paulwalkman

I'm sure you already know the answer since last year ago but I'll answer anyway. If your patient has an inr of >3.5 hold the medication and call the position immediately. Some docs will allow up to 3.5 but that's on the rare patients and should be in his notes. The patient is at risk for bleeding out; A hemorrhagic stroke or bleeding from colon cancer, etc. On the other hand is the inr is

Thank you. Funny, very funny, but could you answer my inquisition please? I'm still not sure what's up.

Thank you for that last mention. Since PaO2 is assumed during routine testing, how would it specifically be tested? Does an arterial blood sample need to be taken to get the ABGs? Early in my career I had a jerk doctor ask me 10 minutes after he wrote an order to put a pt on 3L O2 because her PulseOx was 88ish. I told him the PulseOx and he repeated 3 times successively louder each time "what is the PaO2!!?" I asked "if labs had to be drawn and he yelled back, "No, You go tell me what it is...NOW!" I had to get the charge nurse to talk to him. I just never thought to ask again.

The issue with using the phones in the hospital is the WiFi. iPhones cannot turn that off (as of 2 years ago). Most other phones have a selection to turn of the WiFi and the 2G/3G/4G. In addition to Davis Drug guide I would suggest looking over Skyscape.com. The have a lot of programs that you may find useful.

as a nurse, you gotta-do what you gotta-do. in my experience nurses & pts are ok with butt wiping and butt washing and even putting in a catheter, but some people get anxious about washing the male and lady-parts. i talk to my patients when washing them and encourage them to wash as much as they can to promote independence. i always ask if they would rather wash their own perineum when i reach it or if i can get started (washing the perineum). my patients appreciate my direct questioning and it’s either a yes or no. even if i had a "hot" patient i am not in that mode. after i was in a huge accident at 32 years old i was usually told to wash my own from what i remember and when i was coherent i would not want a male nurse wash me whether or not i was able. when i started walking the rehab i was on had mostly older stroke patients and a nurses aid always asked each person if they need help in the shower. i was asked by a beautiful aid, about 19 or 20 years old if i needed help in the shower. of course i said yes! i had to wash carefully because of the unhealed scars so i could justify to myself that i needed her, but i ended up telling her “no” because i didn’t need her to help, and i would have felt dirty after the shower because i took advantage. consciences suck‼! paul

Hey Katkonk How did you like supplemental Healthcare. I think the pay is low so I'm tryinbg to get perspective. Thanks. Paul

I did Travel Nursing in Texas over the summer. I was with a terrible company that called at 5 or 5:30am and sent me to a random hospital in one particular network. I was expected to hit the ground running...running for my life. I had to find the hospital and then find everything in the hospital for work. Unfortunately, travelling is not for first job experience. most places I know of want at least 2 years experience before yo can travel. I don't know about general agency work, but I woul assume it's nearly the same. Paul

The pay in Texas is very low in general. I don't think it's the company also being cheap because your pay would likely be lower.

Stay away from Ay.a Healthcare. I heard Cross-Country is goodAnyone know about Nightengale Nurses?

There was a study comparing physically exhausted sleep deprived drivers against typical drunk drivers. The sleep deprived drivers were worse off. Not that I'm prtomoting drunk driving, but DEFINITELY don't drive sleep deprived. Paul

Six days in a row are definitely too many. I wrote that post in October 2008, and I kept averaging four or five nights per week. I worked like that until December 5 2008. On my way the home at 8:00 AM on December 5 after working several shifts in a row, I fell asleep while driving and hit a tree. The next thing I remember were some paramedics telling me are going to take me to a local hospital. I told them “not a chance, I need to go to Cooper!”, which was the nearest trauma center. I had blacked out were several days due to a subdural hematoma. I also crushed my left calcaneous, which is replaced with the cadaver calcaneous, crushed my right ankle, where they put in four plates, and had massive internal bleeding. They cut the open sternum to pubic bone to find the bleeding, and remove my spleen. Ten days later I had the first conversation that I remember. I also developed sundowners syndromeI This always anoyed me when my patients had it. Everyday I was told what hospital I was at and every night when I was asked, I thought I was at the hospital I worked in. I kept trying to get out of bed to see patients. I didn't understand that I was the patient. Not good! I remained in the hospital until December 28, 2008. I remained in a wheelchair for a little over three months and I have needed two additional surgeries on my right ankle. With luck, I will be off crutches by 2010. I guess my tips would be: don’t work too many days in row, make sure to get enough sleep, and try not to work night shift. Maybe it has been a blessing in disguise. I can’t do shift work at a hospital anymore, so I am back in school to get my nurse practitioner degree. Paul

