silas2642

Sorry you're in this position-- when these situations occur, it's always the patient who winds up suffering the most. You're probably not going to be able to move mountains in this situation, but as long as you're this patient's nurse, you may find the opportunity to find out exactly what the patient's family wants for their loved one. One thing I've observed during these situations is that often the physician, the family and patient, and the nurse aren't on the same page. What are the family's goals for their father? Is it to prolong his life or to minimize suffering? What did/does their father want? What are they most afraid of? Have they had a loved one in hospice before and if so, was it a positive or negative experience? The same can be said of the doctor. What are his goals for the patient? Has he and the family talked about the short-term and long-term goals for the patient, what appropriate interventions he and the family are wililng/wish to take?

I think that it depends on a number of factors including what kind of investment you want to make (if I remember correctly the Master Cardiology III is quite bit more expensive than the classic II SE), what scope you can hear well with, and if you're going to be willing to upgrade or not in the future. I disagree with the poster who said that the scope doesn't matter-- for people who are just starting out and don't know what they're listening to, it does matter. The seasoned cardiologist can probably hear a grade I murmur using a Fisher Price stethoscope, for students it's harder. I definitely suggest trying before you buy: don't go on to allheart.com and buy based on what you've heard alone. If you're looking for a good scope, then you want one with both a bell and a diaphragm (or bell/diaphragm function), one that fits well into your ears with a good seal that's comfortable for you. And of course you need to be able to be able to hear well with it. If you live near a medical equipment store, then go and try some out-- listen to your heart and lung sounds and then go from there.

Yeah. I would agree with the poster who said that the Littman Classi SE sounds like a good scope for you. It's not outrageously expensive, it's a solid scope with a bell and a diaphragm, it's lightweight, and it'll last you for as long as you take care of it.

I don't know if all hospitals should offer it, but I will say that many alternative treatments like acupuncture and chiropractic adjustments, while not necessarily helpful have been studied to be safe. If it isn't going to harm the patient and makes him/her feel better, I say go for it.

It sounds like you have a problm that is interferring with your ability to do what you want-- I would definitely try and get this under control before you start nursing school/invest in nursing school. There is definitely help out there, and seeing a psychiatrist may not be a bad idea or asking about different types of therapy that may help you. I will say that medicine/nursing is so broad and that you could do a ton with it; it sounds like you already know that you could be in a setting where you have very little contact with oncology patients.

What does your attending think? Why is he clotting, and has he been referred to hematology? Is he an appropriate candidate for a greenfield filter?

Look did you violate the attendance policy or not? It doesn't matter what other people did, it matters what YOU did... if you don't show up to work, that's an enormous problem. You're no good to anyone if you're not reliable.

Honestly I would ask an attending about this issue because you don't want to miss anything like an anemia secondary to malignancy. If her anemia is secondary to one cause, then figuring out the etiology is relatively simple, however, if the etiology is multifactorial, it can get confusing. It may be wise to have someone who is more experienced and can help you through this until you are more comfortable.

How could you possibly know if you haven't seen the patient?

He needs to change, there's no excuse for that kind of behavior. Sit down and explain he you can't behave like that (ie you're dealing with human beings who are sick). If he doesn't change, report him. His actions are intolerable.

The thing of it is, what does DNR mean to the patient? You have to be sure that what the pt actually wants-- does that mean no chest compressions, but you can give vasopressors and fluids? Does he/she want a central line? Does he want to be intubated? I would think that this type of thing requires a face to face conversation with the covering doctor.

Just get the iphone; it's awesome. I'll never go back. Every blackberry user I've ever met is so-so on how they feel about it, but I've never met an iphone owner who doesn't love it to death.

It doesn't matter what other people think of the brand or whatever of your stethoscope, what matters is whether or not you can do your job with the stethoscope. A lot of what you're going to hear is dependent on the user, not nearly as much on the quality of the scope. That being said, sometimes it is easier to get a good scope when you don't know what you're listening to.

Quite frankly, I think that a lot of physicians just don't respect the DNP degree because they feel it's a load of crap-- there is no consistent curriculum across schools for this degree, it can be obtained online, and tons of these courses are filled with fluff like "nursing leadership." On top of that the leader of this entire movement, Mundinger, is claiming superiority of DNP's to physicians when half of her hand-picked DNP's couldn't even pass a watered down step III.

I'm sorry to hear about your night, but it sounds like you helped get the family through what was probably the worst night of their life and you did it with professionalism and a great sense of compassion, which helped them immensely even though they might not even realize it at this point.

i think that you should have paged an md if her glucose was down to 39 and asked what he wanted to do with the meds-- hypoglycemia can be dangerous; remember that glucose is the brain's only source of energy. however, he should have also written an order "page md if blood glucose is less than x or hold meds if glucose less than;" you're a nurse, not a doctor. personally, i think that he just freaked because something bad could have definitely happened if her glucose dropped too low and he would have been responsible for the incident.

Just curious, did they tell you that the pt had pneumonia, or are you just assuming that the the pt has pneumonia because the the O2 sat is low? Because unless they told you that the pt had pneumonia, your approach to the clinical situation may be kind of different.

What was the T3/T4 when you measured it? The TSH alone doesn't really tell you much. Also, how did the pt present and what was the PE like-- these are kind of important clues that you all have to put together. Also, if you're not sure, you really need to be asking a physician before fooling around with someone's thyroid.

I'm kind of with wowza here when asking why on earth would a chiropractor be doing nerve blocks? As far as I know, that's not even within a chiropractor's scope of practice-- I thought that was something mostly pain docs and anesthesiologists did. And if something goes wrong, who is going to help you?

Well, asking the radiologist or a physician seems like a good start. I'm just a med student, but we were taught that you should definitely have a pretty good differential in your mind before you start ordering expensive exams. So with your differential in mind, you could always look it up online from a source like diagnosaurus (I think this is the spelling) or uptodate. Usually they will give what tests are the the gold standard along with what other diagnoses you should be considering. You could also look it up in Harrisons. A lot of hospitals will have it online and most, if not all offices will have a copy in the office. Computer would probably be the fastest way to access these sources, but you could also access them via pda (heard the new iphone is pretty quick).

I'm not totally sure, but I think that they're more worried about the patients than they are about you. C. diff is found in the normal flora of a lot of people. The problem begins when pts are put on antibiotics. which wipes out their normal GI flora, allowing C. difficile to grow unchecked. It produces two toxins, which basically kills the GI lining and wreaks havoc on the GI tract, creating that nasty, foul smelling diarrhea.

Why did you apologize to her? You didn't do anything wrong. You wrote her a note communicating what needed to be done (which was within the scope of her job), and wrote it in a professional manner. She can't call you that. She can't call ANYONE that she works with.

I don't understand why you feel that your scope of practice should be different than a PA's.

Well, you've already been through chiro school once and since that is harder than med school, then med school should be a breeze-- just go for it. You're not that old.

Doubtful; pretty sure that the diaphragm is striated muscle and as such can use anaerobic sources of fuel. The brain works only on aerobic sources-- which is why it is so sensitive to hypoxia/anoxia and only survives for minutes before irreversible damage begins to occur when it is deprived of oxygen. In times of starvation, it can use ketolysis, but not acutely. How cardiac arrest leads to respiratory arrest is probably a little/a lot more complicated then I'm making it. For the most part, healthy people's hearts just don't stop and there is most likely more pathophysiology behind it.