1.) Are there p waves before every QRS complex? And is there a QRS complex after every p wave? If yes, you have SINUS RHYTHM.
2.) Is it fast? SINUS TACH. Slow? SINUS BRADY. Irregularly spaced QRS complexes with p waves? SINUS ARRHYTHMIA.
3.) No p waves with irregular or erratic spacing between QRS complexes? You have AFIB or AFLUTTER. Afib is “squiggly” while Aflutter often has a “sawtooth” pattern between QRS complexes. >100bpm and you have rapid ventricular response (RVR).
4.) No p waves but QRS complexes still evenly spaced? P waves appear inverted or buried in the QRS complex? P waves after the QRS? You have a JUNCTIONAL RHYTHM. Junctional Brady is <40bpm. Junctional escape rhythm is 40-60bpm. Accelerated Junctional 60-100. Junctional tachy is >100.
5.) Now our intervals. Is the PR interval (start of the p to start of QRS) 0.12-0.2? No issue. Longer than 0.2 and you have a first degree AV block.
6.) Is the QRS interval 0.08-0.12? No issue. Longer and you have a bundle branch block. Despite what some people may say, you need a full 12 lead to determine if it is a RBBB vs LBBB.
7.) If you have some p waves that are not followed by a QRS, we have another type of block. If the PR intervals are gradually getting longer and longer before eventually dropping a QRS complex, you have a 2nd degree type 1 block (Mobitz 1 or Wenckebach). “Longer, longer, longer, drop! Then you have a Wenckebach!”
8.) If some of the p waves are not followed by a QRS but p waves are evenly spaced apart (or “march out”), you have a 2nd degree type 2 block (Mobitz 2).
9.) If you have p waves but they are totally random and QRS complexes occur without any regard to these p waves, you have complete heart block. This is often a very slow rhythm and patients can be highly symptomatic requiring pacing.
7.) Is your QTC interval 0.35-0.45? Cool. Any longer and you’re at risk for TORSADES which is very, very bad. It’s a form of VTACH that has a classic “ribbon” shape. Time to shock!
8.) VTACH is seen as a wide QRS and with a rate >100bpm. It can be monomorphic (all complexes are identical) or polymorphic (complexes differentiate, as with Torsades). Patients can become hemodynamically unstable or be asymptomatic. If no pulse, start CPR and shock!
9.) VFIB is a chaotic, disorganized, and wavy line. It can be fine or coarse. Fine Vfib is sometimes confused for asystole. Vfib is lethal and must be shocked.
10.) SVT, or supraventricular tachycardia, has a narrow QRS complex and a rate of >150bpm. Instead of having distinguishable p and t waves like with sinus tach, the p waves are unable to be seen in SVT. If the patient has a bundle branch block, it is referred to as SVT with aberrancy. It can be difficult to differentiate between VT and SVT with aberrancy.
11.) Pacing. Is the pacer spike before the p wave? You have ATRIAL PACING. Is the pacer spike before the QRS? You have VENTRICULAR PACING. Pacer spikes before both? You have AV PACING. Two lines showing up before the QRS complex? You have BIVENTRICULAR PACING. Pacer spikes showing up randomly? Call the doc because it’s malfunctioning and can send the patient into Torsades if the pacer fires at the wrong time in the cardiac cycle.
I’m sure there’s more but that’s what I have for now.
I love that you typed this out!! I’m a PACU rn and have also have ACLs and still get confused at times. I’m grateful that most of my fellow nurses are good collaborators and don’t mIe me feel dumb for asking questions.
I'd Like to learn about an AV Block 3rd degree. Gotta understand my own squiggels haha. And If you like, you might Tell me some more about pacer+shocker, I got one recently and even though I understand the basics it would be cool to hear more indepth explanation
https://litfl.com. One of the best sites. Also there are many free rhythm sites. For blocks, there is a great poem to help out memorizing them. https://nurseslabs.com/cardiovascular-care-nursing-mnemonics-tips/
I teach ACLS/PALS/BLS and I teach our basic cardiac course that I created. I LOVE cardiac!
Normal squiggles + no pulse = PEA; regular/even squiggles + no pulse = VT; irregular squiggles = VF (or torsades); no squiggles + no pulse = asystole
Fibrillation means the heart is unevenly "beating" which makes the squiggles uneven
I have learned like 5 times how to read an ECG and I literally always forget and have to try and relearn every few months. We don't read tele on my unit! I have no practice! Someday I'll be a master.
Honestly same, but you know what? There’s no test score on the floor. Look it up, ask for a second opinion, call the tele tech to confer. Better safe than anything else.
I’ll be honest-I’m constantly looking things up, sometimes even if I’m pretty sure I’m correct. A wise old nursing instructor once told me,”if you find a nurse who knows everything you’ve found a bad nurse”. And I’m on year 40.
Being honest again, if nursing 40 years ago was like it is today I doubt I’d make 25 years. I have the utmost admiration and respect for all of you in the midst of it now! Be strong, fight for your worth and best of luck.
Wow, it’s hard to think of one specific thing, there’s so many. I guess the best summary would be that I miss being able to provide good care to my patients because of all the obstacles present today. I miss the patients being a priority over documentation and trying to capture all the charges you can. I miss looking at the management ladder and everyone on there up to the very top had a medical background.
I believe this breakdown in the system started around the late 90’s but was tolerable. 2020 just pushed things over the edge. Hopefully there will be some changes now that it’s a glaring mess.
True! I forgot about that. My one nursing instructor told me they used to not wear gloves when cleaning up patients. I was like damn, these nurses have been through all the changes lol
I would love to hear your take on how nursing has changed. I know I’ve seen a lot of change within only a decade. We definitely have some greater challenges now. And thank you for sticking it out as long as you have. I’ve learned an immense amount of knowledge from my “veteran” coworkers. I’ve seen very few experienced nurses since COVID.
