Tpn Assessment: Fill & Download for Free

Is this a serious question? The answer to this question is an entire nursing critical care text book. So I'll just say a lot. A whole bunch of stuff.How to run a codeGive bloodRun CRRTRun a ventilatorGive TPNAssessment skills for pulmonary, cardiac, musculoskeletal, neuro, integumentary, urinary, GIDisease processes for the above plus, endocrine and hepatic, and ortho, etc…About 1,000 meds and their compatibilityHow to interpret labsHow to interpret radiology resultsTelemetryA little PT, OT, ST, RT…How to bag a bodyThen there are skills- making beds, placing IV, assisting in procedures, performing EKG's, accessing ports, placing Foleys, placing NG tubes… this list is about 700 items longDo you get it yet? You will never know it all, you will always be learning? And no one person can teach you how to be a nurse bc we all know different things about different things.

“I’ll check on them later,” the resident doctor said, before she turned her back on me and went back to sleep.What that pedia resident told me made my jaw drop.Excuse me? You’ll check on them later?It was 5AM. I was a young NICU nurse scared out of my wits.A premature baby self-extubated, and while she’s currently doing fine on oxygen inhalation, I need someone to order labs and assess her to see if she’ll need to be reintubated. You just don’t extubate a patient who has been on mechanical ventilation, let alone a preemie who didn’t receive a surfactant!Another baby had hypoglycemia despite being on TPN and I needed someone to compute how much D5050 I need to give him, because he is on NPO and obviously the TPN isn’t cutting it and he is also a preemie who might go into hypoglycemic coma or worse, a code, idk.Then a baby delivered via forceps extraction wasn’t breathing and has had meconium staining so I can’t stimulate unless someone did endotracheal suctioning which we weren’t allowed to do, and the OB resident was yelling at me, “Where the hell is your pedia res???”I ran so fast to the ER on-call room. I thought maybe she got tied up with admissions. The ER turned out to be eerily empty. I burst into the on-call room to see her sleeping there, ignoring her cellphone which I’ve been ringing for quite some time now.I woke her up to give my report and she told me she’ll look into them later. This infuriated me and I blurted out, “you better not be going there at 6AM!” Which is the time my shift ends.When my charge nurse arrived for the morning shift, I told her I will be writing an incident report for mouthing off on a resident and the whole incident on why I mouthed off at her.That b*tch of a resident had the audacity to ask the chief nurse if she could write me up for an ethics violation. I stood firm on my well-written incident report. She was suspended for a month. But what infuriated me most is that the whole pediatrics department tried to cover it all up and explained (rather patronizingly) to us that the resident was suffering from depression and anxiety.If you are a healthcare professional and you feel you are having mental health issues, you fix those issues before laying hands on a patient. This is a high-pressure job and people rely on us to deliver the best care at all times. Endangering 3 infants because you’d rather sleep during your shift because you are depressed is a sorry excuse of being a doctor.This is the worst case of doctor behavior I’ve ever encountered. Oh sure, there are a lot more assholes, especially the “alpha” men who like to throw their weight around and get off on humiliation and control of female nurses. I can deal with that. It is rather unfortunate that it exists, but I’ve developed my own strategy for physician “quirks” to make my work easier. However, there was no workaround in this pediatric resident’s behavior. Which is why I consider her the worst.

Edited to add:Thank you for all the kind words. I no longer work in paediatric ICU, it was a job I did for some months but never could have continued with.I now do a mix of emergency/general practice/palliative care. And I still ‘hurt’ people, adults and kids, with procedures and investigations. But I make sure that these things are justified and in the interests of the person I am caring for.But those children, in that place, at that time… they are gone, and my apologies and tears mean nothing to them now. I try not to think about it, and my guilt is a self-indulgence, so many years later.At the end of that job, I had an assessment, and it was given to me in writing afterwards. It was generally very positive, which surprised me. At the bottom of the page was the question “Do you think this doctor is suitable to continue in this specialty/in your department?” The director had written in capitals underneath: NO.It was the only job out of six where I got that answer, and I hold it as a badge of pride.——————————————————————————————————Perhaps a different perspective - I am a doctor who has worked in a paediatric ICU.We had many terminally ill children admitted, whose parents implored us to ‘do everything’ to save them despite the fact that these children were going to die. The director and consultants on the unit generally went along with whatever the parents wanted.However I, as a more junior doctor, was the one sticking needles in these kids. Sticking tubes down their throats, in their bladders, abdomens and chests. reducing their sedation because the parents wanted them ‘awake’, and watching their heart rates go sky high with distress, the tears pour from their eyes as they fought against all the machinery.I cared for an eleven year old with end stage granulomatous disease who could not survive off a ventilator. When one lung collapsed we put a tube in on that side. Then one for the other lung. He was always blue because we couldn’t get enough oxygen into him. The disease affected all his organs so he couldn’t get a transplant. We couldn’t let him wake up because he became absolutely frantic. His parents wanted ‘everything done’, so this young boy lived like this in ICU for four months until his heart gave out.A two year old with leukaemia and graft versus host disease - eleven weeks with blood pouring from his anus, on a ventilator, with no bone marrow and entirely dependent on transfusions. Kept getting septic. Clotted off several major veins meaning getting any kind of IV access was a huge deal - and he needed IVs because he needed blood, and platelets, and TPN, and inotropes to keep his heart working. His skin started falling off too. I still believe that the sedation wasn’t enough - that child was in agony. Finally he got overwhelming sepsis and died when his abdominal wall ruptured and dead bowel fell out onto the bed.I have lots of stories like this. At the request (demand) of the parents, I tortured these kids with needlesticks and all kinds of procedures that had zero chance of making a difference. Parents almost always left the room when we did any of this, returning when it was over.If I had a child in this position I would absolutely, categorically not demand ‘everything’. I would want good palliative care and if that meant they did not live as long, so be it. So maybe you can say I would kill my child. I am certain I would rather they were dead than go through any of that.