January, 2006 Archive

July 26, 2016, 7:41 pm

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Haridra 60 tablet bottle $252.00 Most people can take it without becoming emotionally affected. Haridra 60 tablet bottle $252.00 I, haridra 60 tablet bottle $252.00 however, haridra 60 tablet bottle $252.00 am drawn to it as a moth to a flame.

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Haridra 60 tablet bottle $252.00 It’s cruel. Haridra 60 tablet bottle $252.00 It’s encouraging. Haridra 60 tablet bottle $252.00 Sometimes, haridra 60 tablet bottle $252.00 it puts people in the “dawg pound”.

Haridra 60 tablet bottle $252.00 I am addicted…..to American Idol.

Haridra 60 tablet bottle $252.00 Please help me.

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Life used to be so simple in the ER.
If a patient needed to stay in the hospital, haridra 60 tablet bottle $252.00 you obtained a room number from Admitting.
You then would take a final set of vital signs to verify that the patient was indeed stable for transport, haridra 60 tablet bottle $252.00 bring your nursing notes up to date and double check the lab work to make sure that no one missed the potassium level of 9 or the hemoglobin of 1.
A call to the receiving nurse was then placed to give “report”, haridra 60 tablet bottle $252.00 a verbal narrative of the history of the present illness and emergency department course, haridra 60 tablet bottle $252.00 adding significant historical medical information as necessary: allergies, haridra 60 tablet bottle $252.00 previous surgeries, haridra 60 tablet bottle $252.00 etc.
After receiving a litany of 15 reasons why the receiving nurse can’t take the patient right then, haridra 60 tablet bottle $252.00 a negotiation ensues. Haridra 60 tablet bottle $252.00 A time for transport is agreed upon and the patient goes up with his chart.
Oh, haridra 60 tablet bottle $252.00 how I long for the good old days.
Approximately one year ago, haridra 60 tablet bottle $252.00 some agency (JACHO?) decides that things must change for the good of the patient! Here is what now must be done before the patient goes up:
  • Report must be faxed.
    • This entails writing the entire report. Haridra 60 tablet bottle $252.00 So, haridra 60 tablet bottle $252.00 everything that you have just spent hours writing on the nursing notes must be summarized and rewritten on the fax report form. Haridra 60 tablet bottle $252.00 Even I, haridra 60 tablet bottle $252.00 with my passion for charting, haridra 60 tablet bottle $252.00 think this is asinine. Haridra 60 tablet bottle $252.00 It is also mandatory.
    • It takes longer to fill out the fax report than it does to verbally report.
    • The only advantage is the nurse can’t give you 15 reasons for not taking the patient any longer.
      • In my facility, haridra 60 tablet bottle $252.00 the policy is the patient comes up 30 minutes after the fax. Haridra 60 tablet bottle $252.00 Oh, haridra 60 tablet bottle $252.00 and we call to confirm that the fax is on the way. Haridra 60 tablet bottle $252.00 In the beginning they mysteriously weren’t received.
        • Okay, haridra 60 tablet bottle $252.00 in the interest of fairness, haridra 60 tablet bottle $252.00 sometimes faxes are sent to the wrong floor or a bed number is changed after report has been faxed.
        • And the floor/unit nurses get a 30 minute “heads-up” after the fax and before the patient arrives so they can prioritize prior to getting the patient. Haridra 60 tablet bottle $252.00 Which I know I would greatly appreciate if I worked up on the floors.
    • We tried faxing the nursing notes instead for a brief period, haridra 60 tablet bottle $252.00 thinking that would cover all the bases, haridra 60 tablet bottle $252.00 but how shall I put this, haridra 60 tablet bottle $252.00 not all nurses are thorough “charters” and/or it was difficult to read through to get the pertinent information.
  • We need to practice “medication reconciliation”.
    • This means that, haridra 60 tablet bottle $252.00 when a patient is going to be admitted, haridra 60 tablet bottle $252.00 an exact list of what medications the patient is taking, haridra 60 tablet bottle $252.00 including vitamins and herbal supplements must be listed, haridra 60 tablet bottle $252.00 along with the dosage, haridra 60 tablet bottle $252.00 frequency and the last time the patient took the medicine. Haridra 60 tablet bottle $252.00 Allergies and adverse reactions are also noted for a second time (first on the nursing notes).
    • The goal is a noble one: to make sure the patient is discharged with the medications “matching” the ones they came in taking, haridra 60 tablet bottle $252.00 with or without changes.
    • This is all done on a new form that acts as a physician’s order sheet for meds (ie they can check to order the drug as written or to not order it.
    • Guess who gets to get all this information ready for admission – yep, haridra 60 tablet bottle $252.00 the ER nurse. Haridra 60 tablet bottle $252.00 They say the family can fill out the form and sometimes the patients come in with beautiful computerized lists that bring tears of joy to my eyes. Haridra 60 tablet bottle $252.00 But usually the family is anxious about doing that so it falls to the nurse to complete.
      • Oh, haridra 60 tablet bottle $252.00 and by the way, haridra 60 tablet bottle $252.00 those beautiful computerized lists? We can’t copy them. Haridra 60 tablet bottle $252.00 They must be re-copied, haridra 60 tablet bottle $252.00 by hand, haridra 60 tablet bottle $252.00 on the form.
  • Signature recognition
    • On a separate form, haridra 60 tablet bottle $252.00 in addition to signing your name twice on the nursing notes, haridra 60 tablet bottle $252.00 you must print your name, haridra 60 tablet bottle $252.00 sign your name, haridra 60 tablet bottle $252.00 and designate your work station.
    • Apparently illegible handwriting is making signature reading a lost art.
    • To my blessed delight, haridra 60 tablet bottle $252.00 my facility no longer requires this form. Haridra 60 tablet bottle $252.00 But for many months this was also mandatory.

