Latest Likes For MunoRN

Latest Likes For MunoRN

MunoRN 27,737 Views

Joined Nov 18, '10. Posts: 7,365 (68% Liked) Likes: 17,627

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  • Jun 30

    A 10 ml size plunger is only required when assessing patency, once patency has been established any size syringe can be used.

  • Jun 30

    Unlike women's shoes, there aren't many mens shoes that come in all-white, so for nursing schools I got the shoes I need for my back in mostly white, and a can of white spray paint that works on leather and plastic.

  • Jun 29

    Drugs that contain unstable chemicals often require glass ampules because the rubber cap of a vial with interact with the chemicals in the drug. Some chemicals are best stored hermetically (completely airtight) and while vials are generally considered 'sealed', they aren't truly hermetic.

    I break the vial at it's neck with an alcohol swab or two, then draw it up using a filter needle.

  • Jun 29

    Drugs that contain unstable chemicals often require glass ampules because the rubber cap of a vial with interact with the chemicals in the drug. Some chemicals are best stored hermetically (completely airtight) and while vials are generally considered 'sealed', they aren't truly hermetic.

    I break the vial at it's neck with an alcohol swab or two, then draw it up using a filter needle.

  • Jun 29

    I'd say in general that if you're worried about liability, then being too eager to hand the kid off to someone else isn't necessarily the best way to protect yourself or the facility liability-wise. Just because you get a-hold of someone claiming to be the kids uncle, and who enthusiastically says "I'd love to have an 8 year old girl spend the night at my house", doesn't make that a wise move in terms of liability.
    Every place that I've worked has had some way of boarding both parents and kids. Typically, there is a unit or nearby units where one takes peds and the other takes adult medical patients. We don't board the kid directly, technically we refer the kid to CPS who then places the kid with us.

  • Jun 29

    Quote from KindaBack
    ROTFLMAO...

    Anything tied to my patient is my responsibility? Their lack of insurance? Their inability or refusal to fill their scripts? Their lack of education? Their lack of housing? Their dog? Their utility bills? Their kids?

    Nope, my role is to carry out the legitimate orders of the physicians and help the patients help themselves. Watching their kids, though? Nope, that's what CPS is for... Child ** Protective ** Service... which role requires education and experience very different than nursing.

    When I had a mom brought in for meth psychosis, her kid was not my problem... and I refused any attempts to make it so.
    I think you've responded to a statement that was probably a bit broad with one that's also probably too broad. Our job as nurses isn't just to be a doctor's assistant and execute the plan they put forward, our job is to incorporate the physician's plan into the overall plan for what the patient needs. If a patient comes in because they were unable to fill their scripts, then yes, that's absolutely something the nurse needs to deal with, typically this means referring this issue to someone who can deal with it directly, but to say it's not your problem as the patient's nurse isn't really accurate.

  • Jun 29

    Drugs that contain unstable chemicals often require glass ampules because the rubber cap of a vial with interact with the chemicals in the drug. Some chemicals are best stored hermetically (completely airtight) and while vials are generally considered 'sealed', they aren't truly hermetic.

    I break the vial at it's neck with an alcohol swab or two, then draw it up using a filter needle.

  • Jun 29

    While a peripheral may have two ports that doesn't mean it has two separate lumens, those two ports enter the same lumen.

  • Jun 28

    Quote from hawaiicarl
    I think someone may not be familiar with central line policies. Manufacturers for years have said that only 10 ml syringes or greater should be used for injections on central lines. The rational being that the smaller diameter syringes generate far more PSI than the larger ones, increasing risk for line rupture, and if a thrombus is occluding the line, blasting that thrombus straight into the patient.

    Cheers

    PS - Personally I feel this is an out of date practice, and with the new lines someone should design a research study, and get some grant money to disprove it.
    You can actually generate the same PSI with any size syringe, the difference is how a single force applied to the plunger translates to PSI. More force=same PSI in a larger bore syringe.

