psalm51

Read this solution to the problem of air bubbles in the insulin syringe back in the early 90's. the author reported that blind diabetics used a home made syringe guide for drawing up the correct dose of insulin. And, to eliminate bubbles in the syringe, they would first draw up an insulin dose larger than needed into their syringe x 2 -- and then on the 3rd draw, they would draw the exact dose needed. apparently, this coats the inside of the syringe with insulin and thus bubbles don't stick to the side. been using this method for years and it works!

i have this rider thru state farm. it covers my assets, such as my home. i also have a malpractice policy thru NSO. NSO will cover the nurse in court. but does not cover the nurse for any monetary judgements against h/him. that would perhaps require lien / liquidation of assets. that's what state farm would cover to prevent my losing my assets. btw, malpractice insurance does not cover all expenses r/t a suit. hope this is helpful.

if difficulty swallowing, a liquid form is most appropriate. slow-release tablets cannot be crushed, chewed, or broken. an excellent reference is the Institute for Safe Medication Practice: link posted bekloiw: http://www.ismp.org/Tools/DoNotCrush.pdf

the formula for writing objectives is: WHO + will do WHAT + HOW + by WHEN AN EXAMPLE: At the conclusion of this presentation, the student will be able to formulate a plan of care for the patient with a trach.

Most meds (with few exceptions) go BEST

first, let me say that, if only a few points in math or science lie between your daughter's hopes for becoming a Nurse, i hope that she makes it to the NCLEX Exam. IMHO, this is the best advice so far: "and have her communicate, communicate, communicate with her professors. A school is going to be much more willing to do everything they can to help a student who has taken ownership of their education." as a Nurse Educator, i cannot stress enough the value of meeting often and on a regular basis with the professors. it conveys the message that "I'm trying my best". and "I'm taking ownership of my nursing education." "Please help me to meet my goal". Perhaps there is an extra credit assignment that your daughter could complete to gain points toward her final grade. most schools have policies for students placed on academic probation. your daughter needs to meet with her advisor / dean (or whoever is named in her school's policy). usually, free tutoring is provided and a contract between the advisor and student is formulated. your daughter also probably needs to meet with the Dean of Nursing. again, this communicates a sincere desire on her part to succeed in the program. and she can avail herself of any advice or guidance that the Dean may offer. and, if all else fails, comb over the policies for failing, withdrawal, and readmission. there may be a "loop hole" there. (i'm sorry, but sometimes it does come down to this). if she withdraws, can she then be re-admitted for a re-take of the course she almost failed? how is the withdrawal recorded? as a W- fail? or just a W? can she withdraw or take a leave based on a medical condition? and if so, what are the conditions for readmission? finally, what is the appeals / grievance process? if there is a 20 point difference between passing or failing a course, the appeals process will not help. however, if there is a difference of a point or two, the process may help. the WORST thing to do is to BLAME the professor! it creates an adversarial relationship, which will not be beneficial to your daughter. i wish you and your daughter the best! based upon what you have said here, it sounds as though your daughter would be an asset to our Profession. i am always sorry when i see some good, caring people who i believe would make a good Nurse, fail out of Nursing School b/c of a couple of points in math or science. (BTW, switching schools is not always the answer. many schools take in more candidates than they have clinical spots for -- meaning that the school may take in 100 students, but can only accomodate 60 of them at clinical sites. i've known students who had to go on a 3 year waiting list just to get into the clinicals).

best method for getting all liquid into the 'bottom' part of the ampule is to place between both palms and roll it quickly 2 or 3 times. when i don't have an ampule breaker, i wrap in alcohol swab (package and all) -- it at least helps. best thing to do is present yourself to ER for treatment. a couple of those bills, and the hospital will seriously consider purchasing ampule breaking devices.

federal law re: sexual harassment may apply here. it certainly is a part of our school policy.

i usually share some of my own "bloopers" with students -- and i call them "kodak moments" to be cherished as memories that will add levity to their "worst night". i always reassure students that we all have our stories. on that "worst night" when everything has broken loose and everything seems to be going wrong, you will finally gather a few minutes of quiet alone -- and in that moment, one of your cherished kodak moments will bring a smile to your face and a laugh to your heart -- and everyone around you will wonder what you're up to.

