Latest Comments by BostonFNP

Latest Comments by BostonFNP

BostonFNP Guide 37,367 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care. Posts: 4,365 (60% Liked) Likes: 10,261

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  • 2
    WKShadowRN and Jen-Elizabeth like this.

    Quote from MunoRN
    "A few hours" is actually consistent with the established duration of marijuana intoxication.

    This is a highly potent psychoactive drug with high lipid solubility; fat sequestration results in both a very long half-life, and in chronic users, produces a relatively high steady state of the drug out several days.

    "Because they are extremely lipid soluble, cannabinoids accumulate in fatty tissues, reaching peak concentrations in 4-5 days. They are then slowly released back into other body compartments, including the brain. Because of the sequestration in fat, the tissue elimination half-life of THC is about 7 days, and complete elimination of a single dose may take up to 30 days. Clearly, with repeated dosage, high levels of cannabinoids can accumulate in the body and continue to reach the brain. Within the brain, THC and other cannabinoids are differentially distributed. High concentrations are reached in neocortical, limbic, sensory and motor areas."

    Ashton, C. H. (2001). Pharmacology and effects of cannabis: a brief review.The British Journal of Psychiatry, 178(2), 101-106.

  • 2
    WKShadowRN and AutumnApple like this.

    Quote from KindaBack
    Smoking pot doesn't put your patients at risk, being intoxicated does. My personal experience was that the intoxication lasted for a few hours
    Have you ever looked up the pharmacokinetics of THC?

  • 2
    NotAllWhoWandeRN and TriciaJ like this.

    Wait the same nurse has had this before? With a missing unused patch?

  • 1
    Nurse Leigh likes this.

    At your 5th attempt your chance of passing is very low.

    Have you spoken to your program about resources they may have to help you?

  • 4

    Quote from BeenThere2012
    there has been more than one "error" regarding proper handling of Fentanyl patchs with "per diem" staff.
    . Not making sense to me.
    This is a huge problem! You'd think the director would be irate about it!

    Unless the director is involved...

  • 5
    TriciaJ, Anonymous865, morte, and 2 others like this.

    Quote from BeenThere2012
    I think the point here is that regular staff are following the policy and the per diem are not. Something in training perhaps?
    I would buy that if this was simply an old patch that wasn't signed out. But this is a brand new patch that is missing.

    What part of training covers "when you take a narc out make sure the patient gets it"?

  • 3

    Quote from WKShadowRN
    What I see is a process failure. If regular employees are doing this correctly, what is the breakdown for the others?

    What's the common denominator?
    How is a brand new missing fentanyl patch a process error? It was signed out of the emr and never placed while the old one was left on for 6 days?

  • 13

    Quote from nursesaysay
    I did speak to my director more, she said "as a more senior nurse you should be leading by example".
    I would honestly report this up the chain.

    In my opinion you are leading by example.

  • 0

    Quote from AS8812
    Thank you !
    I thought that is what was meant by it but was unsure because it is listed separately from 'work experience'
    Some places like to separate out clinical and non-clinical work experience as well as volunteer experience.

  • 18
    SororAKS, TriciaJ, NuGuyNurse2b, and 15 others like this.

    You found a serious error. It is not your job to judge if it was an innocent error or not! I would have serious concerns about a manager that wasn't very interested in the error you brought forward. A narcotic is missing, a highly abuse narcotic, and a patient was without pain medication for 3 days.

  • 0

    Quote from AS8812
    I was wondering if anyone could tell me what "clinical experience" means in regards to having it on your CV? The University I am applying to for my DNP says this:

    • Work Experience
    • Clinical Experience
    • Research Experience
    • Leadership Involvement (including board/committee participation)
    • Awards and/or Honors
    • Publication(s)

    Do they mean SCHOOL clinical experience? And if so, what do I include? I assume everyone in nursing school has the same kinds of clinicals right? OB, psych, med surg, etc?
    Im sorry if this is obvious, I guess Im just nervous about applying and want everything to be perfect.
    Normally this would be professional clinical experience: where you have worked as a nurse, a cna/ma, emt, medic, etc. If you haven't had any professional experience, perhaps you can include your nursing clinical rotations.

  • 1
    bbcewalters likes this.

    I remember being a student and having my mentor yell at me about positives and negatives and I never thought it was a big deal. Now its one of my biggest pet peeves with students.

  • 1
    bbcewalters likes this.

    Quote from bbcewalters
    26 yo F C/O sore throat x 3 days.
    Subjective- pt denies cough, fever, HA, NVD, difficulty swallowing, sick contacts. Admits to "sinus problems/allergies in past" sneezing and rhinorrhea, Has not used any OTCs except motrin (don't forget when they last took it) ..... (OLDCARTS is your friend)
    Obj- ASSESSMENT!!! from head to toe... Eyes: PERRLA, Ears: describe tympanic membrane and canal, Nose: describe turbinates and any discharge, Throat: (Looking for strep features vs sinusitis vs URI....) is there lymphadanopathy, palpate sinus cavities, describe if a skin rash is present. Listen to heart and Lungs, maybe if warranted abdominal assessment Make sure to use medical terms, not RED but erythema, not pus, exudate ect...
    Assessment/Plan what do you think top 3 differentials, any tests needed (rapid strep), then plan....antibiotics/watch and wait/ reassure viral....
    Always positives before pertinent negatives!

    This is how I would expect my students to report to me:

    "Jess" is a 26yo previously healthy woman with a complaint of acute onset of sore throat three days ago with sneezing and rhinorrhea, history of seasonal allergies without fever, chills, known sick contacts, dysphagia. On exam she has scant white patchy cryptic tonsils, 2+, worse on the R, slight serrous effusion bilaterally without erythema, shotty tender anterocervical lyhphadenopathy bilaterally. Chest and lungs are otherwise normal. Concern would be strep pharyngitis vs viral/allergic pharyngitis; would plan a rapid strep and throat culture and pend treatment on results. In any case she's likely need some APAP for symptom management.

    It's quick, detailed and pertinent. If I have any other questions I'll ask.

  • 3
    OldDude, Farawyn, and BeckyESRN like this.

    Quote from Farawyn
    I rue the day I've ever said SIDEBOOB!

    Yes. Tits a thing.
    I had too google it. It it semi-not-work-safe.

    I have concluded I am far more concerned about lice.


  • 3
    OldDude, BeckyESRN, and Farawyn like this.

    Quote from kidzcare
    Too early on a Monday for this. Go cover some sideboob
    Is this really an issue? Kids these days.