MunoRN 56,498 Views
Joined: Nov 18, '10;
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10 year(s) of experience
I guess I should do the same for providers promoting Islam and immigration... Domestic terrorists...
But the entire 2nd Amendments purpose is the last 4 words: "SHALL NOT BE INFRINGED".
According to the 2nd Amendment, the right to bears arms shouldn't be hindered
- everything the government has, in regards to specifically ARMS, the people should have access to.
However, even with that being the point - AK-47's aren't protected, meaning that every U.S. citizen's 2nd Amendment rights' ARE being infringed upon. That's the argument. Law makers shouldn't be able to make these decisions, the founding fathers have protected the citizens in the Constitution FROM future law makers, as them themselves escaped a tyrannical government. They wished for their future citizens to have the ability to protect themselves, should the time ever arise that the government turns on its citizens.
But again, people aren't fighting about AK-47's, but you CANNOT simply categorize all semi-automatic weapons as "assault rifles" to ban them because they can be used for bad things. That's literally the point of guns in the 2nd Amendment - to protect yourself, by doing "bad things", possibly killing people/government to protect yourself. It's stupid to call for the ban of AR-15's. Why would you?!
I understand that, it was used as an example, because the backgrounds checks are used for the purpose of seeing if the person is a threat to themselves or other people. If you have depression, you may be a threat to yourself or other people. The laws aren't written that way, as there is no way to find that out unless you have the medical record, but I was playing devil's advocate, if they were, as in you see a person's mental health history, and deem them unsafe to sell a gun to. I still don't know if that would be right.
It would be a better option than the hysterics of "BAN ALL GUNS" though.
All of these things need to be voted on by Congress. These are things Trump WANTS and what a large majority of his base WANTS. Just because they haven't been done, doesn't mean they aren't wanted by many people, or that they won't be done. Have you seen the wall prototypes? Oh, that wall is going up.
I think the vetting process is after the wall deal. I presume that's what's to come after we have secured our Southern border, as then we can focus on people traveling through customs, as we DO have a process for that already. We just want to make it better.
People can't even figure out how many people are REALLY in this country illegally. How do you expect them to know who is voting and where? The voter fraud commission was disbanded because states refused to give their voter information. That WOULD help in identifying areas of voter fraud.
It's not about voting more than once, it's who is voting. A single person could vote more than once, under different names. If you ever have time or interest, check out information on how many deceased people are still registered to vote. It's a real thing, since many people don't think to update that when a loved one dies, as it's not a priority, and most people don't even know they stay registered after death.
The only evidence based use of the NIH scale is prior to tPA, where it can be predictive for the risk of hemorrhagic complications, otherwise it serves no established purpose in guiding care. Serial NIH scores can be useful if they are being used to evaluate the effectiveness of tPA treatment by an organization that is contributing to tPA effectiveness databases, but even then it's only indicated pre-tPA, 2 hours post tPA, and at discharge.
The currently available carpuject holders are the Hospira ones, Wyeth sold the Tubex licensing rights to Hospira. Does it have to be specifically the Tubex branded holder? You'll have no problem finding a Hospira holder if you're just looking for a carpuject holder.
"Always and never.....the enemy of good Medicine!!!"
From what I've gathered here the grand consensus is to do assessment based suctioning and then "Suction with Dignity", PRN.
Although, some clinicians here are insisting that they NEVER EVER Suction, no matter what. My friend's mother was let go at a hospice facility, sounding like she was drowning on her own secretions, and when he asked to get her suctioned, the staff said they do not suction here. He said this haunts him to this day. (His exact words)
again: "Always and never.....the enemy of good Medicine!!!"
I get it..., nasal suctioning is considered torture at End-of-Life, but if you need to suction, at least use a No-Bite V and insert a suction catheter into the oral airway. This suctioning is the least traumatic suctioning you can do for your comfort care patients. This is the definition of "Comfort Care" and "Suctioning with Dignity", as long as it is on an assessment based, PRN basis. I don't think anybody was ever advocating for suctioning on ALL End-of-Life Care.
