Featured

Story Time About the Dog and His Owner.

"You must give everything to make your life as beautiful as the dreams that dance in your imagination"-Roman Payne.
My handsome big dog dedicated to his owner.Runs errand for the owner.
The dog is asked to go into the house and bring kola nut(this could be anything for
entertainment)

It is a bedtime story about a dog and his owner.The owner surprisingly had visitors that they were not expecting .So the owner started a song like this.

My handsome big dog go into the house in the living room and get me some kola nut, so that we can give to these uninvited visitors.I did not invite them and I am sure that you did not invite them.So come on big boy go into the house and get me some kola nut so that we can give to these strangers.Hopefully the kola nut will force them to tell us why they are here.

So the dog went into the house and got the kola nut.The uninvited strangers ate the kola nut.After eating the Kola nut (coca cola) they confessed that they are interested in buying the piece of land in their backyard so that they could be their neighbor.Sometimes a kind gesture can lead to meeting pretty nice people.The dog owner told them that she owns the land but the land is not for sale.So they left back to where they came from.The big dog and his owner live happily there after .The End.

Featured

My Honor As A Nurse.

On my honor as a Registered Nurse.


I will provide compassionate excellent Nursing care.

I will do my best now and tomorrow.
Be a good leader,not a follower.
I must Move Nursing Agenda Forward.
I must do my Best all the time.
I promise to update and obtain required CE every two years.
Advance my knowledge,education,and experiences.
I will be Knowledgeable not Knowledge Deficit.
Team player,work effectively with my colleagues and other ancillary.
Clock or sign in on time.
Clock or Sign out on time. Have all my equipment such as Stethoscope,Pen and Pencils.
I must Reason,and be Reasonable.
Perform my assigned role effectively and efficiently. Follow Hospital policies and Regulations.
Comply with JCAHO Standards of Care and Regulations.
Carry out Doctors Orders on Time.
Troubleshoot and be Supportive of my Colleagues. Know and Understand Patient Bill of Rights.
Respect Patient and Families. “The very First Requirements in a Hospital is that, it should do the sick no harm “Florence Nightingale .
Give medications by mouth and intravenously as ordered. Advocate for my Patients.
And provide TLC.
Must not Abuse Patients Physically, Emotionally or Sexually.
Promote Health and Prevent Diseases.
“I attribute my Success to this -I never gave or took any excuse”- Florence Nightingale .
Nursing Assessment.

441 CASE SCENARIO. MR PROUD JUDGE, RIGHT FEMUR FRACTURE DUE TO FALL.(NURSING)

Age/Sex 78years old man .

MR#Q5555533321.

Acount # Q0000991111.

Staus: Inpatient.

Attending doctor:Bigman, Jimmy. Location:Trauma unit.

Room # 43002.

Code Status: Full code.

06/21/2021

Weight: 132lbs.

Height: 5ft 2inches.

Primary diagnosis: Right femur fractures due to fall at home.

Secondary diagnosis:Hypertension, hypothyroidism, hyperlipidemia.

Isolation precautions: Standard precautions. Allergy: NKDA.

02 93% on Room Air.

Transportation by bed.

Skin intact.

Diet : NPO after midnight.

Uses urinal at bedside.

Surgical Consent to be sign ( In the chart).

Advanced Directive on the chart.NO.

SCD in place(left leg ).

Laboratory Studies:

WBC:8.3.

H/H:14/ 40.0%.

NA:136.

K=3.9.

Bun:18,Cr:1.0.

0.9NS,at 75ml/hr left forearm infusing well via pump.

Complain of pain.5/10.Morphine 2mg Q2hours given prn as ordered with relief. Reassessment of pain in 30minutes 0/10.Patientis resting comfortably in bed.

440 CASE SCENARIO. ACUTE APPENDICITIS, MR BEATME,GOODNESS.

Age/Sex: 39years old man.

MR#Q45000022.

ACCOUNT # Q000000023.

