mandana

I never kept one until I found myself in a situation where I needed one desperately to help someone and didn't have one! Now I keep a commercial first aid kit (just the basics) but I added lots of gloves, a couple ABD pads, larger sterile gauze pads, tape, and a face shield for mouth-to-mouth. Of course, I haven't needed it since the original incident, but it really sucked not being able to do much in an emergency situation. Amanda

I went straight into the OR from graduation and I adore it. I think that if you are 100% sure that you want to be in the OR and you have the opportunity to take a job, take the job. OR nursing is SO different than other types of nursing that I personally don't think the med-surg year is that necessary. Yes, it would help you with your assessment skills, but you'll develop that in the OR too, it will just be more specialized to the procedure. I do see the point that it will make transferring elsewhere more challenging, but at present, I'm so thrilled and challenged with the OR that I'm not interested in going elsewhere. Plus, seeing how short staffed the floors are, I don't think it would be a challenge to get a job in med surg at any point in my nursing career, should I choose that. Good luck, Amanda

Definitely Pepto! I'd take a wide array of OTC stomach remedies as that's what is most likely to get you out of commission. I would ask for a broad spectrum AB for each family member, but none of my family docs would do it, I'm sure. I'd also take a variety of pain relievers - ibuprofen, acetaminophen and I'd also take Tylenol PM just to help get over jet lag and to help sleep when it was elusive. Aside from that, I'd take what I needed for my kiddos - the stuff that I give them here when they have a virus that I know works for their various ailments. Have fun!

My favorite tip for removing staples is to remove every other staple, then go back and get the ones you missed. That way, if you find a spot that isn't totally closed, you've got a little security blanket.

I'll take a shot. pH is maintained by buffer systems, let's talk about the bicarbonate buffer system. CO2 + H2O H2CO3 H + HCO3 In metabolic acidosis, bicarb (HCO3) is decreased compared to the acid in the body. To compensate, rate and depth of respirations increase to eliminate extra CO2. Look at the above formula and you'll see how eliminating extra CO2 will bring the HCO3 level back into balance. Hope that helps. Amanda

Absolutely untrue. 95% of UTI's in males occur in uncircumsized males. Since we know that female partners of uncircumsized males are at a higher rate of contracting STD's, including HPV, it seems to be a fairly logical conclusion that HIV transmission could be increased by non-circ'ed males. Of course we all know behavior is the single biggest factor in transmission, but we also know how hard it is to change behavior. I have lived in Africa at various points in my life, and you can send all the antiretrovirals you'd like - a significant portion of the population will not take them for cultural reasons. You can teach safe sex all you want - a significant portion of the population will not listen (which is true around the globe). You can provide all the condoms you'd like - I'd wager that only a few would actually use them. If circumsizing babies would cut the transmission rate in Africa, then yes, that should be encouraged. Am I sure that it would? No, of course not, but it does stand to reason, given the information we currently have. Amanda

I'm not a pp nurse, but in my facility, nurses do not have to participate in procedures that they consider unethical. For example, if there were a tubal ligation, and you were ethically opposed to that procedure, you would not be forced to participate in it. I don't think many facilities would ask you to do something you were not comfortable with, but I suppose that depends wholly on the facility. You may also want to consider working in a "birthing center" as a nurse. We have several in my area, and those facilities tend to attract patients that are looking for the most natural experience possible and circs are not done. Best of luck to you, Amanda

I did well on both, and I do think that scoring well on the HESI can be a predictor of NCLEX success, but don't expect the tests to be very similar. In some ways, the HESI is harder because the questions are more "factual" or knowledge based, whereas the NCLEX is more situational and requires more critical thinking. The point that I'd make to you is to not get yourself too worked up about the NCLEX, do into it thinking about what you'd do in the given situation in an ideal world, and you'll do fine. Good luck! Amanda

SO, I'm not bashing the obese here, but I will say that I have had many obese patients that absolutely refuse to do anything for themselves. I HAVE had patients of all shapes and sizes with hotel syndrome, but I honestly do not recall an average sized patient ever refusing to reposition themselves, or to get up to use the restroom, or shower, while many obese patients that I've encountered have. I can even take it one step further - it's usually a female, usually between the ages of 30 and 40. (Again, not bashing - I fit two of the three mentioned categories). It got so bad while I was on the floor that I just refused to bathe or toilet these patients (when there was no medical reason for them to be unable to do so). I've got nothing against helping someone with these necessities except when they are physically capable of doing it themselves and refuse. It's NOT healthy to coddle them, IMO. They need to be encouraged to be active participants in their healthcare (and basic personal hygiene), if they still refuse, I feel as if they must be suffering from depression and will ask the MD to address that with the patient.

Cardiac Rehab or Diabetes Education are probably your best bets, but I also like the idea of Renal - very specialized diets and low activity tolerance among that population could make it interesting. Amanda

I think a lot of people with depression find that certain seasons exacerbate the situation. It sounds perfectly reasonable to increase your SSRI dose for the winter months (or on a trial basis) providing it's still a safe dosage. Everything you wrote sounds completely reasonable. If your PCP is not amenable to your suggestion, after explaining what you've written here, then I think a second opinion would be a good idea. I can almost guarantee you that exercise would help you feel better, but you'll probably still need a bit higher dosage, whether you are exercising or not. In fact, you might just want to approach the conversation with, "I've been exercising regularly, but I'm still feeling XXXX, perhaps we could increase my dosage a bit and see if that helps." Best of luck to you! Amanda

Newest information (which any of us who have dealt with this personally already knew) indicates that there is no point in reorienting and that going along with the flow is better for the patient. I know that you could find some published data on this if you'd like to present that to your coworker. Evidence based practice tends to convince people a little more than arguing! Sometimes. Good luck. Amanda

My personal recommendation is inciid.org You'll find tons of the support you seek there. It's amazing how difficult the world can be when you are considering conceiving and it's not coming easily to you - both from people who know your situation and complete strangers. You definitely have my sympathy.

