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camarogirl512 980 Views

Joined: Apr 29, '11; Posts: 25 (48% Liked) ; Likes: 28

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  • Oct 2 '11

    Stop TPN, flush and clamp lumen
    Flush 2nd lumen with 10ml
    Waste 10ml
    Draw labs
    Flush again with 10ml
    Unclamp and resume TPN

  • Jun 2 '11

    hi ORnurse,

    once a student asked this question (2006) and VickyRN gave this response: i thought is so very helpful!

    Tonicity refers to the solute concentration of a solution outside a cell and its effect on cellular fluid volume. The osmolarity of the solution determines the direction of water flow into or out of the cell. In normal body situations, solute concentration within and outside of the cell is usually nearly the same (isotonic).

    Isotonic: same osmolarity as the cells (270 - 300 mmol/L). Equal solute and water--exact same number of particles in both solutions--no net movement of water. Does not change cell volume.

    Higher solute concentration surrounding cells pulls water out of the cells. Hypertonic: higher osmolarity than cells (> 300 mmol/L). Greater solute, less water--water moves out of cells. The cell will shrink.

    Lower solute concentration surrounding cells causes water to move into the cells. Hypotonic: lower osmolarity than cells (< 270 mmol/L). Less solute, more water--water moves into cells. The cell will swell.

    Isotonicity. If the concentrations of electrolytes are the same in the cell and surrounding fluid, the situation is balanced (homeostatic). The cell fluid volume remains the same.

    Hypertonicity: The cell will shrink (crenation) by loss of its fluid to the surrounding hypertonic environment. High osmotic pressure of surrounding fluid pulls fluid out of the cell.

    Hypotonicity. In a hypotonic environment, fluid will enter a cell and cause it to swell and burst. The inside of the cell has higher osmotic pressure than the surrounding fluid, so fluid is drawn into the cell.

    Both hypertonicity and hypotonicity in the extracellular fluids will destroy cells.

    Need isotonicity for cell homeostasis, for balance.

    ½ NS IV is hypotonic relative to cells. Fluid moves from the vascular space into the cells. When a liter of ½ NS is administered intravenously, it will go into the cells and very little will remain in the blood vessel (since it is hypotonic).

    If you put two isotonic solutions side by side, no fluid shift occurs. A liter of normal saline or Ringer's lactate is limited to the extracellular space and will expand the blood volume.

    5% Dextrose in NS is hypertonic compared to cells; pulls water into the vascular space from the cells or interstitium.

  • May 30 '11

    aw, sweetie, just go in there and focus on the tasks at hand, one minute at a time. the minutes will add up to hours and you'll be outta there. then the hours will add up and the days will pass. ::looking around for a hugs!! smilie::

    promise yourself that you will make a time for crying. i used to look at my calendar and say, "thursday, 2pm, that looks good," and giving myself that to look forward to made it possible for me to get there intact. then on thursday at 2pm i would close my door, put on a weepy movie or think the saddest things i could think of, make myself start to weep, and cry til i thought my heart would break. and then wipe my eyes, laugh a little bit, and go for a walk. done.

    it's often a good idea to pull open the door of that dark closet where we put all the stuff we don't want to think about because it hurts too much. like mushrooms, though, those things grow well in the dark. they really can't hurt us if we pull them out in the sunshine, and if that removes some of their power over us, so much the better. plus they're smaller when you're done really looking at them, and they don't push on the door trying to get out so hard. plan a time for it and you control it, and it loses its power over you. this will pass, really. take care of yourself.

  • May 6 '11

    haha no! I applied to every facility in a 50 mile radius!

  • May 6 '11

    Just the other day I had a confused little lady call me "doctor." When I said to her, no honey, I am not the doctor, I am your nurse. Her granddaughter said "don't she wish she was a doctor?" I spoke up immediately and said, Actually, no I do not wish I was a doctor. Had I wanted to be one, I would have applied to medical school. I love being a nurse and would never want to be a doctor. You should have seen all eyes in that room on me, lol.

  • May 5 '11

    Your last sentence says it all. You need the job. Don't be concerned with his poor example. Soon enough you can pay more attention to your own work and your own standards. Don't let him drag you down or run you off.

  • May 4 '11

    Hello! One of my favorite (and not expensive) gifts to give other nurses would have to be nice pens. Most nurses love a good pen (it is amazing how quickly a pen can disappear, and how annoyed you will be when it is your good pen that has vanished). I recently found a pen that came with stickers and "backgrounds" so that it can be personalized. Also, some nurses (like myself) love using highlighters on report sheets. If your preceptor likes using them, a good set might also be a good idea. You could also spring for pens for the other nurses as well. Good luck!!!