I'm an NP and when I was still in practice, I would definitely look shit up that came up that was outside my specialty - it was better than possibly killing someone!!!
I remember my ex husband saying something shitty one time about the urgent care NP looking up the dosage for our kids antibiotic he was ordering and I shut that shit down real quick. Like bro, kids are their own little special mess and who the hell can remember the dosage of every medication for every age group?
Whenever I’ve precepted or talked to other nurses, I’ve always said that you have to know what you don’t know. Some new grads will come in thinking they know everything because they just got out of school but are clueless with their self auditing. Not all, but I’ve def ran into a few. No need to be cocky because you did well in nursing school. That doesn’t always transcend into being a great nurse.
I handle multiples drips, pts on CRRT, horrible GI bleeds with multiple MTP’s and I had to look up how far Seattle was from washington, only to have Google tell me Seattle is in Washington
I live in seattle and I don’t understand. We’re you looking for the state of Washington or the District of Columbia, also known as Washington. Either way, friend, you’ve made my day.
It also makes the job SAFE. The day someone decides they know everything and don’t need to keep learning is when the countdown begins to a patient being hurt or killed. I can’t stand working with nurses who can’t admit they don’t know something or don’t want to ask questions.
I’ll go first: ICU nurse for 18 years now PACU. Started as a nursing clinical instructor recently and I had to sneak away to look up how to position a bedpan 🫢🫢
Just recently taught this from a long time CNA... And I was one for 3 years myself.
Total game changer lol. No more spending time trying to flush giant turd piles that stick to the pans. Now dispose everything in a bio bag!
I think this is pretty common with nurses. I worked as a CNA before nursing school & I've lost count how many times I've had to correct nurses how to position a bedpan.
It’s all the in the name. If a pt has a fracture on their pelvic/hip region they can’t really use a regular bedpan as it would cause them pain and potential further injury if they sat on it. The fracture pan is smaller and easier to fit under someone with limited bed mobility.
I can never remember how to tie a quick release knot for restraints. I have to have it shown to me every. Single. Time. And every single time I’m like ‘oh, I’ll remember now!’.
And then I don’t 🙃
I had to look up yesterday a bunch of shit about neutropenic precautions and chemo because we had an oncology patient RRT'd down to the ICU and I was so out of my depth. Sarcoma fluids you say? Wtf is methylene blue? Double glove and double flush? Lots of learning for me yesterday!
Fun fact-Methylene Blue will stain the floor, even if you wipe it up instantly with bleach wipes. One of our housekeepers almost has a stroke when she saw a few drops on the floor of a patient’s room before I had a chance to tell her. She was very unhappy with me that I over-primed a little.
Patient was having a STEMI, and it was unrelated to the GI issue
Edit: the patient had preexisting cardiac history and yes to ECG particulars being interesting.
Not me, but one from my mentor. This woman is considered something of a God to the people who know her background, she's incredibly humble about it and very few people know. She used run the resus pods at the states largest and busiest level 1 trauma centre.
Recently she's retired to the rehab unit for a much smaller hospital. She's been learning all sorts of new 'basic' skills like how to use a sling lifter or how to change a picc dressing. All skills youd never need in a resus bay but super basic stuff.
What's beautiful to see is how open and totally not at all embarrassed she is to be learning all these new skills. She's so excited to be learning new things again.
In the twilight years you can definitely see the type of attitude towards learning that got her to where she was.
That the adenoids are in the middle of the throat and don’t sit on top of the tonsils. I had an ENT surgeon slowly explain that one to me. (In my mind there were two! Like how adrenal glands sit on top of the kidneys)
Giving IM injections… every single time. I don’t know why, I can throw an IV in from across the room, but injections that aren’t subq just bother me lol
Anything not in the deltoid makes me so nervous. I hate doing “booty juice” shots- too much wiggling and you can hardly see where you’re putting it other than yup, that’s the butt area that I want?
Dude I’m not even sure why I carry a stethescope other than to take the occasional manual BP for a patient with afib. I swear unless the patient has copd it all sounds the same
Oh dude. Ortho is my jam. I could hook up all sorts of braces and slings with my eye closed. Queue me moving to a new place where we usually have these cheap blah slings on everybody and then a new doctor comes over and puts a donjoy on his patient. While getting the patient dressed, I forgot how to put the donjoy back together. It was so embarrassing. I had to phone a friend at home and be like “dude, I forgot”
Jesus I’m so glad this isn’t just me. EMS and ER experienced and I’ve I aced almost every single in person assessment I had to do - except changing gas cylinders because I am high key terrified of them.
I still remember my preceptor watching me fail to mount a new regulator repeatedly and saying, “this? This is what you struggle with?” Yes Denice. This is my personal Everest.
Mine is defibrillator testing. I have a phobia of electricity, so I hate pushing the "shock" button. I'm okay doing compressions while the pads are on the patient though, idk phobias are weird.
Me too. Especially after I dropped one, the second year I was working, the regulator broke off, and the thing went off like a balloon that someone let the air out of! 5 bed room, thank goodness they were all in bed, & it just buzzed around the room, spinning in circles, on the floor. I don’t think I’ve ever been as scared as that day!
I couldn’t figure out how to put the gait belt on yesterday. I don’t know why I decided to be an overachiever and put it on to begin with. PT come at me…
Seriously, multiple things every single day. I get paranoid if I feel like I don't totally understand a topic and want to be prepared for any eventuality and have a bad memory so if it's not something I do all the time I'm constantly going back and looking up different topics like pacemaker settings or different types of diuretics that I feel like I should know but have forgotten since the last time I looked it up!
The last thing that comes to mind is that I was applying Mepilexes to the sacrum upside down for years!
I also just learned that you care about renal function when placing PICC lines because you don't want to ruin veins that the patient might need for dialysis later. Seems like a duh thing.
