mammac5 8,358 Views
Joined Nov 10, '09.
Posts: 735 (30% Liked)
Pts should not NEED a snack. If snacks are routinely needed, the insulin dose is too high.
I like NPPs in primary care, particularly nurse practitioners. I realize many here will not agree with me, and that's fine, but let's not fight about it!
There have been studies that show NP care is equal to (in some cases superior to) physician care, particularly with management of chronic illnesses. NPPs are likely to have more time for chronic disease management and that's the role they would fill in the PCMH model. Frankly, no one needs a physician to diagnose or manage diabetes, hypertension, obesity, etc., since these diseases are diagnosed by numerical value guidelines and managed (in the majority of cases) by published disease-specific guidelines. NPPs work so well in this area since what chronic disease requires is TIME to talk with patients, listen to their concerns/barriers to self-care, help them set goals, assist them in managing all that comes with living with a chronic disease, etc. My personal opinion is that NPs are great here because the focus on communication that comes with nursing education, as well as education in theory which includes helping patients make important changes in their lives.
In addition, NPPs are more than qualified and very skilled with providing preventive care (also guidelines-driven) which will soon be covered under Obamacare for millions more than currently have access to these services.
Now, if I'm having a mysterious constellation of new symptoms that signify a new and possibly serious disease process, I may prefer to have a physician who has spent years honing diagnostic skills and looks for zebras. But for routine care and maintenance of the human, I prefer an NP.
I work in both inpatient and outpatient DM mgmt. There is theoretically no limit to the doses of basal insulin...no upper safe dose to prescribe the way we think of meds like METFORMIN. Having said that, I normally will have pts split a large dose into 2 injection sites for better absorption...say, if they are injecting 80 units total I would have them inject that into two sites, but they can do so at the same time.
Patients who require 200 or more total daily units of insulin may do much better with U-500 insulin since the volume injected is much smaller and seems to be better absorbed/assimilated. I live/practice in an area of the country with high insulin resistance and actually use quite a bit of U-500. We still use NPH for some patients, as well. Especially since it is dirt cheap at Walmart pharmacies...not as great a basal insulin as LANTUS or LEVEMIR (which usually should be dosed BID) but cheap = the only way to go for many patients.
Appropriate to hold the insulin in an elderly patient with CBG of 75 but if your institutional policy says you must notify the prescriber when you judge that the insulin should be held, then you should follow that policy.
Giving the insulin and then offering the patient a milkshake would frustrate the CRAP out of me, as a prescriber! What is the point of that? Why would anyone give a milkshake to a diabetic patient? Sheesh.
Y'all may or may not agree with ChuckE's post, but can we all just agree that it was funny as heck? We have to remember to take nursing (and our responsibilities there) very seriously...but we don't always need to take ourselves quite so seriously.
School matters - particularly for new grads, in my opinion. I was hired at a hospital that is known NOT to hire new grad NPs...even new grad NPs that are already RN employees at the hospital and who have reputations as good nurses and employees. I was offered the job for a couple of reasons (contacts I made in my field during ANP clinicals, solid interviewing skills, etc.) but it was helpful that the physician deciding whether to interview me was familiar with the school I went to and worked with other physicians who did their residency at the same school.
Would I have a job right now if I didn't go to a "big name" school? Maybe so, but it would probably have taken months longer to find something and it wouldn't have been THIS job - which is my dream first job.
As someone who has 66 days until graduation (but who's counting, right?) I can say that the single best piece of advice I can give you is this:
Don't get behind!!!!
Sounds simple, I know, but it can happen very quickly and before you know it you're trying to claw your way out a big old hole you've dug for yourself. Don't let it happen.
Have your calendar ready (one big enough to write lots of things down) and sit down with every syllabus each semester and enter the dates when assignments are due. Then use a highlighter to mark those that are biggies (tests, scholarly papers, etc.) so you can't possibly miss them. Personally I like to make a little square to the left of each calendar entry because I feel strangely satisfied by putting a check in the box for each item I accomplish!
Budget and guard your time. If you're going to work full-time (which no one I know can actually accomplish while also doing 30-hr wk of clinicals) you absolutely must be realistic with your time and expectations. Family & friends must know that you won't have much recreational time during the program and that you will strategically ignore/neglect them when deadlines dictate. Some of them will stick with you and some may fall away, but you just can't attend every single baby shower, birthday party, bridal lunch, church activity, or sports event that you did before you got started.
Boundaries are important and if you live with others they need to know that just because you're home, doesn't mean you're "off."
This whole deal has been a GREAT adventure! I've learned so many things that didn't have anything to do with nursing or medicine - and I hope the same for you, too.
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