March, 2006 Archive

September 1, 2016, 1:06 pm

Does Viagra Expire

Does viagra expire There is a person in this photograph who suffers from a rare, does viagra expire dare I say extinct affliction.

Does viagra expire Yes.

Does viagra expire It’s an actual photo of “Flat Cap Syndrome”.

Does viagra expire Flat Cap Syndrome developed when the brim of one’s nursing cap was larger than the fold behind it.

Does viagra expire Some say that the victims were responsible for choosing to go to a School of Nursing identified by those caps.

Does viagra expire Don’t blame the victim.

Does viagra expire Maybe it was the only School that she was accepted to.

Does viagra expire Maybe…..maybe she didn’t know….

Does viagra expire By the time I graduated, does viagra expire designs in nursing caps had pretty much made Flat Cap Syndrome a thing of the past.

Does viagra expire My cap was never flat, does viagra expire and to this day it stands proudly in its case in the den closet in pristine condition.

Does viagra expire (Disclosure: it’s in pristine condition because I just bought it off of eBay.

Does viagra expire I have to get the green and gold ribbons on it and then I have to get the courage to wear it to work because my co-workers will have a field day with me.

Does viagra expire If all of a sudden there is no more Emergiblog, does viagra expire it’s because they killed me with ridicule.

Does viagra expire Call the authorities.)

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Some of the advantages of working in different facilities are the exposure to different styles of nursing, does viagra expire different opportunities, does viagra expire different patient populations and differing protocols regarding what nurses are able to do on their own.

Does viagra expire I’m not talking about using nurses instead of doctors, does viagra expire a la the problems that Dr. Does viagra expire Crippen at NHS Blog Doctor describes, does viagra expire I’m talking about protocols that allow nurses, does viagra expire using certain criteria established by the ER physicians, does viagra expire to initiate care prior to the doctor seeing the patient.

Sounds like a great way to facilitate patient flow and satisfaction, does viagra expire right?

Does viagra expire It is!

Does viagra expire The best ERs that I have worked in are the ones that, does viagra expire per protocol, does viagra expire allow the RNs to do what they do best.

Does viagra expire Conversely, does viagra expire the worst ERs I’ve worked in allowed the nurses to do nothing without an order.

  • When I worked at “World Renown Medical Center With Hard To Get Into Medical School”, does viagra expire this was the case. Does viagra expire The nurses could not make a move without an order.
    • Why?
    • It was a teaching facility. Does viagra expire How could the interns/residents learn to order appropriately if the nurse did it first? And forget verbal orders, does viagra expire if some resident gave an order you grabbed the nearest order sheet and made them write it. Does viagra expire So often you’d have five or six different order sheets going.
    • Why?
    • Because if there was a descrepancy between what was said and what was done, does viagra expire guess whose derriere would be on the line? Right, does viagra expire the nurse’s. Does viagra expire Remember the old saying about how excrement flows downhill? It’s true.
    • And the wait to get into a room? Hours. Does viagra expire We’re talking 5-7 hours at times. Does viagra expire You could be vomiting, does viagra expire have a 5-day migraine with photophobia, does viagra expire writhing on the floor with right flank pain secondary to a kidney stone and you would STILL be sitting in the ER with all the feverish, does viagra expire coughing bronchitis patients. Does viagra expire And don’t think asthma would get you a front row seat, does viagra expire either. Does viagra expire If your O2 sat was normal, does viagra expire have a seat like everyone else.
    • Why?
    • Because the beds never turned over. Does viagra expire Because one nurse would be responsible for six monitored patients plus the psych isolation room across the hall. Does viagra expire Because….
    • … first the “Pulmonary Team” had to see the patient, does viagra expire then they would decide this was a cardiac problem and you’d wait a few hours for the “Cardiac Team” who would discover that the patient wasn’t on that service after all and a different “Team” would come in an hour later, does viagra expire only to discover that said patient couldn’t be admitted there anyway, does viagra expire but then the patient would vomit blood which meant that they were too sick to transfer and you had to wait for the “GI Team” to come down and finally admit the patient.
    • Not to mention every single pediatric patient in the clinic area getting conscious sedation for their boo-boos.

Does viagra expire Get the picture?

Does viagra expire Then we have example number two.

