October, 2005 Archive

July 23, 2016, 8:26 pm

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Neem 60 tablet bottle $153.00 Lucy thinks this is bad? She should try working in an ER. Neem 60 tablet bottle $153.00 I’ll take dog germs any day. Neem 60 tablet bottle $153.00 In recognition of Halloween, neem 60 tablet bottle $153.00 I have compiled a list of questions I would ask The Great Pumpkin, neem 60 tablet bottle $153.00 who, neem 60 tablet bottle $153.00 as we all know, neem 60 tablet bottle $153.00 rises out of the pumpkin patch once a year to answer rhetorical questions such as:

Neem 60 tablet bottle $153.00 Did Dixie McCall ever leave the nurses’ station on “Emergency”?

Neem 60 tablet bottle $153.00 Why is it easier to stay up until 0700 than to get up at 0700?

Neem 60 tablet bottle $153.00 Why is it that when you have a child requiring transport to a pediatric facility, neem 60 tablet bottle $153.00 the patient is well enough to be throwing a football to his nurse when the transport team arrives?

Neem 60 tablet bottle $153.00 Why would my husband even remotely suggest that I want to watch “Trauma In the ER” on my days off?

Neem 60 tablet bottle $153.00 Why is it when a law enforcement officer seeks medical attention in the ER, neem 60 tablet bottle $153.00 the entire force on duty at that time comes in to say hi? Ditto with the fire guys?

Neem 60 tablet bottle $153.00 How can they say we don’t have universal access to health care when anyone at anytime can walk into any ER for any reason and by law cannot be turned away because of lack of funds?

Neem 60 tablet bottle $153.00 Why are they always defibrillating patients in asystole on TV?

Neem 60 tablet bottle $153.00 Have you ever noticed that if the wait is too long, neem 60 tablet bottle $153.00 patients will “self-triage” themselves out of the emergency department?

Neem 60 tablet bottle $153.00 What is it about “No Cell Phones” that is so hard to comprehend?

Neem 60 tablet bottle $153.00 Why is it that a person will stand in line for three hours for a flu shot and then gripe if their entire ER visit takes the same amount of time?

Neem 60 tablet bottle $153.00 Ever notice how a warm blanket will soothe the cranky patient?

Neem 60 tablet bottle $153.00 Why would county dispatch send four ambulances to one ER within 15 minutes when none of the other hospitals are on ambulance diversion?

Neem 60 tablet bottle $153.00 Ever feel like Sally Brown when you are trying to work and it seems like the entire world is trick-or-treating?

Neem 60 tablet bottle $153.00 How did the nurse on “ER” auscultate a sys-
tolic BP of 40 without a sphygmomano-
meter or a stethoscope?

Neem 60 tablet bottle $153.00 Why would a facility feed into the “instant gratification” culture by placing this ad in the local paper: “It takes longer to walk to your mailbox than it does to be seen in our ER”?

Neem 60 tablet bottle $153.00 And finally, neem 60 tablet bottle $153.00 how much candy will be on the break table at work tomorrow?

Neem 60 tablet bottle $153.00 Happy Halloween! Here’s to no tricks and a ton of treats!

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2:28 pm

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Cialis 40mg pills 360 pills $628.00 I’m sure we all remember our Wheatena lecture! Why, cialis 40mg pills 360 pills $628.00 it was the highlight of my nursing education! Today we have drug reps, cialis 40mg pills 360 pills $628.00 back then they must have had Wheatena reps…

Cialis 40mg pills 360 pills $628.00 I’m a Cream of Wheat fanatic, cialis 40mg pills 360 pills $628.00 myself. Cialis 40mg pills 360 pills $628.00 Freakin’ nectar of the gods, cialis 40mg pills 360 pills $628.00 it is! Trust me, cialis 40mg pills 360 pills $628.00 when you’ve been NPO for 36 hours and you are status-post intubation, cialis 40mg pills 360 pills $628.00 that first swallow is absolute heaven. Cialis 40mg pills 360 pills $628.00 A little sugar, cialis 40mg pills 360 pills $628.00 a little milk…..ahhhh…..the epitome down-home comfort food! I never will figure out how it qualifies as a full liquid, cialis 40mg pills 360 pills $628.00 though.

Cialis 40mg pills 360 pills $628.00 I realize that it has been a long time since I’ve worked anywhere in a hospital but the emergency department. Cialis 40mg pills 360 pills $628.00 I realize that life on the telemetry and med/surg units has changed in the last 16 years.
But…

Cialis 40mg pills 360 pills $628.00 Why on earth does an entire floor have to shut down because one patient goes critical?