if this physician doesn’t have a previously used or pertinent contract, you can check some of the lawyer sites. some of the sites that give formats for resume’s also have non-specific contracts that you would use to make a contract more specific to your situation. it’s best to create an out, or reason for postponement in payments that you could use if needed. check out his practice/work and try to come up with an appropriate salary for the year you graduate. make a list of any and all questions you have after reviewing the unsigned contract and speak to a lawyer. i made a basic contract with my father to pay him back the money i needed that was above the loan max given by the bank so i could always pay my mortgage/bills/etc. on that same note, borrowing money from family of friends is normally a terrible idea, hence the contract. always keep at least one copy of the contract. once it’s signed, it’s signed. i also had a 10k sign-on bonus to work for a year at my hospital. i didn’t have the needed out on either contract, but was given lenience in both contracts due to a terrible debilitating car accident. (i still can't stand). -paul

Hey, Ivanh3, I have to disagree. Obviously you have trie many of the products, which makes your opinion that much more important, but my Verizon XV6800 Smartphone uses the Pocket PC software and I have NEVER had a problem with it. The battery, even when used often, outlasts my 12-hour shift. I will agree with the statement that the original Pocket PCs crash often and hav bugs during the processing. I have mentioned a lot of assets in my previous column but I can't stress enough that, especially for school, it comes with MS Office, including Power Point. -Paul

i agree with rngolfer53 who said “you wouldn't go to an attorney for a nursing question, right? same thing applies in reverse”. definitely check out your contract with an attorney. determine if there is a time period when they have to hire you. is it within 1 year after graduation, 6 months after passing the nclex? that will tell you if they broke contract. i heard you mention your concern that they might not want to hire a 24y/o with chronic health problems. if you are healthy enough to fulfill your shift responsibilities with or without proper assistance that would not put a serious burden upon them you have no problem. you might have a great legal standpoint. you don’t have to be the person who always lifts the bariatric patients or takes care of the patient who is out of her mind screaming. i don’t know what chronic health problems you have, but have you doc write what limitations may be. if you apply again and they say they won’t hire you because you are sick all the time and can’t handle a patient load the way they want you to, they just violated the ada law, (american with disabilities act) the hospital would owe you the fulltime salary that you would have been earning up until that point and the money you would have made if you worked there full time for 2 years (i believe you mentioned the terms of your contract were working for them for two years). and, they would no be allowed to collect the $20k you borrowed for school because it was given to you without the plan to hire you anyway. the $20k was more of a grant, that would not be paid back. i have had a very similar situation happen (let’s say to my best-friend), so i know i am very close with the situation given in this post. but with not being hired (ask if it is because you’re sick-look for a yes) hire an attorney and get another job on his advice. relax. i’ve been there. you need patience, not frustration. good luck, god bless! paul

Pocket PC, Blackberry, or Palm? That became an obvious answer after some research. Let me give you some details. I bought a Pocket PC in my phone; a Smartphone. Aside from a phone and a 3 megapixel video camera/camera there are many other features. Products for any of your questioned items can be purchased at Skyscape.com, but so much comes with it. I have purchased many products I continually use and get updates anytime I sync with my laptop. The Smartphone products are very easy to use and most are low cost and when the yearly subscription runs out you keep the program but just don't get updates for that particular program. I also have a sync with MS Outlook on the Pocket PC/Smartphone. During school that would help download test dates, clinical days, other calendar questions. Of course you would have phone numbers, but also everything else you entered into MS Outlook about the person/company, short Notes you want to remember. Email can also be downloaded FOR FREE when synced. Pocket PCs/Smartphones will download any important file you placed in the folder associated with the Pocket PC which is created when software is installed. It's nice to be able to take notes on you computer, look at a zip drive, MS word full of your research. Also, you have Power Point presentations you or your group have been working on, and can use Excel to segregate the patient's meds names from use/effects/side effects/dosage/ etc. on your Pocket PC that were, and still are, in your computer. It also comes with Adobe Reader, required for some teachers' work, and Windows Media Player. It's not iTunes, but you can transfer the music/videos. If you have enough money buy the use of Internet Explorer. In other works get the POCKET PC/SMARTPHONE. -Paul