About Me

undergrad RN
I'm a twenty-something Canadian student. After stumbling through a few years of college, I finally managed to get into the nursing school of my dreams, where I hope to graduate in 2012 with a nursing baccalaureate degree. I want to offer an honest look into how a modern nurse is educated, both good and bad. Eventually I hope to compare my education to my day-to-day career and see how it holds up. Whatever happens, it should be somewhat entertaining. Find me on allnurses.com!
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Wednesday, August 24, 2011

Loss of a Statesman

As a nursing student who values social justice and universal health care, I too mourn the loss of Mr. Jack Layton, who championed our cause and the well-being of all Canadian people. Mr. Layton was a true statesman who believed in Canada's legacy and also its future, working tirelessly to achieve his vision for our nation. His final letter is one that we can be proud of as Canadians, irrespective of our political leanings. That he took the time to write such a letter speaks volumes about his character and commitment to Canadians, and the address to young people in particular gives me great hope for our future.

In sadness and solidarity,

Undergrad RN
BScN Student, 4th Year

*Although not my MP, Linda is the MP for the ONLY NDP riding in Alberta. All emails and phone calls are transcribed into his book of condolences.
Tuesday, August 9, 2011

Check, check, checking out

So it was SO FREAKING BUSY the other night. The back was stuffed full of sick people and new ones were coming in the door so fast we had two nurses out double-triaging for almost 2 hours. The theme of the night seemed to be chest pains or lacerations secondary to kicking glass/tables/sports equipment.

There were the usual WTF visits, like the mom who ABSOLUTELY had to get her kid "tested" for celiac disease in the middle of the night. At the ER. Where people were practically hanging from the rafters in the waiting room. The urgency? Well, she Googled a new diet and wanted to start him on it the next morning... "Can't I just see the doctor real quick?"

"No. I'm sure the other 25 people in the waiting room would like to see the doctor 'real quick', too." Then, after lipping off the triage nurse, she stormed out. Bye...

Anyway, I had a patient who was recovering from an infected cat bite**. She was on IV therapy q daily and this was to be her last dose.

I pick up the order - Gentamicin 480 mg IV and a PO dose of Cipro.

Go to Pyxis. Look up Gent. Go to withdraw vial.....

.....wait, we only have Gent vials that come in 80 mg/2 mL concentrations?

I check the order again. Yes, 480 mg.

Now, the nurse's cardinal rule in pharmacotherapy is that if you need more than one vial for ANYTHING you're probably doing it wrong. You know, the "thou shalt not overdose the patient into serious complications and probable death" idea. The manufacturers pre-package them in the normal dosages as one step of the safety chain.

I do a quick calc and see that I'd need..... six..... vials of Gent to make the ordered concentration.

I re-check the order and the vial about 500 times. I get an RN to check it. She laughs and says, "Yeah, that's normal for Gent. Don't worry about it!"

Easier said than done. I get to work drawing up the vials and mixing them up in N/S.

Then I go to the patient and start programming the smart pump. Smart pumps have "guardrails" on certain drugs to prevent nurses from accidentally giving unsafe dosages or infusion rates.

So the guardrail pops up with the amount of Gent that I'm planning to infuse. It also pops up with the rate I want to set. The smart pump actually wants me to infuse the 100 mL bag in 30 minutes. I'm all like "screw that, Alaris, you'll run it over an hour!". It's weird that the guardrail cautioned me running the med longer than the time allowed. Usually it's running it too fast that causes phlebitis. But I digress.

So after bypassing 3 red flag safety checks, I was feeling pretty unnerved by the whole experience. I mean, it was only 480 mg of an IV antibiotic, not 48 grams. I was pretty confident that I was giving a safe dosage, and I cleared it with 2 RNs during prep and administration. I also checked my drug guide to verify it was a safe dosage.

Seriously, manufacturers of Gentamicin and Alaris, put guardrails where you need 'em, cuz you just about gave this nursing student apoplexy!

** Who'd've thunk it, but cat bites are among the most common reasons I've seen for people to get cellulitis. Those things just get NASTY! Swelled limbs and purulent drainage. And they usually happen to the nicest people (cat people are usually nice, or nice-crazy, IME). Cute cuddly kitties need to come with a disclaimer.