VicChic

Hi QTBabyNurse, BSN! I've been leaving messages on a number I found online for Q-Centrix but no one ever answers and no operator is available to assist me. I recently submitted my resume to their job page for a Quality Information Specialist/Data Abstractor. I have previous experience with core measure abstraction and HEDIS reviews. Could you help with getting me in touch with someone in particular for an interview with Q-Centrix please? Thanks a bunch, Vic P.S. Would I need a hard-wire connection or would wifi internet connection be acceptable if they provide VPN log in?

Above post in response to this:

LMBO!!!! That's *******' hilarious!!! :chuckle ....and true.

Interesting. Makes we wonder now... Could a nurse with an ADN earned in the US, in turn, work in Canada and vice versa? (Just wondering, b/c for some reason, I always thought the minimum level education of nursing degrees accepted in Canada was the Bachelor's (or US equivalent, the BSN) If ADN acceptable in Canada, does it limit the nurse's practice in any way compared to BSNc?

No one willing to take a stab @ it out there? Any info greatly appreciated so there are no wrong answers here. Just wanted to get some informal insight on it if anyone had any to offer, is all.

I was looking up CE nursing opportunities @ Kaplan University and ran across "Life Care Planning." And you know how when you read the explanation of something over and over and it still doesn't answer your question "What is it?" So I thought I'd run it by Allnurses to ask you Life Care Planners out there or anyone who has done the program: 1.What is Life Care Planning? 2.What's it like for nurses--difficult/stressful/laid back/dull/exciting/fast or slow-paced, etc? 3.What are the general duties/responsibilities? 4.Where do you work? 5.Can you realistically work from home or with insurance/managed care organizations? 6.What is the avg. time spent working on each care plan? 7.Can you specialize in one area according to previous nursing experience? 8.Is there truly a demand for Life Care Planners? 9.How difficult is it to market yourself as a Life Care Planner? 10.Any shadowing opportunities available? Any responses are greatly appreciated, so don't be shy. Thanks!

Didn't mean to make anyone feel like you "just don't get it." I'm just having a hard time understanding why haven't you seen Afib with occassional PAC's unless they were just assumed to be more fibrillations, which I could understand I guess. That's all. Okay, I think now is a good time to say we agree to disagree. I never said I'm right because I'm just right and you're not. I offered knowledge that I have learned by working with cardiac pts and under the supervision of several cardiologists. That's it. Take it or leave it. The review was a nice refresher for myself actually. But I still stand by my responses 100% and so do the cardiologist I've worked with, b/c this is what they have taught me and the information is used by myself and my colleagues regularly. I don't have to argue what is fact already. Fact proves itself. So it's not "mis-information." There are professionals in health care using these very facts to treat pts. If you notice, I wasn't the only one who stated the possibility of Afib with PAC's. Once you have seen it, you don't ever deny its possibility. I'm just grateful for the experience, b/c as I'm learning it's not granted to everyone. I'm just wondering why this is so unheard of to you, b/c it's really not that rare. Okay, not gonna beat that dead horse again (LOL). Yes, it's true that I'm 22. I was wondering how long it was going to take before that came into the discussion. I'm young in nursing, but not new to it. I took prepatory classes for nursing school while still in high school and had credits towards my degree before graduating H.S. b/c it's offered like that if your serious about your training. Sort of a recruitment tool in the area, but it's training still. Before my cardiac nursing which consists of CCU and cardiac stepdown, I worked in the ER, med/surg ICU and in various outpatient centers. So very diverse considering the years in it. So just b/c I'm young, doesn't mean I couldn't know what I'm talking about. Don't you think that's a lil' discriminatory towards age? You don't think the senior could ever learn from the freshman and vice versa? As much as healthcare changes, you bet. And I know this much is true. You might be surprised how many older nurses come to me for advice sometimes simply b/c I am young and they feel I would have the latest information on whatever the topic is b/c I have less to confuse it with from info that's now outdated b/c it's as old as I am, so to speak (LOL). And they to continue to ask even today, so that my let you know a little bit about my credibility. So may we all continue to expand our knowledge basis, both young and aged, in the ever changing world of healthcare, b/c as you more seasoned nurses know already: The only thing that's constant in nursing is that it changes...alot. We're in this together and whatever problems we have in nursing, we certainly don't solve anything by creating discord among each other, nor does the whole "aren't you 22?" arguement do much for dispelling the fact/opinion that Nurses eat their young which further contributes to a myriad of other issues in nursing. If I had a nickel for everytime someone tried to discredit my nursing knowledge just b/c it belonged to a 22 yo.... I probably could retire by age 23! But that's okay, you wouldn't be the first, and certainly not the last. Buh-bye!

