Latest Comments by KelRN215

KelRN215, BSN, RN 51,935 Views

Joined Oct 19, '10 - from 'New England'. KelRN215 is a Infusion Liaison. She has '10' year(s) of experience and specializes in 'Pedi, Home Infusion'. Posts: 6,339 (58% Liked) Likes: 13,493

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    If you have a Perkins loan, it can be canceled after 5 years of working full-time as a nurse. I have no personal experience with anything beyond that. Federal nursing loans can be canceled if you work in a certified "health professional shortage area."

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    When in doubt, I'd always err on the side of reporting. CPS can screen the report out if they don't find it sufficient to open an investigation.

    In my state, I don't think CPS would do anything in this case. Neither party admits to an inappropriate relationship. Overall, CPS in my state is more interested in child abuse/neglect in the home. Sexual relations between a random adult and a minor would be a matter for the police. (As a side note, I don't understand why abuse of one's own child is not a matter for the police in my state. I've never seen a parent get arrested for, say, shaking their baby.) I am aware of a situation with one of my current teenage patients last year in which she snuck out of her house and had sex with an adult male. Her mother woke up and noticed that she had left, searched for her, confronted her when she came home, she admitted what she had done and her mother appropriately reported this to her medical team (oncology) the next day. As mandated reporters, they filed with the state and the state responded by taking emergency custody of this teenager and her siblings and banning the mother from visiting. I still cannot wrap my head around that, as I don't think a teenager sneaking out and doing something her mother in no way endorsed and appropriately reported when she found out about it is a sufficient enough case of neglect to warrant revoking the mother's custody. When the case went to court, the mother did regain custody.

    Actually, now that I'm writing this, it reminds me of 2 situations when I was in high school. One of my classmates, who was 17 when the relationship started, was dating a 29 year old. She was 18 by the time senior prom rolled around and was allowed to bring him as her date. As far as I know, the school never reported anything to the authorities before she turned 18.

    I also had 2 friends who had a questionably inappropriate relationship with a 45ish year old man who was a customer at the pizza shop they worked at. The one who I am still friends with denied that she ever did anything with him but admits that our other friend did. Our assistant principal called my friend's mom but definitely no one filed a report with the state about it.

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    I've been a pediatric nurse for 10 years and always just used a regular stethoscope. I've never owned a special pedi or infant one.

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    vanilla bean and adventure_rn like this.

    Quote from Shawn91111
    It was a practice exam online, and have sent a note to the person running the page to get a better answer. Just wanted to try and get a different response as this was the question and answers with the one that they mentioned being the correct one.

    12. Lab values: pH 7.39, paCo2 30, HCO3 19
    A. metabolic alkalosis, fully compensated
    B. metabolic alkalosis, partially compensated
    C. respiratory acidosis, fully compensated
    D. respiratory alkalosis, fully compensated

    The answer is D: respiratory alkalosis, fully compensated
    I'm going to agree with adventure_rn. Respiratory alkalosis, fully compensated is the only choice that fits with the lab values provided. It's compensated, because the pH is in the normal range of 7.35-7.45. It's definitely not a metabolic alkalosis, since your HCO3 is 19 and it's definitely not a respiratory acidosis since your CO2 is 30. If the answer key also had a choice for metabolic acidosis, fully compensated, I'd have chosen that.

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    KoalalaRN likes this.

    It really depends on the clinic. In an Oncology clinic or outpatient infusion clinic, you could be doing a lot of hands on care. Other clinics, you might spend most of your day on the phone.

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    Here.I.Stand and brownbook like this.

    The great thing about nursing is that you can work in all of the above fields. If you would have asked me when I was in nursing school, I would have expected that I would still be working as a bedside RN in pediatric neuroscience today. I did that for 5 years as a new grad, then went to per diem at a boarding school, pediatric home health visits, and currently liaising for a home infusion company at a pediatric hospital. Other than my new grad jobs, I would not have guessed that I'd ever work in any of the other positions I've held.

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    Quote from cvinson30
    Ok the question is if you have Bicillin 1,200,000/2ml and the doctor orders 600,000, how many mls do you give. I did 600,000/1,200,000 and got 0.5 and then did 0.5 mutiplied by 2ml and got 1ml. So is this right and is so I do the same process if the doctor orders 900,000 right?
    You are making this way more complicated than it needs to be. You have 1,200,000 units in 2 mL. In your head you should be able to figure out that that means you have 600,000 units in 1 mL and then you don't even have to do any further math to get your answer.

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    You went about it a different way than I would have but your answer is correct.

    I would have divided 1,200,000/2 mL to get 600,000 units/mL. (I am assuming the dose in the millions is in units, not mg, because I've never seen a million mg of anything as a dose.) Then I would divide 900,000 units by 600,000 units/mL to get 1.5 mL.