  • May 4 '11

    Take three days off and relax. You owe it to yourself. Then come back and follow your plan to take it again. You will pass as long as you do not give up. Others have done it with multiple attempts, and so can you. Good luck.

  • May 4 '11

    Report the stick. "I didn't think about it at the time, but..." Should you be worried? Statistically, no. I'm an old hospital-trained phlebotomist, and my only stick, in (now) 20 years, involed a safety device. (sarcastic eye-roll)

    Develop a sharps handling regimen from which you do not deviate.

    For me this means (**do as your institution mandates/I do not offer legal advice/I am not condoning unsafe practices/etc./etc**) recapping with a 1 hand scoop, the off hand being tucked to my chest or behind me. Transport the capped sharp to the HazBox holding my arm firmly across my chest, needle-tip pointed parallel to a line from my sternum to Lt shoulder (if someone bumps into you, the sharp is caught between your bodies and natural flexion draws your arm, not the sharp, towards you). When carrying a scalpel or similar item, I carry it parallel to my forearm at waist level, point to the rear, or across my body as with a needle, depending on the environment.

    All of the above applies to clean or dirty, covered, sharps. I honestly cannot think of a time when it is necessary to transport and uncapped/sheathed sharp.

    I'm assuming your stick was related to loading the lancing device? If so, (in the future) stop, discard the sharp and your gloves, wash your hands, then start again. You can simply say you touched the lancet, "oh, shoot, I touched it..." Take it in stride, and you'll be safe, and maintain the stunning aura of competence we all strive to maintain.

  • May 4 '11

    For anyone wanting to learn another language: I'm learning Spanish at the moment. I love learning new things so I'm loving it. But it's hard. I'm relatively old, so I have a brain that is perhaps a little more resistant; I can tell you that it feels like it's solid cement up there when I'm trying to speak the simple phrases we're learning. Nevertheless, I still believe that it's possible.

    The books I'm using are:
    Basic Spanish by Ana Jarvis, along with Basic Spanish for Medical Personnel. The reviews on Amazon aren't great but most of the bad reviews were remarking on the cost and let's face it, text books are expensive. I think the books are just fine for beginning.

    To understand what is required to learn a new language (and to perhaps inspire any older students) there is a great little book out there called The Word Brain. You can print the PDF or read it online. The author taught himself to speak Arabic at 50, so he is an inspiration to me. He tells you how to learn another language and how much work it will entail. He speaks English and many other languages beside Arabic. If (big if?) you have the discipline, you can teach yourself.

    For Spanish, I've found some great online resources:
    News in Slow Spanish
    BBC Spanish

    Unfortunately, the News in Slow Spanish and BBC Spanish teach the Spanish spoken in Spain, which is slightly different from the Spanish spoken over on this side of the pond. News in Slow Spanish has a Latin America link on every episode and there are also links to two audio books in slow (Latin American) Spanish, which sound great. You need a pretty good vocabulary to understand News in Slow Spanish; it's not for the rank beginner.

    The BBC Spanish beginner's website has a fun interactive murder mystery.

    I'm also going to use the text-to-speech (TTS) software from NextUp called TextAloud to create audio drill sets (think audio flash cards) to build my vocabulary and teach my brain to recognize spoken Spanish. I'm pretty serious about learning Spanish. I'm dreaming about visiting some Spanish speaking locales... But I do hope this will make me more desirable as an employee.

    ¡Buena suerte!
    (Good luck!)

  • May 4 '11

    Quote from hotflashion
    News in Slow Spanish

    Unfortunately, the News in Slow Spanish and BBC Spanish teach the Spanish spoken in Spain, which is slightly different from the Spanish spoken over on this side of the pond. News in Slow Spanish has a Latin America link on every episode and there are also links to two audio books in slow (Latin American) Spanish, which sound great. You need a pretty good vocabulary to understand News in Slow Spanish; it's not for the rank beginner.
    Muchas gracias! Yo tambien aprendiendo español porque vivo cerca de el sur. Yo tengo uno o dos pacientes que solo habla español todos las semañas. Cuando yo moví aqui, no pasó mucho tiempo hasta yo sé que necesito hablar español (2 years ago).

    Thank you very much! I'm also learning Spanish because I live in the south. I have one or two patients that only speak Spanish every week. When I moved here two years ago, it was obvious very quickly that I would need to learn Spanish to communicate effectively with my patients.

    I've come along way in two years and although I'm not fluent, I know enough to be able to address basic needs as well as a basic assessment.

    That News in Slow Spanish site is AMAZING. I understand quite a bit but most people talk too fast for me to process, this looks like a great tool to bridge my listening fluency.