Cialis 40mg pills 360 pills $628.00 Let me give a hypothetical example. Cialis 40mg pills 360 pills $628.00 Say there is a telemetry floor that holds 50 patients, cialis 40mg pills 360 pills $628.00 but the census is at 45. Cialis 40mg pills 360 pills $628.00 There are nine nurses (5:1 at night), cialis 40mg pills 360 pills $628.00 a unit clerk and a charge nurse. Cialis 40mg pills 360 pills $628.00 A patient at one end of the unit goes critical. Cialis 40mg pills 360 pills $628.00 At this point:

  • The ER cannot obtain a room number for the new admission because
    • the charge nurse is busy assisting the nurse whose patient is crashing
    • only the charge nurse can assign a room number
  • If a room number has already been assigned, cialis 40mg pills 360 pills $628.00 no nurse on the unit will take report
    • because a “patient is crashing” on the unit.
    • they are busy
  • The new admission happens to be assigned to the nurse whose patient is now critical.

Cialis 40mg pills 360 pills $628.00 Now it doesn’t take the logic of Mr. Cialis 40mg pills 360 pills $628.00 Spock to figure out that:

  • The charge nurse
    • knows which rooms are available for an admit
    • knows which nurses are open for the admit
      • doesn’t need an hour to figure this out
      • can delegate the assigning of the room
      • can make a decision and revise prn
  • The nurse taking the new admit with room assignment
    • has an open room ready and assigned
    • is not involved with the critical patient
    • has no reason not to take report or accept the patient after report has been given
      • hectic activity in one room does not preclude giving care in any other room
      • is able to assess his/her patients without the charge nurse
      • can hold paperwork if necessary until unit clerk is available to process orders
  • The nurse of the critical patient, cialis 40mg pills 360 pills $628.00 if assigned the new admit, cialis 40mg pills 360 pills $628.00 should have the admit given to another nurse and be open for the next admit after they have transferred their patient to ICU.

Cialis 40mg pills 360 pills $628.00 Am I missing something here?

Cialis 40mg pills 360 pills $628.00 In the ED we have critical patients on a continuous basis along with a rotating census in every other bed, cialis 40mg pills 360 pills $628.00 but the unit does not come to a halt because there is a code going on. Cialis 40mg pills 360 pills $628.00 Patients keep getting triaged, cialis 40mg pills 360 pills $628.00 orders keep getting written and carried out, cialis 40mg pills 360 pills $628.00 nurses multitask and take over for each other where necessary.

Cialis 40mg pills 360 pills $628.00 Two nurses, cialis 40mg pills 360 pills $628.00 a doctor and a respiratory therapist (or two) can run a critical patient and get them transferred to ICU. Cialis 40mg pills 360 pills $628.00 It does not take an army….or an entire unit of nurses.

Cialis 40mg pills 360 pills $628.00 Can someone shed some light on this?

Cialis 40mg pills 360 pills $628.00 I just don’t get it.

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July 23, 2016, 12:16 am

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Norvasc 2.5mg pills $136.00 I bought this book as part of a Sesame Street series for my first daughter back in the early ’80s and now I find it on a “review of antique books” site! Good grief! If this is an antique then I’m a pre-historic relic.

Norvasc 2.5mg pills $136.00 Being a nurse never helped me as a parent. Norvasc 2.5mg pills $136.00 When my first baby ran a temperature of 104.8 I ran to the ER as fast as I could get my old VW bug to fly. Norvasc 2.5mg pills $136.00 When I found my 2-year-old son blue and drooling on the side of my bed after a febrile seizure, norvasc 2.5mg pills $136.00 we went 911 all the way. Norvasc 2.5mg pills $136.00 Of course by the time I had #3, norvasc 2.5mg pills $136.00 I was an ER nurse and an experienced parent. Norvasc 2.5mg pills $136.00 She never even saw the inside of an ER until she was 14 and that was only because she was having an allergic reaction.

Norvasc 2.5mg pills $136.00 I know what it is like to be absolutely terrified because your child is sick.

Norvasc 2.5mg pills $136.00 In the ED, norvasc 2.5mg pills $136.00 the child may be ill but you are caring for the parents as well. Norvasc 2.5mg pills $136.00 I find parents fall into three categories:

  • The Newbie: a parent who is dealing with a sick child for the first time. Norvasc 2.5mg pills $136.00 They have no clue about what to do for the fever and they are frantic because the child vomited once and has not stopped crying/fussing. Norvasc 2.5mg pills $136.00 They truly feel this is an emergency. Norvasc 2.5mg pills $136.00 They did not call the pediatrician, norvasc 2.5mg pills $136.00 having rushed to the ER after the first emesis. Norvasc 2.5mg pills $136.00 They usually have at least one grandmother with them for support. Norvasc 2.5mg pills $136.00 The child is dressed in a diaper, norvasc 2.5mg pills $136.00 a onesie, norvasc 2.5mg pills $136.00 a second onesie, norvasc 2.5mg pills $136.00 a one piece sleeper with footsies, norvasc 2.5mg pills $136.00 a sweater, norvasc 2.5mg pills $136.00 a jacket with hood and a thick flannel blanket. Norvasc 2.5mg pills $136.00 They are scared to death.
  • The Walking Worried: They’ve been through this before, norvasc 2.5mg pills $136.00 only the fever keeps coming back when the Tylenol wears off and the vomiting has been going on “all day”. Norvasc 2.5mg pills $136.00 They called the pediatrician and have an appointment for tomorrow but they are too worried to wait that long. Norvasc 2.5mg pills $136.00 There may be new symptoms with this illness or it may have come on very suddenly. Norvasc 2.5mg pills $136.00 They’ve gone through all the treatments they can do at home (ie nebulizer treatments) but their gut tells them something is not quite right or the child is no better. Norvasc 2.5mg pills $136.00 They aren’t panicky, norvasc 2.5mg pills $136.00 but they are anxious.
  • The Veterans: They’ve seen it all. Norvasc 2.5mg pills $136.00 The kids are older, norvasc 2.5mg pills $136.00 or the child is the youngest in the family. Norvasc 2.5mg pills $136.00 They can handle the usual stuff at home, norvasc 2.5mg pills $136.00 so the child will be in with asthma exacerbation, norvasc 2.5mg pills $136.00 an orthopedic injury or a laceration. Norvasc 2.5mg pills $136.00 They’re concerned, norvasc 2.5mg pills $136.00 but not anxious.

Norvasc 2.5mg pills $136.00 So how do we help the parents while we care for the child?

  • Acknowledge that the parents are concerned/worried/anxious.
  • Begin treatment at triage. Norvasc 2.5mg pills $136.00 If appropriate, norvasc 2.5mg pills $136.00 give the medications for fever allowed by the triage protocol. Norvasc 2.5mg pills $136.00 If the child will need to wait to be seen, norvasc 2.5mg pills $136.00 let the parents know that the fever is being addressed while they are waiting.
  • Tell the parents that if they become worried about their child while waiting, norvasc 2.5mg pills $136.00 you (the triage nurse) are available. Norvasc 2.5mg pills $136.00 This will help allieviate some of their anxiety about waiting.
  • Reassure the parents that although the patient seemed deathly ill at home but is now playing peek-a-boo with the respiratory therapist and trying to stand on their head on the gurney, norvasc 2.5mg pills $136.00 this is not unusual for children and we do believe their story…
  • Discuss the care for the illness as you care for the child. Norvasc 2.5mg pills $136.00 For example, norvasc 2.5mg pills $136.00 talk about the need for minimal clothing in the presence of a fever as you undress the child for a weight. Norvasc 2.5mg pills $136.00 Go over what a clear liquid diet consists of when offering the child Pedialyte.
  • Encourage the parents to ask questions if they are concerned about an aspect of care.
  • Be sure to reinforce aspects of care that the parents did right. Norvasc 2.5mg pills $136.00 This is especially important for new parents who may not be confident in their ability to care for a sick child.
  • If the parents are very anxious, norvasc 2.5mg pills $136.00 they may not retain a lot of what is discussed. Norvasc 2.5mg pills $136.00 Let the parents know that everything will be written in the discharge instructions given at the end of the visit.
  • Discuss options for care of future illnesses at discharge. Norvasc 2.5mg pills $136.00 The parents may not realize that there is a doctor on call for their pediatrician 24 hours a day and they are able to give out telephone advice. Norvasc 2.5mg pills $136.00 They may utilize an advice line after hours. Norvasc 2.5mg pills $136.00 During office hours, norvasc 2.5mg pills $136.00 their pediatrician may be able to fit them in to a same-day appointment. Norvasc 2.5mg pills $136.00 It is important that the parents are not made to feel that bringing their child to the emergency department was wrong.

Norvasc 2.5mg pills $136.00 In the beginning of my career in ED nursing, norvasc 2.5mg pills $136.00 pediatric patients were not my strong suit. Norvasc 2.5mg pills $136.00 Adult intensive care skills did not transfer over to caring for children. Norvasc 2.5mg pills $136.00 I took a PALS class and told my co-workers I wanted every pediatric patient that came through the door for two months. Norvasc 2.5mg pills $136.00 I became comfortable with pediatric assessments and treatments. Norvasc 2.5mg pills $136.00 Now, norvasc 2.5mg pills $136.00 after 16 years of ED experience I don’t think twice when my patient is a child. Norvasc 2.5mg pills $136.00 I learned early on that when you care for a child, norvasc 2.5mg pills $136.00 you are caring for a family and that the needs of both the child and the parents must be addressed for a successful outcome.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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