Inpatient Admission .

Date of admission:.03/01/2002.

Location: Medical-Surgical floor. Kingdom of God Hospital Los Angeles, CA 90000.

Primary Diagnosis: Acute Appendicitis.

S/P:Laparoscopic appendectomy( Doctor Nice,Pain.). 4 lap sites with Demaband.

Secondary Diagnosis:Hypertension, ESRD.Hemodialysis, MWF.

02 @ 2liters NC.

Code status: Full code.

Isolation Status: Standard precautions .

Allergy: NKDA.

Diet: Clear liquid diet.

Nephro carb supplement 1 can daily.

Ambulatory.

(+) Bowel movement ×1 today.

Infection disease consult with doctor Nasty,Pauline.

WBC =17(High)

Denies pain 0/10,

Medications:

Norco 5/325mg po Q4hours.

Zosyn 3.375gm IV Q8hrs.

Saline lock 20guage,patent/clean/dry left forearm.

Right upper chest with permacath for Hemodialysis.

439 CASE SCENARIO, MR LONGBOY,JOURNEY. ALTERED MENTAL STATUS.

Age/Sex : 79years old man.

Status :Impatient Admission.

Attending Doctor: Don’thate,Big.

Medical record number: Q555500512.

Account number:Q000000071

Department: MedTelemetry.

No family members at his bedside.

Son: Lam Longboy. 999-999-0000

Confused, AMS.

Limitation of treatment.

Aspiration Pneumonia, Encephalopathy, Leukocytosis,AKI,Hypernatremia.

Hypoxic,Respiratory failure.

No distress,quiet, denied pain 0/10.

Round the Clock Respiratory therapists treatment.

Lasix 20mg ivp Q8hours.

Zosyn 3.375gm IV Q8hrs.

Saline lock left forearm.

Morphine sulfate 2mg IV Q2hours .

Assessment of pain 0/10.

Reassessment of pain level 0/10.

Laboratory Studies.

WBC =13.0.

H/H 9.3/31% .

Bun 22,Cr=2.0.

NA =144.

K=3.7.

(RRT)RAPID RESPONSE TEAM.WHEN DO YOU CALL RAPID RESPONSE TEAM?.

A bedside nurse or a healthcare professionals may call a Rapid response team when their patient has some warning signs” “such as:

Heart rate of 130bpm or less than 45bpm.

Observe acute neurological changes.

Systolic Blood pressure less than 90mmHg.

Respiration of 8 or greater than 30.

New onset chest pain or unrelieved chest pain.

Unstable Dysrhythmias.

Patient need one on one monitoring due to physiological changes.

The patient is assessed by the bedside nurse and determined that the patient is unstable and meets one or two of the criteria stated above. RRT should be called immediately.

RRT consist of ICU nurses, Physician, Respiratory therapists.

The charge nurse will facilitate getting the crash cart at patient bedside.All the necessary equipments readily available.(Oxygen, oxygen tubing, ekg,Abg,AED,laboratory) Nursing Supervisor will encourage the RRT to respond on time by assessing the whole situational process,and bed availability .

Rapid Response team must report to patient bedside within 5minutes.

Patient primary nurse and ICU RN trained responder will perform assessment of patient with Respiratory therapist.

Everything is done and well documented. Education provided to patient families and the nurse.All interventions will be reported to patient primary care physician. Interventions given according to RRT policy.

What is RRT?.

A rapaid response team is a group of healthcare professionals compromising of ICU RN trained responders,Physicians,Respiratory therapists,nurses and supervisors.

FREQUENTLY ASKED NURSING QUESTIONS.

1.What will be your first action,if your patient abdominal wound dehisces and eviscerates?.

Answer: Assess your patient apply moist saline dressing over the wound and notify the doctor.

2.How do you contact the Surgeon when needed?.

Answer: Page the doctor. When you page the doctor you will put in the call back number where you can be reached.

3.Who pronounces the patient death?.