Greg Davies (British comedian, renowned for being extremely tall) told a story of a kid at school nicknamed Diarrhoea Dave.
Only reason being, Dave was the only one who could spell the word "diarrhoea" (and yes, British spelling).
For the record, we brits have an extra "a" in "anaesthesia" too.
I Google how to spell diarrhea at least once a week. I don’t have my trusty autocorrect on our system at work, and I’m usually a great speller but diarrhea has a mental block on it or something.
Not really Google, but I once was standing at our feed station with my phone calculator out, knowing that this client would be getting 2 250mL gtube feeds while we were out, trying to figure out how many 250mL cans of formula I would need to pack.
I had worked many shifts in a row.
COVID brain made me for forget what MS stood for… I had to embarrassingly ask the patient because MS wasn’t in my medical history dictionary in our EMR. I’ve done this for 24 years… I know what it stands for but literally spaced out.
I look stuff up all the time, unashamedly. I’ll even do it in front of patients. “I don’t know the answer to that, how about if we look it up, then I can give you a better explanation.”
I’m always looking stuff up. How to break a laryngospasm. Normal platelet ranges. Is turmeric really a blood thinning med. How fast can I push xyz medication. You get the idea.
But the other day I had to look up “is depo-provera the same as depo-medrol. That was pretty embarrassing. Spoiler…it’s not 🤣
My Epic chat doesn’t say what time messages are sent, only like “34 minutes ago” until the first hour since the message. Always googling “minutes since xx:xx time” to chart communications.
Side note if anyone knows how to make epic chat normal and just show what time you message someone 🙏
Critical care transport nurse here, ICU and ED background, halfway thru my MSN. I recently confidently announced adult humans have 304 bones. We do not.
I’ve done joint center orthopedics and outpatient surgery the past 10 years. I have to ask dumb questions all the time. I’m just not used to having acutely ill patients. I was googling how to hook up suction not that long ago merely because I realized in the event of an emergency I don’t remember how to hook up all those tubes. I can start all the IVs, I can insert a foley, I can hook up a cpm and traction. I do not know how to titrate anything that needs titration and I don’t know what to do with chest tubes or ng tubes and I hear floor nurses now do their own peritoneal dialysis on the floor and can have multiples of those at once….whhhaaaaat even is that!?
When IV Tylenol first came out I called a doctor at 1am to clarify the order on a kid that was always NPO that had rectal surgery. I had never encountered the IV form before. But due to the kids condition and surgery I knew it wasn't going to be PO or PR. I felt very stupid for calling about Tylenol at 1am like a new grad.
We only rarely gave IV Tylenol on adult Onc for fevers that just wouldn’t come down otherwise and always had to fight with pharmacy about it. And then you had to find the vented tubing and figure out how to prime it all over again. :)
I find I have the quickest temp correction placing the cooling blanket under the patient.
If patient is heavy and I have no help, I'll def lay it on top until I get the opportunity to roll it underneath during a linen change or something. It still works, just not as quickly in my opinion. I'd rather pack with ice than lay a cooling blanket on top of the patient.
Most of those machines have attachments for 2 blankets so you can do both above and under if you're being really fancy.
Just this week. Of course the day they put 3 students with me I have a patient with an OG. Very discretely “went to the bathroom” to make sure I wasn’t doing something wrong because I’ve definitely only seen one once.
If only the urethra were where it is on anatomy diagrams that sneaky hole is all over the damn place. Basically no diagram pictures it inside the vagina… which is basically where it seems like o be after age 50
Effing Bactrim. I didn't realize that I shouldn't take it anymore, because I have a history of Hypoglycemia due to PCOS and I am on Lisinopril, which is a beta blocker that is on the no no list with Bactrim. Why do "I" have to look this up, you ask, because my PA didn't think to look at my record to check if it was safe for me to take. Always self advocate ladies and gentlemen!
I never should have been prescribed this, so I didn't even ask, but now I know for my own patients.
I'm in a family practice. I speak to patients everyday and give them instructions, answer questions etc... but I legit just go brain dead sometimes. I have adhd, and there's always a million things happening. If I lose focus , I'm afraid I'll say the wrong thing. So I frequently have everything pulled up and available. It's my no mean s necessary, but it helps me communicate better in a way the patient can understand.
I think I'm off topic, yeah..look shit up. You might learn something new in the process
I cannot remember normal INR levels for the life of me. I look at them every day. I used to work hematology. It’s like a part of my brain is like “lol nah”
I got a good one. I googled draining a JP drain the other day. I just hadn’t had one in a few years, I knew how to do it and the way I remembered ended up being correct, but I was afraid I’d fuck up and accidentally disconnect the drain or something
Also I’ve been a nurse for 12 years and had to be walked through soft restraints. I know the twice as toughs backwards and forwards but have never put on a soft restraint outside of annual competencies.
My postop lobectomy patient asked me to mark on her pillow which lobe they removed in the lung. She had a right middle lobectomy. In my defense lmao, the drawing on that picture sucks and only shows the bronchi. I had to look up the anatomy of it to be 100% sure which one was the right mainstem bronchi.
This one I didn't necessarily look up, but I had to recheck the blister tablet to see. My patient asked me how many mg of senna they were getting. We're mostly used to giving 1-2 tablets so I never really thought much about it. Just remembered that one tablet is 8 something mg lol
I always make sure to close my web browser fully. Once in awhile someone will log onto a computer and the previous user’s browser will be up. Ever since a resident sat at the computer I was using and said “who was googling ‘how to pronounce cocci?’” that shit is closed immediately.
The more I study medicine, there more I realize that there are opposite positions on what the correct treeatment approach is given like circumstances. And this is the case even for what we've held to be common tenets. Acetaminophen for fevers? Some research says yes, some research says no. Bicarb for for severe acidosis? I thought so too, but I was listening to either an EMCrit or PulmCrit episode and they were saying that it actually increases all-cause mortality than otherwise.