Can't help with a pattern, but check out these pony tail scrub hats. I just ordered some and really like them. blueskyscrubs.com Amanda

I totally agree with you. I'm a new grad in a for-profit hospital and I would never, ever for any reason accept a patient load like this. It IS a seller's market and one can afford to be quite particular in selecting their place of employment. From my graduating class, the majority went to hospitals - about 50/50 in regards to non or for profit. Several went to clinics and those who wanted to went into specialty areas with great orientations. It makes me so sad to see nurses say "why is it this way?" when the answer is simply that it shouldn't be and you shouldn't risk YOUR license, YOUR well-being and YOUR conscience if it is. Amanda

I bought all of mine on amazon, but not through the retailer, per se, but the section where people sell their old textbooks. I saved a fortune! Amanda

WOW! I liked my preceptor before but now I adore him. I am 2 weeks into my first job out of school. I think my preceptor gets a few extra bucks for me, but probably not what he should be getting. The first week he just had me observe, which was really helpful. He also really protects me from unpleasantries like grumpy docs and always asks if I'm comfortable with something before expecting me to do it. I'll have six months with him before I'm on my own, but of course, I'll start taking on more and more as I get more comfortable.

I agree with purplemania, intent has a lot to do with it. In my facility, if the patient is cognitively intact and agrees to rails x4 as a reminder to call for assistance ambulating, it is not a restraint. BUT, you better make sure that the patient is alert and aware and agrees to it - and of course, you should document to that effect. If the patient cannot reliably give consent, it's a restraint. Amanda

Yes, the transport nurse was a pro, but so are you. You're right, the parents probably won't remember that you made the discovery, regardless of what happens, but you did exactly what you are supposed to do and you absolutely deserve a big pat on the back for your efforts. What this little guy will have to endure is heartbreaking, even if the outcome is the best possible. You must be a very caring person to be concerned about it, even knowing that you did your very best. As a new grad, I hope that I am as perceptive as I begin my career. Amanda

I think it's great. I put a lot of band-aids on invisible boo-boos at home. It's not going to hurt, and if it helps, great. Amanda

I'm not giving lantus to someone with a BG of 45 without knowing why their BG is so low and discussing it with the MD. I've had this convo with a doc before, he insisted it be given, and I ended up pushing a lot of D5 into my patient that evening.

Ice chips melt to 50% of the qty. For example, if you give a patient a 50cc cup of ice chips, it melts to 25cc water, so you'd record the intake as 25cc. Amanda

Howdy folks. Preface this by saying that I'm not looking for medical advice, just for the proper terminology - and no, it's not me - I am just stumped. 61F, non-smoker c/o rib/heart/breast pain - unsure of source, but palpating area over left breast causes severe, shooting pain. Pain started after major dental work (several root canals, bone graft) and began as oral ulcers, throat ulcers, swollen lymph nodes in axillae with systemic s/s of fever, malaise, arthralgia. These symptoms resolved, but lymph nodes remained swollen and tender and one spot on left chest really painful to touch. Mammo and blood work unremarkable. Chest-x-ray showed fluid in that area of L lung, but MD says not likely to be clinically significant. Of course, if it's that painful, it's significant IMO. CT scheduled to further evaluate. Edited to add - since systemic infection cleared, no other s/s. No SOB, no night sweat, diarrhea, fever, nothing. Just this pain. I'm thinking that this is sequelae to what was probably an infection from dental work and that the body has walled off a little pus ball, or fluid, or something. Does this make sense? Has anyone ever seen this? Wouldn't AB's be indicated while waiting for CT/results? Thanks! Amanda

Wow - that's an amazing story. I've heard similar types of stories but have never seen anything like that up close and personal. I certainly can't offer any sage advice, but I do understand why you have such conflicting feelings about it. Yes, the woman needs help, but I think it's completely understandable that you feel some anger towards the situation as well. Amanda

KScott, I think you make an excellent argument. Someone asked what labor felt like. I had always heard that it felt like "really bad menstrual cramps". OK, fine. I've got endometriosis - no sweat. Menstrual cramps have me in bed for three days every month, I'll be able to handle labor. For me, the pain was nothing like menstrual cramps. It was a visceral pain that started somewhere low and worked up to the base of my stomach every three minutes for a solid minute for 5 hours - and that was just to get to the required 4cm for the epi. I was exhausted. I was completely unprepared (mentally) for the pain, despite several prepared childbirth classes. Even after the epidural, labor lasted another 20 hours and I delivered a 9 pound child with an operative lady partsl birth. With the second baby, I was so apprehensive about a repeat going in that the MD offered me the epi on arrival - 2cm. I delivered my child without pain and in 5 hours from arrival. I'm totally convinced that #1 was so hard on me because I was in so much pain for so long. I was so uptight he just couldn't move down. Baby #2 was an ideal birth experience and I loved sitting in bed, joking, smiling, relaxed up until the moment she made her appearance. For me, there's no question but to have an epidural, although I certainly respect those who choose not to. Amanda