ChristopherH

I believe the answer would be C. Decrease in white count. The others are all symptom related and may not be related to the working of the antiviral med. However if its working it should decrease the viral load and that would, presumably, result in a decreased WBC count as well. Then again that assumes that there is nothing else going on in the body as well, if there is another infection happening concurrently I would think that might not be the case. Anyone else want to weigh in?

I recently viewed a debate with another nurse at my workplace about whether the practice of predrawing certain insulins and tagging the syringes with a resident's name prior to a busy med pass was acceptable practice and/or legal. On one side the argument for patient/resident safety is that if you have a lot of insulins to give during a busy med pass (this is in a LTC/nursing home) with the potential for continual distractions, etc. and you have to give certain doses of certain insulins concurrently (meaning large doses of lantus or levemir coupled with small doses of novolin r) the potential for a catastrophic med error exists if that large dose is mistakenly taken from the wrong vial during a moment of distraction or simple lack of focus. The potential that that error might not even be caught until it is too late is even greater considering that once the vials are put away the contents of both syringes will be clear and indistinguishable from another. This side argues that if the lantus/levemir and regular combinations were predrawn say a couple hours prior to administration in a less busy time period and in a more controlled environment, labeled with the appropriate resident's name and then that label double-checked at time of administration, this would be a safer practice that would greatly reduce the potential for said catastrophic error. This is in reference to a morning med pass, in which insulins are given at 6-6:30 AM (a very busy and congested time on the unit), whereas 2 hours prior the unit and environment is comparatively very calm and controlled. The other side argues that such predrawing should NEVER happen because this 1) would be a violation of standard practice, be comparable to prepouring medications, and similarly to prepouring could be more dangerous if a nurse gets sloppy and gives it to the wrong resident (although sloppyness aside, with a clear nametag attached to a syringe I would think that potential might actually be reduced). I'm not aware if there is a specific law that definitively states this should not be done with insulins in this sort of milieu, however, particularly when large amounts of long acting insulin are given concurrently with small amounts of fast acting insulins. 2)Shouldn't be an issue to begin with if a nurse makes sure every time that what they pay attention to the rights of medication administration and makes certain that they are giving exactly what they are supposed to during the med pass. The counter-argument to this of course is that it is essentially ideological and while in theory is certainly true it also assumes that nurses are going to be perfect every time (and of course nurses are people and therefore are not perfect), regardless of extraneous circumstances and factors that may be present (multiple distractions, fatigue/burnout, feelings of being rushed/hurried or overly busy, etc). 3) Could reduce the potency of the insulin if it is predrawn ahead of time. This is something I'm unsure of, and if somebody has more info on that would be enlightening. Although I am certain that this is true if the insulin is left exposed to light, this wouldn't be the case of course as the syringes would be placed back in the med cart drawer. Similarly if it were mixed insulins I imagine the same would be the case. I don't know if that would be at all true simply by drawing unmixed insulins such as lantus/levemir and regular from their respective vials and storing them in the syringe for a couple hours, or if there have ever even been any such studies of this. My gut feeling is that any resultant potency change (if any) from being stored in a syringe for two hours versus a vial would be minute and negligible, but at the same time I don't know. However I certainly understand the concern when large doses of lantus/levemir (60, 70, 80 units for example) are given concurrently with a fast acting insulin. To put it in a greater context, in the course of the last 35 months I estimate that I've given about 8100 total insulin shots on the unit that I work. To think that just one misstep out of that many shots could potentially kill a person under my care, particularly if it were a large dose of a clear fast acting insulin mistakenly drawn from the wrong vial, is rather intimidating.

Thanks mindlor. I wish I had been AS wise 3 years ago when I first graduated, before splurging on a new car (which, by the way, the dealership reamed me on) and a bike. But you live, you learn. Simplification is often times key...I'm fascinated by this trend of people who live in RVs nowadays. I don't know that I could ever be THAT simplified, but it's a fascinating thought to be nonetheless.