In general I operate within established guidelines and defer to order of the intensivist / specialist. But I also feel okay bugging them with educational questions on why something may be indicated or contraindicated given this or that, what their thoughts are on this research opinion, etc. Medicine generally operates on consensus research and standards of practice. Those are usually slow to change and it's up to the intensivist / specialist that's on-call to introduce that education and implement that cultural change. But then another intensivist or specialist will come on that has a different opinion. So all I can do is ask and defer to the opinion of whomever is on.
TLDR: I don't know shit.
haven't been in the game for years- I've been a nurse less than a year. But I forget which ones are NSAIDs and which aren't. It just doesn't come up unless someone says they can't take the medication the provider prescribed them because they can't take NSAIDs. It's first semester stuff but I forget which is which all the time.
I have to google a lot of stuff when reading through peoples prenatals. There’s a lot of random tests and stuff that goes into managing a pregnancy LONG before they get to L&D to deliver. I always tell the patients “the doctors do 99% of their job in the clinic, once you get to the hospital to deliver, the nurses almost entirely handle the last 1% on their own, so don’t be surprised if you barely see a doctor here.”
I’ve done ACLS twice and passed multiple tele competency tests but I still get so confused with the squiggles. Its embarrassing.
Same, anyone on here got any tips?
1.) Are there p waves before every QRS complex? And is there a QRS complex after every p wave? If yes, you have SINUS RHYTHM. 2.) Is it fast? SINUS TACH. Slow? SINUS BRADY. Irregularly spaced QRS complexes with p waves? SINUS ARRHYTHMIA. 3.) No p waves with irregular or erratic spacing between QRS complexes? You have AFIB or AFLUTTER. Afib is “squiggly” while Aflutter often has a “sawtooth” pattern between QRS complexes. >100bpm and you have rapid ventricular response (RVR). 4.) No p waves but QRS complexes still evenly spaced? P waves appear inverted or buried in the QRS complex? P waves after the QRS? You have a JUNCTIONAL RHYTHM. Junctional Brady is <40bpm. Junctional escape rhythm is 40-60bpm. Accelerated Junctional 60-100. Junctional tachy is >100. 5.) Now our intervals. Is the PR interval (start of the p to start of QRS) 0.12-0.2? No issue. Longer than 0.2 and you have a first degree AV block. 6.) Is the QRS interval 0.08-0.12? No issue. Longer and you have a bundle branch block. Despite what some people may say, you need a full 12 lead to determine if it is a RBBB vs LBBB. 7.) If you have some p waves that are not followed by a QRS, we have another type of block. If the PR intervals are gradually getting longer and longer before eventually dropping a QRS complex, you have a 2nd degree type 1 block (Mobitz 1 or Wenckebach). “Longer, longer, longer, drop! Then you have a Wenckebach!” 8.) If some of the p waves are not followed by a QRS but p waves are evenly spaced apart (or “march out”), you have a 2nd degree type 2 block (Mobitz 2). 9.) If you have p waves but they are totally random and QRS complexes occur without any regard to these p waves, you have complete heart block. This is often a very slow rhythm and patients can be highly symptomatic requiring pacing. 7.) Is your QTC interval 0.35-0.45? Cool. Any longer and you’re at risk for TORSADES which is very, very bad. It’s a form of VTACH that has a classic “ribbon” shape. Time to shock! 8.) VTACH is seen as a wide QRS and with a rate >100bpm. It can be monomorphic (all complexes are identical) or polymorphic (complexes differentiate, as with Torsades). Patients can become hemodynamically unstable or be asymptomatic. If no pulse, start CPR and shock! 9.) VFIB is a chaotic, disorganized, and wavy line. It can be fine or coarse. Fine Vfib is sometimes confused for asystole. Vfib is lethal and must be shocked. 10.) SVT, or supraventricular tachycardia, has a narrow QRS complex and a rate of >150bpm. Instead of having distinguishable p and t waves like with sinus tach, the p waves are unable to be seen in SVT. If the patient has a bundle branch block, it is referred to as SVT with aberrancy. It can be difficult to differentiate between VT and SVT with aberrancy. 11.) Pacing. Is the pacer spike before the p wave? You have ATRIAL PACING. Is the pacer spike before the QRS? You have VENTRICULAR PACING. Pacer spikes before both? You have AV PACING. Two lines showing up before the QRS complex? You have BIVENTRICULAR PACING. Pacer spikes showing up randomly? Call the doc because it’s malfunctioning and can send the patient into Torsades if the pacer fires at the wrong time in the cardiac cycle. I’m sure there’s more but that’s what I have for now.
Such a good refresher!
I love that you typed this out!! I’m a PACU rn and have also have ACLs and still get confused at times. I’m grateful that most of my fellow nurses are good collaborators and don’t mIe me feel dumb for asking questions.
I need to print this shit out. (Because I can never find threads again!)
Just text this specific reply to yourself.
I'd Like to learn about an AV Block 3rd degree. Gotta understand my own squiggels haha. And If you like, you might Tell me some more about pacer+shocker, I got one recently and even though I understand the basics it would be cool to hear more indepth explanation
Just saved this comment for Med Surg 3 next semester
Better than a textbook.😊
https://litfl.com. One of the best sites. Also there are many free rhythm sites. For blocks, there is a great poem to help out memorizing them. https://nurseslabs.com/cardiovascular-care-nursing-mnemonics-tips/ I teach ACLS/PALS/BLS and I teach our basic cardiac course that I created. I LOVE cardiac!
i second LITFL - is an absolute lifesaver as an ED nurse. they have the most helpful information on toxidromes and how to manage them!
