Misplaced Lens Cap

tannertan36

Kaledo Art

Product Placement

#extradirty
Claire Keane

Discoholic 🪩

ellievsbear
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h
Lint Roller? I Barely Know Her

❣ Chile in a Photography ❣
Mike Driver
cherry valley forever

Love Begins
Sweet Seals For You, Always
he wasn't even looking at me and he found me
"I'm Dorothy Gale from Kansas"

blake kathryn
NASA
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@rnurse
Steven Johnson’s Syndrome and Toxic Epidermal Necrolysis
You know in all your pharmacology books when it says a possible reaction from, what seems to be, every medications is Steven Johnson’s Syndrome (SJS)? SJS is a reaction that causes you to develop a large, blistering rash on 10% or less of your body as a reaction to medication: similar to the picture above. However, the rash above covers a much larger surface area than 10% of the body. When the reaction is so large that it covers greater than 30% of the body, you’re diagnosed with SJS’s brother spectrum disorder, Toxic Epidermal Necrolysis Syndrome (TENS). Above is a picture of TENS at peak time (10 days). These patients generally require transfer to a burn ICU for initial management, and care is largely based on supporting symptoms and preventing infection. Unfortunately this can last from weeks to months, and many people suffer chronic problems from this disease.
My patient came in covered on both legs and perineal area with a difuse, circumferential rash similar to the one above after starting Bactrim several days prior, and his trunk had an earlier stage of the rash developing. As we cleaned his arms with CHG to draw blood cultures, he screamed saying that it felt like I set his arm on fire. We gave him 6 of morphine with no relief, and 100 of Fentanyl that took the edge off. Eventually we ended up giving him Ketamine before sending him to ICU.
Out of all of the patients that have told me they were having 10/10 pain, he has to be in the top 3 most believable ones.
Real blood pressure. Intermittently like that and then bottoms out to low 100’s, he intermittently tachycardic too.... pheo?
And people just can’t spell even when the word is right there in the same sentence🙄.
professor: what side effect can bowel preps have?
students: make electrolytes fucky
Until She Wakes Up.
You are to young to be laying in that bed. Â That was my first thought as I got report from the flustered night shift nurse. Way to young. Â I surveyed the room and started my day. Â You were on minimal sedation but not fighting the ventilator or lines that were streaming from you. Â Your hair was freshly dyed and already getting matted with blood where they had shoved central lines in your neck. Â I spent my morning straightening you up and figuring out what happened. Â By 10 am, your loved ones filtered in. Â
He had an easy smile and a friendly demeanor- I could tell why you would like him.  He clearly loved you and spoke about you with humor and pride. He talked about your kids and my heart dropped.  A pre-teen daughter and a teen son…what an awful age to go through without your mom.  I asked if he would be staying in the room with you and he laughed at me.
“Oh, I’m not leaving until she wakes up.” He said smiling.   I nodded and smiled back.  That was Sunday.
Monday you went for emergent abdominal surgery after throwing a clot to your intestines. Â And he stayed by your side.
Tuesday you went for a second abdominal surgery after reoccluding your artery. And he kept agreeing so he could get you better.
Wednesday they closed your now brutalized abdomen. And he stayed hopeful.
Thursday they turned off sedation and hoped you would wake up for us. He encouraged you every step.
Today I watched the last shred of control and hope he had get annihilated.
Today I watched them scan your head. The MRI showed anoxic injury as we expected, but also a large stroke that we did not expect. Â They appeared on opposite sides of your brain. This was a devastating blow that knocked him to his knees and caused him to flee the room.
Today you got a bad prognosis for someone so young and it was confirmed you will never be the woman he loved again.
Today he decided that he wanted everything no matter how invasive and battering it will be to your already hurting body.
Today I watched surgeons circle like sharks and try to decide between a craniotomy to relieve pressure or 3% saline. Â I watched general surgery lurk about deciding if the rising WBCs and persistent fever was her abdomen or a fluke. Â
Today I watched you become a shell of who you were right in front of my eyes. Â Today I watched your kids walk in the room with guarded looks and shocked faces. Â Tears sparkling at the corner of their young eyes.
It never gets easier when you witness pain like that… But, today…
IV Initiation Tips
Consider the key factors!
The patient’s medical history and current medical state If the patient is critically ill or if they could “go south” quickly, vein preservation is crucial. These patients are most likely to require rapid administration of fluid and/or rapid access to a vein for bloodwork in an emergency setting. Ensure that IV access is obtained from the most distal site first and moving upward with alternating sites as required. Patients with a history of multiple hospitalizations or chronic illness where IV access has been an ongoing requirement often know their veins very well and will not hesitate to tell you what areas never work!! Although their insight is incredibly useful, always assess BOTH arms regardless before making your decisionÂ
