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I want to understand clearance better.
I have a patient who always clears >2.0 on the machine for every tx, but when we draw monthly labs, he always come is below 1.2.
Very compliant (phos, ca, fluid gains etc show compliance), never misses tx. Has a fistula >2yrs.
Ps, we have tried different machines so we know it's not a machine error, and different people draw his labs so it's not user error.
What could the cause be?
Still new to HD, so I hope the question makes sense
LovelyRN757, I will be starting with the patho and such coming up in May. Thanks
Is the Admitted Nursing@Simmons FB group still active? I can't find it on the search. I start with the May 2017 Cohort
I start in September too. If you get accepted and decide to attend Simmons in September, join our Facebook group Nursing@Simmons September 2017 Cohort. They also have a Facebook group for all admitted students. I believe it's called Admitted Nursing@Simmons. Goodluck to you.
Thank you for your post and for reminding us that every professional has to start somewhere just like we all once did. It is always so strange to me when nurses are rude or mean to doctors who are asking questions regarding their patients' day and care.
Reminds me of a related problem I have run into at my job.
Most (95%) of our patients have the same doctor who also happens to be our medical director. He will come in at 4am, do his rounds and then write his progress notes. I promise the guy will walk into a dark room, barely place a stethoscope on the patient and do this for all his patients before sitting down to write very detailed notes about the patient's assessment. There is a running joke that he doesn't even put his 'ears' in his ears when he auscultates. We are always complaining that he doesn't really perform assessments, never washes his hands between patients, never gowns up for isolation rooms, and never wipes down his scope between patients. All the nurses complain about him.
Then, there is this other MD. He is neuro and he is the most thorough person I have ever met. He will spend 30 minutes in a room doing a full body assessment including DTRs and everything. He talks to his patients and family, explains everything. Spend tons of time looking over the patients' charts, labs, consults, nursing notes, vitals, I&Os. Everything! He knows his patients in and out. He spends time locating the nurses and asking about progress, concerns, reactions...everything. He always always suits up fully depending on isolation status, down to booties and hair nets. He is always responsive to the nurses' suggestions and if not, he takes the time to explain fully while something may be contraindicated.
You know what, nurses on the unit talk more smack about this MD than anyone else. They complain he spends too much time with their patient, he asks too many questions etc. They hide from him so they don't have to report on their patient, they snap at him if he asks them something. And some are just down right mean to him.
It seems there is no pleasing us. We always find something to complain about.
If you were planning on getting a MSN anyways, I say go for it. The time will pass anyways and you may as well use the time to acquire a degree that you intend to get anyways.
Going back to school and looking for a job are not mutually exclusive. You can continue to look for a job while attending school (until you start preceptorships).
Congrats on your soon to be addition to the family.
Find LTAC Hospitals - Altha.org
Not the most up to date info, but it is a start. Good luck
#1 Every time I see those guys on the travel channel that get paid to travel the world and document it, I know,, that's what I would rather be doing than anything else. I guess that's whimsical coz it will never happen.
#2 Which I am really, seriously, but not too carefully considering. Save up a bunch of $ by doing double for a year then give it all up and go to some remote beach locale and open up a bar with some food bar offerings. And maybe a small guest house/hostel.
I could invite all my fellow stressed out AN members to visit for a week and decompress.
Whenever I have worked LTC, we had several hospice patients.
The hospice nurse was not responsible for any of the daily pt needs like assessment, medication administration, wound care etc. Those are all the responsibility of the ltc nurse and the hospice pt is treated exactly like the regular pt including calling their MD for orders and change in condition.
The hospice nurse did bi-weekly visits to each pt but if they had a bunch of patients in the same ltc, you would pretty much see them daily even though they were not necessarily there to see your pt. They did their own assessment, spoke with the pt about concerns, were very involved in decisions about pain management and would usually write pain med/anxiety med orders on the charts.
If the pt's pain isn't managed, we (the facility nurses) would call the hospice nurse and she would either come in and reassess, or just change med orders over the phone.
One of the most important functions of the hospice nurse in ltc is just sitting and visiting with the pt. The pt's were more likely to share their complaints with the hospice nurse than the floor nurse who was always busy. And finally, being a go between with the pt's family. I can say I really appreciated the information and education offered to the family by hospice nurses. If I had a family member I felt needed intervention, the hospice nurse was always able to talk things over with them and clear the air.