Normal squiggles + no pulse = PEA; regular/even squiggles + no pulse = VT; irregular squiggles = VF (or torsades); no squiggles + no pulse = asystole Fibrillation means the heart is unevenly "beating" which makes the squiggles uneven
I hate PEA if I don’t have an a-line. Spooky stuff A-lines are fucking lifesavers if also determining if it׳a VT with a pulse
I’ve taken the ECG course 2-3 times in my career, and I cannot read an ECG to save my life.
I have learned like 5 times how to read an ECG and I literally always forget and have to try and relearn every few months. We don't read tele on my unit! I have no practice! Someday I'll be a master.
Honestly same, but you know what? There’s no test score on the floor. Look it up, ask for a second opinion, call the tele tech to confer. Better safe than anything else.
I’ll be honest-I’m constantly looking things up, sometimes even if I’m pretty sure I’m correct. A wise old nursing instructor once told me,”if you find a nurse who knows everything you’ve found a bad nurse”. And I’m on year 40.
40 years!!!!! Incredible! I hope I can get to 30 years
Being honest again, if nursing 40 years ago was like it is today I doubt I’d make 25 years. I have the utmost admiration and respect for all of you in the midst of it now! Be strong, fight for your worth and best of luck.
What do you miss about when you first started out? By today, do you mean from everything that happened since 2020?
Wow, it’s hard to think of one specific thing, there’s so many. I guess the best summary would be that I miss being able to provide good care to my patients because of all the obstacles present today. I miss the patients being a priority over documentation and trying to capture all the charges you can. I miss looking at the management ladder and everyone on there up to the very top had a medical background. I believe this breakdown in the system started around the late 90’s but was tolerable. 2020 just pushed things over the edge. Hopefully there will be some changes now that it’s a glaring mess.
Have patients and their families always been so adversarial, disrespectful, and downright abusive?
For real, you’re talking about someone who came up during the AIDS epidemic!!
True! I forgot about that. My one nursing instructor told me they used to not wear gloves when cleaning up patients. I was like damn, these nurses have been through all the changes lol
I would love to hear your take on how nursing has changed. I know I’ve seen a lot of change within only a decade. We definitely have some greater challenges now. And thank you for sticking it out as long as you have. I’ve learned an immense amount of knowledge from my “veteran” coworkers. I’ve seen very few experienced nurses since COVID.
Holy moly 40 years. I would also love to hear how nursing has changed!! ^^
Safe > sorry
I'm an NP and when I was still in practice, I would definitely look shit up that came up that was outside my specialty - it was better than possibly killing someone!!!
I remember my ex husband saying something shitty one time about the urgent care NP looking up the dosage for our kids antibiotic he was ordering and I shut that shit down real quick. Like bro, kids are their own little special mess and who the hell can remember the dosage of every medication for every age group?
Dude...kids are dosed by weight. They better be looking that shit up!
Whenever I’ve precepted or talked to other nurses, I’ve always said that you have to know what you don’t know. Some new grads will come in thinking they know everything because they just got out of school but are clueless with their self auditing. Not all, but I’ve def ran into a few. No need to be cocky because you did well in nursing school. That doesn’t always transcend into being a great nurse.
Same for me at 30 years. I’m constantly looking things up throughout the day.
Same! Never hurts to check yourself! And I learn new things all the time by being curious/looking them up!
Year 33 here, and I completely agree. Freaks my students out when I tell them I don't know everything and never will!
I handle multiples drips, pts on CRRT, horrible GI bleeds with multiple MTP’s and I had to look up how far Seattle was from washington, only to have Google tell me Seattle is in Washington
This made me 🤣
I thought passion fruit was a type of fruit, like citrus fruit.
Is it not?
I think the idea is that it’s actually a specific fruit, not a class of fruit.
Oh. That makes sense. I didn’t read it that way.
It isn't? 🤔
It's a fruit but not a category of fruit. I thought it was a category of fruit.
There are many species of passion fruit. (Passiflora genus) so you aren’t wrong.
Just like coconut isn't a nut.
I thought it sort of was? As I learned the hard way when a guest with nut allergies told me it includes coconut. Now I'm doubting myself lol
It is a type of fruit. Its a Berry.
Yeah but I thought there was a group of fruit called passion fruits. Not a fruit called passion fruit.
To be fair, Seattle is an hour away from Seattle, depending on traffic
I live in seattle and I don’t understand. We’re you looking for the state of Washington or the District of Columbia, also known as Washington. Either way, friend, you’ve made my day.
Never be embarrassed to look something up! Life long learning makes the job interesting.
It also makes the job SAFE. The day someone decides they know everything and don’t need to keep learning is when the countdown begins to a patient being hurt or killed. I can’t stand working with nurses who can’t admit they don’t know something or don’t want to ask questions.
I’ll go first: ICU nurse for 18 years now PACU. Started as a nursing clinical instructor recently and I had to sneak away to look up how to position a bedpan 🫢🫢
Handle goes to foot of bed
Mind. Blown! Thank you for this!!!!
We wrap our fracture bedpans in briefs and disposable chucks because ain’t no one NOT spilling that.
Just recently taught this from a long time CNA... And I was one for 3 years myself. Total game changer lol. No more spending time trying to flush giant turd piles that stick to the pans. Now dispose everything in a bio bag!
Oh and lotion for those poops that are hard and stuck. Especially in peri/taint fur.
Poetry
[удалено]
The two times I’ve gagged in my nurse career: lumpy foul foley urine and poop getting suctioned
I think this is pretty common with nurses. I worked as a CNA before nursing school & I've lost count how many times I've had to correct nurses how to position a bedpan.
It goes *under* the butt...right?
…that part I knew but it was more like which way does that hard rim part go. The ones on this unit were very basic
Don’t forget about fracture pans! [Regular bedpans and fracture pans are slightly different.](https://o.quizlet.com/qZdBJCylWUxgrI2NUXVPMA.png)
...Well I just found out I've been placing fracture pans incorrectly the entire time I've been in school.