    A larger bore syringe (10 ml size or above) should be used per manufacturers recommendation until the patency of the line is assessed. Imagine a garden hose with an open end, no matter how much PSI you apply to one end it will not exert excessive pressure on the interior of the hose.

    This is why multiple practice groups clarify that a 10ml syringe is only necessary to assess for patency, from ISMP for instance:
    5.4 Assess central line patency using at a minimum, a 10 mL diameter-sized syringe filled with preservative- free 0.9% sodium chloride. Once patency has been confirmed, IV push administration of the medication
    can be given in a syringe appropriately sized to measure and administer the required dose.
    Discussion: Care should be taken when assessing for central line patency to avoid possible catheter rupture.
    Manufacturers recommend using at a minimum, a 10 mL diameter-sized syringe for assessing patency because a
    syringe of this size generates lower injection pressure. After patency has been established, however, medications
    can be administered in a syringe appropriately sized for the dose of the IV push medication required.18 Many
    facilities have created policies stipulating that a 10 mL syringe be used for all procedures involving a central line,
    when in fact, it is not necessary to introduce risk through a syringe-to-syringe transfer in order to administer
    medications.
    http://www.ismp.org/Tools/guidelines...guidelines.pdf

  • Jun 28

    Nurse's aren't generally allowed to strike either, at least not without certain restrictions. Legally, nurses have to provide adequate notice prior to going on strike to allow for temporary staff to be put in place, for patients to be moved elsewhere, or a combination of the two.

  • Jun 28

    For jobs that aren't considered "safety sensitive", a drug test that is positive for drug but a valid prescription exists will be resulted as negative. Direct care nursing however is classified as a "safety sensitive" position, which means employers can test for certain drugs and be notified of a positive result with or without a valid prescription. So regardless of whether or not your employer chooses to actually prohibit certain medications even with a prescription, there is no requirement that prescribed medication use be kept secret from them which is the purpose of allowing a prospective employee sufficient time to present a valid prescription to an MRO. The test can be resulted as positive immediately, and then later clarified to be either with or without a valid prescription.

  • Jun 28

    Quote from Altra
    This illustrates exactly why Joint Commission strongly frowns on range orders.

    IMO, your interpretation is incorrect. The order, such as it is, contains only dose but also frequency - and that frequency is every 4 hours.
    The JC doesn't actually oppose the use of range orders, they only require that there be some way of ensuring that the prescriber and the nurse are both understanding the order in the same way, they actually endorse the Society of Pain Management Nursing position statement on range orders which encourages the OP's interpretation. To meet this requirement some facilities get lazy and just say "no more range orders, because they JC said so".

  • Jun 28

    While a peripheral may have two ports that doesn't mean it has two separate lumens, those two ports enter the same lumen.

  • Jun 26

    I try really hard not to give either in the ICU, the use of benzos is strongly linked to ICU delirium, versed in particular should be avoided. It is tempting because you do get a period of calm, but then right back to the delirium and potentially making it last longer and be more severe. If the patient is vented we use primarily opiates, sometimes propofol, sometimes precedex, with a dash of benzo here and there if needed. For both vented and non-vented patients with delirium we usually use seroquel for hyperactive delirium, zyprexa for hypoactive delirium, haldol for when those two aren't cutting it, and we've started adding melatonin as well. Benzos certainly aren't completely avoidable, but we do try to minimize them.

  • Jun 26

    There are certainly patients coming to the ED that need IV fluids, but a lot of it seems to come from the old ED wisdom that IV fluids and O2 can cure just about anything.

    I have worked with an ED physician who claimed they get pressured by the inpatient docs to order IV fluids since that helps justify them ordering IV fluids which is one way to bump a patient's status from observation to full inpatient (so long as the fluids are ordered to run at 100 ml/hr or greater). Basically, this means that the physician who has to do the same H&P either way, can significantly increase what they get reimbursed for that H&P by justifying inpatient status instead of observation.


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