MikeLPN

Saunder's Review and Saunders Q+A together (there was a deal on Amazon back when). I don't know how many questions there are between the two but I did not even get close to covering 50% of the supplied questions. Both come with CD's with test, quiz and study modes. I think that some questions may be covered in both books/CDs but with so many questions and modes for question bank selections I can't tell for sure. They are system hogs, though. I bought the review after Transitions but I don't feel it helped much with school. I did better just focusing on the texts (Ignatavicius for MedSurg and Wong for Maternal and Peds). I didn't use quiz or test mode. I used the study mode and studied the rationales for both the right and wrong answers. I also went through F.A. Davis RNotes and MedSurgNotes when I got tired of the whole question thing. I used a Lippincott's Nursing Drug Guide to study meds because it presented information by drug class more generally in the front of the book. I used Lippincott's Pocket Manual of Nursing Practice for the maternity section but the whole book would have been an awesome tool if I would have had more time and brain :monkeydance: . And, lastly, immediately after graduation I took vacation time from work and cut back my schedule exercised and ate right and studied and worked and just generally regained contact with friends and family. BTW I shut off at 75. I'm from Minnesota and online at the B of N I found out I passed at 24 hours after and I found out my license came through in 48.

This is the camera we have at work. It is made especially for this. http://www.polaroid.com/global/printer_friendly.jsp?PRODUCT%3C%3Eprd_id=845524441763352&FOLDER%3C%3Efolder_id=282574488338439&bmLocale=en_US

Thoracic outlet syndrome?

http://www.hpa.org.uk/

Psychotropic Drugs by Keltner/Folks published by Mosby. It is very comprehensive, detailed and small in size.

I need help from you oncology nurses. My dad is in recovery from colon ca w/mets and my mom just got diagnosed with uterine ca and today we decided to defer radiation d/t quality of life issues. And my wife's sister has small oat cell in the lungs w/mets and non-compliance. What I would like to know is if there is a 'best' nursing/medical oncology reference that is affordable (I'm an LTC LPN and my wife does home care) and authoritative on the units. I plan to buy it online and used will do. Please respond quickly, when it comes to family members getting ill I just get frozen like a deer in the headlights, big eyes and running in the wrong direction and everything

Ayyy Caramba!

I use our wound cleanser for an initial cleaning and then blot it dry while coaxing the remaining skin edges into approximation using swabs if need be - especially if the skin rolls under. Then I apply steri-strips cut to a decent length and try to match up the edges as best I can applied starting from the center to the edges. Apply a telfa and roll gauze over that and set up a tx to remove that in AM and monitor the steri strips bid til healed. I think the most important thing is to get it clean and the edges lined up real close as soon as you can. A skin tear is superficial and the skin is by itself an excellent covering. The steri strips fall off on their own hopefully after holding the edges together for a long time leaving a small scar. Our wound care product rep advised us to use tegaderm or opsite or whatever and change every 3-5 d. and I did try that once and it took forever to heal. So I switched back.

Learn to smile and say "No problem" when everything is going wrong and all at once.

I bought Chart Smart and it helped a little and I try to read some of what the other nurses chart when I can which seems to help more. One time I charted "Bed hold policy not sent because the ambulance would not stop even though I was running after it in the snow and banging on the door for them to stop." :chuckle I guess you just do the best you can, educate yourself about it, see how others do it better and you gradually improve. Make it legible :stone and keep it simple. After you get in so many situations your brain just makes standard templates and you fill in the blanks as you go. At my last eval the DON said I had gotten a lot better

My wife works as a day HHA and about once a month works at the LTC at the local hospital when they are really short days/eves. I work as a full-time eve LPN at a different LTC facility. This was my weekend as charge. Don't get me started. But I have never done this to any one. My philosophy is; It's a job, go with the flow and do your best and try to be nice. She calls me sobbing her eyes out and having a total panic attack this AM from her car because this nurse is riding her so hard. She called her home health super and wound up leaving work early. She is going to file a grievance and I told her to never go back and I hope she doesn't. We don't need the money (?) that bad. Screw them. She saw her replacement driving in as she was leaving (somebody wanted OT perhaps?). Politics. And this nurse actually had time to ride a CNA? And the nerve to ride a way totally complete part-timer who volunteered when you are supposedly short? Sounds to me like she went out of her way to make my wife miserable instead of doing her job. I think she's a flipping goddess for working HHA and LTC as a 49 year old diabetic. I'm SO not perfect especially with the CNAs ( I love the ones that tell me to just back off) but I have never caused anyone to leave much less quit. I will never admit it but good CNAs are the true jewels of the system. You don't get to make my wife cry. (This part of the rant edited because I could see where THAT was going) THAT I will admit

