Latest Comments by NRSKarenRN

NRSKarenRN, BSN, RN Moderator 113,618 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,268 (22% Liked) Likes: 13,297

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    PA as statewide standing order for naloxone, can be obtained at any pharmacy without RX.

    PA Opioid Abuse Act 139 of 2014

    Governor Wolf stood with Physician General Dr. Rachel Levine at the Pennsylvania Medical Society as Dr. Levine signed a statewide standing order for naloxone, a medication that can reverse an overdose that is caused by an opioid drug. The governor was also joined by Secretary Ted Dallas, Secretary Gary Tennis, Secretary Karen Murphy, and Chairman Josh Shapiro.


    Drug supplied to police and EMS in SE PA. Since Act signed in fall 2014, price of drug at pharmacy increased.

    Those desiring med should check Good RX as has discount coupon.
    PA Prices and coupons for 2 syringes (1ml) of naloxone 0.4mg/m range from CVS: $20.18 to Walmart: $32.03 for SAME dose.

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    Devon Rex likes this.

    Never heard of Alderte score so searched for info on it: What is an Aldrete score?

    Glad to see there is an objective scoring system for when one can be safely discharged from a unit post anesthesia.

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    Shout out to the intensive care unit staff of CHA Cambridge Hospital for excellence in caring...thank you for caring for body and spirit. Karen

    Found at NY Times
    By PETER DeMARCO OCT. 6, 2016

    A Letter to the Doctors and Nurses Who Cared for My Wife

    After his 34-year-old wife suffered a devastating asthma attack and later died, the Boston writer Peter DeMarco wrote the following letter to the intensive care unit staff of CHA Cambridge Hospital who cared for her and helped him cope.

    ..On the final day, as we waited for Laura’s organ donor surgery, all I wanted was to be alone with her. But family and friends kept coming to say their goodbyes, and the clock ticked away. About 4 p.m., finally, everyone had gone, and I was emotionally and physically exhausted, in need of a nap. So I asked her nurses, Donna and Jen, if they could help me set up the recliner, which was so uncomfortable, but all I had, next to Laura again. They had a better idea.

    They asked me to leave the room for a moment, and when I returned, they had shifted Laura to the right side of her bed, leaving just enough room for me to crawl in with her one last time. I asked if they could give us one hour without a single interruption, and they nodded, closing the curtains and the doors, and shutting off the lights.

    I nestled my body against hers. She looked so beautiful, and I told her so, stroking her hair and face. Pulling her gown down slightly, I kissed her breasts, and laid my head on her chest, feeling it rise and fall with each breath, her heartbeat in my ear. It was our last tender moment as a husband and a wife, and it was more natural and pure and comforting than anything I’ve ever felt. And then I fell asleep.

    I will remember that last hour together for the rest of my life. It was a gift beyond gifts, and I have Donna and Jen to thank for it.

    Really, I have all of you to thank for it.
    With my eternal gratitude and love,
    Peter DeMarco

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    AJJKRN likes this.

    Ohio Bridal Shop That Closed Amid Ebola Scare Sues Hospital

    Remember when Amber Vinson RN contracted Ebola and her story was spread everywhere including that she had visited a bridal shop week before diagnosis? I remember that shop closed temporarily immediately after news hit... discovered later it went out of business as customers afraid to visit salon. So bridal salon suing hospital for failure to educate staff proper infection control. Karen

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    Not_A_Hat_Person likes this.

    Found at

    Mylan 'incorrectly' classified EpiPens, shortchanging government: Regulators

    ...CMS' comments came after a trio of U.S. senators wrote the Justice Department asking if it was considering an investigation of whether Mylan violated the law "when it apparently misclassified its EpiPen product for the purposes of the Medicaid Drug Rebate Program."

    "The facts laid out ... suggest that Mylan may have knowingly missclassified EpiPens, potentially in violation of the False Claims Act and other statutes," said the letter from Sens. Amy Klobuchar, D-Minn, Richard Blumenthal, D-Conn. and Charles Grassley, R-Iowa.

    Under the Medicaid rebate program, Mylan is paying Medicaid a rebate of 13 percent for every EpiPen it sells through that health-coverage program for primarily poor people, because the company has classified the device as a generic product.

    But CMS said Wednesday that Mylan should be paying, but isn't, a rebate rate of 23.1 percent for brand-name drugs, as well as an inflation rebate that is legally required when drugmakers raise the prices of brand-name drugs above the inflation rate....

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    WOW Mylan’s EpiPen had 3.6 million outpatient prescriptions written last year per article below.

    3,600,000 RX X $55.00 profit/unit per CEO = $198,000,000 profit.

    From Institute for Safe Medication Practices

    What price must we pay for safety? Excessive cost of EPINEPHrine auto-injectors leads to error-prone use of ampuls or vials and unprepared consumers

    Recent errors

    All of the recent events reported to ISMP involved administration of 1 mg of EPINEPHrine by the IV route after switching from EpiPens to EPINEPHrine ampuls and/or vials. For example, one hospital reported three errors in the past 6 months in which the entire contents of the 1 mg/mL vial of EPINEPHrine was administered IV, when 0.3 mg IM should have been administered. In another hospital, a patient who was experiencing an anaphylactic reaction to FERRLECIT (ferric gluconate) was also given EPINEPHrine 1 mg IV when the correct dose and route was 0.3 mg IM. The patient required admission to a critical care unit for close monitoring....

