez. Makes me REALLY not want to start on a non-icu floor.

[veggie530]

Lol, yes. I got a C in microbio. Aced A&P though. But you'll be fine man.



Jeez. Makes me REALLY not want to start on a non-icu floor.

It won't hit you for a while. Just grit your teeth when you get treated like a slave by some junkie for 12 straight hours who later complains about you. When you remember the amount of chit you put up with on that shift from your other 3-4 pts, and your boss is giving you a "coaching" on patient satisfaction, just remember that it's temporary. Some people are afraid to be so closely responsible for the life of another, others are afraid to be in the aforementioned scenario for years on end. Be #2.

[South Side Stev]

I get the 2 3 port lines and start attaching them to each other so I have 5 ports(2 spikes and 3 running secondary). I therefore spike bags and have a 5L bolus gravity and walk away

You could also just get the 3L (I think) bags of NS that urology uses for cystos and TURPs.

I commend your ingenuity though.

[DatMurse]

Understood. See above. Congrats on getting away from the bedside bull****.

6 months in, I honestly like being a bedside nurse. I like the family interactions and psychosocial care and being able to alter their POC. I also like taking care of a dying patient and their family.

I do see alot of dumb **** from bedside nurses like the 10ml flush syringe will blow the site vs a 2.5ml flush.

Like doing bull**** assessments, everyone wants to do a full head to toe x 6 people on a night when people are half asleep, crawling out of bed, and ****. Bed alarms going off and what not. I wish I worked on a full oncology floor and if that was the case I Wouldnt have to deal with all the bull**** on medical. I like stroke patients, but some of this other bull**** is annoying. I am not the best with confused patients, but I am getting better.

[South Side Stev]

I do see alot of dumb **** from bedside nurses like the 10ml flush syringe will blow the site vs a 2.5ml flush.

A larger syringe actually exerts less force than a smaller syringe.

We use a 30cc syringe to distend saphenous vein because it exerts less stress on the vein than a 10cc syringe. So a 60cc flush would be less traumatic on an IV than a 1cc syringe.

[ARN14]

6 months in, I honestly like being a bedside nurse. I like the family interactions and psychosocial care and being able to alter their POC. I also like taking care of a dying patient and their family.

I do see alot of dumb **** from bedside nurses like the 10ml flush syringe will blow the site vs a 2.5ml flush.

Like doing bull**** assessments, everyone wants to do a full head to toe x 6 people on a night when people are half asleep, crawling out of bed, and ****. Bed alarms going off and what not. I wish I worked on a full oncology floor and if that was the case I Wouldnt have to deal with all the bull**** on medical. I like stroke patients, but some of this other bull**** is annoying. I am not the best with confused patients, but I am getting better.

Were you working my for last night? batchitcray/10 trying to escape....not sure how one can confuse cancer care with psych, but hey lets just go with it and send them upstairs anyway. ..bert stare
sitter confusion
tech disappeared
patient crying and really making a big fuss
pain meds that if you dont deliver on time...pepper for the wrath of the patient
complicated potty breaks for patients to the bedside commode
glad that shift is over

[JeffyDOS]

It won't hit you for a while. Just grit your teeth when you get treated like a slave by some junkie for 12 straight hours who later complains about you. When you remember the amount of chit you put up with on that shift from your other 3-4 pts, and your boss is giving you a "coaching" on patient satisfaction, just remember that it's temporary. Some people are afraid to be so closely responsible for the life of another, others are afraid to be in the aforementioned scenario for years on end. Be #2.

Yeah you're probably right. If I do end up having to start on med surg, I'll probably just be thankful I have a job in the hospital. I'm definitely #2.

A larger syringe actually exerts less force than a smaller syringe.

We use a 30cc syringe to distend saphenous vein because it exerts less stress on the vein than a 10cc syringe. So a 60cc flush would be less traumatic on an IV than a 1cc syringe.

