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ACNP's Latest Activity

  1. ACNP

    Honestly...Did I over-react?

    I adamantly APPLAUD you for standing up for yourself and taking charge of your personal health! This is exactly what is wrong with the nursing profession today!! Why can't we look out for ourselves and protect ourselves? Who knows what diseases this patient may be harboring like AIDS or Hep. C. The people who feel that you wasted time or should feel guilty for leaving the floor for 4 hours should be ashamed. We have to take care of ourselves first and foremost! You bet I would have done the same thing. If this scenario had happened outside hospital doors, would it have been assault?
  2. ACNP

    Anyone put in a-lines?

    Ask a CRNA (Certified Registered Nurse Anesthetist) at your facility. We are trained to insert and monitor arterial lines. It is much like placing a 20g angiocath, except in an artery.
  3. ACNP

    Valley review materials?

    Is there any way to contact the nurse anesthesia students ahead of you in your NA program? Perhaps you could send out an e-mail when you get a list of everyone in your program asking if anyone is willing to part with theirs. I know a few of the graduated super seniors in my program sold theirs or passed them down once they took the CRNA exam. I'll be taking Valley next month and using the Sweat book and Memory Master. The materials aren't cheap so it would help to get them from someone else. Good luck in your program!
  4. How about an anesthesia resource book/card? The Handbook of Anesthesiology 2008 edition by Mark Ezekiel is a great resource that I carry with me in the OR. It's a down and dirty quick facts book. You can get it spiral bound as well at Kinko's and also label it with headings for fast reference. My senior gave me this for Christmas when I was a junior in my NA program and it's proved invaluable. Also, the Cusick reference card is good. It's a laminated front and back quick anesthesia facts card (drug dosages, endotracheal tube/LMA sizes for peds. and up, hemodynamic forumlas, etc.) and comes in 2 different sizes. Every anesthesia resident and SRNA I know carries this in their pocket. The website is www.accrs.com Both items are under $20. Hope this helps and congrats to your preceptor. I finish up in December and can't wait to start earning a paycheck! :wink2:
  5. ACNP

    The secret's out so give up now!?

    Please do not believe this CRNA! I am a senior student in a nurse anesthesia program in Virginia and believe me there are tons of job opportunities. I graduate in Dec. 2008 and I get asked everyday in clinical where I'm going to work or if I've signed anywhere yet. Just look on www.gaswork.com or any other CRNA job site and you will see the amount of work available. I get e-mails and flyers from CRNA recruiters at least 3-4 times/week. Some jobs are open for many months or not filled at all due to the lack of CRNAs. Again, if you desire to become a CRNA go for it! There will be a job waiting for you when you graduate. I know that 1/3 of my class has already signed on for a job if that helps.
  6. ACNP

    Anesthesia Careplans

    Hi AmandaSRNA, The Handbook of Anesthesiology by Mark Ezekiel (the 2008 edition just came out) helped me a lot when writing my careplans. It has a lot of the anesthetic implications for ex. HTN, COPD, DM, Renal Failure, Obesity, Latex allergy, etc. It is very small and compact. My senior gave it to me for Christmas last year and it has proved invaluable. I carry it in my bag with me to the OR and pull it out often. It also contains lists of drugs that you commonly give, dosages, onset, peak, duration, side effects, etc. Check it out at Amazon.com and see if this helps. Jaffe and the Anesthesia & Coexisting Disease books are also good but I found this one to be the most straightforward and to the point when dealing with the anesthetic implications of the patients review of systems and writing out your anesthesia plans.
  7. ACNP

