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ReWritten, BSN, RN 2,791 Views

Joined: Jun 21, '08; Posts: 70 (27% Liked) ; Likes: 48
from US ER

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  • Apr 10 '15

    Quote from Anna Flaxis
    It would be changing the order, because infusion orders must contain a concentration and a rate. By mixing the drug in a minibag you would not be following the order.

    For example, your typical IVP Reglan order looks like:

    Reglan 10mg Intravenous x1 now

    An order for an infusion of Reglan would look like:

    Reglan 10mg in 50mL 0.9% NS Intravenous @ 100mL/hr x1 now

    Also, it is not best practice to mix your own medications- routinely prescribed medications should be pre-mixed, in order to prevent contamination and medication errors.

    I am going to disagree with couple of posters.

    I can't remember ever getting an order that included the concentration. There are plenty of drugs that come in multiple concentrations, and the docs have no idea what they are.

    The docs I work with also have no idea how long various IVPB drugs need to run for.

    As an example: Let's say I have an order for regular insulin, 3 units IV. My total volume here is 3/100 of an ML. I don't know the residual volume in the barrel of a syringe, but it could put a heck of a dent in 3/100 of a ml. And, even a minute leak when attaching the syringe.
    What I do is carefully measure in units, then put it into a 10 ml flush, using the insulin needle in the flush barrel. Then, push slowly. If I lose 1/100 of a cc, it is 1/1000 of my dose, rather than 1/3.

    If the doc for some weird reason wrote an order specifying volume, I would ask to change it.

    Another example- IV phenergan. Probably will come to a shock for some but this is not universally forbidden. And, if you think about it, we give many vesicants, and all need to be given carefully. And, like phenergan, none should be given in an artery.
    I have no problem giving IV phenergan, but put it into a bag of 50 ml. Having never gotten an order specifying rate and concentration, I see no problem.

    I would say that unless the doc specifies a rate and volume, those parameters fall into the nursing judgement zone.

  • Jan 26 '15

    I would not get too hung up in rankings of programs, there really is very little objective data being used in these rankings. I certainly wouldn't ignore them completely, but I think if you look at the rankings for the past several years you will see schools that have bounced up and down quite a bit. The fact that they bounce up and down so frequently indicates to me that they are either very close, the data is very subjective, or the inter-rater reliability of these rankings is very poor. Most likely, all three are affecting the rankings. If a program is consistently near the top 1/3, then it's probably very similar to all the others that are consistently in the top 1/3, same for those programs that are at the bottom, I might be weary of those programs.

    I also believe a much bigger factor (as long as the programs are ranked at the same end of the scale), is what the student is going to put into their education. If you put into the program the effort that is needed to actually learn the material, then you will get out of the program what is needed to grow into a safe and qualified provider. If not, well, it doesn't matter much how good the program is rated, you will struggle.

    Another important aspect in your choice of program is the mission of the program. My program is oriented towards rural providers, I live in a very rural area, thus the mission of the program and my mission match up very well. The previous poster mentioned their program had a specialty in ortho, presumably they did too as this is why they choose that program. There are a couple of programs that offer both FNP & ACNP (I believe with an ER focus), so those programs and students have missions that match up. Finding a program where the program's mission matches yours is more important to me than finding a program with a slightly higher number on the latest rankings. It takes more effort to find, but it will help you more in the long run.

    Some things to consider:
    - What population do I want to work with?
    - Primary care, or some specialty?
    - Acute/Chronic?
    These things will all give you an idea of what NP specialty you want to focus on. Then once you have an idea of specialty, consider other aspects of the program:
    - Location, online vs classroom classes
    - Preceptors, does the school assign them, do you find them. There are advantages to both, and also disadvantages to both.
    - Mission of each program compared to your mission, is their synergy?
    - Reputation of the program in your area, alumni?
    - Your willingness to relocate for school/jobs?
    - Impact on your work/family life, how are you going to deal with financial and social issues during this journey?

    I'm sure there are many other things to consider, but those should give you enough headaches and keep you awake a few nights until someone else posts a few more! Seriously, it's a big decision, and one you should spend some time on because there really are many different options for you to take. There is no need to rush the decision. Good luck!

  • Sep 6 '10

    i am going to have to disagree with the general consensus here...i do agree with not charting about the ej fraction. it may be documented in the h & p but that is just going about the call of duty..

    irregular heartbeat and lung sounds are what they are...nurses assess these things all the time and it is within the scope of practice for a nurse to determine these things and chart them. irregular heart beat can result from a mountains of diagnosis. the doctor may be long aware of these things and the have been documented over and over by physicians.....i work in a ltach where people come in for pulmonary rehab...jeeezzzee if i called the doctor every time i heard rales (unless combined with some other kind of symptom causing a acute change) id get fired....people are in the hospital and they are sick....does her boss expect everyone to be well so there is nothing to chart....what i don't understand here is why her boss wants her to lie in her charting...i mean it is what it is .... from the previous post it sounds like most of the people here agree with changing the charting and documenting something that is incorrect with the patient.....