My wife works as a day HHA and about once a month works at the LTC at the local hospital when they are really short days/eves. I work as a full-time eve LPN at a different LTC facility. This was my weekend as charge. Don't get me started. But I have never done this to any one. My philosophy is; It's a job, go with the flow and do your best and try to be nice. She calls me sobbing her eyes out and having a total panic attack this AM from her car because this nurse is riding her so hard. She called her home health super and wound up leaving work early. She is going to file a grievance and I told her to never go back and I hope she doesn't. We don't need the money (?) that bad. Screw them. She saw her replacement driving in as she was leaving (somebody wanted OT perhaps?). Politics. And this nurse actually had time to ride a CNA? And the nerve to ride a way totally complete part-timer who volunteered when you are supposedly short? Sounds to me like she went out of her way to make my wife miserable instead of doing her job. I think she's a flipping goddess for working HHA and LTC as a 49 year old diabetic. I'm SO not perfect especially with the CNAs ( I love the ones that tell me to just back off) but I have never caused anyone to leave much less quit. I will never admit it but good CNAs are the true jewels of the system. You don't get to make my wife cry. (This part of the rant edited because I could see where THAT was going) THAT I will admit

Be quick and be very,very,very gentle. Put the new catheter in as far as you took the old one out (you don't need to be poking the opposite wall of the bladder). Don't push until you get urine, put it in and then wait for it. I've heard of the stoma shifting with bladder spasms on removal but have never personally experienced this :) . I HAVE been kicked in the head (shoes on) during this procedure so if LOC is a problem maybe an extra set of hands would be a good thing. If they get any pain meds or bladder spasm meds maybe those would be good administered before and push, push, push the H2O after. Sterile, gentle and quick. However, of course, any words of wisdom from the more experienced would be well read and taken to heart

Sorry for the rant. I guess I'm just going to have to get serious about the LPN-RN program and quit screwing around. And that's MY attitude :)

I'm new but seeing as how the last charge nurse quit and moved to Alaska because she was tired of all the BS (Her sage advice to me was "Michael, never, ever be charge") then came the day supers "elected" me charge. And me sitting there in the meeting saying "But I don't wanna". Sucker. So tonight I did my 24 person wing (Med Pass/Txs), did a tube feeding on another wing (because no nurse there from 2-4:30), a mixed insulin on another wing + my own 3 IDDM's with mixed insulins (With Accuchecks and who all eat at 6), helped a little with the paperwork and phoned the ER super about sending an end stage cancer to the ER (at 6) from another wing (I know, I know), set up an ABO in a medi-planner at the assisted living facility (Trying to figure out why a PRN was in it and changing the Ca+ time and leaving a note so they could change it all back tomorrow), found out about 9:30 when the NOC nurse called in on the beh. unit that an aide had called in 2 hours before (The portable phone doesn't work, all it does is pull my pants down and ring occasionally and at random). Thank God (I didn't have to pull a double!!!) the EVE nurse said she would pull a double (by this time the DAY scheduler had a busy signal) and one of the aides said she would stay through first rounds after I've called the employee phone book to get replacements. The NOC aides are NOT happy but they know I tried everything. One nurse left early and the aides think they run the place (And I will be the first one to explain in no uncertain terms that they don't). I relieved the beh. unit nurse for 1/2 hour at supper and fed down there so she could get a break which didn't help my timeframe at all and I drove 45 minutes each way to Microbiology Lab this AM did Gram stains for 2 hours and then had 1/2 hour to try to take a nap and eat something before work. All for a lousy buck an hour more in a nursing home Our lone EVE RN works super as the 2nd nurse on a 12 person wing and I get my weekend and her days off as charge And the new management issue? Attitude

We dissected fetal pigs in APII (cats for those with religious preferences). I don't see what the point was of the whole excercise. And then we had to take a lab test to identify the parts of the animals. :uhoh21: This is the third time in my life I have had to do this and I do not see the value in it. And now that I've been an LPN for a couple of years I REALLY don't get it. I thought it was a huge waste of time better spent.