    Regional Anesthesia

    Hi lacedmm1, I attend Virginia Commonwealth University in Richmond, VA. The Anatomy Camp is something that the school started 2 years ago to help with our regional semester. We travel to East Tennessee State University for 4 days and use their cadaver lab. Plus, we get to meet our Southwest classmates who are offsite. VCU's NA program is set up to have students at the main Richmond campus and then in Abington, VA at the offsite campus. Check out VCU's NA home page or PM me if you want more info.
  8. ACNP

    number of cases

    My program has its SRNAs keep an Excel spreadsheet of all the cases you perform. The minimum required cases is 550 with 650 preferred. I think we are also required like 800 hours of anesthesia time. We also keep track of the different types of cases, surgical positions, elderly/pediatric/OB/etc., #oral/nasal intubations/LMAs, use of fiberoptic techniques, methods of anesthesia, #IV caths/A-lines/TLCs/Swans, #spinals/epidurals/peripheral blocks, types of pharmacological agents, etc... in addition to other stuff. Everyday when I'm done with clinical I plug my numbers in to get credit for everything I've done that day. It only takes a few minutes and makes you realize how much experience you are obtaining. Hope this helps.
  9. ACNP

    Regional Anesthesia

    At my current NA program we have a regional semester where we cover everything from spinals, epidurals, peripheral blocks, local anesthetics, acute/chronic pain, and regional complications. We also attend an Anatomy Camp at the beginning of the summer where we get to practice on cadavers and learn the anatomy up close and personal. Several of the clinical sites I have been to and the one I'm at now are willing to teach and let SRNAs perform blocks, spinals, epidurals, etc. We also go through a pain service rotation at our main hospital clinical site. All in all I think we get a lot of regional experience which will help me when deciding on a CRNA position.
  10. ACNP

    Anyone here both an RN and RT before CRNA?

    There is a former RT in my CRNA program. I believe he worked as an RT for several years before obtaining his BSN. He then worked as a critical care RN for about 2 years before applying to the program. He has helped me several times in explaining pulmonary concepts, vent settings, pressure-volume loops, etc. I think by him being a RT it only helped during the interview process as well as now in the classroom/clinical setting. Hope this helps!
  11. ACNP

    Deciding whether to drop out CRNA school?

    Hi Micugirl, First off, hang in there and don't withdraw. CRNA school is too hard to get accepted! I, too, am in my first rounds of clinical rotation except we have class 3 days/week and clinicals the other 2 days. I'm only on my 2nd clinical site but I can tell you it's much better than the first. We do careplans at my school which helps a lot. Yes, they take some time and effort but they really help you think about what types of cases you are doing as well as the anesthetic implications. This way you can write down drug dosages of your induction drugs, volatile agents with MAC values, extras like Zofran, Decadron, Toradol, and any drips you might be using during the case etc. It also helps you think about positioning of the patient (ex. type of OR table--OSI for a hip repair) and its implications, whether you might need a fluid warmer, bair hugger, A-line set-up, fiberoptic intubation cart, etc. This way when your CRNA is tossing questions at you while you're trying to preoxygenate and get ready to intubate you can answer confidently because you've prepared.:nuke: Did they teach your class a lab on a basic room set-up? This helped but when I first started I still needed my senior to come one morning at 5am and help ensure I had EVERYTHING you could possibly think of for my 2 back surgeries that day. As far as OB and peds talk with the senior students about a basic room set-up for this group. We haven't talked about peds/OB in class but some of my classmates have already intubated kids. Just try to read up the night before. The Morgan and Mikhail book as well as the Jaffe book are great resources that I use a lot with my cases. Our class also has a discussion board that we use to communicate with our fellow classmates on our clinical experiences. You can always go talk with your clinical instructor as well as the anesthesia department head at the clinical site. You might feel more comfortable talking with the former since he/she probably knows you better and what you are capable of. I also agree, like jewelcutt, about the antidepressants. If you think they will help, then do it. Just talk with your healthcare provider and decide which one is right for you. Feel free to pm me. Stay strong!!
  12. ACNP