That's what I thought. I was confused for a sec.

[veggie530]

6 months in, I honestly like being a bedside nurse. I like the family interactions and psychosocial care and being able to alter their POC. I also like taking care of a dying patient and their family.

haha, the exact stuff I strongly dislike.

I do see alot of dumb **** from bedside nurses like the 10ml flush syringe will blow the site vs a 2.5ml flush.

Like doing bull**** assessments, everyone wants to do a full head to toe x 6 people on a night when people are half asleep, crawling out of bed, and ****. Bed alarms going off and what not. I wish I worked on a full oncology floor and if that was the case I Wouldnt have to deal with all the bull**** on medical. I like stroke patients, but some of this other bull**** is annoying. I am not the best with confused patients, but I am getting better.

My problem is I view every patient as a math/chem problem that needs fixing. The empathy/compassion thing does not come naturally to me. Plus, my unit lacks good team spirit. I find myself helping others a lot and the favor is generally not well returned. Night shifters tend to be lazy, from my experience and I abhor laziness.

[hxcstunna]

Anyone here get into the nursing program with a B? Dont think I will get an A in anatomy and physiology brahs. Also...is nursing classes harder or just as hard as a&p1?

B in AP classes, currently in RN program, and I definitely find nursing school harder because its just a different way of teaching/learning than I'm used to. Or I just have intense instructors, but I'm loved at clinicals its all good. GL dude.

Disclaimer: im a red *******

[Rabbitw00t]

You could also just get the 3L (I think) bags of NS that urology uses for cystos and TURPs.

I commend your ingenuity though.

The 3L bags of ns are for irrigation only. It says not for injection. Not to say they don't exist. Source: I did turps today

[South Side Stev]

The 3L bags of ns are for irrigation only. It says not for injection. Not to say they don't exist. Source: I did turps today

it was a joke.

[StickLegs78]

My bad, lol. The patient was transferred to the ICU before I even got the third liter in. I'm not sure if it was our place to even take the patient with a pressure that low.

3liter bolus is a bizarre order. 60/40? What was going on with this patient? Completely inappropriate for patient not to get an immediate bolus (pressure bag), MD should have been at the bedside. Not your fault, but wtf.

There are lots of ways to describe these patients, I often call them "Pcl" I.e. Pre-code looking. They require immediate, aggressive intervention.

[IRockNikes]

Well it isn't. A liter over the course of an hour isn't a bolus. If a pump is involved, it isn't a bolus. 999 ml/hr isn't that much volume, that's my point.

I mostly saw this behavior from floor nurses. Not sure why they think everything has to go on a pump or are scared to give volume.

Hospital policy. The only place where this is an exception at my hospital is the ER.

I didn't get away from it, I just get to deal with more of it. Like the nurse who doesn't understand what a bolus is. The one who balks at putting a COPDer on a NRB. The one who sends a UA on a CABG/AVR pt because they "saw sediment in the urine" when they put the foley in- and the patient had a clean UA THE DAY BEFORE.

I dont just deal with stupid people. I deal with stupid people who go out of their way to prove how stupid they are.

Trust me, i deal with more than my fair share of bull****.

Thank nursing school/ NCLEX for this one. You are told that there is a 4L maximum for COPD patients because they retain CO2 and they will lose the drive to breathe. What you aren't told in nursing school is that not all COPD patients are retainers because COPD isn't one disease.

[South Side Stev]

Thank nursing school/ NCLEX for this one. You are told that there is a 4L maximum for COPD patients because they retain CO2 and they will lose the drive to breathe. What you aren't told in nursing school is that not all COPD patients are retainers because COPD isn't one disease.

This is dogma, yet people still perpetuate this. Thats why I shake my head when I hear people say it.

Here is a 30 year old study disproving this: http://www.ncbi.nlm.nih.gov/pubmed/6778278 . It is absolutely retarded to withhold O2 from a COPDer for fear of knocking out their respiratory drive.

