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Patient Flow in the emergency department

 Patient flow in the emergency department is a big deal. Just like if you kink the hose with the tap on full the hose will eventually burst off the tap and water flows out everywhere you dont want it to be. But some nurses who work on quiet, in control wards, (Paediatrics wards are a prime example), don't get this concept. At handover its hard to hear what is being said for so many reasons. There are lots of people in a small space, many talking loudly to get their voice heard over others. Its noisy. The nurse giving handover is behind a mask and a face shield. Its really difficult to hear what they say in the best of circumstances. Handover has just finished in the Emergency department. It is overflowing. Beds with the incoming are lining the corridors. The Ambos are standing with their patients in the airlocks. Ok, so I didn't get the full identification on the mother and child in this scenario. Handover is finished, and I am asked to take mother and child to the Paediatric w...
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Are you being reasonable?

 Saturday Morning. I wake up feeling mentally dragged through a prickly hedge, all scratched up. My thoughts are fixated on the behaviours of these aggressive, demanding people. The situation. Its Friday, I am a relief nurse, and on this day I am sent to work a shift in an adult mental health, low dependency unit. Background After handover, I have 5 consumers allocated to me, I go to the room of my one of my allocated consumers. In the room, there is a16 yr old girl, lying in bed appearing to read a novel, who, told me to   “F off, get out of my room.” She is refusing to eat or drink and has deep, self inflicted wounds. She is refusing to allow staff to look at the wounds. She stays in the bed for some six hours. Later, at end of shift, she craftily comes out to the social area and sits with a real weirdo guy doing a jigsaw, and they have a happy little chat. More than likely she sneaks food while she is there. She makes it appear that she is not eating to prove her point. She...
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I will not be lectured by that man.

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  I am not, as predicted by a divorce lawyer, a "lonely old woman". I have been freed from the entrapment of a controlling relationship. At 60, I am realisticly aware that any new relationship will quickly deteriorate into a burden. Waking up with another old fart would be depressing I couldn’t deal with their toileting issues           Integrating them into my family would not work             I would feel compelled to:                                                                                                      cook and clean for them      take them to medical appointments   ...
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Family and Palliative Care

 Gurgling. the old italian was gurgling. There was a collection of fluid at the back of his throat that he could not swallow.   It was 730 am. The assistant fed him a 1/2 cup of juice and a spoonful of cornflakes with milk for breakfast. He then pushed her away and swore at her. He was assessed as a high risk of aspiration- he was sitting bolt up right in bed, and was given food when wide awake After about 45mins   the old man started coughing and coughing, choking, spitting everywhere, spluttering, vomiting. He pushed away the yankeur sucker that i tried to shove into his mouth, he got really angry with me for continuing to try, and swore at me in Italian. It lasted at least 30 mins.   Loud, blustering coughing, on and on. The 3 co patients were all crying , “save him”, “some body do something”. “Please stop it”. “I cant stand it”.   The room sounded like a cacophony of mayhem and madness. Finally the old man coughed up enough to be able to breathe again. When ...
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Budesonide (Pulmicort)

Budesonide (Pulmicort) class:    Inhaled cortico Steroid;  also available as a  topical nasal steroid decongestant   action: not known , anti-inflammatory Indications :  prevention and treatment of asthma, adjunct to those not controlled by traditional bronchodilators, NOT FOR ACUTE ATTACKS,  allergic rhinitis, relief of inflammation after removal of nasal polyps. Actions : Decereases inflammation in airway. promotes beta 2 adrenergic receptor activity. Contraindicated: acute infections. (due to blocking of inflammatory response). Systemic effects minimal. Care during pregnancy. Adverse: Sore throat. local burning irritation, stinging, headache, dry mucosa, hoarseness, coughing,dry mouth and fungal infections are common side effects. REBOUND CONGESTION. Drug – drug: not found Care/ Teaching:   take up to 1 week to cause changes, no effects after 3 weeks discontinue. not absorbed systemically if inhaled corr...
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Ipratropium (Atrovent)

Ipratropium (Atrovent) class : anticholinergic Note: nasal spray, and inhaler Indications : maintenance of bronchospasm associated with COPD, treatment of allergic rhinitis as nasal spray. Actions : antagonizes the action of acetylcholine. Blocks vagally mediated reflexes. Dries up secretions caused by stimulation of PNS. Action is SLOW.  This is more of a preventer. Adverse : Nervousness, dizziness, headache, nausea, GI distress, cough, palpitations. Drug – drug: other anticholinergics. peanut allergies Contraindications . Any condition aggravated by atropine like effects. Eg narrow angle glaucoma, bladder neck obstruction or prostatic hypertrophy, conditions aggravated by dry mouth and throat. The presence of known allergy to drug or soy products o r peanuts ( the vehicle used to make ipratropium int an aerosol contains a protein associated with peanut allergies) Drug : drug: other anticholinergics eg Atropine           ...
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Diphenhydramine (Benedryl)

Diphenhydramine (Benedryl) class : Antihistamine ( expectorant) book p 829 says benedryl is guaifenesin Actions : enhances output of respiratory tract fluids, reduces adhesiveness and surface tension of these fluids.-> more productive cough-> less coughing. Competitively blocks histamine at H1 receptors sites. Has atropine like antipruritic and sedative effects Indications : symptomatic relief of respiratory conditions for a dry nonproductive cough in the presence of mucus in the respiratory tract. Adverse : drowsiness and sedation. Dryness of respiratory and GI memebranes.Nausea, vomiting headache, dizziness, rash Drug – drug: moai, interacts fexofenadine, ketoconazole or erythromycin Contraindications : diabetics (syrup of sugar) Care/ Teaching : Administer on empty stomach, 1 hour before or 2 hours after meal, to increase absorption. May be given with meals if gi upset. lozenges to relieve dry mouth and GI upset., safety for falls, avoid alchohol,-> serious s...
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