If the hospice pt was turning bad, we always called the hospice nurse and she would (depending on how dire the situation was) send a sitter to be with the pt and family in the final moments, and if she wasn't busy attending to another terminal pt, she would also come sit with the family and if needed change roxanol/ativan orders prn. The hospice nurse would also come to the facilty to pronounce and do the final paperwork with the family and funeral home reps.
To summarize, HOSPICE NURSES ROCK!!
Please forgive me as I have never worked in a place such as you describe, but your post made me laugh!
I am sure to you and to those in the middle of dealing with the issue it is a serious issue.
Have you thought about having a security guard to maintain order in the clinic when you are open, and in the parking lot and by the door when you are out to lunch?
I did my community health practicum at the local city clinic and they had a guard in the clinic enforcing such rules as no talking on cell phones, everyone must wait in the designated area etc. Maybe if the problem is considered bad/annoying enough by the people with the money, they will be willing to part with some of it to provide a guard.
Why was his blood sugar low? Was he too zonked and did not get to eat his meal? Did anyone follow up with the lack of meal intake? Maybe then the sedation could have been caught before RRT was necessary.
Like others already said, just because you are on the patch doesn't mean you can't get IV fentanyl.
This seems like a teacheable moment for all involved. The MD could probably have more closely considered the renal issue. The nurse that gave it could have considered other prn orders before giving the IV fentanyl. Closer meal intake monitoring and follow up is probably called for. And,,, if the nurse was looking for the PCA to get the blood glucose level because that was the only machine available, then maybe there is a lack of supplies issue (that would be a shock right??)
Then again, I could be completely wrong.
When I was about 5 months pregnant, I worked 1st shift at the nursing home. I must have forgotten to hydrate coz I was leaning on my medcart infront of a resident's room getting ready to pull their meds.
All of a sudden, I start seeing stars, try to lean back on the wall but ended up going forward into the cart, which the wheels were unlocked. I ended up head/face first on the cart then the floor and my medcart ended up on the other side of the hall.
The poor resident who had witnessed the whole thing started yelling for help and I woke up with my coworkers and several residents looking down at me.
Lesson learned::::Always keep hydrated.
You did the right thing by getting EKG and continuing to monitor.
In this case, also report to the charge nurse and they will advice further based on their experience and unit protocol.
Most importantly, once the monitor tech has notified you (and the charge nurse) of the changes, she should not be talking to other nurses or non-nurses about your patient and her opinion of what you are doing/not doing.
PS..all units I have ever worked at have a protocol for all these things. Like what labs you would want to draw etc..
"What stressed me out was I had to take care of pts and monitor tech started to stress me out by keep talking to other nurses and then I had to explain it to them the situation or none-nurse staffs and what I got from them is "I am not doctor." I am new grad, it already stressful enough to take care of patients with these situation as I am scared they will go unstable, yet dealing with others and their questioning make me second guess myself and become doubting myself. "
FYI: Most places have printed on the occurance form that the form is NOT to be copied. Do NOT indicate to ANYONE that you made a copy of the form for yourself as the copies would be "discoverable" if the family/ resident should sue over this incident. Not sure but copying the form might also get you into trouble for violating facility policies. This type of situation is truly a "no win" for the nurse involved.
Walden currently allows students to enroll in the FNP specialization in the following states: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. Check back often as more states will soon be added to this list.
For assistance in deciding which online degree specialization fits your goals, request information or speak with an enrollment advisor by calling 1-866-492-5336. A list of international toll-free phone numbers is available for students outside the United States.
Note on Certification
The MSN nurse practitioner specializations are designed to prepare graduates to qualify to sit for national nurse practitioner certification exams, which are required for practice as a nurse practitioner in most states. Because no graduate program can guarantee that graduates will be permitted to practice as a nurse practitioner upon graduation, we encourage students to consult the appropriate Board of Nursing or state agency to determine specific certification exam requirements. Walden enrollment advisors can provide information relating to national certification exams; however, it remains the individual's responsibility to understand, evaluate, and comply with all requirements relating to national certification exams for the state in which he or she intends to practice as requirements vary widely. Walden makes no representations or guarantee that completion of Walden coursework or programs will permit an individual to obtain national certification. For more information about nurse practitioner certification exams, students should visit the American Academy of Nurse Practitioners at www.aanpcertification.org, the American Nurses Credentialing Center at www.nursecredentialing.org, or other nurse practitioner certification exam websites.
(copied from Walden's website on 9/24/2012)
I found this article pretty interesting, and the comments after the article even more interesting.
What do you guys think about banning stuff like pb&j due to food allergies, and how does your school (or your kid's school) handle this issue?
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