July 27, 2016, 10:10 pm

Endep 25mg Pills $132.00

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Endep 25mg pills $132.00 This is an interesting little gem.

Endep 25mg pills $132.00 I believe it was part of an ad for health insurance.

Endep 25mg pills $132.00 Interesting because it looks about circa 1950.

Endep 25mg pills $132.00 Because for what I spend on amazon.com, endep 25mg pills $132.00 I could have my appendix out every ten days.

Endep 25mg pills $132.00 With the Grade A anesthesia!

Endep 25mg pills $132.00 And because this patient looks to be headed for surgery in an evening gown!

Endep 25mg pills $132.00 Honey, endep 25mg pills $132.00 in my facility, endep 25mg pills $132.00 you don’t even get to keep your underwear on!

******************************

I’ve lived through many changes in health care over the last three decades.

Seen trends come and go.

Seen fancy “miracle” drugs come and go. Endep 25mg pills $132.00 And come back again.

But something is happening.

The changes are coming faster.

I’m coming up on three years in my current ER.

Here are a few of the changes I’ve seen in that relatively short length of time.

******************************

Patients are more open about their health issues.

  • Patients seem more willing to let you know when they have infections like Hep C or HIV.
    • Words and intitials that used to be whispered with averted gaze are now spoken outright and without shame.
    • I like to think that patients are more comfortable because they don’t feel the stigma that was once attached to infectious disease. Endep 25mg pills $132.00 Maybe I’m naive. Endep 25mg pills $132.00 I hope not.
    • I’ve had more than one patient warn me to be extra careful when taking their blood!
  • Patients are more upfront about their sexuality and medications taken for it.
    • I used to have to ask about Viagra specifically; no nitroglycerin if Viagra is on board! I still ask, endep 25mg pills $132.00 but have noticed an increased willingness to mention the presence of Viagra without being asked.
    • Again, endep 25mg pills $132.00 I’d like to think this is due to increased patient education from both health-care providers and that patients feel more comfortable informing us of these medications.
*****

Endep 25mg pills $132.00 More patients are using the emergency department as their source for narcotics.

  • This leads to me believe one of three scenarios:
    • 1. Endep 25mg pills $132.00 The patient has chronic pain and they must utilize the ER when they experience breakthrough pain or when their coping mechanisms are overwhelmed. Endep 25mg pills $132.00 Or…
    • 2. Endep 25mg pills $132.00 The patient does not have an adequate pain control regimen in place as yet and continues to experience episodes of pain requiring narcotics. Endep 25mg pills $132.00 This is also legitimate. Endep 25mg pills $132.00 Or…
    • 3. Endep 25mg pills $132.00 The patient is a drug-seeker. Endep 25mg pills $132.00 You know them. Endep 25mg pills $132.00 It’s a feeling in your gut. Endep 25mg pills $132.00 Daily visits for two weeks. Endep 25mg pills $132.00 Two visits in 24 hours, endep 25mg pills $132.00 more than once. Endep 25mg pills $132.00 Overly-solicitous behavior to the nurses. Endep 25mg pills $132.00 (I’m good, endep 25mg pills $132.00 but no, endep 25mg pills $132.00 I’m not Mother Teresa, endep 25mg pills $132.00 thank you anyway.) “Allergic” to every medication other than the one(s) they are asking for. Endep 25mg pills $132.00 There have been shifts when I have seen 6-7 of our “regulars”. Endep 25mg pills $132.00 Some call in ahead to see how busy we are. Endep 25mg pills $132.00 This is not legitimate.
  • So how do you know which is which?
    • Many times, endep 25mg pills $132.00 you don’t.
    • That means everyone is treated as if their request is legitimate and they are not drug seeking.
    • But I can tell you there are more narcotics flowing out of emergency departments today than I’ve ever seen. Endep 25mg pills $132.00 I can also tell you that when
      • I know the patient’s name when they walk in the door, endep 25mg pills $132.00
      • when I can write their medical history from memory on the triage chart, endep 25mg pills $132.00 and
      • when I am giving amounts of medication that would put me out for eternity, endep 25mg pills $132.00 we have a problem, endep 25mg pills $132.00 Houston.
    • Sometimes, endep 25mg pills $132.00 I can’t help but feel like a drug pusher – in the literal sense. Endep 25mg pills $132.00 We are doing these patients a dis-service by continuing to feed their addiction. Endep 25mg pills $132.00 It’s a sad situation; it’s almost like they live from visit to visit. Endep 25mg pills $132.00 But they still come in. Endep 25mg pills $132.00 Because they get what they want.
*****

Endep 25mg pills $132.00 There are more patients in the emergency department.