Age, body size and weight, skin and vein condition, level of activity If possible, try to initiate the IV on the non-dominant arm to reduce the risk of losing the IV during patient activity. Confused patients who are prone to pulling at tubes are often “tricked” by IVs that are placed in hidden spots like the ventral forearm with a light sleeve to cover the area. Remember it is never appropriate to cover an IV site with gauze and tape, you should always be able to quickly assess the site especially during continuous infusion. Elderly patients lose subcutaneous tissue as they age, their distal veins are frail and roll easily and are prone to blowing. These patients will also experience worse complications if infiltration or phlebitis occurs at a distal site. The general rule that I use for the elderly is to try to find the straightest distal vein that is available, usually in the forearm. Obese patients may not have veins that are visible. Practicing identifying veins by touch first may help you to improve your IV access skills on heavier patients where visualizing veins is challenging.
The type of IV fluid or medication to be infused IV fluid or medications with a high osmolality or low pH will require a larger vein that can tolerate the infusion Vesicant medications cause tissue necrosis and can damage surrounding tendons and ligaments in the hands/distal forearm. These medications should ideally be administered at a more proximal site with a larger IV. It is also important to ensure that there is adequate blood flow around the IV site to carry fluids and medications into circulation, especially if they are vesicants. Consider this: Vancomycin has a pH of ~3.9. Lemon juice has a pH of 2.5-3. When administering Vanco through a peripheral IV, not only does the site have to be large enough to tolerate the drug, but there has to be enough bloodflow AROUND the catheter to carry the drug into circulation and prevent local damage.
The expected duration of I.V. therapy If the patient is expected to receive IV therapy for less than one week, start with the most distal site in the upper extremities and move upward. This is extremely important for vein preservation and keeps vein selection high if IV access is lost. If the patient is expected to receive IV therapy for longer than a week, and/or requires frequent blood work and intermittent IV meds but has poor venous access, discuss the option of a central line/peripherally inserted central line as a more appropriate alternative with the medical team and/or venous access support team at your work
Your level of experience - If the patient’s veins are a level 4 or 5, consider observing a more experienced nurse insert the IV until you have become more comfortable with your skills, or have them guide you through vein selection.
Consider the vein level! The lower, the better.
Consider where NOT to poke!
NEVERÂ place an IV in:
Veins below (DISTAL to) a previous I.V. infiltration or phlebitic area
Areas of skin inflammation, disease, bruising, or breakdown
An arm affected by a radical mastectomy, edema, blood clot, or infection
An arm with an arteriovenous shunt or fistula.
Avoid veins in the wrist for venipuncture as they run in close proximity to nerves. The cephalic vein on the lateral (thumb) side of the lower forearm/wrist is right next to the radial nerve, I always avoid this site and consider it a last resort for this reason.
Avoid valves. Where two veins conjoin into one there will be valves. Valves can also be visualized as distinct bumps along a straight vein during vein engorgement. You cannot pass an IV catheter through a valve. It will be met with resistance and it will be painful for the patient.
Consider appropriate gauging!
24- to 22-gauge for children and elderly patients
24- to 20-gauge for medical patients and postoperative surgical patients
18-gauge for surgical patients and for rapid blood administration. Blood can be infused through smaller-gauge catheters, but the flow rate will be slower.
16-gauge for trauma patients and those requiring large volumes of fluid rapidly.
Consider useful techniques!
Warm the arms for 3-5 minutes prior to searching for a vein
Position the arm at or below the level of the heart to encourage blood flow
Use a blood pressure cuff in the elderly. The tightness of a tourniquet can actually blow a punctured vein and a cuff is much more pressure sensitive against the skin of these patients
Use moist compresses or rub the site to encourage blood flow
When cleaning the site, apply good pressure, this can really help you to visualize the vein better immediately prior to puncturing it
Stabilize the vein throughout the IV insertion. Pull downward on the skin distal to the puncture site with your non-dominant hand and maintain that stabilization UNTIL THE CATHETER IS IN. Before puncturing the skin, make sure you are stabilizing far enough down the arm or hand that you can get a low enough angle to go into the vein and not through it.
Insert the catheter with the needle bevel up at a low angle. When blood return is observed, lower the angle level to the arm and advance the unit slightly to confirm placement. Blood return should continue during advancement, at which point the catheter should advance smoothly while the needle is retracted.
Learn to insert the IV holding it with your thumb and middle finger. This eventually allows you to advance the catheter with your index finger while retracting the needle with your thumb and middle finger.
