Latest Comments by MunoRN

Latest Comments by MunoRN

MunoRN 25,515 Views

Joined Nov 18, '10. Posts: 7,235 (68% Liked) Likes: 17,104

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  • 1
    sherri64 likes this.

    Quote from sherri64
    If you do some research you will find that it is possible to OD on marijuana and that people have died from it. So your statement you are giving patients in ER is incorrect. I believe in medical marijuana, not recreational. And no, comparing it to ETOH is wrong. That is like apples and oranges. Very different drugs.
    Source?

  • 1
    KindaBack likes this.

    In some settings, such as publishing research, it's totally appropriate to list the alphabet soup of credentials and degrees, in many other settings though it makes it appear like we're trying spruce up the title "RN" by burying it under a bunch of other letters.

  • 4

    While I strongly agree with the premise of the article in the title, the author is disturbingly misinformed about how inpatient hospital billing works, and mainly what I took from the article that there is something very wrong with nursing education.

    Individual gauze rolls are not reimbursed for separately, ALL payers reimburse based on bundled services, and one thing that is common to all payers is that they anything that can be considered "floor stock" is not separately reimbursed. Medications are also not reimbursed for separate from the bundled reimbursement, the only exceptions being blood factor products which medicare will reimburse for separately, other payers do not, observation status patients, and outpatient surgery/procedure patients. This is not well understood by direct care staff nurses, but I would hope that a UCSF professor who teaches Financial Management for Nurses should definitely have a better understand than she appears to.

    I do agree that nurses in general need to take a more active roll in controlling healthcare costs, we need to evolve beyond our traditionally submissive roll and more actively challenge unnecessary treatments, tests, courses of care, etc.

  • 3

    Quote from tyvin
    Drug testing companies don't care who ordered the test; they are required to report a positive or negative to school/employer/etc,. You volunteered to take the test. Now, why the drug testing people are calling you is they want verification of a Rx for the medication. You give them the name of your doc, and than they call to verify that the doc does prescribe the med PRN or routine; it's over, and a negative is given to whomever ordered the test. If you don't provide a doc's name that has the ability to tell them they do, infact, prescribe the medication to you, your drug test will be sent as a positive (not good; you want a negative).

    Even if you're taking many meds, as long as you have a Rx for the meds, and they can confirm it, the result will be negative. Drug testing companies cannot disclose what legal meds you have.

    The drug testing company cannot disclose why you were positive (I know many do but that's illegal!). You could go and tell the school what happened before they get the results, but as a future nurse it doesn't look good that you would take someone's meds.

    I'm playing devil's advocate here because I understand, but as a nurse you can't take meds that aren't yours if they are scheduled. I would schedule an appointment, not email. You need to be looking into their eyes when you tell them. I don't know what will happen, but go fight. Nursing schools have such a large pool of future students that when they see a positive drug screen...

    Positive drug tests are very serious.
    Whether or not a drug test will be reported as positive with a valid prescription depends on what the employer has directed the MRO to define as positive. For the majority of jobs, employers can only test for illegal drug use (either illegal substances or drug use without a valid prescription). For direct care nursing jobs however, employers can also screen for potentially impairing medications regardless of whether or not the person has a valid prescription.

  • 5

    I know I'm going against the grain here, but I don't have any issue with this policy and actually I'm all for it. First of all, they aren't refunding anyone's bill, they're only refunding the co-pay or less, which so far as only totalled 80,000, Geisenger's yearly revenue is $4,000,000,000. Considering this policy has now gotten people all over the country talking about Geisenger, that's probably the cheapest marketing campaign ever for a healthcare organization. Also, the practice of refunding part or all of a patient' copay is very common, all Geisenger is doing is publicizing it.

    From a nursing practice perspective I'd much rather have a patient who's dinner tray was 45 minutes late know right then that they're free to choose to pay part of none their deductible, since at that point I owe them nothing. I would love to say (not necessarily in these words) to a patient who complains about a late meal tray "what do you care, you're essentially getting paid $150 because your mealtray was late, for that kind of money all of your meals are going to be late and I'm going to eat half the meal before I give it to you".

  • 5

    Unless the doctor extensively made the family aware of his financial ties to the nursing home and documented the family's awareness of this very well, including a witness to the disclosure, then this is a pretty severe violation of his license. These violations are rarely taken lightly by regulatory and licensing agencies.

  • 2
    Nurse Leigh and elkpark like this.

    Parents aren't really as free in decision making for their children as they are in making decisions for themselves. An adult can make pretty much whatever decision they want, but parents are legally required to ensure the welfare of their children, so while they get some leeway, they will often be successfully challenged in court if they are making a decision that would clearly cause harm in declining a well established as beneficial treatment.

  • 2
    toomuchbaloney and Tweety like this.

