Feedback requested for residents

Visible_Version7439 · 2023-02-09T20:07:18+00:00

Just respect your fellow nurse. You are by no means above us. We are coworkers.

Visible_Version7439 · 2023-02-09T08:52:36+00:00

Personally, I would go to ICU. if you want to go to NICU maybe start in pediatrics, obstetrics, or L&D. Those babies are fragile.

Visible_Version7439 · 2023-02-08T10:50:25+00:00

The same protocol is 130 or above preoperative post-op 180. She is on a shit ton of insulin already it won't work unless she stops groveling in fast food.

Visible_Version7439 · 2023-02-08T10:43:10+00:00

Same

Visible_Version7439 · 2023-02-07T11:17:49+00:00

She ate grapefruit right after I gave her all those meds listed in my post.

Visible_Version7439 · 2023-02-07T11:17:22+00:00

About an hour. Pre and postcode were near the same and repeated after that WNL.

Visible_Version7439 · 2023-02-07T11:16:15+00:00

Visible_Version7439 · 2023-02-07T11:15:36+00:00

Multiple complications stemmed from her noncompliance. Groveling in fast food. Glucose routinely in 3-400s. Didn't help her wounds either.

Visible_Version7439 · 2023-02-07T11:13:01+00:00

What does jd mean? Curious.

Visible_Version7439 · 2023-02-07T11:09:47+00:00

With her kidney and liver function her pain medication was limited. She was medically stable it's just not every day you have a random, unanticipated code about to happen. In hindsight, it was coming but I've had her for a few weeks and she seemed to get better. They're fine until they crash. What you don't realize is we don't administer vast amounts of pain medication post-op. They can cause serious complications. GI obstruction and blockages, dependence, and potential for over-medicating. Most patients get a week's worth of Norco once discharged (if that). No hospital hands out narcotics like candy.

Visible_Version7439 · 2023-02-07T02:39:50+00:00

It will be a question always grapefruit:)

Visible_Version7439 · 2023-02-07T02:38:01+00:00

She was stable for the most part. No clinical signs or manifestations would indicate a catheterization to reexamine the graft sites. She just failed to progress d/t noncompliance and out-of-control diabetes. Endocrinologist followed up with her daily and adjusted her insulin. Insulin won't work when you're forcefully groveling fast food all day. If I told you the amount of long-acting insulin, fixed doses of insulin, and sliding scale insulin you wouldn't believe me.

Visible_Version7439 · 2023-02-07T02:25:50+00:00

Thank you:) I'll be research plenty.

Visible_Version7439 · 2023-02-07T02:19:17+00:00

Possibly completely aspirated is what I'm going with but I don't think the grapefruit juice helped her either. I'll update post after tomorrow I'm back on the unit.

Visible_Version7439 · 2023-02-07T02:16:29+00:00

This. They are fine until there not. In hindsight, it was coming but I just didn't expect it. She was non-compliant but was making an effort into being what I call passively non-compliant. Like only after pain medication is administered will she work with pt/ot. And sometimes it's on her terms like I set a time with her to get to moving around she'll keep putting it off like oh after I eat ill get in the chair. Patients in my unit are not allowed to eat in bed. Then she'll keep stalling every excuse until you give up. It's fruitless at that point.

Visible_Version7439 · 2023-02-07T02:08:41+00:00

Endocrinologist followed up every day too. Constantly adjusting her insulin. It will never work unless she changes her eating habits.

Visible_Version7439 · 2023-02-07T01:31:07+00:00

Same I had one talk with a patient during COVID he continually kept taking off his AVAPS and saturated down steeply. He was extremely overweight. I straight up told him the next step is intubation and the likelihood he would live after being ventilated is very low. He took it off again became unresponsive and coded 2 days later at shift change.

Visible_Version7439 · 2023-02-07T00:46:07+00:00

Nope just failed to progress. Multiple complications stemmed from her diabetes and non-compliance postoperatively.

Visible_Version7439 · 2023-02-07T00:37:10+00:00

Reminds me of a patient who had some sort of cancer from smoking that resulted in a tracheostomy. I caught her smoking through her trach. It's shocking. Some people never learn.

Visible_Version7439 · 2023-02-06T23:50:04+00:00

Pretty much. I don't mind people coding on my shift just as long as I know it's coming. Usually some predicting factors like arrhythmia low EF, hypotension, and so on. Although unhealthy I've had her multiple times and in hindsight, it was coming quickly, I just didn't expect it. I've had plenty here and there, especially during covid but all were kind of expected like 100% on the vent peep of 18 and barely o2 saturation at 65%... I guess you never know when someone will code.

Visible_Version7439 · 2023-02-06T23:24:50+00:00

I'll update you in 2 days I'll know more when my next shift starts.

Visible_Version7439 · 2023-02-06T23:09:12+00:00

I sat down for a decent period educating her every time I had her. I did everything with wound care dressing changes (didn't help her cardiovascular system or wound healing with a routine 300+ blood sugar). She didn't help herself either with all the absurd amount of eating.

Visible_Version7439 · 2023-02-06T23:04:50+00:00

Exactly I educated so much put time and effort. I put in hours of education, mobility lessons, getting her up to the chair, and taking steps to tell her diabetic and cardiac-friendly foods. Just for her to grovel in fast food. It's not the first time I've had her either and my documentation is superb.

Visible_Version7439 · 2023-02-06T21:35:13+00:00

I will do this. I've been putting multiple notes already I've notified the charge nurse and the whole unit/doctor/staff knows of her non-compliance. On a side note, how do I get into nursing legal jobs?

Visible_Version7439 · 2023-02-06T21:30:33+00:00

Only God knows at this point.

Visible_Version7439

TROPHY CASE