Toquay

Sounds like a passport was implanted which looks like a mediport only much smaller. The passport can indeed migrate or flip over so its very important to feel and determine that the port/septum side is up. You must still use a huber or noncoreing needle to access the silicone septum which is only about as big as your smallest fingers nail bed. The size of the patient or the amount of tissue one has to feel through can make this port a little more tricky to access. You should still feel the back of the port through the septum when accessing before trying to use it. Once accessed follow your hospital port policy for maintaining it. Hope this helps. Toq

I am a nurse but not in OB so wanted to ask the experts. Is it common for OB to change the due date in the last few weeks pregnancy? Daughter had been going to fetal maternal medicine for entire pregnancy until a week ago and has been told she is due Nov 19th and at her OB appt the other day (OB she has never seen before) was told her due date is the 26th. OB stated only US that counts was the 6 wk one as it is most accurate (daughter was getting an US twice a month through preg) and that all other US are off by 2 weeks. This OB insisted my daughter heavily consider epidural since it was first baby and started throwing out possibility of c-section, I asked about epidurals slowing labor and was told "not the way they do it" as they only do it at a certain point in labor. I told her I was under the impression that anesthesia called the shots and most times it was at their convenience or when they were on the unit to which she did agree that was partially right. Daughter lost her mucous plug 1 week ago (I saw evidence of this) had some contractions but nothing that lasted or became regular. She saw OB (not the one above) the next day and was confirmed to be 2cm dilated but no mention of effacement. The OB above refused to do vag exam after moving my daughters due date back a week states baby has 2 more days to be at 37 wks and this would be risky for baby. She did do a speculum check and stated cervix was closed up and not 2cm anymore, explaining that the cervix opens and closes at the end of pregnancy. I know the baby will come when it is good and ready and not before. However, my questions are is it common to discount all US except the first one? Is it usual for cervix to close after losing mucous plug and being at 2cm with manual exam? Can the speculum exam be as accurate in determining the cervix was closed (exam was super fast maybe 3 secs)? Finally any thoughts on the epidural (I know its a personal choice) and laboring times? Women have given birth for thousands of years it is not an unnatural act it seems like instilling fear in expectant moms is common. Thanks for any feedback, I know every pregnancy can be different. Toq

Edison Community College ADN 1992 Review for NCLEX by hospital internship (once a week x 6 weeks) Passed 1st attempt

The best advice I can offer to any new nurse is to be very kind to yourselves and don't be afraid to say you are overwhelmed. The best thing students can do before applying to a department is to be very observant of the staff during your rotation through there. Do the staff help each other, are they patient with students or new nurses on their unit (ask the new nurses how they feel), are there cliques or cattiness? If it's a unit you did not rotate through ask the director of that department if you can come have an observation day as part of your learning experience and watch the teamwork or lack thereof. Then choose wisely the place that will nurture you and allow you to grow as nurse. Toq

Just a question for the OP, since it seems vomiting was relieved why not go home and take the RX's you already had? Toq

I was giving a guy a TD IM shot in his arm. He is all tense so I told him "Just relax, let it hang limp" and he replies "It usually is" and his wife starts to giggle. I proceed to give the injection and say "This won't hurt but you'll be a little stiff in the morning" to which he says "It always is" and the wife is now howling with laughter. I musta turned 5 shades of red when it dawned on me what they were thinking. We all had a good laugh but now I make sure to add your arm to the instructions. Nothing dangerous or bad but I sure felt silly. Toq

Another solution that may work for you is going to part-time, since your spouse makes enough to support this change. This was to option I went with a few yrs ago and its worked out great. I love nursing and using my skills to help and educate people but was getting burnt out doing full time for 15 yrs (ER night shift). I would find myself counting down the hours I had left to get ready for work and feeling emotionally drained before I even got to work. I found myself snapping at things that were beyond my control and dwelling on it for hours. I felt isolated in my feelings and stopped doing things for myself because I was so mentally drained. Now that I work part-time (3 twelve hrs shifts a pay period), I am able to go to work feeling refreshed and new every other week-end. I find I am more helpful to my co-workers and to my patients because I am now taking care of me. I only wish every nurse were able to to work these type hours and still make ends meet. I do help out co-workers and cover shifts for them to help out now and then and admin likes this as I am never in overtime. Its a shame to lose good nurses totally and this may be something to think about. Toq

