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RedERRN's Latest Activity

  1. RedERRN

    Post Cath Provigil

    Provigil's generic name is Modafinil. According to the prescribing information found at provigil.com, "PROVIGIL (modafinil) is a wakefulness-promoting agent for oral administration." and "The precise mechanism(s) through which modafinil promotes wakefulness is unknown. Modafinil has wake-promoting actions like sympathomimetic agents including amphetamine and methylphenidate, although the pharmacologic profile is not identical to that of sympathomimetic amines. At pharmacologically relevant concentrations, modafinil does not bind to most potentially relevant receptors for sleep/wake regulation, including those for norepinephrine, serotonin, dopamine, GABA, adenosine, histamine-3, melatonin, or benzodiazepines. Modafinil also does not inhibit the activities of MAO-B or phosphodiesterases II-V." What makes it even more suprising to me that Provigil is being prescribed post-cath is what the website has to say about cardiovascular side-effects: "In clinical studies of PROVIGIL, signs and symptoms including chest pain, palpitations, dyspnea and transient ischemic T-wave changes on ECG were observed in three subjects in association with mitral valve prolapse or left ventricular hypertrophy. It is recommended that PROVIGIL tablets not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced the mitral valve prolapse syndrome when previously receiving CNS stimulants. Such signs may include but are not limited to ischemic ECG changes, chest pain, or arrhythmia. Modafinil has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable angina, and such patients should be treated with caution. Blood pressure monitoring in short-term ( larger when only studies in OSAHS were included, with 3.4% of patients on PROVIGIL and 1.1% of patients on placebo requiring such alterations in the use of antihypertensive medication. Increased monitoring of blood pressure may be appropriate in patients on PROVIGIL." Of course, I have yet to ask one of the cardiologists who is prescribing this WHY they are prescribing it - I also haven't had to give it since my original post :)
  2. RedERRN

    Post Cath Provigil

    I have recently run across patients who are post-cath that have an order for PO Provigil 200mg BID. I have yet to ask a cardiologist the reasoning behind this, but I have researched the uses of Provigil. All I can find is that Provigil is used for narcolepsy and correction of circadian rhythms in those who do shift work (labeled uses) and in post-traumatic brain injury patients to help restore neurologic function. I have asked and asked other nurses (including the director of our CVU) and pharmacists and no one else know the reasoning either. Have any of you run across this? Why is Provigil being used in select post heart cath patients? Thanks for any input.
  3. RedERRN

    Highest BP you have ever seen on a pt

    Highest BP: 277/224 (My mother in law during adrenal crisis) Lowest BP: 20 systolic (pt fresh in from EMS - came in "nonemergent" ) Highest blood sugar: 1900 (my case-study for nursing school - Dx HHNK) Lowest blood sugar: 8 (and the patient lived!) How about highest potassium? For me it was a 50-something-year-old lady with no Hx of dialysis that suddenly became "paralyzed." Her potassium was 9.9 - nonhemolyzed!!!! She was cured by immediate insertion of a quinton cath and dialysis!
  4. What about the coroner? Could he/she convey this information to the family without negative retribution?
  5. RedERRN

    Boosting Morale in the ER

    Always take into consideration what the nurses have going on in their rooms. For example, if Nurse Smiley has an STEMI in one room in prep for stat cath lab and a patient with ARDS in prep for RSI in another room, then she is not the nurse to send the 101y.o. full code from EMS who is now apenic and unresponsive. Never, never, never enter the room and just stand there watching your staff work their butts off (I had a charge nurse who would just come and stand at the door during codes...she never offered help or anything)! Do whatever it takes! If the patient needs poop cleaned off of them so they are presentable enough to go to the floor then clean them up! While being chums with the other members of administration can make you feel more powerful and may help you climb the proverbial ladder, making friends and having fun with your staff is waaaaaayyyy more important - after all, we see ourselves as your coworkers. Oh, and CONGRATULATIONS!!!!! :yelclap: ~*~Sally~*~
  6. RedERRN

    Specimen Mislabeling- Help!