[StickLegs78]

This is dogma, yet people still perpetuate this. Thats why I shake my head when I hear people say it.

Here is a 30 year old study disproving this: http://www.ncbi.nlm.nih.gov/pubmed/6778278 . It is absolutely retarded to withhold O2 from a COPDer for fear of knocking out their respiratory drive.

While I think most people agree that the simple concept of hypoxic drive in COPDers (taught in many nursing programs), is not valid, there are still good reasons not to just blast copders with O2. This articles touches on some of the issues ( in the pre-hosptial setting), but the reality is that this stuff is just not fully understood at this time.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564043/

[South Side Stev]

While I think most people agree that the simple concept of hypoxic drive in COPDers (taught in many nursing programs), is not valid, there are still good reasons not to just blast copders with O2. This articles touches on some of the issues ( in the pre-hosptial setting), but the reality is that this stuff is just not fully understood at this time.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564043/

Nobody is talking about "blasting" people with O2, as EMS typically does. You give them as much as they need and obviously accept their ****ty metrics (Sa02 90ish, PO2 60ish, CO2 60ish, etc).

The situation I referenced happens all too often: COPDer huffing and puffing with a Sa02 in the 70s. Some nurse flips her **** when you want to put them on a Venturi/NRB, because "that's too much 02, they'll stop breathing".

[StickLegs78]

Nobody is talking about "blasting" people with O2, as EMS typically does. You give them as much as they need and obviously accept their ****ty metrics (Sa02 90ish, PO2 60ish, CO2 60ish, etc).

The situation I referenced happens all too often: COPDer huffing and puffing with a Sa02 in the 70s. Some nurse flips her **** when you want to put them on a Venturi/NRB, because "that's too much 02, they'll stop breathing".

You don't run into RNs slapping 02 on A COPD whose sat is 90%? I see that all the time.

Honestly, when I care for copders, the main number I care about is the pH - if it's normal, they are in their normal state, all is well.

There are certainly reasonable people that think, in some patients a sat of 85% is ok.

Oxygen hurts these patients, just not fur the reasons lots of RNs are taught.

[guyman123]

3liter bolus is a bizarre order. 60/40? What was going on with this patient? Completely inappropriate for patient not to get an immediate bolus (pressure bag), MD should have been at the bedside. Not your fault, but wtf.

There are lots of ways to describe these patients, I often call them "Pcl" I.e. Pre-code looking. They require immediate, aggressive intervention.

Patient was a rapid response from ED (???), where she received 4L of NS. When she got to me, BP was in the 70s - low 80s. She had diarrhea for four days, but I don't think that would bring the BP down that low. She's been discharged since. CC doctor was with me most of the time. He ordered an additional 1L x 2, along with the 1L bolus ordered by the admitting, but I'm not sure why the pressure bag wasn't ordered. Aware me on why the 3L bolus shouldn't have been done. Just curious.

[DatMurse]

I go out with some people that relocated to an LTAC(VIBRA/kindred). I constantly hear them say "I am getting great experience" or "I am a master and wound care".

It gets to a point where I am pretty sure they are in denial. I hate doing dressing changes on bed sores and **** that shouldn't be there. They take care of the people that nobody wants to care for in the hospital. We transfer them there because they are status quo and nothing changes. I know I am going on a long rant but its BS exp because its long term care that we push out of the hospital.

[DatMurse]

You don't run into RNs slapping 02 on A COPD whose sat is 90%? I see that all the time.

Honestly, when I care for copders, the main number I care about is the pH - if it's normal, they are in their normal state, all is well.

There are certainly reasonable people that think, in some patients a sat of 85% is ok.

Oxygen hurts these patients, just not fur the reasons lots of RNs are taught.