Once the IV is in, follow the two T rule: Transparent Dressing and Tourniquet. As soon as the dressing has secured the site the tourniquet should come off.
It is okay to instruct the patient to clench their fist during IV initiation, this helps with venous filling. However this should be avoided if the IV site is being used to draw blood on insertion (often seen in ED) and should always be avoided with blood work. Fist clenching can result in inaccurate lab results due to hemolysis and excessive local muscle contraction.
OP medic_memes
*whispers*
“Don’t worry, just checking in on you”
OP MaleNurseMindSet
Name a more beautiful deaeration chamber
*Senator talks shit about nurses*
Every nurse, everywhere:
Situations Anyone Who Has Laughed At The Anti-Vax Movement Can Relate To.
A Letter to a baby nurse
(I seen this and had to share,
I have been an ED nurse for almost 26 years, it has been an amazing career, It is not easy but more than worth it! Just remember we were ALL BABY NURSES AT ONE TIME!!!
A LETTER TO THE BABY NURSE
Right now, there is a baby nurse who is searching online and deep inside for an answer. There is a brand new member of the profession who is questioning her calling. There is a newly-minted graduate who wonders how school seemed to teach her everything and nothing all at the same time. There is a greener-than-grass new hire who is praying that she doesn’t kill somebody at work tomorrow, and wonders if she already did yesterday.
Dearest baby nurse, don’t let this scary new world drag you down. You’re going to have moments when you are sitting on a toilet seat for far too long, probably for the first time in your entire shift, and question why you even decided to become a nurse in the first place. That’s okay.
You’re going to have days — many of them — when you plop down in your car after leaving work two hours later than anticipated; and you’re going to turn off the radio; and you’re going to roll down the windows; and you’re going to cry the most painful and ugly cry. That’s okay.
You’re going to have shifts where your head is spinning and your hands are shaking and your brain is thinking faster than your fingers can type. That’s okay.
You’re going to have moments when you clean more bodily fluids in one 12-hour day than an average person might in a lifetime. You’re going to feel that — sometimes — you’re the only person on the entire unit, because everyone around you is just as busy as you are. That’s okay.
You’re going to have times when patients yell at you for something you didn’t know (that perhaps you should have). They will complain about you to anyone that might listen. They may even become so frustrated with their care that they threaten to leave. And this is going to bother the hell out of you. That’s okay.
You’re gonna listen for 20 minutes and still not hear a damn murmur. That’s okay.
You’re going to have moments when you feel like something “just isn’t right” with the patient in your care. You won’t have enough experience as a frame of reference for what may be happening, or why. You’re probably going to feel helpless in these moments — it’s a “tip of the tongue” phenomenon to the highest degree. That’s okay.
You’re going to feel devastated the first time a veteran nurse yells at you — even more so when their reaction is for something nit-picky and non-essential. You’re going to mumble something unsavory about them under your breath. That’s okay.
You’re going to call a doctor to clarify an order, and she’s going to complain. She’s going to want answers, details, vital signs, and a picture of what is happening with your patient, and you’re going to word-vomit something that probably makes very little sense to an angry cardiologist at 3 a.m. That’s okay.
You’re going to walk into a room expecting to pass your morning medications and come to find your patient unresponsive. Maybe she’s stopped breathing. Perhaps she’s lost a pulse. Either way, you’re going to bring forward everything you learned in every class, clinical, and scenario — and forget how to do any of it. You’re going to scream for help. You’re going to look like a deer in headlights. And you’re going to wonder, “When the hell am I ever going to be able to be as good as they are?” That’s okay.
You’re going to lose that patient, on an unexpected shift, and in an unexpected way. You’re going to think it was your fault. You’re going to be riddled with guilt and feel ashamed of how you reacted. You’re going to replay that scenario in your head over and over again, and every time wonder why you didn’t see it coming. You can’t always see it coming. You can’t always be the hero. And that’s okay.
Because someday you will be.
Someday you’ll understand the subtleties and nuances that no one can teach you except for time Herself.
Someday you’ll be able to balance the full-fledged mountain emergencies with the miniature mole-hill ones.
Someday you’re going to address a patient or family member who is frustrated with a sense of firm yet compassionate care, and will know how to redirect their emotions.
Someday you will call a doctor, and she will thank you for keeping such a close eye on whatever concern you’ve already handled.
Someday you’re going to finally take a lunch break, and it will actually be during lunchtime.
Someday you’re going to do chest compressions or inject medications or ventilate a patient, and your paralyzing fear will be replaced by sheer adrenaline.
Someday, somebody is going to die on your watch — but whether it’s through blood, sweat, and heroics or a quiet and accepted end — you will have made a difference in the journey of that patient and his or her loved ones.
