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Double-Helix, BSN, RN 28,711 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,072 (52% Liked) Likes: 5,715

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  • 2:00 am

    Quote from AJJKRN
    I think hypotension and bradycardia are on a bit of a different level than mild nausea or say drowsiness...
    Or an allergy to fentanyl because it causes "itching."

  • 2:00 am

    One of my biggest pet peeves is documented “allergies” that are actually expected side effects. When clinicians try to order these medications it triggers a hard stop in the computer system. Then pharmacy has to call the ordering doc to clarify. It creates delays, extra work, and sometimes ends up with the patients not receiving the medications that would be most effective for them.

  • 12:31 am

    Defibrillation does provide sort of an electrical reset for the heart. However, compressions do not restart it. The normal electrical activity of the cardiac pacemaker cells do that. The cardiac pacemaker cells are capable of spontaneously generating and sending out their own electrical impulses. During fibrillation, those cells are all firing at random, and therefore can't create a coordinated contraction of the myocardium. The electricity in the defibrillator interrupts that firing. The hope is that, once interrupted, the pacemaker cells will then start sending out coordinated signals, resulting in coordinated myocardial contractions and a return of normal rhythm.

    Compressions manually circulate blood while the heart is not pumping or not pumping effectively. Each second without cerebral perfusion increases the likelihood of neurological damage. Minimizing that down time is essential in improving resuscitation outcomes. Compressions are restarted immediately after defibrillation not to restart the heart, but in case the heart does not restart. The heart may have restarted on it's own after defibrillation, but delaying compressions in order to perform a rhythm check can be detrimental if spontaneous circulation has not returned.

    Does that help?

  • Feb 25

    Did you fail the NCLEX? If you were granted a temporary GN licensure and then failed the NCLEX, that licensure would be revoked.

    If there is is no reason for this prohibition explained in the letter, you need to first figure out why you received it by calling the BON. If you're sure it's some kind of misunderstanding, I would still go to work, but bring the letter and immediately discuss it with the charge nurse or nursing supervisor on call. They may allow you to just stay and observe, do online learning, etc. so you aren't practicing but you don't get penalized for missing an orientation day.

  • Feb 25

    Quote from AJJKRN
    I think hypotension and bradycardia are on a bit of a different level than mild nausea or say drowsiness...
    Or an allergy to fentanyl because it causes "itching."

  • Feb 25

    One of my biggest pet peeves is documented “allergies” that are actually expected side effects. When clinicians try to order these medications it triggers a hard stop in the computer system. Then pharmacy has to call the ordering doc to clarify. It creates delays, extra work, and sometimes ends up with the patients not receiving the medications that would be most effective for them.

  • Feb 24

    1.5 inch needle is the longest recommended length even for larger adults. To say whether it was adequate in this case without seeing this patient’s body habitus is impossible. but if he’s only about 200lbs, you certainly can’t worry about someone questioning your practice for using a 1.5inch needle in this case.

  • Feb 24

    I'm so sorry for your loss. It is always difficult when a loved one dies, and even more so when they die unexpectedly in what is supposed to be a "safe" place. It's also normal to want answers. It sounds like your family members are trying to "let sleeping dogs lie" and not search for details surrounding your father-in-law's death. That is normal too. Both are methods of coping, and I encourage you to respect that, for now, your family members don't want to seek more information. While it may be therapeutic for you, the process may be quite traumatic for some of them at this point in their grief process. For you and those members of your family that feel like you would benefit from additional support, your family physician or the hospital's social work department may be able to provide referrals to a grief counselor. Also, if your employer offers an Employee Assistance program, you could take advantage of those benefits- they aren't only meant for job-related stresses.

    Generally, if they family has questions about a loved one's care, the next of kin would need to initiate a discussion with the primary physician caring for that loved one. Of course, this can be very difficult to do when the family is still reeling from the shock of the loss. If the questions aren't sufficiently answered by the physician, the family can request to speak to additional members of the care team, request a copy of the medical records, and involve an attorney if it feels warranted.

  • Feb 22

    Quote from sianee
    That's why I brought a vacation house somewhere else where I can have peace. I work in Florida and I just brought a vacation house in Rhode Island so I can get away from the tough job that I'm working.
    Quote from sianee
    I could quit my job, I have no other way to pay for my bills. My job does not approved a 1 month leave of absent. I asked for 3 weeks in the past, it was refused.
    Do you think the money you spent on the vacation house 1400 miles away could have been used to pay your bills so you could quit the job that doesn’t allow you to take vacation?

  • Feb 22

    I'm so sorry for your loss. It is always difficult when a loved one dies, and even more so when they die unexpectedly in what is supposed to be a "safe" place. It's also normal to want answers. It sounds like your family members are trying to "let sleeping dogs lie" and not search for details surrounding your father-in-law's death. That is normal too. Both are methods of coping, and I encourage you to respect that, for now, your family members don't want to seek more information. While it may be therapeutic for you, the process may be quite traumatic for some of them at this point in their grief process. For you and those members of your family that feel like you would benefit from additional support, your family physician or the hospital's social work department may be able to provide referrals to a grief counselor. Also, if your employer offers an Employee Assistance program, you could take advantage of those benefits- they aren't only meant for job-related stresses.