    A description of the "conspiracy" in Delaware which was really just a data entry glitch.
    The conspiracy theory-du-jour: Did The Washington Post steal Delaware votes from Bernie Sanders? - The Washington Post
    And while exit polls aren't usually as inaccurate as the Delaware appeared to be even for just a few minutes, they can be pretty far off, it all depends on how many people feel like answering questions about who they just voted for honestly, which many people don't, myself included.

  • 1
    Slhengy likes this.

    Quote from BostonFNP
    THC itself is very lipofilic, it has a Vd of 3.5/kg and is also highly protein bound. THC has a half-life of more than 30 hours. 11-hydroxy-THC also is lipofilic and has a similar half-life. Drugs screen look for THC-carboxylase because it is even further downstream and persists the greatest amount of time and while not psychoactive it is diagnostic for use, just like methadone metabolites. Drug screening is not done for psychoactive reasons, it's done to diagnose substance use/abuse.
    The excretion half life of THC, which includes the time it spends as an inactive metabolite, is often quoted at about 30 hours, but the duration of circulating active forms of THC is not anywhere near that. Peak concentrations of the active forms of THC typically range from 50-200 ng/ml, and fall to less than 5ng/ml in less than 3 hours and to <1 ng/ml by 12 hours.
    Drugs and Human Performance FACT SHEETS - Cannabis / Marijuana ( D 9 -Tetrahydrocannabinol, THC)

    There are two main tests used for testing marijuana, testing for any use at all which tests for the inactive metabolite, or testing for active THC levels, which is what is used to confirm being currently under the influence for DUI, impairment at work, etc.

  • 1
    Dany102 likes this.

    Quote from Dany102
    Wow... I just realized I've been reading your user name as "Munro" all this time... Silly me.

    D.
    Everybody does, it's ok, it's the "R" right after "Muno". I also see it that way frequently.

  • 3

    Obviously there's a bit more to it, but generally when the next of kin decides the patient would no longer stop CPR we stop CPR. Are there places where you just say "too bad" and keep going?

  • 2

    Quote from BostonFNP
    I am not exactly sure what you mean by this. The psychoactive component of marijuana is delta-9-tetrahydrocannabinol which itself is lipophilic and thus stored in the body readily and is extremely potent, measured in nanograms. If it is extracted or leeched from fat cells, both it and its psychoactive metabolite 11-OH-THC, result in long-term potential impairment. Alcohol is almost immediately psychoactive but quickly clears the body. It's metabolite, acetaldehyde, is also found in marijuana smoke...
    11-OH-THC is an intermediate metabolite and is typically further metabolized prior to lipid absorption. I wonder if you're confusing 11-OH-THC for THC-COOH which is the metabolite commonly found long term in fat stores and is what urine drug screens look for, THC-COOH has no psychoactive or other impairing properties. 11-OH-THC is absorbed in fat tissue as well, but the levels it's absorbed at and then reintroduced into circulation are far less than the plasma concentrations we know cause measurable impairment.

    There's certainly some alteration of cognition and functioning beyond just the acute phase or "high", although it's not clear it's significantly different than other causes of less-than-perfect functioning. Alcohol's metabolite that is impairing and has been shown to remain in circulation for as long as two weeks, yet it would be a bit silly to say that nurses shouldn't be allowed to have a beer on their day off. I have three kids, which is a pretty clear risk for impairment since it causes me to work more fatigued and distracted than if I had no kids, should nurses be forbidden from having kids?

    Quote from BostonFNP
    There is also no doubt that nurses (or any HCP) should care for patients under the influence of alcohol, so the same should be true for marijuana, and acute impairment has been demonstrated at significantly longer intervals than alcohol.

    I don't think chronic alcohol abuse is any more benign than marijuana use, but it is legal, for better or worse.
    Acute impairment (being "high" or "drunk") are actually about the same for both marijuana and alcohol, typically 2-3 hours for smoked marijuana and typically 4-6 hours for digested marijuana.

    Unless the federal government decides to establish justification for federal jurisdiction of marijuana laws, which they don't appear interested in, the legality of marijuana falls to the states, and a number of states has made it legal.

  • 3

    Typical testing for marijuana doesn't test for active marijuana, it tests for the metabolites of the drug which are fat soluble. The metabolites are stored in body fat, then when that fat is eventually broken down through ketotic energy production, the stored metabolites it contained are excreted in the urine. Because of this highly unpredictable excretion, it's certainly possible for someone to test positive months after infrequent use.

  • 3

    Quote from tntrn
    Tell that to the guy on the TV today who went to Target to ask specifically about the policy. I am relating what he was told.
    Here's there policy: Continuing to Stand for Inclusivity
    It does not allow for a man who generally identifies as a man to identify as a woman only when using the bathroom or fitting room.

  • 11
    kalycat, kbrn2002, Pat_Pat RN, and 8 others like this.

    My kid was watching yo-gabba-gabba when I was picking a name, Muno is this guy: Yo Gabba Gabba! Muno Action Figure | Tv's Toy Box

    At the time, I found it funny that he looks like a mascot for some sort of STD awareness campaign.


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