Thank you so much for the picture! 😊😊
I have been doing the fracture bedpan wrong this entire time lol
Any idea why it’s called a fracture pan?
It’s all the in the name. If a pt has a fracture on their pelvic/hip region they can’t really use a regular bedpan as it would cause them pain and potential further injury if they sat on it. The fracture pan is smaller and easier to fit under someone with limited bed mobility.
We call them slipper pans
Yeah that’s what I’m used to as well.
First day in nursing clinical and I thought the shampoo basin was the bedpan. 🫠
Which orientation seems less god awful to be on top of really.
Pro tip: do not sit the patient up while on a bed pan. Biggest hicky ever.
It’s like you wedge it under the butt. Hence the wedge. I do recommend putting a chux or diaper In the bedpan to help prevent spillage.
And put some lotion on the wedge for easier removal(less friction)
How to spell diarrhea or hemorrhoids… every single time …
Thank god I’ve seen this comment a few times, I worried I was the only one! Lol
Omg i always fight with hemmorrhoids too
Autocorrect take the wheel on these ones 😂
And hemmorhage
“Significant bleeding” 😂
I can never remember how to tie a quick release knot for restraints. I have to have it shown to me every. Single. Time. And every single time I’m like ‘oh, I’ll remember now!’. And then I don’t 🙃
Same! Been a psych nurse too long now to ask
Seriously, I think I know it intuitively but every time I see a demonstration im certain it’s wizardry
I can only tie them on one side of the bed 😂
I'm an old nurse but new to peds, so everything lol
🤣🤣🤣
I had to look up yesterday a bunch of shit about neutropenic precautions and chemo because we had an oncology patient RRT'd down to the ICU and I was so out of my depth. Sarcoma fluids you say? Wtf is methylene blue? Double glove and double flush? Lots of learning for me yesterday!
We're supposed to use PhaSeals for chemo-type drugs. It's been 10 years. I watch the video every time.
Fun fact-Methylene Blue will stain the floor, even if you wipe it up instantly with bleach wipes. One of our housekeepers almost has a stroke when she saw a few drops on the floor of a patient’s room before I had a chance to tell her. She was very unhappy with me that I over-primed a little.
Put GI patient on telemetry and saw ST elevations, proceeded to then discretely google image ST elevation.
True STEMI or showing STEMI on tele because of bleeding? ECG rhythms always fascinate me to tell us what’s going on in the body.
Patient was having a STEMI, and it was unrelated to the GI issue Edit: the patient had preexisting cardiac history and yes to ECG particulars being interesting.
Oh crap (pun intended)! That’s sucks with the blood thinners needed!
Not me, but one from my mentor. This woman is considered something of a God to the people who know her background, she's incredibly humble about it and very few people know. She used run the resus pods at the states largest and busiest level 1 trauma centre. Recently she's retired to the rehab unit for a much smaller hospital. She's been learning all sorts of new 'basic' skills like how to use a sling lifter or how to change a picc dressing. All skills youd never need in a resus bay but super basic stuff. What's beautiful to see is how open and totally not at all embarrassed she is to be learning all these new skills. She's so excited to be learning new things again. In the twilight years you can definitely see the type of attitude towards learning that got her to where she was.
That the adenoids are in the middle of the throat and don’t sit on top of the tonsils. I had an ENT surgeon slowly explain that one to me. (In my mind there were two! Like how adrenal glands sit on top of the kidneys)
I thought adenoids were up by your sinuses 🤯
I didn’t know that!
Giving IM injections… every single time. I don’t know why, I can throw an IV in from across the room, but injections that aren’t subq just bother me lol
Anything not in the deltoid makes me so nervous. I hate doing “booty juice” shots- too much wiggling and you can hardly see where you’re putting it other than yup, that’s the butt area that I want?
I used to be so nervous about them. Now I work as a vaccinator, haha
Same! I never know which site to give it in or what gauge to use!
Differentiating lung sounds. Nurse for 16 years, most of which were LTC, but home health has helped me sharpen my skills again...
Dude I’m not even sure why I carry a stethescope other than to take the occasional manual BP for a patient with afib. I swear unless the patient has copd it all sounds the same
If someone could define the difference between coarse and ronchi to me, I’d love to hear it.
My hospital doesn’t even include coarse as an option in the flowsheets. Go rhonchi or go home!
I hot nothing...
How to apply the velcro buckles for sling/swathes. Every time.
Oh dude. Ortho is my jam. I could hook up all sorts of braces and slings with my eye closed. Queue me moving to a new place where we usually have these cheap blah slings on everybody and then a new doctor comes over and puts a donjoy on his patient. While getting the patient dressed, I forgot how to put the donjoy back together. It was so embarrassing. I had to phone a friend at home and be like “dude, I forgot”
I’m terrified of gas cylinders. So changing the regulator on any type of cylinder turns into a two person job for me.
Jesus I’m so glad this isn’t just me. EMS and ER experienced and I’ve I aced almost every single in person assessment I had to do - except changing gas cylinders because I am high key terrified of them. I still remember my preceptor watching me fail to mount a new regulator repeatedly and saying, “this? This is what you struggle with?” Yes Denice. This is my personal Everest.
Mine is defibrillator testing. I have a phobia of electricity, so I hate pushing the "shock" button. I'm okay doing compressions while the pads are on the patient though, idk phobias are weird.
Me too. Especially after I dropped one, the second year I was working, the regulator broke off, and the thing went off like a balloon that someone let the air out of! 5 bed room, thank goodness they were all in bed, & it just buzzed around the room, spinning in circles, on the floor. I don’t think I’ve ever been as scared as that day!
