angelicalace

[angelicalace]

New Post Coming at 10 pm

Hey Friends!

I will sharing a new story around 10 pm tonight. I can’t wait for you to read it. 

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My life…

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Just sayin. 😉😂

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I’m dead 🤣💀

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The Do’s and Don’ts of Bringing your patient to the ICU

Just had a patient who coded on one of the med-surg floors of my hospital brought up to us the other day. They did a great job and with the rest of the team got the patient back and stable for transport. Bedside handoff was a complete CF though. The whole situation made me think of all of the various rapid responses and codes that have ended up in our unit and how those various nurses did (good, bad, and otherwise). Just some tips from us in the ICU to make everyone’s life a little easier. Come in with your patient. I swear to God if I see you sitting at the desk to give me report on this “supposedly sick patient”, I’ll ask you to take them back. I had a patient literally spewing blood from her oral and nasal passages and the nurses was calmly sitting at the nurses station like I was going to come and get report from her. WTF. No. If your patient is sick enough to call a rapid response, code, or emergently upgrade them to ICU status, then get your ass in here and tell me what is up with them and why they needed to come here. We multi task and if anything, I can listen to you and we can look at all the various things while we’re in the room. Bedside report is the way to do things anyway. Speaking of report. For the love of God, there is a reason we are taught SBAR. Forgot what that is (or never have heard of it)? SBAR is a handy way to give a handoff or make a recommendation to a provider. 

Here’s how it works. S – Situation. Pull a Mike from Jersey Shore and tell me what “the situation” is.  B – Background. This is your time to briefly tell me about the patient’s history. Keep it pertinent. I can always go back into the chart and look up the rest of the stuff. A – Assessment. Tell me your assessment of things. For example, your patient was in respiratory distress and was desaturating. You took a listen to them, suctioned them, and called respiratory. Things weren’t doing better and you continued escalating things. R – Recommendation. This is pretty easy, as you are recommending that they get a higher level of care with the use of a rapid response, code, etc. Here’s an example of putting it all together (based on a patient I received from the oncology floor – details have been adjusted).  “So this is Mrs. L, she was with us and having an ok day until she started getting hypotensive about 30 minutes ago. She got as low as the 70s and also was tachycardic to the 130s, looking like afib/flutter. She has a history of MDS diagnosed 5 years ago which has transitioned into AML. Also has a history of afib and GERD. She got a bit tachycardic when working with therapy this morning but didn’t have any issues with blood pressure until now. I notified service and we started a bolus as well as a unit of blood since her HgB came back below 7. Then while checking blood vitals, she got hypotensive to the 70s, which is when we called the rapid response.” See? Organized and to the point. Here’s an example of a complete clusterfuck of report that we got on another patient who coded on the floor. “So she’s medicine service. I don’t know why she’s bleeding from her mouth, I think it’s because she’s so dry. We had to put an IO in her. She has a big abdominal hemtoma. She’s had basically no urine output all day and she had this weird green stuff coming out of her foley. We started her on pressors. She has this unit of blood and another unit ordered. Anything else you need to know?” Yeah, I don’t know, like what the hell happened to this patient? I don’t give a crap about the green stuff in her Foley. Why did you call a code? Did you preemptively call a code because they patient was altered? Did they actually lose a pulse? If so, what rhythm did they go into? What is their history? That’s stuff to know should the patient lose their pulse again in the next few minutes.  Listen, I get it. Codes and rapid responses are stressful and scary, especially if your patient was fine one minute and definitely not fine the next. There are a lot of people asking a lot of questions and it’s easy to get flustered. We’ve all been there. But just like any other stressful situation that you are dealing with in your daily work, you need to take a deep breath and carry on. 

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[angelicalace]

ATTENTION NEW MEDICS!

I present to you the seven things that will save your uniform.

In the last three years I’ve come in contact with a lot of fluids that I had to learn (the hard way) how to clean out of my uniforms.

Hydrogen peroxide will pull blood from almost any fabric. The sooner you pour it on the stain, the better.

Dawn dish soap will help to break down grease in your uniforms. Apply to the area, lightly scrub/work it into the fabric and wash in COLD water.

Oxy-Clean laundry spray will work on blood (I usually use it along with peroxide on blood), pen (not permanent), and mud. In my experience, it’s been safe on all materials.

Lysol laundry sanitizer goes in every other wash on my uniforms. Won’t fade colors. Won’t peel vinyl lettering on clothing and leaves a fresh clean scent.

As far as detergent and fabric softener, use something that agrees with your skin. The two pictured are relatively inexpensive. I dilute my fabric softener to preserve the vinyl lettering on my shirts.

AND ALWAYS WASH ANYTHING WITH STAINS IN COLD WATER. DO NOT TUMBLE DRY YOUR STAINED CLOTHING. IT WILL SET THE STAINS AND YOU’LL BE STUCK WITH BOB’S BLOOD ON YOUR SHIRT FOREVER.

[angelicalace]

❤

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I’m personally NOT vegan, but understanding where other viable sources of protein can be found is critical.

via SimpleHappyKitchen

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Great submission!

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I hear a patient verbally abusing one of my coworkers...

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Appendix of Questionable Intentions.

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when someone says “the grades are up” and everyone starts freaking out

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A note about LGBTQ+ and nursing

A good nurse will listen to you and address you however you want to be addressed.

We do need to know some things to help you with your care such as:

- which organs you have, don’t have, and what has been removed. (surgical history)

- if you are on hormone therapy: what kind, how long? (Medication history)

- who is your support system and do you feel safe at home?

- are you satisfied with your sex life and do you feel safe with your partner(s)?

These questions seem super personal, but it is our job to make sure that we are providing the best possible care. A lot of things differ when organs are different. (Ex. A trans woman that still has a prostate can still get prostate cancer.) Lab values change, and we can’t risk a misdiagnosis because we didn’t know details. And we are bound by HIPPA to keep your medical information private.

Nursing is a profession where you HAVE to be accepting of everyone. If you can’t, find another career.

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[angelicalace]

How To Focus Better, Boost Concentration & Avoid Distractions

[angelicalace]

Some of these pictures are of lava rock, and others are of smokers’ lungs—can you tell us how many of each? Even if you can’t, one thing is for certain. Cigarette smoking can harm nearly every organ in your body.