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MunoRN 49,889 Views

Joined Nov 18, '10 - from '.'. MunoRN is a Critical Care. She has '10' year(s) of experience. Posts: 8,389 (70% Liked) Likes: 21,776

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  • 10:47 am

    Each time he wakes you up during the day, wake him up at the corresponding time during the night.

  • Nov 22

    The duration of action of ipratropium is 2-3 times that of albuterol, which is why duo-neb or plain ipratropium is typically given every 4-6 hours, if additional albuterol is required in between those doses then plain albuterol is used.

    Keep in mind that albuterol actually contains two active ingredients; S-albuterol and R-albuterol. The R-albuterol is what provides the beneficial effects, S-albuterol is a byproduct of producing R-albuterol, S-albuterol causes bronchoconstriction and airway inflammation and appears responsible for the paradoxical effects of albuterol. Ipratropium helps treat the negative effects of albuterol, or you could just avoid the S-albuterol all together and use levalbuterol which just the beneficial R-albuterol without the harmful S-albuterol.

  • Nov 22

    Quote from CMA-RN29
    Medical assistant can admin meds and vaccines. I know I messed up but I do have an associates degree for medical assisting. They don't have to verify anything. And I don't work in a Pcp office either. Basically the only difference between my RN and I is that an RN can give narcotics and start iv's.
    Not to downplay your mistake, but what you would be doing as a nurse is actually very different since as a nurse you will be administering medications, as an MA you are giving medications under the direct supervision of a nurse, physician, or other LIP. The medication error in your example was the fault of the licensed person who was supposed to confirm you were giving the correct medication, dose, etc.

    Keep in mind that in regulatory terms, "administering" does not simply mean the act of physically giving or injecting a medication, it refers to the complete process of evaluating the appropriateness of the medication, verifying the dose is appropriate, etc.

  • Nov 21

    Quote from PeakRN
    ...Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. ..
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.

  • Nov 21

    There are very clear requirements for ignoring a patient's right to refuse, failing to abide by those requirements is a crime, sometimes even a felony so it should be taken seriously. If the patient is truly incompetent, which is a fairly high legal standard, permission to provide interventions against the patients refusals must be obtained from the POA or court appointed surrogate.

    The first step would be to address why she is not wanting to be turned for a clean up, and in the case of a hip replacement this is likely due to acute pain with turning the hips, proper treatment of this pain prior to turning is expected whether or not the patient is hesitant to be turned.

  • Nov 20

    Tube feedings should not be paused when repositioning, regardless of where the tube is, there is absolutely no benefit to this but it does often result in long periods of missed feedings when staff forget to restart the feeding which not only impairs nutrition but has been known to cause more acute problems such as hypoglycemic episodes.

    Common gastric volumes can be as much as 500ml, and is often 200ml or more. If you stop a tube feeding running at 60ml/hr to avoid adding more tube feeding the stomach while the patient is flat, how much are you actually avoiding? If the patient is flat for 2 minutes then you've only kept 2mls from getting into the stomach (and that assumes there is no gastric emptying while flat which is unlikely). There seems to be some sort of belief that by pausing the feeding the stomach magically becomes empty, when it essentially has the same volume, and therefore the same risk for aspiration, whether you pause it or not.

  • Nov 20

    As a Critical Care nurse I would say all hail every nurse who takes 5, 6, 7 etc of patients that aren't that much less sick than my 2. I remember when I first started in ICU, a nurse who was orienting me declared "there's a special place in heaven for med-surg nurses", after many years in the ICU I have to agree.

  • Nov 20

    Quote from LPNalltheway
    Hello, Muno..
    But let's say in a doctor's office setting usually doctors won't give pt anything for the 'pelvic pain" for example.. they send the pt to get a pelvic ultrasound and the pt f/u after that. So no action to stop the pain is taking until the results from the ultrasound are back..
    Then chart that. Pt reports...MD notified...further assessment of pain etiology is pending.

  • Nov 20

    I assume this isn't what you really meant: "Do not chart that a patient is in pain unless you have intervened. No prudent nurse would even think of documenting "Patient complains of radiating chest pain," without subsequently documenting what was done about the issue. Thoroughly chart all notifications, interventions and actions taken to avoid liability. "

    If you intervene then chart what intervention was provided, if you don't intervene then chart why. Intentionally omitting an otherwise pertinent finding to avoid liability for not acting on that finding is falsification of charting.

  • Nov 20

    Each time he wakes you up during the day, wake him up at the corresponding time during the night.

  • Nov 20

    Quote from blondesareeasy
    Lie.
    Tell em' you got the shot.
    Go to Walgrens, get a receipt for something, tell em' you bought the shot.
    Photoshop someone else's receipt.

    Flu shots are a pharmaceutical gold mine.
    The flu kills OLD people and the immunocompromised. It doesn't kill people that go to work for a living and are up walking around.

    So play the game until a LOT of years go by that will prove that the flu shot ain't what it's supposed to be.
    I've worked ICU for a decade now and I can tell you that the one thing other than trauma that is most likely to put an otherwise completely healthy, young, and "up walking around" person on aggressive life support is the flu. On more than one occasion I have had to tell the husband of a young, otherwise extremely healthy, mom in her 30's that it's time to have their kids come in and say goodbye because they probably aren't going to make it through the night. I inevitably get asked frequently with these patients "but it's just the flu" and "but he/she was so healthy". I would normally say that everyone is entitled to their opinion, including yours, but after seeing first hand the beliefs that form, and the decisions that are made based on the type of comments you are making here I have come to believe that you are simply an absolutely horrible person for spreading these reckless myths.

  • Nov 19

    There is no CMS standard on how far any kind of dispenser can stick out from the wall, that doesn't mean that Joint Commission surveyors won't claim there are various made-up standards that the facility isn't meeting, this is why the Joint Commission is quickly loosing business to other more competent survey organizations.

  • Nov 19

    Quote from PeakRN
    ...Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. ..
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.

  • Nov 19

    Quote from PeakRN
    ...Once the patient is declared brain dead the OPO will send out a RN who takes over patient care. They have a set of protocols and a Doc on call to determine care. The hospital should not be giving care once the OPO takes custody of the patient. ..
    This must vary regionally because in multiple facilities I've worked at the hospital staff RNs continue to care for the patient up to the point they are being wheeled into the OR for procurement. The OPO sends out an RN transplant coordinator, but they provide no direct care after the brain death declaration.

  • Nov 19

    ADN programs have given extra "points" for previous degrees for a while now, although it does seem as though it's become effectively a requirement for admissions in some programs given the number of applicants with a previous bachelors. It's pretty unlikely if not simply impossible to get into many of the ADN programs in my area without a bachelor's degree, although varies by region. If you're having trouble getting into a program in your area without a bachelor's then you might consider widening the geographic area you're looking in.


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