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**LaurelRN

**LaurelRN MSN

Interventional Radiology
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**LaurelRN has 6 years experience as a MSN and specializes in Interventional Radiology.

I was a nurse for 10 years, I became a NP and have been working in IR for 10 months. Loving my new role!!

**LaurelRN's Latest Activity

  1. **LaurelRN

    Joint commission and their ridiculous mandates

    The funny thing is JACHO found that their own standards inhibit the ability of nurses to care for patients and their own inspections create part of the problem in health care. That's why I have left the bedside. I'm tired of not being able to actually take care of my patients. It's more about charting, HCAPS scores and patient/family satisfaction than anything else.
  2. **LaurelRN

    help me figure out what happened :/

    Though what everyone else has said could quite possibly seem feasible. I am more inclined to think (though without labs, trending vitals, and pt history, it's a guess) someone who is in renal failure quite often has electrolyte imbalances. What was the potassium? Mag? Calcium. I have seen more codes from electrolyte imbalances than I would care to. I do agree that the D50 IVP was just coincidence. Don't get too hung up on it- good luck
  3. **LaurelRN

    New RN, 3 weeks into orientation, total screw up.

    Nugget...As with everyone else (for the most part)...Inexperience does not mean you screwed up...The Dilaudid...I don't know that I wouldn't have given it...Yes it can cause respiratory depression...however..."below 8, intubate" is not necessarily true..many factors go into whether we intubate someone or not...NARCAN is a wonderful thing (well to reverse narcotics) intubation is for people who cannot maintain adequate oxygenation/co2 exchange and maintain a neutral acid/base balance. translation..if they are breathing 6 times a minute and are pink, good sats, and arousable to verbal stimuli...my book- that's ok.---that said...I may hold it if they are already lethargic- depends on their pain level. As for the hypoglycemia...nope..not on you (well..except the cookies...I mean...real sugar, high carb ones)...as said before...regular insulin is short acting...a late night, early morning hypoglycemia...nothing to do with you unless you gave Lantus or some other long acting insulin. My one problem with your post is that your "preceptor" is barking orders to you. Though she is there to guide you..barking orders is not OK. Hang in there. You've done the hard part...you're a nurse!
  4. **LaurelRN

    Can someone PLEEEEASE explain INSULIN DRIPS?

    H_2_0 There are alot of things at play here. 1) as most everyone here has said, the insulin drip is not really to bring down the blood sugar ( I mean it does, but that is not the primary reason). In DKA, A) you have the absence of insulin B) you have acute dehydration C) electrolyte imbalances D) acidosis. so A) give insulin- brings down blood sugar B) Give NS until blood sugar is under 250-300 ( depends on your facility), corrects dehydration- helps correct the acidosis. C)sometimes people with DKA will have K+ levels at 7 (The highest i've seen - well, and the patient is still alive is 7.6) Insulin chases potassium back into the cell. D) This is the biggie- Ph of 7.30, 7.25, 7.2, I even seen 7.0 ( well and he was still breathing)- This is the real reason you're giving insulin and fluids. Correct the acidosis- its metabolic. You just have to do it slowly- because remember, for every tenth ph you go up, you potassium comes down by 0.6. You don't want to cause hypokalemia...most facilities start fluids with K+ added once the blood sugars normalize and the Ph starts to get near normal. (which is why we do labs so often) Eating..well.... that's up to the doc. Some will let them eat- others won't. It makes it a bit difficult, but you're doing Q1 hr FSBS- so it really isn't a big deal. Lantus- again, so do some don't. We have one endo guy that swears by it and one that won't start it until they are off the gtt. You just have to be careful. Correct slowly. And if you have a question- you ask it. As a advocate for your patient- (and your license) you have the right to question any order a MD gives you. Hope we've helped
  5. **LaurelRN

    BKAT-Critical Care

    i took it, no preparation- it was cake. it's a few med compatibilities, acls, rhythms, prioritization, lines, hemodynamics...stuff like that....
  6. **LaurelRN

    The strangest thing you've ever seen on an x-ray?

