Content That MAtoBSN Likes

Content That MAtoBSN Likes

MAtoBSN 2,996 Views

Joined Apr 14, '11 - from 'PA'. MAtoBSN is a N Supervisor - SNF/Rehab/LTC. She has '15' year(s) of experience and specializes in 'SNF/Rehab. Pediatrics. OBGYN.'. Posts: 94 (22% Liked) Likes: 39

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  • Apr 2

    First, apologies for invoking the words of Dr. Phil, but sometimes he says things that make sense - and yes, I am aware that even a stopped clock is right twice a day. I may need to borrow Farawyn's bag.


    OP, you can't change what you don't acknowledge.

    You need to take an objective look at this and your previous threads and read them as though someone else wrote them. Do you see the drama, self entitled attitude, and many errors in judgement they contain?

    I see no jealously from your supervisor, and to suggest she is jealous of you is such a cop out you use to not take responsibility for *your* actions.

    You need to be brutally honest with yourself and make some major attitude (and behavioral) changes.

  • Mar 30

    Quote from CCL RN
    You don't do "caths by yourself" and you don't "stand in one place for hours"
    Good Lord, that was obviously an exaggeration. I meant that she is actually doing the insertions, not just getting supplies, circulating, etc.

  • Mar 30

    3 PVCs in a row is Vtach. It really depends on the patient scenario. Is this patient throwing a lot of PVCs and then has a 3 beat run of vtach? Is this new onset? Was the patient symptomatic? It's always better to be safe than sorry and notify. However, most physicians will not get excited unless it is more than 5-6 beats which is enough for a patient to lose consciousness.

  • Mar 30

    A blocked, or non-conducted PAC is what the name implies... A premature atrial beat that is not conducted to the ventricles; P wave but no QRS. The key is the fact that it is early. So take your calipers and measure out the P-P interval then measure form the last normal p wave and look where the calipers land. Does the non conducted P wave come sooner than where your calipers land? If so then it is a blocked PAC. They commonly are buried in the preceding T wave so look closely for changes in T wave moroplogy. There may be an extra hump or taller peak. Now with Second degree type 2 there is not a premature beat, there is an intermittent failure of conduction to the ventricles. So same as before take your calipers, get the P-P and measure out from the last normal P. Is there a non conducted P wave exactly where your calipers land? That is second degree hesrt block. Slide your calipers from that non conducted P wave and they should land exactly on another P wave, this time with an associated QRS. This is what people refer to as "marching out". With a second degree type 1 (Wenckeback) there is no marching out of p waves. Each consecutive PR Interval increases until there is a non conducted p wave. Longer, longer, dropped then the cycle repeats. So fixed PRI for the beats preceding a dropped best is not Wenckeback, most likely a PAC or 2nd degree type 2. Hope that helps, I typed this on my IPad so sorry for the format and typos

  • Mar 30

    When cardiac muscle suffers ischemic injury, various enzymes are released that can be detected through bloodwork. The problem is that the serum levels of these enzymes don't rise immediately, depending on the specific enzyme it can take as much as 24 hours after the ischemic event for the rise in that enzyme level to reach a diagnostic threshold.

    Even when using the enzyme that is the most sensitive and has the shortest duration to a peak, Troponin I, it still takes 2-3 hours for about 80% of patients who have had an MI to show a positive Troponin I result, and generally someone can't be considered "ruled out" by troponins until at least 6 hours has passed since the onset of symptoms.

  • Mar 30

    If you are actually choosing leads, you are already ahead of a lot of telemetry nurses. Many couldn't monitor v6 if asked. Many believe there is a "V Lead", and it sits in the middle of the chest. (Same applies to ER, and less frequently, ICU.)

    Most nurses don't even know the difference between a lead and an electrode. This confusion is actually furthered by the AACN literature, as well as anything else that refers to a "5 lead system", or a "3 lead system".

    A lead is a view of the heart. It looks at the electrical pathway from a particular direction of travel.

    There are 12 leads commonly used to monitor the heart. There are a bunch of other leads occasionally used, including v4r, v7-9.