    Okay, here goes. From the dinner/lecture I attended the most common side effects from Cymbalta were nausea, constipation, and dry mouth (anti-cholinergic effects) in the studies. The nausea should subside within the first week. The speaker also kept saying that Cymbalta is weight neutral meaning it's not supposed to make you gain weight. One thing that the speaker did leave out that the Lilly people do not tell you also is that if your patient smokes, they are receiving 1/3 less of the drug due to some interaction (I learned this today from our Effexor rep). One thing I don't like about Cymbalta is that it took over 10 years before it got approved for public use and it only used about 12,000 people in its study. Also, it has only been compared to Lexapro which is just a SSRI. I would like to see a side-by-side study between Effexor XR and Cymbalta. However, the only drawback with Effexor is making sure they don't develop high blood pressure and it is only 40% plasma protein bound making it "supposedly" have more side effects or drug interactions. Plus, your patient can't skip or miss a dose due to the withdrawal effects. I think I have a fair amount of patients on equal Cymbalta and Effexor. The doc that I work with doesn't even prescribe any SNRIs or SSRIs. He still prescribes a ton of Elavil and Pamelor (old TCAs)!! I don't like these b/c they have so many side effects. Oh well, guess I could do my own study :) and see which one is better tolerated with good results. P. S. The dinner was Ruth Chris Steakhouse (excellent) and I had the cheesecake for dessert. It was worth every calorie and fat gram!!!
  13. ACNP


    I work with pain management patients. I prescribe a lot of Cymbalta due to the SNRI effects. A lot of my patients have the depression, sleeplessness, as well as pain. It also works well with neuropathic type pain (numbness, tingling, burning, sharp, shooting pain) that keeps a lot of my patients from sleeping through the night and functioning during the day. I find that if Neurontin, Gabitril, and the new one Lyrica is not helping for the neuropathic type pain then I will switch them to Cymbalta as well. Some side effects that I've had reported are irritability, nausea, and weight gain. The majority of patients are on 60 mg QD but I've got some on 60 mg BID. A lot of my patients also want a "quick fix" so I have to remind them to give it at least a month or longer to take full effect, shorter if I'm switching them from Effexor XR or some other SSRI. I'm attending a dinner/lecture this Tuesday on Cymbalta and how it helps with depression and pain so I'll try to post back some things I learn from the speaker (he's some well-renowned psychiatrist, I can't remember his name).
  14. ACNP

    Fight burnout but pay bills?

    Hi! I feel your stress and exhaustion. Have you thought about working agency in your area? I was in the same predicament when I graduated from nursing school and had to start paying back student loans and wanting to live decent. When I would work agency, I would make in one 12-hour shift what I would make in 3 12-hour shifts at my regular job. I eventually ended up going full-time agency and prn staff nurse. Agency usually pays on a daily or weekly basis and you work the shifts you want and the places. You could also work more than just 4 hours at a time. If you don't need the insurance, agency is the way to go or some of them even offer insurance these days. It sounds like you have great experience and are good with the patients. Good luck with whatever you do and congratulations on starting nursing school in August.:)
  15. ACNP

    Need help with essay for NP program

    If you need something else to discuss in your essay you might talk about how NPs aid in health promotion, disease prevention, and thereby decreasing hospitalization expenditures and rising healthcare costs. As a NP you are not only able to diagnose and treat patients but also educate them about their disease and treatment plan to prevent extra healthcare costs in the future (for ex. think reducing hypertension with risk factor modifications and encouraging secondary care such as cholesterol and diabetic screening). Preventative care is a big thing with NPs. Also, with the advent of managed care in our society and an ever growing number of uninsured people, NPs are able to provide quality, cost-effective healthcare especially in underserved, rural areas like the Appalachian ones (Eastern KY, West Virginia, etc.). Hope this helps and good luck towards your goal of becoming a NP!
  16. ACNP

    Advice please, re Narcotic Diversion/Rx Forgery

    Speaking from the perspective of a NP who used to deal with pain management patients, have you informed your present pain MD about calling in these Lortab prescriptions? If so, have you also set up a narcotic contract? Honestly, I would have pressed charges against you for falsifying information and obtaining C-III narcotics. I prosecuted 3 patients for calling in pain meds under my name where I used to work. They were caught when the pharmacy tipped our office off as to what was going on. Three other NPs in the practice in different cities also had their DEA numbers abused and pressed charges as well against other patients. I worked too hard for my license as well as to have the ability to prescribe narcotics to put it in jeopardy. You have to seriously think of what could have happened if say you overdosed from taking too many Lortab or if someone else had gotten their hands on the pills. Have you thought about a morphine pump or even a nerve stimulator? For a chronic pain situation such as yours it is worth investigating and try to reduce the number of pain meds. Sorry to sound harsh but you got off lucky with the MD not pressing charges.