    We did a bronch on a guy who came in with "resp distress"...found a $1 and cocaine residue...had a post op a few days ago...a VERY large sweet potato stuck in the rectum...smh...as said before...we couldn't make this stuff up!!!!
  7. **LaurelRN

    PICC Line Clarification

    ok- so here's the low down.... some picc lines are cut to the length for the specific patients- thought not all. here's are clue...if it is a power picc (mostly used in acute care) they are not cut. if it is not a power picc (and they will say right on the picc if it is) then it could be cut. it depends on the manufacturer. when a patient comes to your facility with a picc line- it should say on it how far in it is. most uncut picc's are 45-55 cm- and will have some of the catheter looped under the dressing. if it is something less less 45cm and nothing is hanging out- it is one that is cut. as for the lumens- there are 1,2,3 and soon to be 4 lumen picc lines. every lumen has it's own hole that it comes out of (distal,proximal, etc) which is why they can be used with drugs that are incompatible. hope that helps! 🙂
  8. **LaurelRN

    CCRN Exam

    it sounds to me like you are well prepared. i didn't do half of what you have and i passed. don't fret...it is actually played up as a much harder test than it really is. i'm sure you'll do great!!
  9. **LaurelRN

    requirements for crna and rn?

    So I'm a little confused about what you're asking, but here's my A CRNA is a nurse ANESTHETIST...you administer anesthesia. If you want to do more surgical assist- then you want to be either an OR nurse or a surgical tech. For either CRNA or an OR nurse you must become a registered nurse- either 2 year ADN or 4 year BSN. TO become a CRNA, you still must become a nurse (BSN) and then have at least a year of ICU experience- then must be accepted to a CRNA school which is 2 1/2 to 3 years long. A surgical tech hands the instruments to the doctor- that varies by college but is about 15 months to 2 years. You should go talk to a college counselor and possibly go shadow each of the above listed careers to get a better idea of what it is that you want to do.
  10. **LaurelRN

    Prospective nursing student: need experienced advice.

    I'm not sure I agree with you on this one Hello RN...I am an ASN- had three job offers prior to graduation and at this point could go to any hospital in this area. Idk where you are located- but here in Florida- nurses are still in high demand even for LTC's. Yes, I agree that eventually, hospitals will require a BSN- but not yet. Just my
  11. **LaurelRN

    Death and Dying in the ICU

    I work in the Southeast in a general ICU. We do not have a DNR policy and quite honesty we really need one. There always seems to be at least one patient in our unit that has some sort of "code status" issue going on. Our MD's are NOT good at discussing or even broaching the subject of code status. I personally think our docs push people into more aggressive decisions and sort of "lead them on" about how sick their loved ones are and what the chances of survival truly are. As for treatments- of the patient is withdrawl of life support- everything is withdrawn- (we s RNs' keep our monitors on and can see the one at the desk- so we turn off the one in the room. But temps, labs, etc- are all withdrawn. We do go in to turn (carefully!! no terminal turns please!), or suction. If the patient is not a withdraw- it is up to the MD to make the decision on what treatments are done. Sometimes we will stop everything but the vent or only the vent and tube feeds...but almost always- if we stop one- we stop all.
  12. **LaurelRN