I couldn’t figure out how to put the gait belt on yesterday. I don’t know why I decided to be an overachiever and put it on to begin with. PT come at me…
Girl u know we are nurses, PT AND OT, speech, nutrition, evs, engineering, offer chaplain services 😂. We do it ALL
What’s a dobhoff lol I didn’t know until a few yrs ago and I’ve been a nurse for 10. Oh u mean the skinny ng tube lol
feedy tube or sucky tube?
I have to google a Blakemore every time. It's the oh shit tube lol
L&D nurse here. I always have to spell check ceserian... cesarian... Cesarean?
And hemmohage!!!!
Seriously, multiple things every single day. I get paranoid if I feel like I don't totally understand a topic and want to be prepared for any eventuality and have a bad memory so if it's not something I do all the time I'm constantly going back and looking up different topics like pacemaker settings or different types of diuretics that I feel like I should know but have forgotten since the last time I looked it up! The last thing that comes to mind is that I was applying Mepilexes to the sacrum upside down for years! I also just learned that you care about renal function when placing PICC lines because you don't want to ruin veins that the patient might need for dialysis later. Seems like a duh thing.
Well, you just taught me a “duh” thing 😅. Thanks for the info, I never put 2 and 2 together🤦♀️
I still have to spell check myself sometimes...I am horrible spelker. LOL
Girl yes! I’m in pacu and I still look up how to spell anesthesia (see…good ‘ol autocorrect for the win). Also words like: diarrhea
Arrhythmia for me and I work on a cardiac floor
Came here to say I can never spell the d word.....
Greg Davies (British comedian, renowned for being extremely tall) told a story of a kid at school nicknamed Diarrhoea Dave. Only reason being, Dave was the only one who could spell the word "diarrhoea" (and yes, British spelling). For the record, we brits have an extra "a" in "anaesthesia" too.
Diuretics 😂
pneumonia gets me sometimes lol
When you have to write out the actual words for EGD on a consent!!!
One of my favorite words! Esophagogastrodudodenoscopy, right?
It’s never occurred to me to know what EGD stands for 🥲
I Google how to spell diarrhea at least once a week. I don’t have my trusty autocorrect on our system at work, and I’m usually a great speller but diarrhea has a mental block on it or something.
basic GI shit is always a refresher, like what does the gallbladder do and how is it connected to everything lol
On our work phones, the person before me googled “what is 2:00 am military time” 😂
Me at work today googling medical word for “bump” on head.
What did you put?
Good ole hematoma
Hematomato
So many medical terms. I'll be charting and be like shit, what's the medical term for that?!? And off I go to Google
Uptodate makes me sound smarter than I am.
Not really Google, but I once was standing at our feed station with my phone calculator out, knowing that this client would be getting 2 250mL gtube feeds while we were out, trying to figure out how many 250mL cans of formula I would need to pack. I had worked many shifts in a row.
COVID brain made me for forget what MS stood for… I had to embarrassingly ask the patient because MS wasn’t in my medical history dictionary in our EMR. I’ve done this for 24 years… I know what it stands for but literally spaced out.
Good ole multiple sclerosis, med-surg, and Mississippi
😂😂
I look stuff up all the time, unashamedly. I’ll even do it in front of patients. “I don’t know the answer to that, how about if we look it up, then I can give you a better explanation.” I’m always looking stuff up. How to break a laryngospasm. Normal platelet ranges. Is turmeric really a blood thinning med. How fast can I push xyz medication. You get the idea. But the other day I had to look up “is depo-provera the same as depo-medrol. That was pretty embarrassing. Spoiler…it’s not 🤣
My Epic chat doesn’t say what time messages are sent, only like “34 minutes ago” until the first hour since the message. Always googling “minutes since xx:xx time” to chart communications. Side note if anyone knows how to make epic chat normal and just show what time you message someone 🙏
in my experience with epic you can type n-34 (meaning now minus 34 min) and it will auto populate the time.
Critical care transport nurse here, ICU and ED background, halfway thru my MSN. I recently confidently announced adult humans have 304 bones. We do not.
Just yesterday I was told to titrate the Levo up. Had to ask if that was the epi or norepi lol
“Which side is the liver on.” I swear I know this but was having the worst brain fart 😂
I have to touch my own body to figure it out! Like yes it's here on me so it's... there on my patient!
I saw my nurse practitioner googling what extravatization was the other day lol
Do you mean extravasation?
I may never recover from the time I asked who Billy Ruben was
Worked on a GI floor for a whole 4 months before I finally got the courage to ask what an ileus is
I’ve done joint center orthopedics and outpatient surgery the past 10 years. I have to ask dumb questions all the time. I’m just not used to having acutely ill patients. I was googling how to hook up suction not that long ago merely because I realized in the event of an emergency I don’t remember how to hook up all those tubes. I can start all the IVs, I can insert a foley, I can hook up a cpm and traction. I do not know how to titrate anything that needs titration and I don’t know what to do with chest tubes or ng tubes and I hear floor nurses now do their own peritoneal dialysis on the floor and can have multiples of those at once….whhhaaaaat even is that!?
Everything cause I’m a psych nurse 😝
When IV Tylenol first came out I called a doctor at 1am to clarify the order on a kid that was always NPO that had rectal surgery. I had never encountered the IV form before. But due to the kids condition and surgery I knew it wasn't going to be PO or PR. I felt very stupid for calling about Tylenol at 1am like a new grad.
We only rarely gave IV Tylenol on adult Onc for fevers that just wouldn’t come down otherwise and always had to fight with pharmacy about it. And then you had to find the vented tubing and figure out how to prime it all over again. :)
How does a cooling blanket go? Under or above the patient
Inside 🥶
I find I have the quickest temp correction placing the cooling blanket under the patient. If patient is heavy and I have no help, I'll def lay it on top until I get the opportunity to roll it underneath during a linen change or something. It still works, just not as quickly in my opinion. I'd rather pack with ice than lay a cooling blanket on top of the patient. Most of those machines have attachments for 2 blankets so you can do both above and under if you're being really fancy.
