October, 2007 Archive

July 29, 2016, 2:57 pm

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Detox liv.52 100 tablets bottle $315.00 scrip

Detox liv.52 100 tablets bottle $315.00 I can just imagine the dialog for this photo:

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The life of an emergency department nurse is often chaotic and stressful. Detox liv.52 100 tablets bottle $315.00 If “a picture is worth a thousand words”, detox liv.52 100 tablets bottle $315.00 let me take a moment to actually show you what a typical shift in a community ER might look like.

Disclaimer: those depicted in the following photographs shall remain nameless to comply with current HIPAA regulations regarding patient confidentiality.

*****

simian

Detox liv.52 100 tablets bottle $315.00 Any visit to the emergency department begins with triage.

Detox liv.52 100 tablets bottle $315.00 Here, detox liv.52 100 tablets bottle $315.00 we have a patient with a chief complaint of pain, detox liv.52 100 tablets bottle $315.00 nausea and feeling as though he is “full of air”.

Detox liv.52 100 tablets bottle $315.00 The patient’s wife reports increasing incidents of the patient hiding behind chairs and flinging feces in her direction, detox liv.52 100 tablets bottle $315.00 thereby causing increased stress in the home.

Detox liv.52 100 tablets bottle $315.00 It is important to note that although the patient is smiling, detox liv.52 100 tablets bottle $315.00 he reports pain to be a 10/10. Detox liv.52 100 tablets bottle $315.00 Nurses must be careful to take the patient’s word and not make value judgments based on outward signs of pain or a lack thereof.

Detox liv.52 100 tablets bottle $315.00 On arrival to the room, detox liv.52 100 tablets bottle $315.00 the patient immediately asked for something to eat. Detox liv.52 100 tablets bottle $315.00 This is not an unusual situation, detox liv.52 100 tablets bottle $315.00 as 98.6% of all nauseated patients become hungry on arrival.

Detox liv.52 100 tablets bottle $315.00 A banana was given.

*****

Detox liv.52 100 tablets bottle $315.00 collaboration

Detox liv.52 100 tablets bottle $315.00 Communication is the heart of collaboration.

Detox liv.52 100 tablets bottle $315.00 Here, detox liv.52 100 tablets bottle $315.00 our intrepid emergency department nurse pleasantly explains to a primary care physician the purpose of the medication reconciliation form.

Detox liv.52 100 tablets bottle $315.00 Dr. Detox liv.52 100 tablets bottle $315.00 Primary is astounded at the amount of work the nurses do to make his job of ordering easier. Detox liv.52 100 tablets bottle $315.00 He vows to make sure he completes the form in the future. Detox liv.52 100 tablets bottle $315.00 Another ER success story!

Detox liv.52 100 tablets bottle $315.00 I’m sure holding Dr. Detox liv.52 100 tablets bottle $315.00 Primary by the back of the neck had nothing to do with it…

*****

compressions

Detox liv.52 100 tablets bottle $315.00 CPR certification is one of the more important requirements of emergency department nursing.

Detox liv.52 100 tablets bottle $315.00 Here, detox liv.52 100 tablets bottle $315.00 we see one of the ER staff working diligently, detox liv.52 100 tablets bottle $315.00 practicing chest compressions on a colleague.

Detox liv.52 100 tablets bottle $315.00 Uh oh! It seems that someone has forgotten the “R” of CPR and now their colleague is exhibiting decerebrate posturing.

Detox liv.52 100 tablets bottle $315.00 No problem! It takes more than profound anoxia to keep an ER nurse down!

Detox liv.52 100 tablets bottle $315.00 Our posturing partner finished the shift and managed to make it home before calling in brain-damaged.

Detox liv.52 100 tablets bottle $315.00 The nurse was, detox liv.52 100 tablets bottle $315.00 however, detox liv.52 100 tablets bottle $315.00 counseled for not breathing on the job.

*****

blog

Detox liv.52 100 tablets bottle $315.00 Technology plays an important part in emergency department medical records.

Detox liv.52 100 tablets bottle $315.00 Computers have made it easier to read blogs on the job access patient’s medical records, detox liv.52 100 tablets bottle $315.00 thereby improving continuity of care.