    Survey regarding tube feedings

    PICO Question: In critically ill mechanically ventilated adults receiving temporary enteral feedings, does the implementation of a nurse driven enteral nutritional therapy assessment protocol reduce the risk of hypocaloric intake compared with current practice? Survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): Select all that apply RN________ NP_________ PA_________ OTHER (Please specify)_____________________________ 1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults? a. Yes and it is clear, concise, and easy to understand b. Yes, but I don't quite understand it c. No d. Not sure 2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient? a. Always nasal b. Always oral gastric c. Whichever is easier d. The purpose of the tube drives my decision (for the purposes of draining or feeding) e. Other_________________________________________ 3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated? a. Salem Sump (gastric) b. Other Gastric__General NG tube____________________________________ c. Post pyloric (Nasojejunal : NJ tube) d. Not sure e. Other___________________________________________ 4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated? a) Bowel sounds auscultated in all four quadrants b) Lack of abdominal distention c) Patient has been intubated for more than 72 hours d) The therapy has been ordered so there is no other criteria necessary [B]e) Other__All of the above are issues that would be considered- however, "D" is the most often reason._______________________________________ [/b] 5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient? a. 10 milliliters an hour and advance to goal as tolerated b. 20 milliliters an hour and advance to goal as tolerated c. Bolus feedings d. I start my feedings at the goal rate e. Other (please describe)__As ordered by the MD_________________________ 6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy? a. Gastric residual volumes b. Promotility agents c. Patient positioning d. All of the above e. Other_____________________________________________ __ 7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy a. Bowel sounds auscultated in all four quadrants b. Lack of nausea and or vomiting c. Lack of diarrhea d. Gastric residual volumes e. Other______________________________ 8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes? a. Every hour if residuals remain high b. Every four hours c. Every eight hours d. Once a shift e. Other_____________________________________ 9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate? a. There should be no gastric residual volume b. 10% of amount of feeding instilled c. 20% of amount of feeding instilled d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy e. Other_______each of our MD's has their own acceptable residual- highest amount is 200 ml_____________________________________ 10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings. a. Greater than 50% of the amount of feeding instilled b. Greater than 250 cc in a four hour period regardless of the rate c. Greater than 500 cc in a four hour period regardless of the rate d. Greater than 100 cc in an hour regardless of the rate e. Other _______________________________ 11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient? a. I discard all gastric contents b. I return all gastric contents c. I return only 250 cc of gastric contents d. I return only 500 cc of gastric contents e. Other__________200 is the most I would return if the pt is getting continuous feedings__________________________________ 12.) How often do you flush your feeding tubes? a. 60 cc every 2 hours b. 60 cc every 4 hours c. 60 cc every 6 hours d. After administering medications e. Other___________at least every 4 hours and after meds__________________________________ ___ Please feel free to add additional comments: I personally don't feel that enteral feedings are a good soource of nutrition. Many critically ill patients need higher levels of calories and protein- these just do not provide it. I think food services should make a puree of REAL food and make it into a thin enough liquid that we can give it through an NG tube- IMHO- just my
  13. **LaurelRN

    everyone is stumped

    Thanks everyone for your input. Sadly, this pt did not survive. Later, we found out that she had sleep apnea and the MD's believe that she prob had some sort of reaction to the house fogger and b/c of her apnea started having resp distress. Then due to the distress with combo apnea became hypoxic and had a seizure. Unbelievably, after a fentanyl, ativan, and diprivan gtt, she became hypotensive- even after they were d/c'd - had to start Levo. Anyway- thanks for everyone's input- it was a wild ride!
  14. Hi there, I don't know if you've moved here yet or not- but take it from someone who has worked for both hospitals- go to the Cape.
  15. **LaurelRN

    I have wanted to be a nurse for years

    YOU CAN DO IT!!!Trust me you can. I was a CNA for 2 years then became a PCT. I had two kids- then got divorced. I made a decision- (this is important!!) I started taking prerequisites and after finishing them got into nurse school on my first try. It was hard- but I did it. YOU have to make the DECISION that you are going to do it. If you set your mind to it--YOU CAN!!! GOOD LUCK!!
  16. **LaurelRN

    New Nurse who hates her job...nursing is not what I thought

    You can take this for what it's worth..it's just my ...... Real world nursing is NOTHING like school. School is theory and in theory you have all the staff you need, all the equipment, etc,etc...that said, there are some things you could do. Quit....not likely a good choice for obvious reasons transfer...look into other floors that may not be as high a turnover- they vary for hosp to hosp- but I know our resp floor is much slower paced than the PCU I work on. Take a closer look....this is probably your key. As a new nurse, you have ALOT of unanswered questions. You probably still question yourself about the littlest things - (thus taking longer- not a bad thing..) Are you well organized? Do you have a good grasp of you patient population? When things are going down the tubes..do you have resources like a preceptor or charge nurse to help? These are all things you might want to look at. If you have questions-ASK. There are NO stupid questions! I hope this helps. Though I had 10 years of healthcare experience prior to becoming a nurse...I just finished my first year and have to say- it does get better.Hang in there!