Phillygryl

Does anyone know of a refresher course for an LPN who has been out of the field for a few years! I live in the Philadelphia, Pennsylvania area

Does anyone have any tips on how to clear clogged feeding tubes? Almost everytime I come on the floor the feeding tubes are clogged!! Any easy to unclog them?

I have a case with a client who has Soto's Syndrome and Mental Retardation. I do not know why, but this client gets very agitated and bites the back of his hands (knuckles) and his lower arms. Is there anything that would help prevent this. I don't know if the mother would be amenable to him wearing gloves. I suggested today that we bandage his knuckles and I did not get a favorable response. What can I do?

Snow Bunny: I really am not trying to be hostile toward Helene Fuld, or maybe I am. I just think they provide inferior education. By the way, I graduated from LIU in 1976 and pursued an MBA in 1980. When I was in undergraduate school, it was all the buzz, LIU was in jeopardy of losing its certification. I was not sure exacly what that meant but the "word" was that our degrees when we got them may be worthless!!! The school restructured its curriculum or whatever they had to do to satisfy the State and there was no more talk about that. Snow Bunny, the fact that Helene Fuld has such a low pass rate means something. There are nursing schools that actually have a 90-99% pass rate on the State Boards. I think that means something!!! I suppose you are absolutely right but I never heard it said about how difficult the school was until I was in there!!! Not being from New York City probably didn't help. One LPN I worked with said he had gone to Helene Fuld one semester but once he saw how the classes were conducted, he turned around and walked away I asked him why he said "They don't do any teaching there" they throw most of the work at you!! Those are his words. Was Helene Fuld for him NO! was it for me NO! you don't know until you are in the middle of the water and then you are thrown off the boat. Some of what I am saying is for dramatic effect, but you know what I mean. Some people need a little more support. I got involved in a study group, but I lived in another city so it was difficult I used to come into NY and go to Bellevue and study with a group. (They are open 24-7 by the way). LIU being all gravy I don't know what you mean. I did look into the program after the fact and one difference is that all of the courses are broken down. For instance, instead of Med Surg II which you get at the end of the Helene Fuld program and so many people fail, from the very beginning of the LIU nursing program you are taking Pathophysiology courses . I believe there are three or four pathophysiology courses and there are separate nutrition and Pharmacology courses that are not required at Helene Fuld. For me, understanding something thoroughly is what matters, because once I understand it I will be able to answer questions about it in the future no matter how the material is presented. In Helene Fuld I did not have enough time to get that comprehension the matter just came too fast. By the way, I passed all of the theory courses at Helene Fuld I failed clinically. At Helene Fuld there are about 5 or 6 nursing core courses you need to pass to graduate. At LIU there are about 15 and I not counting the prerequisites. Just a little more insight into my preceptions.

Dear Snow Bunny: You are living in a dream world!! Yes, from what I can understand and from what I observed when exams are given at Helene Fuld, they take extreme precautions NOW because they know a lot of cheating goes on. The facts, however, will not bear out your statements! Helene Fuld applied to the State of New York to have a BSN program about 4 years ago and it was denied because of low pass rates on the State Boards!!! They don't have a BSN program yet. I think the pass rate on the Boards is about 70% I was told it is getting better. Check the stats the numbers don't lie. I suppose they are also riddled with complaints from students. There exist Helene Fuld graduates who were A students who were unable to pass the State Boards for up to 3 years after they graduated!!! How can you explain this unless they cheated in school but maybe my assumptions are wrong. What I say is based on what I saw not on speculation, what I wanted it to be or what I thought it should be It is based on facts. Some students who were in my class cheated their way through but it was ok as long as you kissed up to the teacher. How do I know they cheated, I saw them look on other people's paper and ask answers to questions, share care plans, etc. Basically, the school is good. I am not saying it is the worst school on the planet (but it has to rank high up there). However there needs to be more student support, at the time I went to the school, the library closed at about 8pm. Sometimes my classmates and I wanted to study after class, but we couldn't use the library and even if you did get in, there was not a lot available in the library. No skills are taught or reviewed in the clinical lab. There are no tutoring services available and no computer simulations or anything to help you with the clinicals. Just recently they added some NCLEX preparation classes for graduating students. Next with the clinical aspect. The semester I was at the school they had a checklist of things you were supposed to do in clinical, but it never really adhered to or filled out, if you ran into a glitch or stuck out in clinical that was it for you, the teacher would zoom in on you and ride you like a horse from here to Texas until you collapsed!! Don't tell me what a top rate school is because I graduated from one Long Island University. You don't find the things going on there that occur in Helene Fuld because the program is designed to help the students. I know LIU has a 4 year BSN program and Helene Fuld is an accelerated program. I thought it was an accelerated progrm not an abbreviated program!!!