Endep 25mg pills $132.00 This isn’t my imagination, endep 25mg pills $132.00 we’re adding more nurses like crazy to handle the load!

Endep 25mg pills $132.00 I’ll use my shift, endep 25mg pills $132.00 the night shift, endep 25mg pills $132.00 as an example:

  • The old night shift
  • Clear out the patients left over from PM shift by 0100
  • Stock the unit and order meds.
  • Catch up on all the nursing journals and research papers you have not had a chance to read. Endep 25mg pills $132.00 (Translation: knit, endep 25mg pills $132.00 crochet, endep 25mg pills $132.00 write letters, endep 25mg pills $132.00 catch up on your novel, endep 25mg pills $132.00 do crossword puzzles, endep 25mg pills $132.00 gossip and eat, endep 25mg pills $132.00 eat, endep 25mg pills $132.00 eat!)
  • Put all evidence of professional journals away by 0530 so that the day shift doesn’t think you sat on your butt half the night.
  • Get ready for the daily hip fracture patient that is sure to come in between 0545 and 0630 and the daily pulmonary edema patient that will come between 0615 and 0700
The new night shift:
  • Come in at 2300, endep 25mg pills $132.00 pour coffee.
  • Run your derrierre off with a nearly full department.
  • At 0200, endep 25mg pills $132.00 make more coffee (you never had a chance to sip the first cup).Run your derrierre off with the new patients that have just arrived as you hit the “on” button on the coffee pot.
  • At 0400, endep 25mg pills $132.00 make more coffee. Endep 25mg pills $132.00 Actually drink half of this cup. Endep 25mg pills $132.00 Go attend to the four pediatric patients from the same family who all have fevers and just walked in with all four grandparents and a fourth cousin once removed.
  • At 0600, endep 25mg pills $132.00 forget any more attempts at coffee. Endep 25mg pills $132.00 Grab your six-inch high pile of charts and begin documenting what you did five hours previously.
  • Take the next hip fracture and pulmonary edema patients.
  • Kiss the day shift.

*****

The paperwork has become unmanageable.

I’ve blogged on this ad nauseum.

Ostensibly, endep 25mg pills $132.00 the paperwork is supposed to document good patient care.

  • In reality, endep 25mg pills $132.00 it borders on preventing adequate patient care as the nurse spends more time at the chart than at the bedside.
  • You don’t get a “gold star” on your record for making sure your patients received good skin care.
  • You get a “gold star” for filling in all the blanks on the chart.
******************************

Endep 25mg pills $132.00 So it appears the rapid changes I’ve witnessed in the last three years are a mixed bag.

Endep 25mg pills $132.00 On the one hand, endep 25mg pills $132.00 patients are more willing to discuss intimate aspects of their care with their health-care providers.

Endep 25mg pills $132.00 On the other hand, endep 25mg pills $132.00 the census of my emergency department is swelling secondary to non-emergent patients utilizing our services.

Endep 25mg pills $132.00 A major factor are patients with chronic pain utilizing the ER for pain relief services on a continual basis. Endep 25mg pills $132.00 Most are legitimate. Endep 25mg pills $132.00 Many are not. Endep 25mg pills $132.00 And that is sad for two reasons.

  • Addiction sucks.
  • The abusers make it that much harder for legitimate pain patients to be viewed clearly and dispassionately.

Endep 25mg pills $132.00 Add the increasing amounts of paperwork, endep 25mg pills $132.00 and you see a much different ER than you saw just three years ago.

Endep 25mg pills $132.00 I wonder what changes I’ll be writing about in 2010…..

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13 Comments

  • Sid Schwab
    Sid Schwab

    October 28, 2006 at 10:30 am

    Re: grade A anesthesia. There’s an old saw about the patient asking the anesthesiologist how much he charges and, when he hears the answers, exclaims: You charge that much just to put me asleep???? No, the answer comes. Putting you to sleep is free. We only charge for waking you back up.


