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