  • Small community hospital, does viagra expire one that I will call “Mini County Hospital”. Does viagra expire Sat right in the middle of a very ethnically diverse, does viagra expire lower-income area of a suburb that could be called the Meth Capital of the SF Bay Area. Does viagra expire Many patients. Does viagra expire Many clinical, does viagra expire non-emergent patients. Does viagra expire Some very emergent patients.
    • The nurses were not allowed to do anything. Does viagra expire Nada. Does viagra expire Kaput.
    • Why?
    • Because the department had a wide mix of nursing experience, does viagra expire from new grads to newly designated dinosaurs like me, does viagra expire and there were no protocols because they could not depend on all the nurses to have the same level of competency.
    • So one day, does viagra expire Nurse Experience (me), does viagra expire brings in a patient with chest pain, does viagra expire starts a line while the tech does the EKG and within five minutes hands the doctor the EKG and the orders for CBC, does viagra expire Chemistry Panel, does viagra expire Cardiac Enzymes and portable chest to the unit clerk. Does viagra expire No problem, does viagra expire right? Wrong.
      • I was curtly asked, does viagra expire “Who the hell told you to order those labs?”.
      • I looked at Dr. Does viagra expire Who Was In Training Pants When I Graduated From Nursing School and said that they were the standard labs ordered for a chest pain patient suspected of having a cardiac problem.
      • “You are not covered to order these labs!
      • I said , does viagra expire “Are you telling me that after (then) 24 years experience in nursing, does viagra expire that I cannot at least get a cardiac workup started?
      • That was exactly what he was telling me. Does viagra expire I had three times the experience and was old enough to be his…..older sister, does viagra expire but it didn’t matter. Does viagra expire The nursing expectations went to the lowest common denominator, does viagra expire that of a new grad.
    • Which meant the patients in the waiting room waited, does viagra expire sometimes 8 hours for the same reasons stated above. Does viagra expire The nurses could not facilitate patient movement. Does viagra expire Because we worked with relatively new doctors, does viagra expire every child who vomited even once got an IV and a bolus. Does viagra expire Most got septic workups.

Does viagra expire Now let’s contrast this with an ER that runs quite smoothly, does viagra expire which happens to be where I am now and plan to retire from when I’m so old I can’t stand up straight.

  • This ER has nursing protocols. Does viagra expire Detailed, does viagra expire well written protocols. Does viagra expire Here’s what happens when you come into this ER:
    • For example, does viagra expire you come in and your chief complaint is nausea, does viagra expire vomiting, does viagra expire diarrhea for three days with fever and you are extremely dizzy when upright. Does viagra expire I’m your nurse.
      • Before the doc shows up I will have orthostatic vital signs, does viagra expire an IV in, does viagra expire bloods drawn, does viagra expire a bolus of Normal Saline initiated (unless you are elderly or have heart trouble) , does viagra expireat least a CBC and Chem 14 ordered (with additional blood in case more tests are added) and you can expect me to ask for and collect a UA and an stool specimen, does viagra expire which may or may not be needed, does viagra expire but they will be collected just in case.
    • Or you are an elderly male who looks 8 months pregnant and hasn’t urinated for 2 days except for a little bit here and there. Does viagra expire You can barely walk, does viagra expire you are in so much pain. Does viagra expire If I’m your nurse you will have a catheter in before you can say “ouch”, does viagra expire assuming your prostate co-operates.
    • Your wait on a bad day in our waiting room may be three hours max.
    • Why?

Does viagra expire Because the Registered Nurses in my department are covered by extensive ER protocols and we work with doctors who respect our judgement and know we would not order outside of our protocols.

Does viagra expire My attitude is that by the time that doctor walks in to see the patient, does viagra expire everything he/she needs has been at least considered. Does viagra expire I am able to do much more than described above, does viagra expire but it often isn’t necessary because the doctors see the patients so quickly, does viagra expire they are usually right behind me.

Does viagra expire (Yeah, does viagra expire I have a great job, does viagra expire which I appreciate all the more because I’ve had some bad ones.)

Does viagra expire So the Emergency Departments that give nurses the most autonomy via protocols wind up being the ones that really need it the least. Does viagra expire And they wind up being the ones with the highest patient satisfaction ratings.

Does viagra expire A little ironic…

Does viagra expire Doncha think?

ddd

Does viagra expire Addendum: Dr. Does viagra expire Who Was In Training Pants When I Graduated From Nursing School turned out to be one of the neatest persons I have ever met and he is a fantastic doctor. Does viagra expire He was the one I missed most acutely when I left for my current job. Does viagra expire Go figure.

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September 1, 2016, 8:21 pm

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    • Waitress at Bumbleberry’s Restaurant (now defunct – similar to Marie Calendar’s); spent all my tips on albums
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  • 4 of my Favorite Foods
    • Avocados
    • Guacamole
    • Diet Pepsi – fountain
    • Quarter Pounder With Cheese – I have no shame!
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    • Puerto Rico – shaking hands with Steve Perry
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    • The Complete Hitchhiker’s Guide To The Galaxy (all the books)
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  • 4 Songs I Could Listen To Everyday
    • “My Immortal” – Evanescence
    • Anything by Journey
    • The entire “Mad Season” album by Matchbox 20
    • Anything by Robin Gibb (or the Bee Gees)
  • 4 Reasons I Blog
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September 1, 2016, 12:39 am

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Prednisone 5mg pills $128.00 Ah, prednisone 5mg pills $128.00 it isn’t often that I feel a “rant” coming on but there is something that I feel very strongly about.