Yes, some of the clients in this facility get large doses of insulin 70/30 bid, but the one person I am thinking of is severely overweight and can apparently handle the insulin. This client is about 150 lbs and has fingersticks that can be as high as 548, so I guess that is why he changed her insulin order. She has no sliding scale!! What determines whether a MD orders a sliding scale or not, it seems better than ordering massive BID orders of insulin!!!

In the description of Lantus, I have read that (1) It can be given irregardless of food intake and (2) It works over a 24 hour period. I just had a client go into a diabetic coma because of administration of Lantus. The client had a fingerstick of 319 and was given 35 units of Lantus as order. This was in the am, so the client had eaten a breakfast of pancakes. Four hours later the client was found in bed difficult to arouse and the nurse working at that time had the sense to take a fingerstick, it was 20!!!! The client is also supposed to have 25 units in the pm. I have had this experience before with clients who had large doses of Lantus ordered. Has anyone else had this experience? Is this an indication of some health problem the client has?

It is an assisted living facility and the diet is not the greatest, in fact no matter what is served to the clients, they can leave the facility to go and get whatever food they want to eat!!!

Several of the clients in the facility where I work are insulin dependent and regularly have blood sugar readings in the 300's and above. What kind of care will I have to give them in the future, they get insulin coverage 4 times and day and a dose of Lantus at bedtime. This does not seem to be controlling their blood sugar!!! Are they in a permanent downward spiral healthwise because the diabetes seems to be progressing! Will they soon be amputees?

Is it appropriate for a client to have and order for Vicodin q 6 hrs and an order for Percocet q 8 hrs and concurrent orders for prn motrin and tylenol prn. The client just had eye surgery for cataracts and she has a history of CHF and COPD, In any event, she became non responsive and her face became swollen and was subsequently hospitalized. She said the doctor told her her potassium levels were high!!! Does this make sense? I read that high potassium levels are associated with dysrhythmias!!!

Another client in the facility was on Vicodin q 8 hrs prn in addition to the tylenol 325 prn. She had surgery for cataract removal and the doctor ordered additionally Percocet q 6 hrs prn. One of the nurses gave the client the Vicodin at 7 am and then because the client is so drug seeking erroneously gave her the Percocet which resulted in him being written up for double dosing. My question is this really his fault or should one of the orders been d/c'd. What is the since of having all of these prn orders? By the way, as of today, the client is the hospital!!!! She became edematous in the face and non responsive!! the client has a history of CHF and COPD!! What do you think

I have to call back and find out about the client myself!! The client is non verbal but thankfully the assistant who takes care of her observed her exagerated body movements. No syncope and since she doesn't talk she cannot express how she feels!!!

Can anyone direct me to a website that would help me understand what vital signs indicate? For instance a client in the assisted living facility where I work had a reading of 75/42 hr 76. She has Parkinson's and is 68 years old. I sent her to the hospital right away. I definitely feel the 42 is too too low. She also seemed to have some sort of tremors going on which I know goes with Parkinson's. These movements however were sporadic and very jerky. What are the vital signs saying??

I work in an assisted living facility! A client there who needs knee surgery but is refusing it has Hepatitis C. A chronic user of pain medication and a former IV drug abuser gets 500 mg of Tylenol and 50 mg of Trammadol q 6 hrs. She also has prn order for (2) 325 mg of tylenol also q 6 hrs additionally, she has an order for 1 mg of Ativan q 6 hrs. Everyone administers it she even complains that at night she is given 1000 mg of tylenol!!! Is Tylenol contraindicated for people with Hepatitis C or not???

A while ago on the MSN webpage, they were talking about belly fat. The article stayed that excess fat in the belly was a bad sign healthwise and that it was more dangerous than excess fat in other areas of the body!!! Anyone know the reason for this? The article did not spell out the reasons why clearly enough? I know that being overweight is not healthy but the article seemed to stress that the "beer belly" was more dangerous!!!