musingmom 3,111 Views
Joined: Jun 21, '12;
Posts: 80 (56% Liked)
; Likes: 196
So is anyone trying to incorporate the new recommendations and definitions into their current sepsis protocols? If so, how are you reconciling the CME core measure reporting requirements that are based on the outdated info?
I gave this last week: 60 mg of solumedrol was the order, and the Pyxis gave me 2 vials of 40mgs in 1 ml. If I call the pharmacist, she will tell me how many mls to give, but since I am ultimately responsible for what the patient actually gets, I should know how to do it myself.
We typically get an order such as Fentanyl gtt, titrate to CPOT of 1. I have seen target scores from 0 to 2, depending on the patient and circumstances. It's almost always paired with sedation, for which we use a different scale.
The other option not already discussed here is the entry level masters. If you are sure advanced practice is where you want to end up, check it out in your state. There will be those that say you need bedside experience before you move to advanced practice and those who will say that primary care is nothing like the bedside, so it's not necessary. People feel strongly on both sides. I have a previous BA and that's the route I took, although after the prelicensure portion (which is the equivalent of a 15 month accelerated bsn) I took a job as a bedside nurse and am finishing the Masters part-time. I will have 3 years of bedside experience by the time I graduate. Part of my dilemma is I am seriously considering an acute care np path, and bedside experience is very useful for that.
The entry level masters programs have pretty good reputations here, and mine required a 240 hour preceptorship before finishing the prelicensure portion. I was a very competitive new grad candidate.
The other thing I would suggest in your decision making process is to check the NCLEX pass rates for the programs you are considering. That may help narrow it down for you.
Three times in the last year I have dreamt that I was getting a central line, in my ICU, by one of the fellows. Three times. Always in the RIJ. I'm 11 months into my new grad year. Please, no more central lines.
At the risk of generalizing a people group and some specialties:
I have several friends with asbergers. Their attention to detail and ability to make critical thinking connections without bias would make them excellent nurses in critical care and/or OR. I'd want them to be my nurse over the warm fuzzies with excellent people skills. But they are all engineers.
When asked why the unit was hiring, the interviewer said that recently the entire night shift quit all at once.
I can't find any info on the prevalence of immune compromised children in schools, nor can I determine your exact definition of "immune compromised." Your link does not shed light on any of that, nor does it even mention the exposure of immune compromised children to unvaccinated children... in fact your link confirms that many times, when most vulnerable, immune compromised children must stay home. Which is what I said. It also confirms that immune compromised children are just as at risk with the common flu, as with a disease that has a vaccine, as either could be very problematic for them. Which is what I said.
Here is the CDC's info on the CA measles outbreak: Measles | Cases and Outbreaks | CDC. I hope you'll forgive me if I don't take the Today Show's word for anything. The CDC says the outbreak originated with a traveler from the Philippines, though they never found that individual. The link gives the reasons why they made that determination. The outbreak then spread through unvaccinated individuals, both children and adults. The number of cases linked to Disneyland was actually far less than cases in 2014, linked to the Amish in Ohio. But even the 2014 outbreak was linked to the Philippines. Of course, "Disneyland measles" is far more sensational than "Amish measles," I guess, which is why it received more news coverage. And legislation.
At any rate, I'm done with this, I've made my point. I AGREE that vaccinations are important and safe, and high rates protect those who cannot be vaccinated. I really dislike the rhetoric that comes with all the schools must be fully vaccinated and it's all those unvaccinated children's fault, because it is inaccurate and weakens the case for vaccination.
Last shift: I got called to a (intact motor function) patient's room because he wanted me to fix the temperature. Ok, that's plausible, often in order to get the wall thermostat to work we have to call engineering. I asked if he felt the room was too cold, or too warm. He said too warm. Well the thermostat was already on the lowest setting, and it was cool in the room (to me), so I suggested that maybe he would like to take some of the 7 blankets off of himself, you know, to cool down.
He replied, "Well, what if I get cold?"
I said, "Uh, cover yourself back up?"
He said, "Is that ok to do on my own?"
Yes. Yes it is.
Musingmom are you trying to tell us there are no school children undergoing chemotherapy, have HIV/AIDS or other immune compromising conditions in all of California.?
Outbreak Clusters Appear Among the Unvaccinated
Earlier this year, researchers confirmed that a 2010 whooping cough outbreak in California, the nation's worst in over 50 years, was spread by children whose parents applied for non-medical exemptions to school vaccination requirements, many for religious reasons. Anti-Vaccination Movement Causes a Deadly Year in the U.S.
This is only one incidence where unvaccinated school children were spreading vaccine preventable disease. It happens all the time.
"This is just saying that if your child is going to go to public school, they can't put other kids at risk."
(Sorry I don't know how to use the quote feature that shows the author on my phone.)
I don't like this rationale. Before I go on, my kids are fully vaccinated, and I think vaccines are safe, and to not vaccinate only means you are choosing the risk of the disease, over the risk of the vaccine. But, NOT vaccinating does not put others at risk -at school-... There are no immune compromised kids at school, because their risk is just as great to the flu as to measles, meaning either could be really bad for them. And, there are no babies under 1, the other risk group I hear cited.
Now, if you want to talk about herd immunity, and vaccination rates commensurate with effective herd immunity, then I get you. But using school milestones is just a convenient way to enforce vaccination. As far as I know, people who got measles in the recent outbreak who had confirmed vaccination histories all had not been vaccinated. If you are vaccinated, you are not going to get it. School children who are vaccinated do not get diseases from school children who are not vaccinated. If someone has different info, I'd be glad to look at it.
And I don't like it. If we legislate the stupid out of people... How long before someone else's stupid is something I don't want to do?
However, I don't have a better solution either. In Southern California, my demographic, there are still a lot of people with bad information, or who refuse to make a decision just in case (which is choosing the disease imho), or are just lazy (they exist, I know them) and this will get those people vaccinating.
In the debate over this law, the "crazy" was too loud, and the parental rights folks didn't get a word in edgewise. I.
I was an EMT before becoming a nurse. The EMS standard for an out of hospital birth is largely to DO NOTHING. Make sure baby is breathing and keep it warm, preferably on mom's skin. Otherwise, don't touch anything. Transport. Turns out, nature pretty much has the process perfected.
My school had a maximum number of units you could have "in progress" in order to be accepted. So, you need to contact the school and ask if you need the required units at the time of application, or if you only have to have them by the time you start.
I did nursing school with a newborn. It is definitely doable, with a lot of support and organization. I agree with a lot of the previous posters, so I won't repeat what they've said about the newborn period. Here's a few other things to consider:
You will need more support than just your husband. Do you have lots of supportive family around? What will be your child care plan? Most day cares won't take an infant under 6 weeks. Do you have resources for in home care? You might be able to take a sleepy newborn to lecture, but definitely not lab. (My husband took 8 weeks off to care for our baby while I was in school, and after that my sister watched her.)
The other thing I would point out, is that this is your first baby, so it's hard to know how things will go. When I had a baby during school, it was my fifth. I have pretty easy babies: they sleep and eat well and generally aren't colicky. If the newest baby didn't sleep or had colic, it would have been much harder to get through.
I will say that if you can do it, it would be ideal, get through those classes during the newborn phase, and the baby will be a year old by the time you start nursing school. But if it doesn't work out, I have no doubt based on your posts that you will get it done eventually!
Best wishes and congratulations,
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