Detox liv.52 100 tablets bottle $315.00 Here we have Dr. Detox liv.52 100 tablets bottle $315.00 PuterGuy and our hard-working ER nurse perusing the previous history of one of the patients in the department.

Detox liv.52 100 tablets bottle $315.00 Hmmm….

Detox liv.52 100 tablets bottle $315.00 It seems this patient has a family history of feces flinging.

*****

coworkers

Detox liv.52 100 tablets bottle $315.00 Ah, detox liv.52 100 tablets bottle $315.00 cameraderie! How would ER nurses survive without it?

Detox liv.52 100 tablets bottle $315.00 It’s your coworkers who have your back, detox liv.52 100 tablets bottle $315.00 help you when you are swamped, detox liv.52 100 tablets bottle $315.00 fill-in for you when you are sick, detox liv.52 100 tablets bottle $315.00 take the feces-slinging patient when you’ve had enough and basically make coming to work a joy.

Detox liv.52 100 tablets bottle $315.00 They also hold you up when you are sleeping at 0500, detox liv.52 100 tablets bottle $315.00 as is obviously happening with our hard-working ER nurse.

*****

Detox liv.52 100 tablets bottle $315.00 unitclerk

Detox liv.52 100 tablets bottle $315.00 This concludes our pictorial look at a day in the life of an ER nurse.

Detox liv.52 100 tablets bottle $315.00 In conclusion, detox liv.52 100 tablets bottle $315.00 when things get hairy, detox liv.52 100 tablets bottle $315.00 the department is bursting at the seams and you don’t think you can take another step or read another order…

Detox liv.52 100 tablets bottle $315.00 …don’t forget to hug your administrative assistant/unit clerk.

Detox liv.52 100 tablets bottle $315.00 They’re the ones who actually run the department, detox liv.52 100 tablets bottle $315.00 anyway.

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

No emergency nurses were harmed in the making of this pictorial.

All photos taken with an iPhone, detox liv.52 100 tablets bottle $315.00 which was not mine. Detox liv.52 100 tablets bottle $315.00 Because I don’t have one. Detox liv.52 100 tablets bottle $315.00 Yet.

This is dedicated to all the ER nurses who think the night shift doesn’t do anything. Detox liv.52 100 tablets bottle $315.00 I hope this dispels any of those unfounded notions!

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July 29, 2016, 9:05 am

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Epivir 150mg pills $272.00 It’s time once again for Grand Rounds, epivir 150mg pills $272.00 this time hosted by the intrepid contributors of Pallimed: A Hospice and Palliative Care Blog, epivir 150mg pills $272.00 where many in the medical blogosphere did not hesitate to participate in the “Prognosticate” theme of the week.

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Epivir 150mg pills $272.00 Our favorite Mother Jones is taking the reins for the next Change of Shift, epivir 150mg pills $272.00 coming up a week from Thursday at Nurse Ratched’s Place. Epivir 150mg pills $272.00 Head over to Blog Carnival with your best by-for-or-about nursing posts or send them directly to nurseratcheds place at yahoo dot com. Epivir 150mg pills $272.00 Either way, epivir 150mg pills $272.00 I predict that many of you will send in submissions!

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Boy, epivir 150mg pills $272.00 talk about shifting gears, epivir 150mg pills $272.00 I have to go write a five page rough draft of my critical argument paper. Epivir 150mg pills $272.00 The topic?

Terri Schiavo.

There’s a topic that will yank me back to reality real fast.

Wish me luck.

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July 29, 2016, 2:04 pm

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Imigran 50mg pills $275.00 I’m not sure how mad the doctor is in this film, imigran 50mg pills $275.00 but it’s Basil Rathbone!!!!

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Medication reconciliation forms.

Imigran 50mg pills $275.00 Every time I fill one out I have every four-letter-word known to man run through my brain and then I invent some new ones.

And last night it got worse.

Pardon my language, imigran 50mg pills $275.00 but I am pissed off. Imigran 50mg pills $275.00 Royally.