    ...Available EPINEPHrine auto-injectors

    Mylan’s EpiPen is the most frequently prescribed EPINEPHrine auto-injector, generating more than 3.6 million outpatient prescriptions last year.1 Several rival products joined the market only to fall by the wayside. EpiPen’s strongest competitor, Sanofi’s AUVI-Q, was removed from the market in October 2015 due to concerns about inaccurate delivery of the dose. A generic EPINEPHrine auto-injector by Impax (labeled as Lineage Therapeutics, which Impax acquired) generated less than 200,000 prescriptions last year,2 largely because prescribers are much more familiar with EpiPen. Also, the Impax product cannot be substituted as a therapeutic equivalent for EpiPen because the US Food and Drug Administration (FDA) has determined that there is insufficient data showing that the generic auto-injector is therapeutically equivalent. (The Impax product is not AB rated in the Orange Book.) The Impax auto-injector is not covered by some insurances, and purchasing groups have had difficulty negotiating contracts with the company. Thus, EpiPen essentially has a virtual monopoly on the market, contributing to ongoing price hikes over the years.

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    BeckyESRN, MrNurse(x2), and djh123 like this.

    Quote from MrNurseXY
    May be premature, but it could be "abdominal migraines". These kids can vomit 20 times daily. It is often seen as psychosomatic. Prescribing Imitrex is a way to rule it out. Anxiety is a common symptom.
    What is CVS? | CVSA
    Thank You... always learn something new reading the school nurses forum.

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    Percephone likes this.

    i've worked primarily with Geriatric clients in home health, many with Dementia. paternal grandfather placed in SNF 30 yrs ago when Alzheimers advanced and gransmother got sick and hospitalized. Just placed my father 2 weeks ago in Memory Care unit after 2 years decline, vistiing several hours every other day o get him adjusted. Observed and heard so many similar conversations. They have such patience with "Paul" who loves to pace one end of floor to other, trying all doorknobs then flinging himself on floor in hallway for 30 min refusing to get up.

    Yesterday Dad tapping watch at 12N telling me they didn't have any food for breakfast except for small round item (donut) and no food for lunch. "They left people alone in dining room and wouldn't give us more to eat". Can see staff setting up dining room for lunch. Passing aide in hallway she mentioned Dad now allowing her to bath him, got shower yesterday...and this morning had bacon, eggs toast AND donut "He eats everything I give him".

    I'm so grateful that there are chatty, attentive LPN's, aides and activity assistants who don't mind listening to the same story for 10th time in 30 minutes, can sooth the screamers and ensure nutrition with the picky eaters.


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    sevensonnets, Loracs72, and Kitiger like this.

    Cantor Tubes still exist...

    Still remember the night I dropped 10cc glass testube filled with mercury that shattered into tiny beads size of dippin-dots ice cream all over the nurses desk, rolling over the edge onto the floor underneath desk...took me 20 minutes with piece of cardboard to corral them into plastic urine container.

    You instill mercury into smaller tube which fills and weights down balloon end

    Heard it called a Miller Abbot tube too.

    [IMG] B3VwzVZ96Ul0idJy-PGlw[/IMG]

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    Augh, the good old days...

    Gomco Portable Gastric Drainage Aspirator
    Fiddled with these many times on night shift to get suction to work AND responsible for emptying them --no eyeshields to prevent splashing in the 1970's.


    Buretrol IV set is still used today, seen in pediatric units. See Buretrol Youtube video


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    sevensonnets and traumaRUs like this.

    I'd taken the day off from work to complete masters class paper, typing away from my dining room computer. Taking an eyebreak, checked email and saw news scroll on Comcast of 1st plane hitting tower. My husband was home so we quickly turned on Wpvi/abc TV and with disbelief saw the second plane hit the towers, saw people dangling or jumping from upper windows due to fireball and then slow motion building crumble. We were glued to the TV rest of the day.

    My cousin's wedding was scheduled for that weekend in Newport Beach RI. With the airports closed, several family/friends unable to attend. Leaving Philadelphia, PA we drove up I-95 on Friday amazed to see the black dusty skies from building collapse + still smoldering items remaining, Traffic was so light on NJ turnpike around NY and eerily quiet. As we drove home Sunday evening, still 2 spirals of smoke seen over NY city.

    Many prayer offered that week, and yearly thereafter.

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    twinmommy+2, BabyFood26, sirI, and 2 others like this.

    Turns out the reported "Nurse" in this famous LIFE WWII V-J picture was actually a dental assistant at the time! Karen


    Greta Friedman, the woman kissed by a sailor in the iconic picture taken in Times Square on V-J Day in 1945, has died, according to her son Joshua Friedman.Friedman told CNN that his mother died at an assisted living home in Richmond, Virginia. She was 92.

    The black-and-white photograph of Friedman, dressed in a white uniform, being embraced and kissed by a sailor to celebrate the end of World War II became an enduring image....

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    Kaci Hickox 's lawsuit will be allowed to proceed re false imprisonment and violation of privacy--- highly think she will win invasion of privacy portion of suit as media circus developed with public outside tent setup she was subjected to. Karen

    From Philadelphia Inquirer :
    September 8, 2016
    by The Associated Press

    Some of Ebola-quarantined nurse's lawsuit claims are tossed

    ...U.S. District Judge Kevin McNulty agreed with state lawyers that the Republican governor and state health officials are immune from the federal civil rights charges brought by nurse Kaci Hickox. But he ruled in a decision published last week that Hickox can proceed with parts of her lawsuit alleging false imprisonment and invasion of privacy....
    ... Hickox said one thing is certain: "This decision vindicates my rights by giving me the opportunity to find out from Governor Christie directly whether the decision to detain me was motivated by science or by politics," she said in a statement. "Christie was ultimately responsible for my detention, and he should have to answer for it and show it was made in good faith."...
    ...The judge wrote in his decision that "bad science and irrational fear often amplify the public's reaction to reports of infectious disease." He wrote that Ebola is a virus and not a "malevolent magic spell" but that the state should have some latitude in its efforts to contain it..