ERNurse752

I am in the FNP program at UIndy (will graduate next May.) The WHNP/CNM program coordinator, Barb Winningham, is amaaaaaaaaaaazing. One of my friends is in the WHNP track and graduating this spring. I'm not sure about job opportunities. I'm considering switching to WHNP, though, although I still like the FNP stuff too.

I was on mag for preterm labor and was taken off of it after a week because I gained 10 lbs of fluid. I was on it again a couple weeks later after my c section (breech twins), this time for preeclampsia, and blew up like a balloon...which was also probably from all the fluids I got.

I am in a brick and mortar program. Our clinicals are arranged for us. The preceptors are not faculty, but are approved by faculty. I believe we can also find our own if we have something specific in mind, but the site and preceptor must be approved.

A serum level > 150 ug/ml at 4 hours post ingestion is toxic - don't forget that the time the blood was drawn is everything in determining toxicity. A serum level of 10 ug/ml could be toxic, depending on the time of ingestion and the time the level is drawn. You can actually have an undetectable serum level and still have toxicity, if the acetaminophen is already metabolized. (It's actually the metabolite of acetaminophen, NAPQI, that is hepatotoxic.) Liver enzymes will not typically start to rise until around 24 hours after a tylenol overdose. There are tons of little factors to go into APAP toxicity. The local poison center should always be contacted in any potential toxicity situation.

When I left ER, they were going to just NS irrigation for lacs - for the tissue damage reason you said, and also because the mechanical act/pressure wash effect of a good irrigation was found to be what really cleaned the wound, not the actual agent used for the irrigation. I worked in various ERs, and in the Level I the nurses did the lido. Never heard of ER techs suturing.

So he really did have a broken bone! Now I am craving an orange julius...

This thread is actually pretty interesting. With my background, withdrawal treatment is pretty much banana bags and benzos, benzos, benzos. (Well, for EtOH withdrawal or benzo withdrawal, anyway.)

How about Pop Tarts? I could go for some of those right now, and I'm not even withdrawing from anything.

And sweaty/slippery hands. Although, if that were the case, he would need to be fed as well. And I imagine he was able to feed himself just fine.

I agree with the previous posters, and also wonder whether his hands were broken.

You're welcome. A good website (discussion board format) is http://www.thebump.com Lots of different baby boards, including a Trouble Trying to Conceive Board. To get to that specific board, click on "boards" in the brown banner at the top of the home page, then you will see the link for that board. (Abbreviated TTTC sometimes.)

If that person has not already, they should see a urologist who specializes in male infertility.

I'd say there are too many variables for here. That person should see a reproductive endocrinologist for a workup and then go from there.

I'd choose MRSA since there's a vaccine for Hep B and a way to verify immunity to it. Plus you'd typically get it from a needlestick or bood exposure, and you can get MRSA from anywhere.

Do you have any gut feeling about whether you want to stay hands on/treating patients vs. not? That helped me make my decision...in an NP program now.

Ditto that. If you tap on the diaphragm/bell, does the sound travel to you? If not, try twisting it around once. It might be turned off.

I'm an INFJ. :) My J is pretty "weak." I'm in the middle on N and F. I'm a very strong introvert. I also like this site's summarization of INFJ: http://www.geocities.com/lifexplore/infj.htm I think it sums me up pretty well. My current job is pretty harmonious...very low turnover...have autonomy...get to think...don't have people in my face all day, which I like...I don't have to delegate to anyone...no one delegates to me...management doesn't care what we do as long as we do the right things...it's busy, but not total chaos all the time...I feel like I can really help people...I don't feel like I have to ignore people in order to keep the ceiling from falling in elsewhere...I work with a lot of really smart people...my coworkers care about helping people too...I can reflect and be thoughtful...I can research...I can teach...hmmm, that's all I can think of right now. I used to do ER...tried a few other specialties, work in a poison center now. NP student now, but still early days there....will be interesting to see how it goes!

It is definitely pretty stressful. For me it had more to do with the noise, the hordes of people all over the place, and the high patient to nurse ratio combined with high acuity. Also, I felt like a task robot a lot of the time...just do do do without having time to really think or talk to people. I did love the wide variety of patients though, and always having something new, learning so many different things, and the drama in general. I work in a poison center now. Worked out well with the ER background. Very interesting job. Lots of pharmacology, lots of overdoses (accidental and intentional) besides just the kiddos getting into things.

I am now curious to see what specialties all of you are in, or interested in? I used to do ER, which I enjoyed a lot of the time, and hated a lot of the time because of the chaos and not being able to provide my standard of good care. Jumped around for a bit trying to find my niche. Am now doing toxicology, which I love...I get to think, be autonomous, make decisions, feel like I really help people. I'm also in an FNP program, so I'm curious to see how that goes. (In my first semester now, so no clinicals yet.)

I am INFJ/INFP - my J is pretty weak/close to midline, however you want to say it. I can definitely relate to this thread. I've been a nurse for over 7 years now. It does get a bit easier as you gain experience, and you start to gain confidence in your own skin and how you give care. If possible, find someone (whether through observation or talking to them) who seems similar to you, and see if they can teach you. That would help make you more comfortable, I think. I am also hypersensitive to my surroundings, and to my patients' feelings...it can be a blessing and a curse. You pick up on things other people don't, but we tend to get more stressed out in the process. I think the actions of other people (staff not pulling their weight) tends to bother us more. I haven't mastered dealing with any of these things...they aren't really an issue in my current job, but I suspect they will be again in the future.

Here are a few websites I thought might be helpful: http://www.aafp.org/afp/20020215/599.html http://www.kernicterus.org/ http://www.emedicine.com/ped/topic1061.htm

just an fyi (not specifically directed at you, just in general) most forms of visine contain imidazoline decongestants. it can have clonidine-like effects with a small dose ingested. cns/resp depression, bradycardia, hypotension. i've seen a kid become comatose from it.

I carried a pair in my pocket also.

Ditto Elavil and other tricyclics - very bad in overdose. Rapid CNS/resp depression, tachycardia, wide QRS, v tach, seizures, etc. You can let them sleep too, but be prepared to rapidly intubate and to deal with the other potential problems that will very likely occur.

Ipecac and gastric lavage are not typically recommended anymore, although there are a few cases where they can be used. Activated charcoal can be given to a patient if it is less than 1-2 hours post ingestion, and they are awake and alert. There are a few cases where charcoal can have benefits given more than one time, or given later in the ingestion - like aspirin. It should not be given to a patient who is already sleepy, because their risk for aspiration is increased. Risk for aspiration is also greatly increased when charcoal is given via NG or OG, so that is also typically not recommended. Sleeping is fine. Any patient who is sleepy from whatever they overdosed on should be on a cardiac monitor and pulse oximetry. A 12 lead EKG should also be done. Treatment depends on what kind of "sleeping pill"' they took, as that can cover more than one class of drug. But bottom line, you monitor their airway and respiratory status. If there is a lot of concern, they should be intubated to protect their airway. Poison Control should always be called. Even if it something you're familiar with, poison centers collect data for research and epidemiological purposes besides just giving tox advice.