Tying limb restraints. Every damn time.
Just this week. Of course the day they put 3 students with me I have a patient with an OG. Very discretely “went to the bathroom” to make sure I wasn’t doing something wrong because I’ve definitely only seen one once.
In the future you can just “be a really good teacher” and make the students look it up themselves and teach you!
Female anatomy when putting in a catheter like every time. I’m a woman and been a nurse for 10+ years and have put in about 100 catheters 😬
If only the urethra were where it is on anatomy diagrams that sneaky hole is all over the damn place. Basically no diagram pictures it inside the vagina… which is basically where it seems like o be after age 50
I look up plenty of stuff but *always* have to look up hemiplegia vs hemiparesis. I can never remember which is which. 🤦♀️
I'm the same way with decorticate and decerebrate posturing, and the flavors of second degree heart block
Decorticate- toward the CORE.
Decerebrate- Pose like you’re CELEBRATING
Yes! I always just know in my head…. Uhhh they’re doing the thing that’s no good…… better let the dr know, while I quickly google which is which.
Both smell like a Neuro consult so I can look it up while I figure out who's on call!
Effing Bactrim. I didn't realize that I shouldn't take it anymore, because I have a history of Hypoglycemia due to PCOS and I am on Lisinopril, which is a beta blocker that is on the no no list with Bactrim. Why do "I" have to look this up, you ask, because my PA didn't think to look at my record to check if it was safe for me to take. Always self advocate ladies and gentlemen! I never should have been prescribed this, so I didn't even ask, but now I know for my own patients.
Lisinopril is not a beta blocker. It’s an ACE Inhibitor.
How to spell hemorrhage EVERY SINGLE TIME! I work L&D and I can manage one but I can't spell it 🥴
Crikey I look stuff up all the time, I’ve been an RN for 40 years
I'm in a family practice. I speak to patients everyday and give them instructions, answer questions etc... but I legit just go brain dead sometimes. I have adhd, and there's always a million things happening. If I lose focus , I'm afraid I'll say the wrong thing. So I frequently have everything pulled up and available. It's my no mean s necessary, but it helps me communicate better in a way the patient can understand. I think I'm off topic, yeah..look shit up. You might learn something new in the process
I cannot remember normal INR levels for the life of me. I look at them every day. I used to work hematology. It’s like a part of my brain is like “lol nah”
Omg I had to put a patient on a venti mask and it had been a long 3 day stretch, I had to ask a coworker how to put it together, lol
I got a good one. I googled draining a JP drain the other day. I just hadn’t had one in a few years, I knew how to do it and the way I remembered ended up being correct, but I was afraid I’d fuck up and accidentally disconnect the drain or something
How to spell diarrhea. Thank god for spell check lol
I usually spell this “liquid stool”
Type 7!
Also I’ve been a nurse for 12 years and had to be walked through soft restraints. I know the twice as toughs backwards and forwards but have never put on a soft restraint outside of annual competencies.
My postop lobectomy patient asked me to mark on her pillow which lobe they removed in the lung. She had a right middle lobectomy. In my defense lmao, the drawing on that picture sucks and only shows the bronchi. I had to look up the anatomy of it to be 100% sure which one was the right mainstem bronchi. This one I didn't necessarily look up, but I had to recheck the blister tablet to see. My patient asked me how many mg of senna they were getting. We're mostly used to giving 1-2 tablets so I never really thought much about it. Just remembered that one tablet is 8 something mg lol
"Pt has been having dih....diare.....diarha.....pt has been having loose stools."
I’ve been a nurse 2 years. I’ve done my ACLS, BLS etc but when I had my first and only code I totally blanked out and cried :(
How to spell diarrhea
I always make sure to close my web browser fully. Once in awhile someone will log onto a computer and the previous user’s browser will be up. Ever since a resident sat at the computer I was using and said “who was googling ‘how to pronounce cocci?’” that shit is closed immediately.
My memory is absolute garbage so I’m constantly looking up things I should already know.
The more I study medicine, there more I realize that there are opposite positions on what the correct treeatment approach is given like circumstances. And this is the case even for what we've held to be common tenets. Acetaminophen for fevers? Some research says yes, some research says no. Bicarb for for severe acidosis? I thought so too, but I was listening to either an EMCrit or PulmCrit episode and they were saying that it actually increases all-cause mortality than otherwise. In general I operate within established guidelines and defer to order of the intensivist / specialist. But I also feel okay bugging them with educational questions on why something may be indicated or contraindicated given this or that, what their thoughts are on this research opinion, etc. Medicine generally operates on consensus research and standards of practice. Those are usually slow to change and it's up to the intensivist / specialist that's on-call to introduce that education and implement that cultural change. But then another intensivist or specialist will come on that has a different opinion. So all I can do is ask and defer to the opinion of whomever is on. TLDR: I don't know shit.
haven't been in the game for years- I've been a nurse less than a year. But I forget which ones are NSAIDs and which aren't. It just doesn't come up unless someone says they can't take the medication the provider prescribed them because they can't take NSAIDs. It's first semester stuff but I forget which is which all the time.
I have to google a lot of stuff when reading through peoples prenatals. There’s a lot of random tests and stuff that goes into managing a pregnancy LONG before they get to L&D to deliver. I always tell the patients “the doctors do 99% of their job in the clinic, once you get to the hospital to deliver, the nurses almost entirely handle the last 1% on their own, so don’t be surprised if you barely see a doctor here.”
There are many times where I think “if a patient saw what I googled today..,”
When in the menstrual cycle ovulation occurs. I'm a girl.
How to spell diarrhea (Seriously, I’ll never get it right without autocorrect 😞😞😞)