Lol @ o2 when sat is 90%. I dont give a **** about oxygen. just as long as sats are 90%+.(obv chest pain is different)

I had a nurse who I do like cause she is smart but we differ in regards to palliative care. A guy with lung Ca and maybe 3-12 months to live and she wants to try to wean him off oxygen. he was wondering why we were being stingy with oxygen. I Went in the room and told him I dont care how much oxygen he gets. Whatever he wants, ill give him that oxygen.

[StickLegs78]

Patient was a rapid response from ED (???), where she received 4L of NS. When she got to me, BP was in the 70s - low 80s. She had diarrhea for four days, but I don't think that would bring the BP down that low. She's been discharged since. CC doctor was with me most of the time. He ordered an additional 1L x 2, along with the 1L bolus ordered by the admitting, but I'm not sure why the pressure bag wasn't ordered. Aware me on why the 3L bolus shouldn't have been done. Just curious.

7 liters is just a massive amount of fluid for a non-bleeding patient to receive. 4l and a BP still in the 70s probably means she's not just dehydrated and something else is going (septic? Perfed bowel, etc?)

Think about it, entire blood volume is only 5l. If you give a non-bleeding patient 4l and his or her BP is still super low, the answer is certainly not to give 3 more liters. The tank is full, time to start pressors and figure out what is going on.

Not getting an echo at that point is ridiculous. Invasive hemodynamics monitoring is also called for...you are going by the cuff?

[guyman123]

7 liters is just a massive amount of fluid for a non-bleeding patient to receive. 4l and a BP still in the 70s probably means she's not just dehydrated and something else is going (septic? Perfed bowel, etc?)

Think about it, entire blood volume is only 5l. If you give a non-bleeding patient 4l and his or her BP is still super low, the answer is certainly not to give 3 more liters. The tank is full, time to start pressors and figure out what is going on.

Not getting an echo at that point is ridiculous. Invasive hemodynamics monitoring is also called for...you are going by the cuff?

Maybe they did more extensive monitoring when she was transferred to the ICU. The only orders I had were to transfuse the boluses and get blood work, which looked fine, before she was moved over, but I see where you're coming from. Whatever it was, she's gone now

[Megalomaniacal]

Good Morning Murses

Sorry for the late response but I had fun in A&P 1 and 2 as a Biomed, Cardiovascular definitely was my fav portion, apparently there is a math equation for a heart attack.

[guyman123]

Ok, brahs. I was just awared that one of the patients I had last night died tonight, so my question is, what is the process following the patient's death? Does the hospital check through all the charting to see if anyone made a potential mistake? The patient's family was very anal about everything and kept asking tons of questions and thought we weren't doing enough for her. I don't think I messed up with anything, but she was very confused/agitated and did pull her newly placed Dobhoff out on my shift, but I don't think that's relevant at all.

[ManimalGainz]

Ok, brahs. I was just awared that one of the patients I had last night died tonight, so my question is, what is the process following the patient's death? Does the hospital check through all the charting to see if anyone made a potential mistake? The patient's family was very anal about everything and kept asking tons of questions and thought we weren't doing enough for her. I don't think I messed up with anything, but she was very confused/agitated and did pull her newly placed Dobhoff out on my shift, but I don't think that's relevant at all.

Nah man. In most cases the hospital has to have a reason to go back and look at your charting, ie the family tries to sue the hospital. Even if that happens, they generally go after the hospital as a whole because it has a lot more $$$ than a single nurse will. So unless you effed up pretty bad (like made a huge med error, was practicing medicine, etc) then you should be good.

Worst case scenario they fire you if you messed up and you can just get a job elsewhere. We had a nurse at my hospital that recieved a patient that had just had a chest tube placed. It was believed that the patient arrived to the floor with the chest tube clamped (of course this cant be proven). Anyways, the RN didnt check the CT and left it clamped for several hours. The patient eventually had a tension pnuemo and died. The RN was fired and I heard that a few weeks later she had a job at another hospital. It was a simple mistake really.....the RN was just busy and missed something small and it cost someone their life. But she had a job a few days later. **** happens