Answer: The doctor pronounces the patient dead.

4. Is 20seconds hand washing adequate if water and soap is used?.

Answer: That is correct CDC recommends 20seconds of thorough handwashing with soap and water.

5.What is the very first thing that you will do,if you incur a needle stick at work?.

Answer: The first thing to do is to wash the punched site with soap and water.

The next thing will be call and notify the supervisor, fill some form and go to employee health for some laboratory work.

UNLOCKED CRASH CARTS.(NURSING)

Crash Carts must be locked at all times. If crash Cart is used for RRT or CODE BLUE, it must be restocked after use.So the unlocked crash Carts must be placed in a secured area until it restocked and relocked with new lock and number documented in the log book on the crash cart.

Crash carts are checked every shift by in coming Charge nurse or resource nurse. It is important to know the importance of the Crash Carts.

438 CASE SCENARIO, PATIENT ADMISSION.(NURSING)

Age/ Sex: 86years female.

MR# Q00000033.

Account number Q5555500678.

Date of birth 00/00/1925.

Attending doctor: Shieldme,Jimmy.

Diagnosis Left foot Cellulitis. Swelling, redness, 2+edema, pulses noted.

Secondary diagnosis: Hypertension.

Past medical history:Dementia, cough,hypertension osteoporosis, Pyelonephritis.

Allergy: No known Drug Allergy.

Weight 120lbs.Alert and oriented x3.GCS =15.

Family members at his bedside.

Room air.Uses bedpan.No other skin issues. 0.9NS @ 50ml/hour. 20 gauge right ac.

VSS: 123/54,88,18,98%Room Air.Arm ID band in place.Fall risk assessment completed. Fall precautions initiated.Placed patient on fall precautions based on her age.Side-rails upx2,bed brakes on.Bed in low position, yellow fall risk sign on her door, fall risk armband in place.Abuse assessment done.Patient is asked if she feels safe at home.She said yes.Suicide risk assessment done.Patient has no plans for suicide. She answers “NO”. Non English speaking, communicated through family members. Patient did not travel out of USA in the last three months. She is not exposed to tuberculosis,Influenza, COVID19.

Laboratory tests

Lactic acid =2.6.Blood culture result pending ,CBC with difference,Comprehensive Metabolic Panel(CMP).

Medications:Vancomycin 1gm IV Q24hours.

losartan 100mg po daily.

Aspirin 81mg po daily.

NURSES WITH DISABILITIES.( MY PERSONAL EXPERIENCES AND PERSPECTIVE)

So many physically disabled nurses face discrimination among their peers, patients families and the organization. It is important to know that as a disabled nurse,you are protected under ANA new code of Ethics 2015,” Treating other family with respect, promotion of health and wholeness, safety and competence. Colleagues treating each other fairly. The (ADA)America Disability Act of 1990 or 2008 Amendment .(ADAAA)

http://www.NATIONALNURSESUNITED.ORG

Nurses with disabilities are forced to leave the profession because of discrimination against them.They are tagged, labeled, called names.

Throughout my nursing profession, I have met nurses with disabilities but never paid attention rather gave them respect and accommodation. These are great competent nurses ,highly compassionate.Some of these nurses became physically disabled on the job but they never complained rather did their job quietly and go home.

Most people see the profession without seeing the “Human Beings” in the profession. That nurses are human beings, they cry ,they laugh, they hurt and they develop health problems just like any other human being. Some psychological factors can be major problem to acceptance. Most people need some degree of security and stability to change and accommodate something different such as been disabled. Most people will find a comfortable zone and do everything to maintain it.Conformity and commitment to “normalcy” can be a powerful force against change. And that is detrimental to accommodation of handicapped colleagues.