Good Med Aides Rock

NPH 15 units. R 11 units. But only after a recheck before. And a follow-up would be nice.

LOL in end stages COPD/CHF not taking oral well and was previously on 40mg oxycontin po bid. I spoke to NP who then gave order for buccal oxycodone (oxyfast) 10-20mg qh prn because of concerns with pain coverage. Now somebody on days (who were also crushing the oxycontin) has added an FYI to med sheets which says give oxycontin rectally if unable to swallow. I've seen this once before and I disagree. It just seems to me that if the tablet moves away from the mucosa there will be an unpredictable and untitratable absorption pattern, a BM could dislodge the tablet thereby losing all pain control and there are question as to whether or not the tablet will properly dissolve given the differences in the environments. And it's got to be there for 12 hours. I think that pain relief at the end of life is extremely important. No one should experience pain at the end. I think starting fentanyl trans-dermal now would be a swell idea combined with the oxyfast and would be easily titratable. We might not have much time to be experimenting to see if pr would work and then arguing over whether it worked. Keep in mind that the resident has severe pain when moved and fairly severe dementia and is not able to communicate much verbally. So I guess my question (after venting) is does this work? Any takers?

The needles for lovenox seem dull. Is there a reason for this?

You will get a better idea of when to yell at the CNAs and when to be nice to them and what they look like when they are actually working hard. You know what they know and you know how to do their job so when the time comes to :angryfire you can say "I've done your job, don't tell ME!"

Well, I've only had one "tense" epsiode. Resident was diagnosed with a UTI in AM. A new TMA called me down way late. He had crackles, mottling, an almost undiscernable BP way low, no intake, demented, SPO2 awful and DNR besides. The paramedics didn't want to take him even though the family wanted him to go. All I could do was repeat "The family wants him to go so he goes." I had explained the options and the poor girl just was so upset she couldn't make up her mind at 10 O'Clock at night so we decided to send him. The EMT went on about how it was a waste, etc and called his supervisor. I still wish we could have started our version of informal hospice instead of carting this poor guy around. It would have been so much better in retrospect. I feel that the EMT was right in a moral and economic sense but that his primary job was not to be so.

Well, I've only had one "tense" epsiode. Resident was diagnosed with a UTI in AM. A new TMA called me down way late. He had crackles, mottling, an almost undiscernable BP way low, no intake, demented, SPO2 awful and DNR besides. The paramedics didn't want to take him even though the family wanted him to go. All I could do was repeat "The family wants him to go so he goes." I had explained the options and the poor girl just was so upset she couldn't make up her mind at 10 O'Clock at night so we decided to send him. The EMT went on about how it was a waste, etc and called his supervisor. I still wish we could have started our version of informal hospice instead of carting this poor guy around. It would have been so much better in retrospect. I feel that the EMT was right in a moral and economic sense but that his primary job was not to be so.

I've tanked a lot of BP's with nitro. Usually it's the beginning of the end and I call for orders for ASA NOW (depending) + MSO4 if there is time The nurse I was with (who's wing it actually was) is really experienced in LTC. We just looked at each other and pretty much said "You know what's going to happen, we give her NTG, her BP drops and all we can do is stand there and go OOOPS!" She was young ('60s) and had a chance, she was on a bunch of BP meds and a fairly complicated hx besides. Her husband is sitting right there and they are both just so nice to us. I guess my question is about ACLS + NTG in this situation. Like I said we were SO ready to give it but we held ourselves back just on intuition mostly. We were right in the end (I think) and things turned out really well for her. I was just wondering if there was any hard and fast justification either way

I've tanked a lot of BP's with nitro. Usually it's the beginning of the end and I call for orders for ASA NOW (depending) + MSO4 if there is time The nurse I was with (who's wing it actually was) is really experienced in LTC. We just looked at each other and pretty much said "You know what's going to happen, we give her NTG, her BP drops and all we can do is stand there and go OOOPS!" She was young ('60s) and had a chance, she was on a bunch of BP meds and a fairly complicated hx besides. Her husband is sitting right there and they are both just so nice to us. I guess my question is about ACLS + NTG in this situation. Like I said we were SO ready to give it but we held ourselves back just on intuition mostly. We were right in the end (I think) and things turned out really well for her. I was just wondering if there was any hard and fast justification either way