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    There's not really any such thing as a "low" creatinine. You want your patient's creatinine to be < 1, generally. The range for creatinine at the hospital I'm followed at is 0.5-1.2. Labs determine their ranges based on their patient population so that the range is the median. My creatinine is very frequently in the 0.7-0.8 range. 1.3, on the other hand, would be a concerning creatinine for some patients.

    Your patient is NPO. He needs K+ containing fluids or adjustments in his TPN, if he's on TPN.

    Dilantin level is slightly below the therapeutic threshold but, if he's not having seizures, it may be a fine level for him. If he is, his dose needs to be increased slightly.

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    In peds, you remove it wherever you can get to the kid. If the kid is jumping on the bed, you may have to reach up and do it while they're doing that. I don't really see the issue. I've had patients with spina bifida who self insert Foleys at night and they remove them however they please in the morning. Many of these patients chronically straight cath and do that while sitting/into the toilet as well. I've had a Foley and my only focus when I woke up the morning after surgery was getting it out. I very well may have been sitting up when it was removed. I cared only that it was removed, not what position I was in.

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    Quote from Turtlepower
    So, I'm starting this topic bc I believe that many of us have crossed paths w/ nurses who are downright mean and unhelpful. Today was my 1st day @ clinicals where we all received our for 1st patient. I introduced myself to the nurse I was following and he instantly gave me the cold shoulder, and wouldn't even shake my hand. He continued what he was doing on the computer and turned his back towards me... very awkward. When it came time to do shift report, I listened in on what the night nurse had to report to the day shift nurse, half of the things she was saying about the patient I have never even heard before. I was out of my element and completely nervous. My nurse I was following wasn't very helpful at all and just basically said "do what your instructor has assigned you to do" with a straight up attitude. I asked him if he needed anything and he told me "no" He then proceeded to ask me how long I was following him in a tone and manner like he was fed up that he got stuck with a student nurse which was the case...hahaha)

    I later decided just to ask if the other girls needed any help with their patients and they were happy to share their patient.

    What have you student nurses in the past done to get through a situation like this?
    You know, it actually isn't the staff nurses' jobs to be helpful to you or to give you extra things to do. It is your instructor's job to teach you so telling you to do what your instructor has assigned you is fine advice. The staff nurse has an assignment of patients besides the one that you are assigned to. He may very well have looked at his assignment and knew he had to hit the ground running to stay ahead of the game for the day and you hovering and interrupting his report with the night RN slowed him down/prevented him from starting his day. If you have questions about your patient, you should review them with your instructor.

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    berdawn and Here.I.Stand like this.

    Eh, I've been a pedi nurse for over 10 years and I don't see this as an ethical dilemma. Not even a little one. When you say the parents are having it removed "on the state's money", do you mean the child is on Medicaid?

    Her are some examples of ethical dilemmas I've actually seen in pediatrics-

    End of life child with a progressive, high grade, brain stem tumor. Parents insisted on having her trached because they didn't believe that she was terminal. Ethics team sided with the parents because they knew the trach wasn't going to prolong her suffering or change her prognosis. She died trached and vented in the ICU, after being pronounced brain dead.

    Teenager with anti-NMDA receptor encephalitis. Parents read on the internet that this can be associated with ovarian tumors and insisted on an oopherectomy even though all of her ovarian scans were normal. The case went to court. The court sided with the family because the intention of the surgery wasn't to sterilize her.

    P.S. pretty sure both of these children were on Medicaid, too. That doesn't may the situations any more or less ethically complex.

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    JadedCPN and chare like this.

    I'm a pedi nurse and all meds are dosed by weight in kids. A frequent problem that we encountered when I worked in the hospital was that the system did not automatically update the "weight for calc" (the weight the system used to calculate medication doses) when new weights were documented. You had to go into a completely different place in the EMR and document a new weight for calc. Most people didn't do this every time a child was weighed. Depending on diagnosis, some children are weighed daily in the hospital. For babies or kids who are in for prolonged periods of time, this can be problematic.

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    I worked per diem at one. Nurses were only available from 7:30-3:30 so it was up to the dorm parents to administer evening meds. We put them in envelopes labeled with each student's name and left them for the administrator on duty that evening, who came by to pick them up.

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    Rose_Queen likes this.

    Quote from Zelda30
    Let's just say if I do the LPN program and go to a LPN TO BSN Program. Will that work?
    You seem stuck on becoming an LPN for some reason. If that's what you want to do, do it but becoming an LPN is an unnecessary stop on the road to a BSN. The route you are talking about taking is going to take much longer than if you just entered a traditional 4 year BSN program.


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