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  1. EricJRN

    Blood draws on infants

    Are you looking for the maximum safe volume? Like myfavouritescar suggests, in most infant situations there isn't a set amount that we draw. Rather than "drawing a rainbow" as a standard practice, with infants we usually figure out exactly what the orders are going to be and then draw the minimum amount needed to accomplish that testing. Do you use Microtainer tubes or something similar to them? With this type of system, 0.5 mL is usually plenty for a green top (chemistry) or a purple top (hematology). Accurate blood cultures seem to require at least 1 mL, even from the tiniest patients. If you're using a Microtainer-type collection system and only collecting the blood required for ordered tests, needing to draw potentially unsafe volumes of blood shouldn't be a common problem.
  2. EricJRN

    Distant Learning

    Distance learning usually involves the use of the internet, videos, television, satellite classrooms or lessons by mail. It does mean that in some cases a student could earn a degree from a school thousands of miles away, but you should contact the individual program to find out about specific licensure or residency requirements.
  3. EricJRN

    Is Nursing for Me?

    Welcome to the site. Can you be a little more specific with us about what you would find attractive in a career? What initially pulled you toward nursing or toward speech-language pathology? For many people, a lot of the search for a career involves trial and error. I applaud the intent behind career inventories, and I took them myself when I was in your position. I also know how much my personality and my interests changed between my late teens and my mid-20's, when I ultimately found happiness in a career.
  4. EricJRN

    RNC Question

    I used the Certification and Core Review question-and-answer book by Watson to figure out which areas I needed to focus on when I studied. I studied mostly from Gomella, Merenstein and Gardner, and the Core Curriculum... but I didn't read any of them from start to finish.
  5. EricJRN

    NRP vs PALS?

    A few examples: There is a big difference in things like the ratio compressions to ventilations (3:1 for the neonate) and the rate for assisted ventilation (40-60/min). PALS also doesn't emphasize differences between self-inflating BVM's (like the standard Ambu bags) and flow-inflating bags ("anesthesia bags"), both of which are in common use in delivery and neonatal settings. Actually, you don't talk about management of the newly-born infant in the delivery room at all in PALS. A very common and very important scenario in the delivery room involves managing the meconium-stained infant. (The steps are much different depending on whether the infant is vigorous or not at delivery.) PALS would not discuss that at all. PALS also doesn't cover any of the skills required to manage preterm neonates or babies with congenital anomalies. You won't talk about the essential steps in helping to thermoregulate a preemie (use of the radiant warmer and/or plastic bag). You won't learn the one critical exception to that rule that you should always bag-mask ventilate before intubation. I teach both classes, love both classes and advocate for both classes. I think each class has a wealth of valuable information. PALS would definitely help build your confidence in resuscitating infants outside of the L&D setting, but it's not even a starting point for someone who would perform neonatal resuscitation as a job requirement. (Oops... The last several posts didn't pop up for me before I posted. Sorry to be redundant!)
  6. EricJRN

    High Frequency Jet Vent?

    Lots and lots of variation by center. At a previous hospital, we got micropreemies on HFOV ASAP, then used HFJV for those who didn't respond well to the oscillator. But once we weaned to a Servo vent, we left them intubated for long periods of time. At my current unit, we usually start micropreemies on SIMV-PC and focus on early extubation (often within hours). We use HFOV as rescue. Apparently we have access to jets, but I've never seen one used on a neonate there. Other centers may use HFJV, but they may reserve it for cases of PIE or meconium aspiration. I think one problem is that there may not be a lot of clear and convincing data to prove one ventilatory strategy superior to another.
  7. EricJRN

    Would this kind of role be possible in the US?

    Oops... I read too fast. It looks like they are employed in several different settings - hospital and out-of-hospital.
  8. EricJRN

    Would this kind of role be possible in the US?

    It sounds like this is a prehospital role with a different scope of practice than that of current EMS personnel. http://news.bbc.co.uk/2/hi/health/4634569.stm Here in the US, it would be a huge shift in thinking to provide some of these services (like antibiotic prescriptions) in the prehospital setting. The 911 system is already so commonly utilized for non-emergent issues, I could see the situation getting even worse with the availability of this type of provider. I do like this idea slightly better than the crazy one currently being tossed around in some areas involving nurses attempting to screen 911 calls for legitimacy prior to dispatching help.
  9. EricJRN


    http://www.azbn.gov/Documents/applications/App%20Packet%20Downloads/CNA%20Exam%20Endorsement%20Pkt%202009.pdf You will want to apply for CNA certification by endorsement. http://www.azbn.gov/Documents/education/Nursing%20Programs/Nursing%20Programs%20List.03.28.11.pdf On the same website, a list of approved LPN programs in AZ.
  10. EricJRN


    Oops... I didn't see your post before mine! Haha. Have a good day.
  11. EricJRN


    BabyLady, See post #4. Looks like the baby already delivered and has undergone surgery. It's definitely an eye-opening experience to see the differences in care provided internationally. While we would consider a pediatrician to be inadequate to manage sick neonates, in many parts of Africa the pediatrician is a luxury. In many parts of the continent, general practitioners are responsible for almost all of the medical and surgical management of adults, children and infants. In the US, we're used to a system of seamless, rapid transports and ever-escalating levels of care. In much of the world, that just isn't a reality.
  12. EricJRN


    Just wanted to wish you good luck, gcumba. I was in Durban for a conference a few months ago and was able to see the disparities that exist between two neighboring hospitals. Here in the US, we think we have disparities in the level of care between hospitals, but it's nothing compared to the situation in Africa. Definitely come back and update us on anything you learn. It could help others in similar situations. I know that sepsis is a huge issue for kids with abdominal wall defects in developing and middle-income countries. That's often linked to the fact that these babies tend to be born at facilities that cannot provide definitive management, leading to delays associated with referral and transport. It sounds like you've avoided that big hurdle with this baby, so hopefully everything will continue to move right along.
  13. EricJRN

    No blood transfusion r/t high WBC??

    I don't think there's a specific contraindication. It may just be an attempt to be conservative. When a patient produces a ton of leukemic cells, other blood cells can be "crowded out" - which contributes to the anemia and thrombocytopenia you often see even before treatment in leukemia. The doc is likely thinking that the anemia will get better with "watchful waiting" as the white count continues to decrease.
  14. EricJRN

    What do you do when you're a pt?

    I know I would dislike taking care of a mouthy nurse, so once if it does come out, I try to reassure them that I'm a baby nurse and that I get all of my adult health information off of Grey's.
  15. EricJRN

    Nursing shifts: Is this fact or fiction?

    Yes, a schedule of three twelve-hour shifts per week is a common full-time schedule for hospital nurses. At my hospital and many others, we do self-scheduling, which means that we submit the days that we would like to work for the upcoming month. There are some rules about the minimum number of weekends and holidays we have to work, but outside of that, management can usually accomodate our self-schedule without too many changes. Some places use matrix scheduling instead of self-scheduling. I don't know a lot about that, but basically, it involves working a set schedule rather than one that resets every month. While you don't pick your days, you know months in advance if you have a conflict and need to arrange a switch with a coworker. Flexible scheduling can definitely be an advantage of working in nursing.