    Generally, if they family has questions about a loved one's care, the next of kin would need to initiate a discussion with the primary physician caring for that loved one. Of course, this can be very difficult to do when the family is still reeling from the shock of the loss. If the questions aren't sufficiently answered by the physician, the family can request to speak to additional members of the care team, request a copy of the medical records, and involve an attorney if it feels warranted.

  • Feb 22

    Depending on the structure of your curriculum, missing a semester may mean you end up an entire year behind, since some programs only offer certain classes in the fall, and those classes must be completed before you can move forward in the program.

    Have you discussed this with your nursing school Dean/advisor? Do you know what the expectations are for clinical attendance? If the birth of your child means that you miss even just 1-2 clinical days, will you still be allowed to continue in the program? Do they offer make-up days later in the semester for students with extenuating circumstances? Do you need to provide a note from your OB that you can return to school with no restrictions? If you have physical restrictions, will the school accommodate them during clinical rotations? Also, any plans you make to return to school immediately are tentative. Pregnancies are unpredictable. What if you need to be on bed rest? What if you end up having a cesarean section? You may end up missing more school time than you planned. Will the school allow you to withdraw from classes and re-enroll next semester/year, or will you have failures on your record? These are details that you need to discuss with the nursing school before you can make an informed decision.

  • Feb 22

    I'm so sorry for your loss. It is always difficult when a loved one dies, and even more so when they die unexpectedly in what is supposed to be a "safe" place. It's also normal to want answers. It sounds like your family members are trying to "let sleeping dogs lie" and not search for details surrounding your father-in-law's death. That is normal too. Both are methods of coping, and I encourage you to respect that, for now, your family members don't want to seek more information. While it may be therapeutic for you, the process may be quite traumatic for some of them at this point in their grief process. For you and those members of your family that feel like you would benefit from additional support, your family physician or the hospital's social work department may be able to provide referrals to a grief counselor. Also, if your employer offers an Employee Assistance program, you could take advantage of those benefits- they aren't only meant for job-related stresses.

    Generally, if they family has questions about a loved one's care, the next of kin would need to initiate a discussion with the primary physician caring for that loved one. Of course, this can be very difficult to do when the family is still reeling from the shock of the loss. If the questions aren't sufficiently answered by the physician, the family can request to speak to additional members of the care team, request a copy of the medical records, and involve an attorney if it feels warranted.

  • Feb 22

    One of my biggest pet peeves is documented “allergies” that are actually expected side effects. When clinicians try to order these medications it triggers a hard stop in the computer system. Then pharmacy has to call the ordering doc to clarify. It creates delays, extra work, and sometimes ends up with the patients not receiving the medications that would be most effective for them.

  • Feb 22

    Defibrillation does provide sort of an electrical reset for the heart. However, compressions do not restart it. The normal electrical activity of the cardiac pacemaker cells do that. The cardiac pacemaker cells are capable of spontaneously generating and sending out their own electrical impulses. During fibrillation, those cells are all firing at random, and therefore can't create a coordinated contraction of the myocardium. The electricity in the defibrillator interrupts that firing. The hope is that, once interrupted, the pacemaker cells will then start sending out coordinated signals, resulting in coordinated myocardial contractions and a return of normal rhythm.

    Compressions manually circulate blood while the heart is not pumping or not pumping effectively. Each second without cerebral perfusion increases the likelihood of neurological damage. Minimizing that down time is essential in improving resuscitation outcomes. Compressions are restarted immediately after defibrillation not to restart the heart, but in case the heart does not restart. The heart may have restarted on it's own after defibrillation, but delaying compressions in order to perform a rhythm check can be detrimental if spontaneous circulation has not returned.

    Does that help?

  • Feb 22

    LPN and RN are different degree programs. Yes, you can become and LPN and then enter an LPN to RN bridge program. This is a good option if: 1. You can’t afford an RN program or 2. Your GPA doesn’t qualify you for an RN program (which tend to be more competitive). But if your ultimate goal is to be an RN, it may be better to enter an RN program directly. You can either enter an associate’s degree (ADN) program (about two years long) or a four year baccalaureate (BSN) program. The BSN degree is preferred among major hospital systems and in some cases required for hire. You will be a more competitive applicant if you have a BSN degree. However these programs take longer to complete and cost more money

    LPNs have a narrower scope of practice than an RN. That means that while many of the skills and knowledge is the same, they can ultimately do less than an RN does. For example, in some places an LPN cannot administer IV medications without additional training/certification. For this reason, LPNs have been phased out of most hospital systems. They still can find employment in long term and skilled facilities and some clinics.


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