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getoverit, BSN, RN, EMT-P 5,740 Views

Joined: Dec 30, '07; Posts: 448 (50% Liked) ; Likes: 783
MICU/CCU, fire department paramedic; from US
Specialty: 18 year(s) of experience in ER/ICU/Flight

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  • Apr 11

    rntobeme,
    I appreciate the fact that you're genuinely worried, the other posters are correct that your "risk" is extremely low and it is an over-reaction.
    to put it in context, I had blood from an AIDS patient (full-blown with sarcoma all over his torso) get all over me, including in my open mouth. I was afraid that I may have contracted HIV because my risk was about 1,000x more than yours (not making light of your situation, just presenting statistics). My risk was still less than 1% and I have been negative, that was 16+ years ago....I ain't worried about it anymore.
    So I do know what it's like and I wouldn't be concerned at all if I were you, especially because you don't know if you were even exposed to anything at all. Get tested at the health department, planned parenthood, etc and put your mind at ease. But I'd be way more worried about contracting hepatitis...HIV is a very easy disease to avoid.

  • Feb 22

    One of the nurses I work with just came back from a vacation and a lady on the plane suffered a cardiac arrest. Apparently, the plane had a defib, IV supplies, O2, ACLS meds, etc...
    I had no idea and neither did she, but she worked the code with another nurse and an EMT. They successfully resuscitated the lady and made an emergency stop to offload her. Pretty crazy story and her cell phone has been ringing off the hook from people calling to thank her. Still waiting on the airline to call and apologize for losing her luggage!!

  • Feb 22

    One of the nurses I work with just came back from a vacation and a lady on the plane suffered a cardiac arrest. Apparently, the plane had a defib, IV supplies, O2, ACLS meds, etc...
    I had no idea and neither did she, but she worked the code with another nurse and an EMT. They successfully resuscitated the lady and made an emergency stop to offload her. Pretty crazy story and her cell phone has been ringing off the hook from people calling to thank her. Still waiting on the airline to call and apologize for losing her luggage!!

  • Dec 9 '17

    Quote from Ruby Vee
    It's not that simple. Clearly you don't know what you don't know. Precepting is a very difficult job, especially if you're trying to do it well (rather than collecting your $.75/hour for "babysitting" while the new nurse flounders). Some folks are good at it, others aren't. Some enjoy it; others tolerate it and a few hate it. Some nurses who enjoyed precepting have been precepting continuously for YEARS on end and are burned out and have begun to hate it.

    Precepting used to be rewarding, but these days new grads are more and more entitled. They want the preceptor to change her schedule to accomodate the newbie's preferences. They want any feedback wrapped in rainbows and sprinkled with fairy dust to the point where any NEGATIVE feedback can be ignored. Everything is all about "my learning" to the point where even the patient is lost in the shuffle. They rush to "report someone" every time they have a negative interaction because they're certain that every negative interaction is "bullying." Preceptors are then bullied by their orientees who are rushing to complain to the manager because "Ruby wouldn't eat lunch with me, WAH!" (My sister was in town for 24 hours for a conference at my hospital and I chose to have lunch with her so we could talk about my mother's latest nursing home eviction and where we might place her instead. I explained that, even though I shouldn't have had to. The orientee is an adult -- she can eat one meal by herself!) Or "Anne didn't say hello to me in the lobby!" (Anne had driven to work wearing her sunglasses, left them in the car and was headed up to the unit more or less by braille to put in her contacts. She didn't SEE the orientee, but probably would have greeted her warmly had the orientee said hello first.)

    Until you have actually precepted -- and tried to do it well -- you have NO idea. Perhaps it would be best not to rush to judgement until you have actually walked a mile in a preceptor's shoes.
    Ruby Vee, I have read your posts for many years and am a little taken aback by this one. I have been a preceptor for over 20 years and have received more than a couple awards for teaching/precepting. Not bragging on myself, just giving a little context for me to use your words back to you: clearly YOU don't know what you don't know and it would be best for YOU not to rush to judgment.

  • Dec 9 '17

    I've always wondered if the nurses who don't like teaching or precepting also didn't like it when their teachers and preceptors were helping them learn new things.... Seems like a double standard at times

  • Dec 7 '17

    Quote from Ruby Vee
    It's not that simple. Clearly you don't know what you don't know. Precepting is a very difficult job, especially if you're trying to do it well (rather than collecting your $.75/hour for "babysitting" while the new nurse flounders). Some folks are good at it, others aren't. Some enjoy it; others tolerate it and a few hate it. Some nurses who enjoyed precepting have been precepting continuously for YEARS on end and are burned out and have begun to hate it.

    Precepting used to be rewarding, but these days new grads are more and more entitled. They want the preceptor to change her schedule to accomodate the newbie's preferences. They want any feedback wrapped in rainbows and sprinkled with fairy dust to the point where any NEGATIVE feedback can be ignored. Everything is all about "my learning" to the point where even the patient is lost in the shuffle. They rush to "report someone" every time they have a negative interaction because they're certain that every negative interaction is "bullying." Preceptors are then bullied by their orientees who are rushing to complain to the manager because "Ruby wouldn't eat lunch with me, WAH!" (My sister was in town for 24 hours for a conference at my hospital and I chose to have lunch with her so we could talk about my mother's latest nursing home eviction and where we might place her instead. I explained that, even though I shouldn't have had to. The orientee is an adult -- she can eat one meal by herself!) Or "Anne didn't say hello to me in the lobby!" (Anne had driven to work wearing her sunglasses, left them in the car and was headed up to the unit more or less by braille to put in her contacts. She didn't SEE the orientee, but probably would have greeted her warmly had the orientee said hello first.)

    Until you have actually precepted -- and tried to do it well -- you have NO idea. Perhaps it would be best not to rush to judgement until you have actually walked a mile in a preceptor's shoes.
    Ruby Vee, I have read your posts for many years and am a little taken aback by this one. I have been a preceptor for over 20 years and have received more than a couple awards for teaching/precepting. Not bragging on myself, just giving a little context for me to use your words back to you: clearly YOU don't know what you don't know and it would be best for YOU not to rush to judgment.

  • Nov 17 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Nov 9 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Nov 9 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Sep 25 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Aug 29 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Aug 6 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • May 3 '17

    The insulin injection is just a hormone that stimulates glucose to cross the cell membrane and provokes the uptake of potassium as well. I believe it has something to do with the size of the molecule (macro-). The high potassium you saw in your patient was serum k+ so it needs to be forced back into the cells. Remember that if all our potassium was in the extracellular space it would be immeasurably high: 50-100x the normal value.
    Within 30-60 minutes the potassium should begin to shift back into the cells. The glucose is given to prevent iatrogenic hypoglycemia. IV calcium should be given if any acute EKG changes are noted and most of the literature I've read lately doesn't support the effectiveness of NaHCO3 very much (in fact, we don't use it much anymore).
    Recent AHA guidelines don't recommend giving a potassium-binder like Kayexelate anymore for emergent treatment of hyperkalemia. It forms a composite of resin and potassium which is excreted in feces, but takes at least 24 hours. Occasionally we give them all in conjunction with each other, to provide immediate and extended treatment.
    Of course one of the fastest and most reliable ways of correcting the k+ is hemodialysis. It's interesting to note that albuterol also displaces the potassium back into the cell and can be used to potentiate the effect of the insulin.



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