Latest Comments by Lev <3

Lev <3, BSN, RN 44,482 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,726 (53% Liked) Likes: 5,045

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    My state allows some school's brick and mortar programs but not their online programs. Every program needs to be approved individually.

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    I took it after about 1.5 years or so of ED experience.

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    Perhaps a risk for fall?

    Also this patient would need anticoagulation to prevent a future stroke. Think along those lines.

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    Without any background information regarding the patient's BP you can't answer the question. On NCLEX a question like this would have the BP.

    My first instinct was sedative as you thought for the reason you thought. Many times, stroke patients have highly elevated BPs (hypertension is a risk factor for stroke) which need treatment. If there is a brain bleed acutely you must get the BP under control STAT. In the ED, we treat BP aggressively for patients getting TPA to get the systolic BP under 180 and diastolic under 100. Other posters were correct in bringing up permissive hypertension. If the patient has a BP of 162/84, their home anti-hypertensives may be held.

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    Hi everyone,

    Thinking about NP yet again. The local program I was interested in switched over to a DNP.

    Anyone have experience with University of Cincinnati or University of Ohio online FNP?

    Is Vanderbilt really hard to get into?

    Also how does it work with some states now allowing certain online NP programs?

    My undergraduate GPA is just shy of 3.3 (could have done better, I know) but I took two NP classes as a non matriculated student locally and I got an A in advanced pharmacology and a B (got an 88%) in advanced pathophysiology. I know that I am smarter than my GPA.

    Does it pay to take the GREs?

    Thanks

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    Any time fluid is removed from the body, even if not taken directly from the bloodstream, there is risk of decreased BP.

    As another poster correctly stated, all that fluid in the abdomen (4, 5 + liters) is providing pressure against the abdominal vasculature. What do you know about causes of hypertension? Whenever there is decreased compliance of a vessel, the pressure inside the vessel increases. When all that fluid is drained, sometimes rather rapidly, the vessels can now expand fully and dilate to their regular capacity. Now the blood has more room to flow and therefore there is decreased pressure in the vessels.

    However, fluid in the abdomen (depending on volume and size of the patient) can increase intrathoracic pressure which can decrease blood pressure (especially in patients who are dehydrated) because the increased pressure reduces preload and afterload and impairs cardiac output. You will see this with patients on BIPAP too. So I guess things balance themselves out at times.

    The other point to bring up is that of fluid shifting. The fluid shifting effect is more of a factor when large volumes of fluids 5+ liters are removed and especially in patients with cirrhosis. In this case, infusion of a volume expander such as albumin may be indicated.

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    Precedex doesn't work on all patients. Also to avoid the hypotension/bradycardia, titrate slowly.

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    Reglan too fast can cause severe anxiety. I routine mix in minibag.

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    KeeperMom likes this.

    huddle at every shift - 630, 1030, 1430, 1830

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    OrganizedChaos likes this.

    we do the hand face test or if really mean a whiff of ammonia

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    Days but weekend option? Better parking, no management

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    R8T3D_RN likes this.

    IMHO, you should have started nicardipine first if you were only starting one. The goal is to control BP which is what nicardipine is best at.

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    I have seen the combo for dissection, but the deal was give bolus of esmolol and start esmolol drip if the HR starts going up from the nicardipine.

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    OrganizedChaos likes this.

    Yes, a dying person can have some or all normal vital signs. There is no 100% fool proof way to predict when death will occur
    . Some go in a matter of hours and some linger on for days.I'm sorry for your loss. -spoken as an ER nurse who recently was a hospice nurse for an ER patient.

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    Do you type or write out notes? I have discovered that writing notes in class vs typing on the laptop helps me considerably.


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