    Most of us use a 5 electrode system, sometimes called a 5 lead system. At any given time, the "5 lead" system can display any of 7 leads. I, II, III, AVL, AVF, AVR, and a choice of v leads.

    As a nurse, you can choose which v lead the machine will be monitoring by choosing the placement of the precordial (brown) electrode. You can then choose any of 7 leads for the machine to display. Often, you can choose for the machine to display 2 leads at once.

    Most nurses don't really care which lead are monitored or displayed. The overwhelming majority of the time, any lead shows us what we want to know: too fast, too slow, or not beating. But, when you r monitor alarms V-tach, it sure would be nice to know that the patient has a rate dependent bundle branch block. Or, if you knew your patient had had an event resulting in some ischemia to the lateral wall of the heart, you might really want to watch v6 for elevation.

    It cool stuff to know, and fun to learn. I am not an expert b any means, but I enjoy studying the stuff, and periodically pick up on an important change in patient condition.

  • Mar 30

    Half of the meds are unnecessary and are likely making the prescribing doc some money from the pharma company. The laws regarding ltc patient ratios clearly show that the government doesnt give a flying chuck about safety.

  • May 28 '15

    Eris- I don't have a lot of advice for you as in my 42 years on this earth, I've never written a thank you note to a place I have interviewed. I just wanted to reply and let you know I would hire you, you're well spoken (or written, as it were) and obviously have a great head on your shoulders. Your coming here and looking for the best advice possible (and the fact that you look for guidance from those around you) shows me you're responsible and eager. Good luck to you, I think you have good instincts.

  • May 28 '15

    While the facility may be open 24/7, HR typically is NOT! They are open during "business hours" and closed on major holidays (and likely are given Black Friday off as well). Also, remember that HR deals with more than just hiring nurses. They are responsible for taking care of staff health benefits, resolving staff complaints, dealing with difficult situations (firing personnel), etc. While it would be nice to hear back from HR the day after an interview (or the national holiday), it often takes at least a few days, if not a week (or more) to verify your license, check your references, call previous employers if necessary, etc. Once all this is done then they will call you to notify you where to go for a live scan (or whatever background check they use), etc. Don't be nervous at this point that the interview went worse than you thought! It is not worth the added stress! When HR DOES contact you, feel free to ask your question about scrubs then. Some psych facilities wear scrubs, some do not and will wear khaki pants/black slacks and a polo shirt or blouse, etc. It really depends on the facility.

    Good luck in your (likely) new position!

  • May 28 '15

    Quote from klone
    I have never sent thank-yous to HR. That's their job. That said, if you really want to, I would do it via email.
    This.

    Phone interviews are usually pre-screening for whether they are going to proceed to an in person interview.

    I experienced phone interviews and had no follow up interviews occur.

    I save my thank-you's until the entire interview process is complete.

  • May 21 '15

    I didn't say it was. I know I was in the wrong.

  • May 21 '15

    Quote from samirish
    Cost of living is so relevant that until I know what part of the country someone lives in, knowing how much they make doesn't really mean anything.

    Example: I live in Illinois, (not Chicago)here a good burger is going to cost about $12.
    In California where my cousin lives, a good burger costs $29.

    Same burger, same setting, but different part of the country.
    *** $29! That must be up north someplace. I was in San Diego in August and had the best burger in my life for $5 at a little road side stand just off I 15 a few miles south of Temecula.

  • May 21 '15

    Quote from PMFB-RN
    *** $29! That must be up north someplace. I was in San Diego in August and had the best burger in my life for $5 at a little road side stand just off I 15 a few miles south of Temecula.
    You went to Nessy Burger! Yes, their burgers are legendary.

  • May 21 '15

    Traveler!
    >50.00/hr. Extra shifts...
    Work 9 months (just 3 contracts) take 3months off for myself.

    More than doubled my income and increased my vacation time by a factor of 5.

  • May 21 '15

    It's a preliminary interview...once you go on and schedule the first interview that includes the unit remain patient and if they don't back to you within the next week, give them a call.

    Best wishes.


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