And while some days you may still feel like a hamster on a wheel, going through the motions just to stay afloat — someday you will realize that you are not the one sinking and needing to be saved. Rather, you’ve grown into a life raft for another baby nurse, insecure and unaware of all of her untapped potential.
Someday you will understand that the nursing profession is perhaps the hardest of them all, but in so many different ways, the most rewarding.
And someday you will stand up for yourself; stand up for your patients; and stand up to the barriers that impact your highest capacity to care — this day will remind you why you trudged through every tear, scream, and exasperated sigh.
So do not give up, baby nurse: new to the world in which nurses beget nurses; still questioning why nothing ever ends up like the texts books might have said. No matter how bad it feels — no matter how hard it seems — always turn to the nurses who can teach you that one can have a brilliant mind and a beautiful soul; one can be funny when things feel too serious; one can be tough as nails and still be softened by the circumstances; one can make mistakes and still maintain integrity. Stand your ground, baby nurse; ask questions; study hard; prioritize what matters; own up when you don’t know; and don’t let anyone beat you down — especially that little voice in your own head. If you allow yourself to do it, you’ll be amazed by how quickly a baby nurse can grow.
Lovingly cheering you on,
A Former Baby Nurse
#ERNURSE #ERNURSES #TRAUMANURSE #TRAUMAJUNKY
#BCEN
A little trick I picked up working in the ER - How to inflate a pressure bag in record time!
Patient Satisfaction
Okay… rant time.
I get that healthcare is moving towards patient (and therefore customer) service. I get it. I don’t like it, but I get it.
Because the best treatment isn’t about what the patient wants.
It might suck. It might be repeatedly replacing an NG tube “that keeps slipping out”. It might be a CPAP machine that keeps them out of respiratory acidosis. It may be that potassium bag that burns when their K is 2.
I get it.
But today I had to give a patient a $25 gift card to Target because she complained up the ladder that her SMALL BOWEL SERIES was taking too long. I had doctors, I had X-ray techs, I had transporters all talking to this patient and still she was unhappy because it wasn’t on “her schedule.”
Okay, give a gift card if “Oops, gave you the wrong med.” “Sorry for busting your lip when I intubated you in surgery.” “Oops, the water line broke in the floor above you and soaked you and your loved ones.”
Not for a test that takes a certain amount of time and was done portable and therefore done in her room.
End rant.
Can I please get a new nurse?
how is this a universal experience?
male high school bullies: become cops
female high school bullies: become nurses
As a nursing student, I can attest to the amount of bullying and horrible behavior I’ve seen from fellow nursing students. One of the students in my school’s nursing program got kicked out because she was bullying her own patient…
My mom is also a nurse and she has both witnessed AND personally experienced bullying from her fellow nurses. My dad is a nurse as well and has had his own coworkers try to sabatoge him.
This is called “lateral/horizontal violence” and it’s sadly prevalent in the Nursing profession.
it goes as deep as the billing offices for hospitals too. i cant tell yall how much highschool drama my mom has had to deal with in 20 years of billing.
When I first started at my Rural Hospital, my very first day our unit clerk pulled me aside and saidÂ
“If anyone, and I mean anyone from a doctor to a housekeeper to a fellow nurse, EVER tries to pull some “eat your young” shit, you tell me. We have a zero tolerance policy for that here. If you ever feel unsafe you come to me and I’ll fix it, no questions asked”
And while I’m grateful I’ve never had to do that, I did see a student approach her one day, and I didn’t see the initial event between students I saw the after effects. I guess our Unit Clerk told the student who was trying to sabotage another student twice to cut it out, and on the third time she called this student out in front of everyone. During morning handover we have a 2 minute group huddle and our unit clerk stood up, called the bully student to stand next to her, and said something to the effect of
“Student, I’ve told you twice now to leave other students (because I guess there was a few) alone, and you haven’t, so now I’m handing you over to the rest of the nurses. Nurses, this student is a bully and I’ve had multiple people notice it and have also seen zero behaviour difference. Instructor, we have a zero tolerance policy for bullying here. If this doesn’t change in the next 3 days, we will ask management to remove the student from the hospital”
And you know what? That student didn’t even dare to pull any shit again. By the end of it they were even nice and helpful and had improved as a learner but also as a human being. And I will never forget that moment. 2 private interactions weren’t enough so our unit clerk made it public so we as a team could look out for the students, and it worked.Â
I’m sure there was plenty of room to backfire, but the relief in the faces of the students who were being bullied was real, because all too often bullying isn’t even acknowledged let alone dealt with.Â
Fuck Eat Your Young, I’m here to Protect Our Own
yesyesyes! don’t fall for that shit.
🤷🏼‍♂️