*****

Let me do a quick recap of what we are required to do, imigran 50mg pills $275.00 as nurses, imigran 50mg pills $275.00 on the medication reconciliation form:

  • We are required to write down precisely what the patient tells us, imigran 50mg pills $275.00 even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, imigran 50mg pills $275.00 we have to write “Ativan, imigran 50mg pills $275.00 25 mg” on the reconciliation form.
  • If the patient hands us a list of their medications and instead of “Furosemide”, imigran 50mg pills $275.00 they have written “Furobedide” we have to write it exactly as it is printed on the list!

Imigran 50mg pills $275.00 Now, imigran 50mg pills $275.00 the paper that we so painstakingly fill out in our ER is then taken upstairs with the patients that are admitted and all the admitting doctor has to do is look at it and check off the box if they want it ordered in the hospital.

Imigran 50mg pills $275.00 Did you get that? We nurses write the orders out in their entirety and all the doctors have to do is CHECK A FREAKING BOX.

Imigran 50mg pills $275.00 Sorry, imigran 50mg pills $275.00 I’ll try not to shout.

Imigran 50mg pills $275.00 What this means is that (1) the patient is actually writing their own orders based on what they tell the nurse on admission when (2) the admitting physician should be responsible for finding out exactly what the patient is taking and write their own orders!

*****

So what’s new, imigran 50mg pills $275.00 you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, imigran 50mg pills $275.00 yadda, imigran 50mg pills $275.00 yadda?

Hardly.

I walked into work last night to find a note on the bulletin board (this is the preferred method of communication where I work) telling us that Dr. Imigran 50mg pills $275.00 Q found a dosage error on a medication reconciliation sheet that would have “sent a patient to ICU” and that we nurses in the ER needed to be more careful.

<commence seething>

It gets better. Imigran 50mg pills $275.00 Attached as an afterthought was a post-it note stating Dr. Imigran 50mg pills $275.00 Q also thought that the floor nurses should go over in detail everything that is written in the ER after the patient gets up to the floor. Imigran 50mg pills $275.00 Oh….and he appreciates all our hard work.

<full seethe ahead>

I left a choice note on his note and I am too old and too cynical to give a damn about the repercussions.

*****

So this week’s theme for Grand Rounds is prognostication.

I foresaw this trouble looooong before now. Imigran 50mg pills $275.00 The way we are required to fill out the medication reconciliation sheet is a safety hazard. Imigran 50mg pills $275.00 It has been, imigran 50mg pills $275.00 it is now, imigran 50mg pills $275.00 and it will continue to be.

It is the rare patient who knows exactly what they take, imigran 50mg pills $275.00 how much they take or why the hell they even take it!

But this is what their orders are being based on.

Even if they come in with two full pages of medications, imigran 50mg pills $275.00 single spaced and printed off a computer, imigran 50mg pills $275.00 when I verify the meds with them there will be 3-4 changes and at least three that have been discontinued.

So now the ER is getting criticism while doing something the doctor should be doing to begin with, imigran 50mg pills $275.00 but that is not the worst part.

*****

The system is set up so that any discrepancy, imigran 50mg pills $275.00 any dosage error, imigran 50mg pills $275.00 any transcription error (we aren’t allowed to xerox the patient’s list) – any adverse reaction/incident….can be blamed on a nurse for writing it “wrong”.

Yet they require us to write it “as is”.

The system is set up to fail. Imigran 50mg pills $275.00 Somewhere, imigran 50mg pills $275.00 somehow, imigran 50mg pills $275.00 someone is going to be hurt. Imigran 50mg pills $275.00 And I’m not exaggerating when I say it will be the nurse whose signature is on the bottom of that form that will take the fall.

So, imigran 50mg pills $275.00 Dr. Imigran 50mg pills $275.00 Q, imigran 50mg pills $275.00 before you come down and spread your eminent wisdom to those careless emergency department nurses, imigran 50mg pills $275.00 why don’t you find out why that dosage landed on your patient’s form, imigran 50mg pills $275.00 realize that you should be ultimately responsible for what is ordered and then thank us for doing your job.

Don’t criticize us on one hand and then patronize us with your appreciation of how hard we work.

You don’t have a clue, imigran 50mg pills $275.00 buddy.

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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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