How many nurse have KNEE IMMOBILER on while they work?.Pay attention you will find one or two of them in your shift. They try to hide it because of fear of discrimination, they kept on working, and so many nurses suffered in silence. I recalled 15years ago a nurse was diagnosed with breast cancer but her insurance didn’t cover the treatment regimen, so she was left to worsen.She became disabled from arthritis and stopped working,then developed diabetes then breast cancer. She cried and I cried her with her.I went and spoke with her doctor who told me that she doesn’t have insurance to cover her treatment. She helped and treated others for 30years but she was denied help when it was her time.

In 2014 ,as I worked as a Registered nurse, I observed a nurse that limps .I felt sorry for her.She was severely discriminated against. She was labeled and tagged as “Handicapped Nurse”.I recalled a patient family member came to me one day that I was in charge and asked, “Do you know that she is handicapped?.” I replied ,yes sir I know. What do you need ?.I can help you. He replied she need to be fired immediately. I responded okay sir,I will let my manager know.

Nurses discriminated against her so badly. She will hide in the rest room and cried.She had a wonderful manager who had her back. I later found out that she became disabled just few years before I started to work there.

Today I remembered her as if it was yesterday. Whenever she sat down,she will have bags of ice blocks in her hip to reduce the inflammation. I believe that she has severe Osteoarthritis. She eventually was forced to resign, stayed home and babysit her grandchildren.

pixabay.com

There are so many reforms that can help families who are in medical debt and that include the nurses.The Robby Lewis House Bill 1420 became law in Maryland ( Charity care reforms became State law)www.NATIONALNURSESUNITED.ORG

Nursing profession is a hazardous job that most of us are not aware of .

During COVID19 PANDEMIC so many nurses died from COVID19 because they were in forefront. Some of them became permanently disabled and are forced to resign or retire.As at January 2020 there were 282 confirmed cases in four countries and nurses were in the forefront. On January 24th 2020,NNU and CNA/NNOC sent facility requests for information to make sure that they are prepared for COVID19. January 30th,2020 Global Nurses United demanded WORLD HEALTH ORGANIZATION to strengthen its guidelines on prevention and to control the deadly COVID19 PANDEMIC. But most of these organizations turned their deaf ears.

On February 28th 2020 NNU warned that United States hospitals are not prepared for COVID19 after an infected patient at UC DAVIS MEDICAL CENTER led to self-quarantine of at least 36RNs and 88 other health care workers. On MAY 12TH 2020, 1,000 NURSES HAD VIGIL TO HONOR FALLEN NURSES.Nurses due to the nature of the jobs are in forefront with so many plagues. Over 600,000 individuals died from COVID19 in United States including nurses.

NURSES ARE HUMAN BEINGS AND SHOULD BE TREATED LIKE HUMAN BEINGS.

REFERENCE:

WWW.NATIONALNURSESUNITED.ORG

Neal-Boylan L,Hopkins A,SkeeteR,etc. al.The Career trajectories of health care professionals practicing with permanent disabilities Acad Med 2012;87:172-178.

QUESTIONS ON MEDICATION SAFETY.

  1. How do you explain high alert drugs?.

A. The drugs that only physicians can give. B.Pharmacy must approve drugs.

C.The drugs with many side effects.

D.Are most likely to harm the patient if given wrongly.

Correct answer D.

2.Which of the following can lead to errors among health care professionals when administering medications?.

A.Look alike and sound alike medication. For example: Clonidine, klonopin.

B.The availability of high concentration of medication.

C.Medications with similar package color, shape and size.

D.All of the above.

Correct answer D.

3.Medication errors can be reduced by?.

A. Proper medication adminztration.

B. Medication dispensing.

C.Medication labeling .

D.Medication prescribing.

E.All of the above.

Correct answer D

4.Complications of IV therapy are?.

A.Bacteremia.

B.Circulatory overload.

C. infiltration.

D.All of the above.

Correct answer D.

5.What are the high alert medication?.

A.Heparin, insulin, , dopamine,potassium chloride, theophylline.

B.0.9NS,Tylenol, NSAIDS.

C.Motrin ,Norco.

D.None of the above is correct.

Correct answer A.