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Meriwhen ASN, BSN, RN

Psych Sheep RN

Reputation Activity by Meriwhen

Reactions Given

Like 15

Reactions Received

Like 33
Haha 1

  1. Like
    Meriwhen, ASN, BSN, RN got a reaction from macfar28 in Holding voluntary patients - illegally?   
    Sure, you could AWOL--I didn't say you couldn't. But why would the discharge process be any different whether it's med-surg or psych?
  2. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  3. Like
    Meriwhen, ASN, BSN, RN reacted to Sour Lemon in Weird Interview!?   
    As a goofy person myself, I would have interpreted her behavior as goofy and a bit flippant ...right up my alley. I'd be excited about the job.
  4. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  5. Like
    Meriwhen, ASN, BSN, RN got a reaction from Coffee Nurse, BSN, RN in Per diem rejections   
    I had that happen to me.  I ended up getting the job and staying there for more than two years.
  6. Like
    Meriwhen, ASN, BSN, RN got a reaction from HomeBound in Help with ACLS   
    Verbalize out loud every single thing that is going to happen, because when you run the megacode you will be telling each of your team members what they will have to do.
    They're going to give you somewhat obvious strips, they're not going to give you something that's literally on the border between two heart rhythms.  That being said, you do need to practice reading the strips until you know them well.
    List each of the megacodes (bradycardia, SVT, PEA, etc.) and the medications and dosages for each.  Use flashcards to help you remember them.  
    Keep in mind that the patient's condition may change during the megacode and you may have to jump to a new algorhythm.
    While your teacher won't be able to give you any hints...I've done ACLS 5 times (4 megacodes have been asystole *sigh*) and in all the classes, we were allowed to help each other during the megacode to a certain extent.  We could not feed the leader all the answers, but we could brainstorm what was happening in the megacode.  So you'll have a little support.
  7. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  8. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  9. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  10. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  11. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  12. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  13. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  14. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  15. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  16. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  17. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  18. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  19. Like
    Meriwhen, ASN, BSN, RN got a reaction from Sour Lemon in Written Up   
    IMO, the orders are clear.  
    But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take.  I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications.  Then if necessary, the anxiety PRN dose could be used.  
    If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication.
    I also think writing-up the OP was a bit extreme.
  20. Like
    Meriwhen, ASN, BSN, RN reacted to Coffee Nurse, BSN, RN in Per diem rejections   
    O.o So I just looked at my phone, turns out I got a voicemail at literally the same time from the nurse manager asking if I want to come in and see the unit.  You know, I try not to rag on HR in general but man...  Still -- yay?
  21. Like
    Meriwhen, ASN, BSN, RN reacted to umbdude, BSN, RN in Giving up PA school acceptance to pursue ASN?   
    It doesn't sound like a wise decision especially considering you are only in your mid-20s and don't have kids yet. 2 years of PA education will fly by. After that, you can work part-time as a PA and probably make more than what RNs make full time.
    Advanced practitioners are treated with far more respect and have more autonomy. I won't go into the negatives of bedside nursing as a RN because there already are a gazillion threads about it.
    Focus on the long term, not the next 2-3 years. Good luck whatever you choose. 
  22. Like
    Meriwhen, ASN, BSN, RN reacted to Davey Do in Written Up   
    A rule of thumb I use with any controlled meds when the order is unclear: Separate by an hour.
    Patients will come in on different controlled substances and say, "I take them all at once at home!" I say, "I don't know you and I will always error on the side of safety, so make a choice: Are you feeling more anxiety or pain (benzodiazepine or narcotic analgesic)?"
  23. Like
    Meriwhen, ASN, BSN, RN reacted to Tenebrae in Written Up   
    But its two seperate orders. 
    Order 1 is to be given for sleep
    Order 2 can only be given q8
    Nothing mentioned that order 1 and order 2 have to be given 8 hours aparrt
  24. Like
    Meriwhen, ASN, BSN, RN reacted to Sour Lemon in Written Up   
    I actually think the orders were very clear. What varies are unit culture and nursing judgement. 
    I don't even think there was an "error" in judgement ...just a difference of opinion. If we're looking at facts, the OP was perfectly right.
  25. Like
    Meriwhen, ASN, BSN, RN got a reaction from HomeBound in Help with ACLS   
    Verbalize out loud every single thing that is going to happen, because when you run the megacode you will be telling each of your team members what they will have to do.
    They're going to give you somewhat obvious strips, they're not going to give you something that's literally on the border between two heart rhythms.  That being said, you do need to practice reading the strips until you know them well.
    List each of the megacodes (bradycardia, SVT, PEA, etc.) and the medications and dosages for each.  Use flashcards to help you remember them.  
    Keep in mind that the patient's condition may change during the megacode and you may have to jump to a new algorhythm.
    While your teacher won't be able to give you any hints...I've done ACLS 5 times (4 megacodes have been asystole *sigh*) and in all the classes, we were allowed to help each other during the megacode to a certain extent.  We could not feed the leader all the answers, but we could brainstorm what was happening in the megacode.  So you'll have a little support.
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