A few yrs back had a 32 yr old female arrive by EMS... she walks off the rig through our doors holding her fingers to her carotid "I have no pulse" and denies any other complaints. Ems giggling and shaking their heads. Triage--------------> Toq

Maybe over time due to people opting for more government health care options over the higher priced Insurance companies, we will all become government employees and at 20yrs of work we get to retire with full benefits. I can dream can't I? With the hits my 401K took I will prolly have to work til the day I die. I envy my firefighter neighbor who retired at age 45 OMG!! Toq

The new bill will make insurance "affordable" for many that currently can't afford coverage. There will be subsidies to help the unemployed and low income. Businesses will be encouraged to provide health care options to their employees, again I venture to say not many employers provide "free health care", there will be a cost. Parents will be able to keep children on their family plans until age 26, again premiums will increase. Many people that are employed had opted out of health care for multitudes of reasons, these people will now have to contribute to the health care system to some degree whether they like it or not. I think alot of people feel this new bill is "free" health care when its truely not, more people will have to contribute to the system than currently do. I am undecided how this will all work out in the long run but I guess time will tell. Toq My hubby was informed his insurance would now require a 3k deductible and that is before co-pays will even start, and of course he still has to pay the weekly premiums.

Ok Just had to post this... [url=http://http://www.youtube.com/watch?v=_m64cy1MMPg][/url] http://www.youtube.com/watch?v=_m64cy1MMPg Toq

The intractable nausea and vomiting that is observed putting their finger down their throat to make themselves heave. The hyperventilating anxiety attack put in a stretcher complaining they are going to passout and being told to "Go ahead". I personally like the fake seizures that need to sign papers for registration and the seizing stops long enough to sign their name and then resumes. Toq It's all job security and if you don't laugh once in a while the absurdity will kill you.

Could go either way depending on the age of the pt, VS, and history. If both are equally critical my ER would make room for both, if any delay (room being cleaned, pt being moved) I would get the EKG, start the line get the labs and put O2 on the pt. I can even get an updraft ordered for the SOB if their symptoms indicate the need for one. Toq

Hospitals are businesses and are about their bottom line and making money. I think Nurses and other hospital staff will see their own benefits take a hit. Meaning the hospital will decrease the percent they pay for employee benefits. You may see fees for the once free in house services or programs (employee assistance, smoking cessation, weight management, etc) and pay more for your own personal/ family coverage and have higher deductibles. Probably get the speech how we all have to pull together meaning the end of yr evaluations will continue to have lower than cost of living increases to off set their loss. The funny thing is the person in management that comes up with this will probably get a pay raise and promotion as well as a new committee to work under them. Toq

The storm is coming and we all have no clue the magnitude of it. The people that can pay now will continue to pay and the ones that can't or won't will still not be able to contribute (except to the debt of healthcare). Doctors will continue to order exorbitant tests to cover their butts from lawsuits. Example, person that comes to ER 50 times a year for abd pain will always get the full meal deal work up because the one time its not done and they actually have something wrong they win the lawsuit lottery. Every chest pain over age 45 (some younger) regardless of tests being negative will be admitted to be precautionary. As long as the liabilty of the doctors are high they will protect themselves, it we make them less liable then we have to worry about quality of care standards. Preventative care will help if people actually go to visits and try to take better care of themselves. However, I still see people that say that can't get to walmart for the "free" antibiotic but they can afford the daily 6 pack beer and their smokes. The cost to try and overhaul the healthcare system will come at a price to all of us there really is no way to avoid it, higher taxes (instituted slowly to make Obama look good), perhaps lower pay to medical personnel, higher insurance premiums for the haves to cover the have nots. I honestly think they should start with overhauling present programs and weed out the fradulent advantage takers. How many are on disability collecting a check and can work? I see alot of young people on disability these days and while some may be legit I would venture to say some are not, they should be working and supporting the system. Healthcare is definately broke and we do need reform, but you can't spend trillions of dollars and not expect our personal bottom lines to change. Toq