  • Deacon Barry
    Deacon Barry

    October 28, 2006 at 1:28 pm

    You get regular hip fractures and pulmonary oedemas at awkward times. With us it’s corneal ulcers – and we always seem to get them coming in on Friday afternoon! Why Friday? It’s as if they wait until their working week is finished before deciding to do something about that sore eye they’ve had since Tuesday…


  • Fat Doctor
    Fat Doctor

    October 28, 2006 at 3:12 pm

    Kim, where on earth do you find these pics? Please tell! I won’t steal the concept (promise) but I just have to know! 🙂


  • motherjones-rn
    motherjones-rn

    October 28, 2006 at 3:26 pm

    What do you mean you’re not like Mother Teresa? A nurse must have the patients of a saint to work in an ER.

    I love the sign about grade A anesthesia.

    MJ


  • Rob
    Rob

    October 28, 2006 at 8:50 pm

    The narcotics thing is the bane of our existence in the office as well. On a typical day I will get 10-20 phone calls regarding narcotics. You are always doing this intricate dance of wanting to meet the needs of your patients without creating addicts. As I get older I am meaner and meaner about them. When I first started out I cared more about making patients mad at me. The problem is, if I turn them away, guess where they end up. Yes, in the ER.


  • TC
    TC

    October 29, 2006 at 2:56 am

    I hear ya about the drug seekers. But are you really going to make any difference to there addiction in one ER visit? Or even several visits? It’s not a good forum to address a possible addiction problem. Something really needs to be done with the state of all mental health services, including addiction treatment, which has become virtually non-existent in my neck of the woods unless you have really good health insurance.


  • angry doc
    angry doc

    October 29, 2006 at 4:44 am

    Kim,

    I’m going to steal that picture for my own blog. 🙂


  • S. R.
    S. R.

    October 29, 2006 at 3:42 pm

    The drug thing happens on the medical floor too. 10/10 pain every two hours that can only be removed with the 4mg shot of Morhpine, not the Vicodin 5/500 tab. If you still have 10/10 pain every two hours after 7-14 days in the hospital, you should be writhing, urinating yourself, and in the ICU, not asking for sandwiches.

    It’s not that i don’t care about pain; it’s that these requests take away from other patient’s care. Addicition is narcissism, however.


  • Carol
    Carol

    October 29, 2006 at 8:58 pm

    Just a laygirl’s observation… I read more and more about ER’s being swamped with pain patients, and about office doctors being stingy with narcotic rx because the gov’t is watching like the KGB, and sometimes even arresting doctors for treating intractable pain with big narcotic scripts. I wonder if there is a correlation?


  • apgaRN
    apgaRN

    October 30, 2006 at 9:56 am

    And then come the babes… if mom has been abusing narcs (or other drugs) throughout pregnancy, baby is addicted too. The high-pitched screaming of a baby in withdrawal is enough to put me over the edge. And to keep me from feeling an ounce of sympathy for drug-seeking moms.


  • TuxBaby
    TuxBaby

    October 30, 2006 at 1:02 pm

    I can relate! We get those “frequent flyers” too. I remember about 4-5 regulars who I could probably pre-chart the initial info, and stash the charts under the triage desk for the next visit… (of course I didn’t actually DO that)! I also know of some of the drug seekers being not-so-thrilled with the ER doc for giving them Stadol or Talwin and sending them on their way- and without the great high they had hoped to get. We’ve even had some call in to see what ER doc was on shift- because some were more free (more naive?) than others.

    As for the paperwork…. you get gold stars for yours?!?? I never got any stars for my stacks-of-charts! **pout**

    ~TuxBaby


  • Sometimes desperate ER patient
    Sometimes desperate ER patient

    December 3, 2006 at 8:26 pm

    I make sure that I NEVER ask for any narcotics in the ER, and yet they all treat me like a potential drug seeker. Why? I would rather have pain than to have to put up with the yuckky side effects of pain pills.


  • Virginia
    Virginia

    January 27, 2007 at 12:19 pm

    Thank you for the great web site – a true resource, and one many people clearly enjoy


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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