ashcarr30 922 Views
Joined: Apr 3, '09;
Posts: 15 (20% Liked)
; Likes: 4
I thought this was a great topic and I wish there was more information out there. I have pt's come onto our program with multiple BP meds, cholesterol meds, thyroid meds, multiple BPH meds, psych meds.... the question is not just what meds to we keep but when to we start to taper longstanding meds (such as psych meds) so we can avoid an abrupt d/c of these meds when they stop swallowing which is also not ideal.
I have recently started to slowly remove BP meds in homes where pts have ability to monitor BP daily. I am amazed how well most of them do without their BP meds. In fact, in all the homes I have d/ced their BP meds (only been working with hospice for last 9 months and getting more and more intersted in polypharmacy at end of life in past 4 mo) I have never once had to restart. With most geriatric practioners I speak with they typically say that having a pt with a slightly elevated BP is a better situation than a low BP as it increases their risk for falls.
I would be interested to stop thyroid meds and then after a few weeks check their labs and see if there are any issues. Looking up the impact of inappropriate dosage of levothyroxine, side effects and drug interactions, it does seem like something that would be worthwhile to discontinue if possible.
I am hoping to go to NP school in the spring and would love to further study polypharmacy at end-of-life and when to dc meds.
I read this article recently and have been thinking about it quite a bit and I am so pleased you posted it. To begin with, I think clinicians have varying skill levels (and willingness) of communication with patients and families about the disease process, plans of care and expected prognosis. I also think that patients and families need repeated conversations to better understand what to expect. Having video's to better demonstrate treatment options and manifestations of a disease are underutilized in my opinion.
On a side note, I hear regularly from family members and young adults that if they have advanced dementia they want to be "taken out of their missery" or some joke about ending their life. I have never heard how someone wants everything done so they can stay alive to lay in a bed while their caregivers, as good as they may be, watch tv and talk on the phone all day which is typically what I see even in the best senerios with caregivers of advanced dementia.
Yet, families continue to struggle decisions about treatment and end-of-life decisons for individuals with advanced dementia. I think this highlights the need to have conversations often and early about goals of care with chronic illnessess, particularly with dementia in its early stages.
To go back to your question about "whether hospice is one area of healthcare, and nursing, that has an ideologically pure mission statement?" I dont know if I understand your question completely but in reference to your satisfaction with the hospice nurse "doing the right thing" at the end of the article by telling the man that "it would be cruel" to place a feeding tube in his father who had advanced dementia, I think that hospice nurses undertand the inevitably of death at the end stage of disease. There needs to be more conversations about the anticipation and expectation of death and not what can be done to prolonge the inevitable with uncomfortable and often futile treatments that often come at the end of life. Hospice nurses have end-of-life and goals of care conversations frequently. Despite health care cut backs which are necessary and inevitable, hospice nurses continue to have "The Conversation" with patients and families which is often long overdue at the point that we are having them and this is an intergral and valuable part of hospice nursing.
Poetslove@- I tried to "pm" you so I could send out a message but I cant really figure it out... I had scheduled to do two of my NLN exams on Monday the 11th and then the last one on August 1st. I just got my first job as an RN and its beginning Monday the 11th- of course. So now I am going to have to delay my exams. I am concerned that due to everything else I am going to have to study for my new job, I am going to get a little rusty on the information I need to recall for all these NLN exams- how did you find psych? Did you study much? What did you use to study? I suppose I can just wing it and if I dont get a 50% I can do it another time.
anyway, would love to hear what you thought of it and if you have any tips.
has anyone done the NACES RN-BSN mobility exam? I would like to get them done before we start in the fall...
has anyone applied or attended the SUNY Downstate RN-BSN?
if so, have you heard back if you were admitted yet?
anyone that has gone through this program- any feedback?
I am starting my two year nursing degree this fall. I want to be working on my language skills so that, in time, I will have another language to speak to patients with.
I currently speak basic mandarin however I feel like since Spanish is more widely used, it would be a better option.
My mother lives in Mexico and the clinics she goes to are bilingual. They said I could intern there and work on medical spanish but I dont know how realistic that is considering it I would have to work there for free and continue to pay rent at my place in NYC.
Does anyone out there know the need for mandarin speaking nurses? Or have any further comment on choice of language.
Just a little FYI, I applied for a private school that is about $11,000 a semester and I got grants, scholarships and loans..it covers everything...So, I never thought I would be applying for a private college either, but I ran out of options..so, believe it or not, you most likely will not have to pay for a dime..I would just apply for the heck of it and see what kind of grants, etc will cover it! Best of luck to you
I am taking it now with Prof. Wladis. I was bummed to take this class because I have taken a lot of college level math classes and thought this would be really a waste of time.
I have learned a lot about medication dosages, way to administer meds, IV infusion rates- It has been very helpful. I also took it online.
I have heard that it is not very good and descriptive when taking it in person.
I will be starting the PBISON ATOP program in the fall. I plan to keep my current job. I currently work 32 hours a week but I am considering going down to 28 hours/wk during school. I currently take 10 credits at BMCC while working 32 hours a week and its not a huge struggle, but BMCC classes are not the most difficult (also I am only taking all the ATOP pre-reqs).
I see the classes for ATOP are Thursday from 3-8 and Friday/Sat 8-8
Does this mean the classes are offered during this time? Or does it mean I will have to commit to be at the school during these times. It seems like a ton of hours for the 6 credit NG101 class. This is the only class I will take over the fall.
I would love to find out, from someone in the class, what they suggest as far as # of hours I should work and how much time I will actually be at the school taking 1 nursing class.
Thank you for your help
you know, I dont know I called last friday for the status and I was so excited when I found out I got in, I forgot to ask all the details! I have not received my packet of details yet. During my interview they told me I had everything in order to do the night program or the ATOP program so, I am thinking it is one of those?
ooh sorry about that, I cant remember at the moment
When I had my interview the women really stated that they look at everything and not just the NLN. They look at grades, experience and character. When I asked them what they wanted in a applicant they told me they look for that "spark"- that genuine interest in that field and in people in general. I would def. call. The waiting was really difficult!
yes, i just applied, i got in and will be starting in the fall. I am really looking forward to it. So sorry I cant answer more questions about the school- I have been in touch with the people in the admissions office whenever I had questions and I found them to be very helpful!
I got a 96%- did you take it already?
I heard back after about a week-after all my stuff was sent it. They called and set up an interview and I heard the decision about 3 weeks after the interview.
Their website says:
Phillips Beth Israel School of Nursing is accredited by The National League for Nursing Accrediting Commission, 61 Broadway, 33rd Floor, New York, NY 10006 (212-363-5555)
You can call and check.
I interview and they told me they were.
I hope so because I just got in and intend to go their in the fall.
Advertise With Us