1. had a student who was an auto mechanic. first time insertion of an indwelling catheter. student charted "foley installed". :) 2. helping a student formulate a nurse's narrative note when another student interupted with a question. i answered that student's question and re-focused on my student who was writing a narrative note only to find that this student had written my answer to the other student's question in the chart. :) 3. had a student who warned me that she was particularly sensitive to odor of BM. i suggested that she put a little tooth paste under her nose. she did. it worked. the only thing is hse forgot to remove the tooth paste as she goes walking down the hall. :)

I want HER INSURANCE!

the "official" DO NOT CRUSH list http://www.ismp.org/Tools/DoNotCrush.pdf

the principle is that if it will beccome liquid when left at room temperature, then it is liquid. pudding qualifies.

the law does not stop at the hospital entrance. if i, as a citizen, feel threatened by the words or acts of another, i have every right to call the police. i thiink she has a good case.

novolog is not regular insulin. novolog (aspart) is rapid acting insulin - with an immediate onset. novolog is the "other" coverage. it is appropriate for "peakers" -- that is, for those whose blood glucose level peaks (a sudden sharp rise) following meals. most of us are use to covering with regular insulin for diabetics whose blood glucose level rises gradually to a sustained high level. i've not given the 70/30 as coverage -- but i could see how some diabetics would benefit.

How do you waste your medications? current unwritten policy is to FLUSH information has been shared in my hospital. many of the nurses have begun to dispose of most meds in the sharps container -- still no formal written policy however. Do you have environmental concerns? absolutely Are there laws/policies that mandate disposal practices in your area? no law yet - just guidelines What kind of facility do you work in? hospital What state/country do you work in? Pennsylvania

does your hospital have a policy on the proper disposal of medications? several government agencies (epa, etc.), state epa, and professional organizations (american pharmacist association) have developed guidelines for medication disposal. most of these guidelines address disposal in the home. perhaps these guidelines are not binding on healthcare organizations (??) one would need to refer to their STATE epa for that information. a search of "disposal of medications" yields a number of states that have weighed in on this issue. it's interesting that Canada already has a NATIONAL program in place. http://www.whitehousedrugpolicy.gov/publications/pdf/prescrip_disposal.pdf http://www.smarxtdisposal.net/index.html the guidelines are consistent across the board. hope these links are helpful. imho, we should be taking steps to prevent further contamination of our waters by unused meds.

1. learn to manage your stress! You are about to engage in a rigorous academic program. the academic component alone is stressful enough. 2. take responsibility for your actions / inactions. placing blame on others doesn't solve the problem. 3. pace yourself! organize! organize! organize!

our students prepare the day before by reviewing the patient's chart and kardex. they MUST attend report the morning of their clinical assignment. not understanding why your students don't attend report -- or why they don't receive report from their CI. how are your colleagues on your unit handling this? what does your manager say? it does seem that the current situation is an imposition on you and your patients.

Oxygen is a comfort measure too. it is ok to titrate oxygen to baseline sat. it's when we go over the patient's baseline sat that, theoretically, we could knock out their hypoxic drive.

even if the family member is a bonafide physician, PA, or NP -- they should be talking to the patient's attending -- not the RN -- even if they are credentialed by the hospital in which their loved one is a patient. it's not legal for them to give an order -- and certainly not legal for us to carry it out.

as an old nurse in tne twilight of my professional practice, i say go for the 'adventure'. go to the the BIG medical centers in some 'exotic' place, such as seattle, san francisco, or even minnesota. learn ALL you can! then, if you really want to you can always return to MO or KS. this is one of my regrets i had always wanted to go to some of these "far off" places -- but settled for 'safe'. i did practice in the Chicago area for > 10 years and LOVED it. but then moved back home where i've been for the past 20 years. i would go back in a heart beat. wish i had tried out seattle and san francisco too.

siggie, GOD bless you! i'm 58 and been around the block too. can't wait to retire -- although i will be joining the ranks of the poor.

i was taught 25 units of regular is the legal limit except in DKA, HHNS. i would definitely want to clarify anything over 25, especially if given IV. theoretically in a perfect world, every unit of reg insulin decreases the BS by 10 - and the BS should not be lowered more than 100 points an hour.

i suffered whip lash once when the over zealous linen cart guy crashed into my med cart. honest. threw me off balance and i landed against the wall. took a couple of ASA and get a good laugh out of it every once in awhile since then.