    I am sorry that you are going through this with your staff. It sounds very frustrating; however, I am sure the nurses are not intentionally leaving the labels off of the lab draws. After all, that only creates more work for the RN by having to recollect the specimen... Sounds to me like your perspective is not from the staff nurses' perspective - not that that's a bad thing...but in this instance you should really seek out the staff nurses' advice. Pick their brains. Maybe you could even set up a "Task Force" of staff RNs to nit-pick and address this issue thoroughly. This would not only address the problem at it's root, but it would make any necessary changes more acceptable by the staff since they wouldn't be changes "forced" on them by management. [banana]Just my $0.02.[/banana]
  7. RedERRN

    question about treatment for pt

    This sounds to me like a classic case of MI-induced heart failure. Possibly these changes were due to an infarction she experienced prior to the CABG? That would explain the "wet" lungs and dry bladder... If this is the case, you cannot prevent the A-fib in her. You just have to do exactly what you did: monitor her and treat as necessary.
  8. RedERRN

    turning non-emergent pts away

    The ER I work in has a policy where all patients meeting triage levels of 4 or 5 (we use the 5-tiered ESI) are sent to "Quick Care" where they receive a MSE (Medical Screening Exam) by a physician. If their chief complaint is then deemed to be non-emergent, the patient is instructed by the physician (by scripted dialogue) that their condition is not an emergency. The patient is then given the option of #1) staying at our facility to receive treatment after paying either $150 cash or their entire non-emergent co-pay or #2) leaving our facility to seek care at one of the many urgent care facilities across town or with their private MD. The reasoning for this policy is that soooo many patients present to the ER with non-emergent complaints. These patients contribute to the overcrowding and sluggish throughput. Unfortunately, we nurses can't legally tell them that they are not having an emergency and need to leave. According to EMTALA, all patients must receive a Medical Screening Exam by a physician. By following our policy we cover all the bases. It seems to work WONDERS...and word has spread pretty quick around town, too!
  9. RedERRN

    Feeling jaded...

    Hmm, it's kinda funny that you posted this because I am going through the exact same thing - except my area of 3 years experience is the ER. I've deliberated about making a change from the ER to the ICU for about a year now and I have finally decided to make the leap. The hospital that I work in is VERY bad about holding resentments against those who do departmental transfers within the hospital (ie ER to ICU) so I am going to a different hospital to do work in the ICU there. Maybe you could use a good break from the same thing too. I've talked to almost all the 15+ years experienced nurses that work in my ER and every single one of them says they experienced the same type of thing early on in their careers and switched to a different specialty for a while. That is the best benefit of being a nurse - we get to choose where we work and what we specialize in...might as well close your eyes and jump - as long as no bridges are burned, what can it hurt? Sally
  10. RedERRN

    Heparinized vs Nonheparinzed saline in arterial lines

    NS here
  11. RedERRN

    Average Tenure as ER Nurse?

    I have been feeling really, really burnt out lately. I used to love my job and look forward to going to work everyday. Now it seems like every new patient is a new stress that I will leave feeling "incomplete" about. I find myself wishing I had critical care holds so I could spend the time with them that is enough to leave me feeling satisfied about the care I've given. I don't know if I'm going through a temporary burn-out or if this is forever... Are any of you going through this, or have you experienced this before? Just out of curiosity, I was also wondering if anyone knows any statistics on the average number of years spent as an ER RN before moving on to other departments/careers... Thanks Sally
  12. RedERRN

    Vit K

    I'm like gonzo1, I've had only 2 patients in situations where they needed it IV...and it was a very slow IVP...I give it IM fairly routinely.
  13. RedERRN

    The C.R.A.P. Score

    That is toooooooooo funny!!!!!!!!! :rotfl: :rotfl: :rotfl:
  14. RedERRN

    Orientation to Triage

    Your method sounds much, much better than the training given at my ER!
  15. RedERRN

    slave labor

    Wow. This is a perfect example of "eating your young." Great job, digidog!
  16. RedERRN

    advandced monitoring in the ER

    In my ER these things are not optional...they are mandatory. We spend 90% of the time with no available adult ICU beds...NONE. Our ER becomes the ICU overflow area. If a patient needs CVP monitoring, we do it. Central lines are inserted by the surgery residents. A-lines are commonplace for the Level I area of our ER and all those rooms are stocked with A-line setups. There are a few things that we do not do: most enemas epidurals PCA pumps