Prednisone 5mg pills $128.00 Maybe it makes me a heartless nurse.

Prednisone 5mg pills $128.00 Perhaps it makes me a bad mother.

Prednisone 5mg pills $128.00 The issue?

Prednisone 5mg pills $128.00 I cannot stand it when conscious sedation is ordered for children who have a laceration.

Prednisone 5mg pills $128.00 I am old-school. Prednisone 5mg pills $128.00 I believe in wrapping them like a mummy, prednisone 5mg pills $128.00 placing them in a papoose and holding them during the suturing. Prednisone 5mg pills $128.00 It’s faster, prednisone 5mg pills $128.00 the pain stops after the lidocaine injections and the child is then up and ready to go immediately.

Prednisone 5mg pills $128.00 For the uninitiated, prednisone 5mg pills $128.00 “conscious sedation” is a term used when a patient needs an especially painful procedure done. Prednisone 5mg pills $128.00 An IV is placed and they are given medications that (1) reduce the pain (2) sedate the patient and (3) cause amnesia so the patient doesn’t remember what the procedure was like when they wake up.

Prednisone 5mg pills $128.00 During the procedure the patient is placed on a cardiac monitor, prednisone 5mg pills $128.00 oxygen, prednisone 5mg pills $128.00 a respiratory therapist is present in case there are airway problems, prednisone 5mg pills $128.00 reversal agents are kept at the bedside in case of emergency, prednisone 5mg pills $128.00 and the patient has the IV as previously mentioned.

Prednisone 5mg pills $128.00 It is a wonderful way to get patients of any age through procedures like reducing shoulder dislocations or fractures or hip prosthesis dislocations.

Prednisone 5mg pills $128.00 It also ties up one nurse with one patient for however long it takes that patient to recover. Prednisone 5mg pills $128.00 The patient is never left alone. Prednisone 5mg pills $128.00 The drugs are short acting, prednisone 5mg pills $128.00 but recovery can take as long as one hour for some patients, prednisone 5mg pills $128.00 depending on how much medication they were given and how fast they metabolize it. Prednisone 5mg pills $128.00 Vital signs are taken every five minutes during the procedure and then every 10-15 minutes after until the patient is awake, prednisone 5mg pills $128.00 able to tolerate clear fluids, prednisone 5mg pills $128.00 have vital signs near pre-procedure levels and can ambulate.

Prednisone 5mg pills $128.00 Is this really necessary for a child with a one-half inch laceration on his forehead?

Prednisone 5mg pills $128.00 Ah, prednisone 5mg pills $128.00 I hear the chorus now….

Prednisone 5mg pills $128.00 From the parents: “But it is so traumatic on my poor child to hold them down!”

Prednisone 5mg pills $128.00 They’ll get over it. Prednisone 5mg pills $128.00 I not only remember getting stitched at the age of three I still have the scar!

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Prednisone 5mg pills $128.00 From the ER docs: “It’s hard to hit a moving target!”

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Just a couple of my personal beliefs.

  • Every person getting conscious sedation, prednisone 5mg pills $128.00 including kids, prednisone 5mg pills $128.00 gets an IV whether or not the doc believes it is warranted. Prednisone 5mg pills $128.00 Emergency situations are rare, prednisone 5mg pills $128.00 but that patient is my responsibility, prednisone 5mg pills $128.00 too, prednisone 5mg pills $128.00 and my derriere is on the line if we aren’t prepared for them.
  • If conscious sedation is ordered, prednisone 5mg pills $128.00 I feel it is the doctor’s responsibility to explain to the parents exactly what that entails, prednisone 5mg pills $128.00 including oxygen, prednisone 5mg pills $128.00 monitoring, prednisone 5mg pills $128.00 IV medications, prednisone 5mg pills $128.00 etc. Prednisone 5mg pills $128.00 Just telling the parents that the patient will sleep through the procedure is not enough. Prednisone 5mg pills $128.00 They shouldn’t have to hear that from the nurse who is having them sign that they have received informed consent.

Prednisone 5mg pills $128.00 End of rant.

Prednisone 5mg pills $128.00 Now, prednisone 5mg pills $128.00 to end on a positive note:

Prednisone 5mg pills $128.00 Emergency room physicians are second only to plastic surgeons when it comes to stitching lacerations on patients of any age. Prednisone 5mg pills $128.00 I’ve seen some beautiful repair work by ER doctors in my time.

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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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