Haridra 60 tablet bottle $252.00 So, haridra 60 tablet bottle $252.00 in one year, haridra 60 tablet bottle $252.00 three new pieces of paperwork were added to the already hectic activity that accompanies a patient admission. Haridra 60 tablet bottle $252.00 Two of which require the nurse to sit, haridra 60 tablet bottle $252.00 undisturbed, haridra 60 tablet bottle $252.00 for a minimum of 20 minutes to complete in addition to all the regular paperwork. Haridra 60 tablet bottle $252.00 We have no recourse but to do as we are told.

Haridra 60 tablet bottle $252.00 I wish someone would tell these agencies off.

Haridra 60 tablet bottle $252.00 Where is Simon Cowell when you need him?

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July 26, 2016, 3:46 am

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I also forgot to mention that Emergiblog has a post in the latest “Carnival of the Mundane”, zanaflex 4mg pills $240.00 this time hosted by Kaply over at her blog. Zanaflex 4mg pills $240.00 It’s my post on using the nursing process to assess your boxes of candy. Zanaflex 4mg pills $240.00 Truly a skill that all should possess.
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July 26, 2016, 12:46 am

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I hate spleens. Protonix 40mg pills $146.00 I really do. Protonix 40mg pills $146.00 I mean, protonix 40mg pills $146.00 I’m glad I still have mine, protonix 40mg pills $146.00 and I fully intend to keep it. Protonix 40mg pills $146.00 But spleens aren’t very forgiving and sometimes they are downright sneaky.

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Protonix 40mg pills $146.00 My ER. Protonix 40mg pills $146.00 My non-trauma center ER. Protonix 40mg pills $146.00 As triage nurse for the day, protonix 40mg pills $146.00 I began taking the history. Protonix 40mg pills $146.00 Slight pain on palpation when left lower ribs are softly touched. Protonix 40mg pills $146.00 Pain increasing slightly with inspiration. Protonix 40mg pills $146.00 Lungs clear. Protonix 40mg pills $146.00 Denies SOB. Protonix 40mg pills $146.00 I’m thinking pulmonary contusion, protonix 40mg pills $146.00 maybe rib fracture. Protonix 40mg pills $146.00 The mechanism of injury was not great, protonix 40mg pills $146.00 but the patient was walking and looking good on scene and when he got to the triage station. Protonix 40mg pills $146.00 Then, protonix 40mg pills $146.00 suddenly the patient begins to look rather, protonix 40mg pills $146.00 uh, protonix 40mg pills $146.00 sick. Protonix 40mg pills $146.00 Icky. Protonix 40mg pills $146.00 Pale. Protonix 40mg pills $146.00 Nauseated. Protonix 40mg pills $146.00 Shocky. Protonix 40mg pills $146.00 Bad.

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Protonix 40mg pills $146.00 Mom gets sent out to registration and patient comes with me, protonix 40mg pills $146.00 in a wheelchair for obvious reasons but now she can’t stand up straight anyway. Protonix 40mg pills $146.00 I grab the ER doc on the way in. Protonix 40mg pills $146.00 He examines the patient only to discover within about one-half second that it is not the ribs, protonix 40mg pills $146.00 it’s left upper abdominal pain and we are goin’ to the OR. Protonix 40mg pills $146.00 Mom returns within minutes and gets the scoop. Protonix 40mg pills $146.00 Two large bore IVs with a bolus (BP falling)while the OR gets ready and off we go.

Protonix 40mg pills $146.00 Ruptured spleen.

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It had been a helacious shift.

Protonix 40mg pills $146.00 Everyone was very sick in some fashion or another, protonix 40mg pills $146.00 almost all requiring IVs and medications for pain or nausea (or both). Protonix 40mg pills $146.00 Lots of respiratory distress and a couple of in-house codes to top it all off. Protonix 40mg pills $146.00 (We lose the ER doc and an ER nurse for what is hopefully a short period of time when someone in the hospital has a cardiac arrest).

Protonix 40mg pills $146.00 We had people sitting in the waiting room that I desperately wanted in rooms; they were miserable.