Keep in mind these books aren't written using actual NCLEX questions, and sometimes the authors of these books aren't all that bright.
As a general rule, NCLEX questions are written to determine if you understand the nursing process and if you can prioritize properly. If the question doesn't confirm that adequate nursing assessment has already occurred then the answer is the one that includes assessment. Aside from the fact that 8.9 by itself isn't an indication to transfuse, the first step would be to correlate that lab finding with a nursing assessment to give that number context.
Same goes for the V-tach question, initial assessment would include determining whether the monitor is correct, but then assess the patient, I've had patients in a slower V-tach that stay in that rhythm for hours and just hanging out watching TV, so assessing how that finding on the monitor actually translates to the patient would typically be the correct answer on the NCLEX.
No later than one hour after administration of any pain med. Nursing judgment based on onset of action. Also during normal vitals.
forgot to address the first part. Our hospital pain policy states to reassess pain no more than 1hr after any pain medication administration. I suspect most hospitals have some form of policy dictating frequency of assessment for various situations.
JC had no problem with range orders. They had a problem with interval of re-administration. They wanted specific parameters for second doses in any range orders. So MDs needed to provide PRN with an indication followed by when to give second or third doses within the overarching range. We got dinged on this because the JC took the same order and went to multiple nurses to gauge when/if the next nurse would give the next dose. They described the lack of parameters as "nurse prescribing".
It is written in every single textbook, every guideline that EEG, evoked potentials, fPET, fMRI, MRA, etc. are not, in any case, predictable of anything. Yet, there are some neurologists who clearly abuse system under premice of "telling them what they want to hear" and "not robbing them of hope". Yes, there were bare handful of unpredictable "recoveries" (BTW, nothing that happened before 2003 - 2005 when fMRI and fPET scans got out of purely academic settings, can be relied upon) but overall chances are neglugible and what happens next is, IMHO, sometimes becomes borderline torture or corpse desecration.
It is nor nursing role to tell patients all that, especially in our days of "customer servive" everything. But it can and should be RN role to alert higher-ups, risk management, social work, clergy and physicians/providers who feel comfortable speaking with families in distress and do whatever to make family hear the holy truth. And, of course, the first thing to be withdrawn must be "customer satisfaction".
IMHO again, "ethics committee" must stop being a spineless gathering which issues "opinions". Once care is declared futile by people who are supposed to be experts, the patient authomatically becomes DNR for 72 - 96 h, and if no clinical progression is noted, "no code" with set data of care withdrawal within 72 h. If family still wants of wishes, they should be welcome to do whatever, but from the "care withdrawal" point of no return no insurance, and especially Medicare/Medicaid, should be allowed to pay a red penny for anything, as well as federally sponsored institutions must not be allowed to keep the patient on their premices.
If family still wants to sue, good luck for them. At least, most $$$$$$ thus redisributed will not be spent on literally moving air to and fro a dead human body.
This is new to me, but - if I understand this article correctly - it is possible to recover from post-arrest status myoclonus. This article was published in 1998, so it may not be reliable. I'm interested it what others have to say.
Early myoclonic status and outcome after cardiorespiratory arrest | Journal of Neurology, Neurosurgery & Psychiatry
Negative. It gives a clear instruction on when to reassess and when the second dose *should* be given. 1 hour after administration of the first. 1-2 q6...second dose 1 hour after. The ONLY written instruction is when to reassess and the parameters to give the second dose (1 hour after). If the order said something along the lines of "may give second dose whenever the hell you want for x pain score"...then certainly whenever. And it wasn't one surveyor. It was something their whole team sat down with us and had us develop a plan to fix it.
I'm not "confusing" anything. I'm taking a clear instruction as it's stated. Two parts in a single sentence : 1. Reassess in one hour 2. Give second dose of painful. I literally had this discussion last year with JC last year when we got dinged on our ordersets.
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