Well, it's tricky though not necessarily that difficult if you can live within your means. I have no kids so that I imagine is a bigtime start lol. In my case I'm close to being paycheck to paycheck right now (not good), however my 2007 stang will be paid off in a year which should make a HUGE difference in the amount I'm able to save, will likely be ditching a motorcycle I have which will save some, student loans will take care of themselves with some time, and in 3 years should be vested in my state retirement system (retirement pension). Suze Orman advises her callers to save for 8 months worth of living expenses before making any major purchases, and I feel that is sound advise. Whenever I can get to that point I will feel a whole lot more secure in my position as well, and far more confident/less dependent/less of a slave to the institution because of it. Not to get off on too much of an aside or anything...

Welcome to the real world soldier. I can't WAIT until the day that I am financially secure, because I will be one hornery bastard about certain administrative and bureaucratic practices in healthcare the day that occurs. Not to mention office politics!

All of these people are correct, that's ********. And yeah whoever that "employee" is needs to mind his/her own business and GET A LIFE! Have more confidence and stand up for yourself, for what you give of yourself to help your patients you are most certainly worth it! If your manager doesn't have your back, that's just plain sad. I suggest even printing up the replies in this thread to share with your manager just how many healthcare professionals have your back on this!

Good advice from Beast master. I'm not fit to judge who is right and who is wrong as far as whatever disputes you have had, as I don't know the absolute circumstances surrounding them. However there are certainly seasoned nurses and such who have LOUSY, pretentious and power tripping attitudes and are worth of a sound slap upside the head. However, that's obviously not an option. I say stand up for yourself ANYTIME you feel that you are being disrespected, but also know your limitations and try to think about what would or wouldn't sound acceptable if the DON were to overhear the conversation and your response to it. But also own up to any non-petty mistakes that you make quickly, and accept whatever crap you may end up taking if you do make such a mistake as it will always come with the territory. And find somebody you can confide in there too, I would think there would have to be at least one warm soul somewhere in that facility who would have some knowledge of your problems, offer you an ear and maybe a little sound advise too. And if not, than the place you are at is in one SAD state of affairs, and I would be looking to expand my horizons and look elsewhere if the place truly is that bad.

In what way does humidity generally affect infection control and pathogen transmission during these colder months? I ask because in my nursing home the management has recently banned the use of humidifier's in the rooms of resident's for reasons related to infection control. I just read an article however stating that influenza virus, for one, generally transmits in colder and dryer air, and not in more humid air at all.

Hi Jennifer, nice to meet you. I graduated from NHCTC-Stratham last year. It's true that your composite score is more important than your individual marks. The vast majority of the students who got into my class had composite scores in the 98th percentile or better. They do take other things into account however, like experience, prereqs, etc. Having experience at Exeter is a big plus as Exeter is one of the finest hospitals in the region. When I got in I had scored in the 98th percentile composite (though, with the exception of math, I think my individual marks were in the low 90s), but hadn't yet done A+P 2, microbiology or human growth and development. I also had several years experience working in a resthome and had been promoted to an MNA. Good luck! Chris

Good point. And in my case, I work in a nursing home. There aren't doctor's around every corner in long-term care, and they can be difficult to reach in general. You also aren't going to be getting ABGs on a patient who's in such a facility, the best you have to go on is your pulse oximeter.

LOL...good info. I actually looked in my medical surgical nursing book beforehand (smeltzer and bare, copyright 2004) and read the pertinent information, but the info was rather generic and it didn't say anything as far as what is too much O2 and what is too little, just the basics about "if you give too much it will suppress their repspiratory drive etc. etc." but nothing about where that threshold actually lies. As I said, i suspect that it's entirely individualized. I would think that the worse their degree of pulmonary obstruction is, the more CO2 they will retain, therefore the less O2 you can give them without suppressing their respiratory drive. I would think that the only way you could determine this on an individual basis would be by aggessively check their O2 sats with each change. But I don't know if there is a specific level that your general person with COPD absolutely cannot go above.

I recall being told by an instructor during my nursing clinicals that a patient can be on up to 4L of O2 but no more due to the retention of CO2 and loss of respiratory drive if they have COPD. A colleague of mine today told me that she was told that it shouldn't go over 2 Liters however. What is the correct answer, or is it one of those things that is more individualized to meet the needs of the specific patient? Also if anybody has any good sources or links to studies for this info it would be a bonus.