Protonix 40mg pills $146.00 Finally we get one bed open. Protonix 40mg pills $146.00 I’m about to call in the next patient. Protonix 40mg pills $146.00 This guy walks up being supported by friends. Protonix 40mg pills $146.00 “Hey, protonix 40mg pills $146.00 like, protonix 40mg pills $146.00 he has the flu, protonix 40mg pills $146.00 man. Protonix 40mg pills $146.00 Been vomiting all night. Protonix 40mg pills $146.00 He even passed out twice at home!” Sounds like he’s dehydrated from gastroenteritis just like the rest of the county. Protonix 40mg pills $146.00 But passing out twice kind of gives you priority for a bed. Protonix 40mg pills $146.00 We don’t take kindly to syncope (fainting).

Protonix 40mg pills $146.00 I asked the patient to gown and lay down on the bed. Protonix 40mg pills $146.00 He said it hurt to lay down. Protonix 40mg pills $146.00 Well geeze, protonix 40mg pills $146.00 dude, protonix 40mg pills $146.00 if you don’t lay down and you’re dehydrated you’re gonna pass out again! I said it a wee bit more professionally than that. Protonix 40mg pills $146.00 Nope, protonix 40mg pills $146.00 he wasn’t gonna lay down. Protonix 40mg pills $146.00 Okay.

Protonix 40mg pills $146.00 “Look, protonix 40mg pills $146.00” I told the friends. Protonix 40mg pills $146.00 “Sit next to him on the side of the bed. Protonix 40mg pills $146.00 If he feels dizzy lay him down.”

Protonix 40mg pills $146.00 He needed an IV, protonix 40mg pills $146.00 like yesterday. Protonix 40mg pills $146.00 But….. Protonix 40mg pills $146.00 three more patients walked in and I ran out to have them sign in for triage and make sure none of them was having a heart attack, protonix 40mg pills $146.00 stroke, protonix 40mg pills $146.00 etc. Protonix 40mg pills $146.00 And someone had to take report from the medics who had brought in a possible stroke victim.

Protonix 40mg pills $146.00 Did I mention that at this particular facility there were only 2 nurses after 2300? It was after 2300.

Protonix 40mg pills $146.00 I heard loud cries for help from the friends of our vomiting, protonix 40mg pills $146.00 fainting guy. Protonix 40mg pills $146.00 I rush in to find him, protonix 40mg pills $146.00 essentially unconscious, protonix 40mg pills $146.00 sitting between them. Protonix 40mg pills $146.00 They hadn’t laid him down. Protonix 40mg pills $146.00 So I did. Protonix 40mg pills $146.00 He woke up.

Protonix 40mg pills $146.00 Blood pressure of 70 systolic when flat. Protonix 40mg pills $146.00 And in pain.

Protonix 40mg pills $146.00 I still thought he was a severe case of dehydration but a little voice inside my head made me act like a trauma nurse and put in two large bore IVs. Protonix 40mg pills $146.00 One of them was a 14 Gauge. Protonix 40mg pills $146.00 A freakin’ hose. Protonix 40mg pills $146.00 Had the ER doc at the bedside by that time and he did his exam. Protonix 40mg pills $146.00 The patient’s abdomen was rock-hard. Protonix 40mg pills $146.00 It was so tender that even touching the hairs on his upper abdomen was excruciating.

Protonix 40mg pills $146.00 No fever. Protonix 40mg pills $146.00 Sudden onset. Protonix 40mg pills $146.00 Denied trauma. Protonix 40mg pills $146.00 Normal BMs. Protonix 40mg pills $146.00 Weird.

Protonix 40mg pills $146.00 The IVs kept flowing so that I could get his blood pressure up and try to address the pain issue. Protonix 40mg pills $146.00 And the pain kept getting worse and the blood pressure would not respond. Protonix 40mg pills $146.00 It seemed like it took forever to get my patient to the CT.

Protonix 40mg pills $146.00 Ruptured spleen.

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Protonix 40mg pills $146.00 Say what?

Protonix 40mg pills $146.00 We didn’t believe it. Protonix 40mg pills $146.00 We had one “ruptured spleen” in surgery already. Protonix 40mg pills $146.00 We thought they had faxed us the earlier report.

Protonix 40mg pills $146.00 Then the truth came out. Protonix 40mg pills $146.00 Three weeks earlier, protonix 40mg pills $146.00 a large tool had fallen onto the patients left side. Protonix 40mg pills $146.00 It was sore, protonix 40mg pills $146.00 nothing major. Protonix 40mg pills $146.00 He did notice he could no longer jog without pain, protonix 40mg pills $146.00 which he thought was weird, protonix 40mg pills $146.00 but nothing to see a doctor about. Protonix 40mg pills $146.00 He had a hematoma on his spleen. Protonix 40mg pills $146.00 It started bleeding that night, protonix 40mg pills $146.00 giving him the “flu” symptoms he presented with.

Protonix 40mg pills $146.00 He made it. Protonix 40mg pills $146.00 So did the first patient. Protonix 40mg pills $146.00 I, protonix 40mg pills $146.00 however needed a weeks worth of Ativan after that shift.

Protonix 40mg pills $146.00 So don’t be surprised if you are ever in an ER for a sprained ankle and the nurse asks how your spleen is feeling.

Protonix 40mg pills $146.00 It will be me.

Protonix 40mg pills $146.00 I hate spleens.

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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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