You guys, I know you all are way too smart to let this one go over your head. All I'm doing is simply presenting a scenario to you. The question was asked if you could have PAC'S with Afib. The answer to that question is simply YES, you can as the original responder put it. I guess my only mistake was going into further detail. I keep forgetting everybody doesn't alway benefit from the who, what, when, where, and WHY. But I LOVE knowing WHY. It helps me to understand. All I'm trying to do is explain why, so there can be a full understanding of the reason the answer is simply "yes." So there's another confusion about this? Okay. I thought I had explained it simple enough but....here goes. Once again, if the patient is in A-fib (ok, take that in for a sec) and then you see PAC's, not actually a part of the Afib b/c .....you have atrial contractions--- "How can you tell," you ask. PAC's with Afib are usually frequent enough to tell that the p wave is not just another quiver of the A fib b/c that atrial contraction is originating from the same foci so the p waves should look identical to each other. And to quote myself before someone else does so there's no confusion left hopefully (LOL), "PAC's are usually frequent enough to tell that the p wave is not just another quiver of the A fib" due to the pathophysiology like what I was explaining earlier about the heart's attempt to convert back into sinus. (See earlier posts) Now that we've establish that, this contraction IS NOT Afib--it can't be...there's a P WAVE involved. Still with me? Now... it's presumptuous to call it a "SINUS" beat b/c there would have to be a ventricular contraction to follow IMMEDIATELY after the p wave, because as you know, sinus beats are composed of both p waves and QRS complexes. A sinus beat is not what I interpreted out of the original post, only Afib and PAC's were mentioned. And that's the reason why those beats would not meet the criteria to be called sinus--simply put, no ventricular contraction, only a premature atrial contraction, which is why the nurse called it "Afib with PAC's." So in a nutshell, you got Afib, then a few definite, true p waves->No longer just Afib---they are not followed by QRS complexes-->Cannot be sinus. So what do you all call this if it's not Afib with PAC's b/c ever since I learned rhythm interpretation that's what I've called them, that's what other nurses have called them, and the cardiologist. Now I've answered alot of you guys' question, so how about answering one for me? Where are all of you working at and/or where have you worked and what is your discipline? This helps me to understand why this is such a hard concept to understand. B/c I find it hard to believe anyone working cardiology, or tele, or ER (or anywhere where telemetry is used) is struggling with this. Afib with PAC's is not your everyday kind of rhythm, but it's not so rare that it causes this kind of confusion normally, so I'm just trying to get some understanding so I can better relate. And then again, I can't help but feel there may be understanding of all of this that I am saying, but it's just more fun to watch just how far can we kick a dead horse b/c I'm at the point of ad nauseum (LOL) j/k. If you have anymore questions, please ask; that's how you learn. But if your intent is to be facetious, please I ask, go to the Nursing Humor Forum. My intent is to genuinely address the OP's question, and hopefully facilitate learning. Thank You.

Not stretching, just explaining what I, along with others in cardiac nursing/cardiology already know and accept to be fact. Sorry you don't comprehend but you are in good company. After all, it's a cardiologist that had to explain it to me FYI. :wink2: I had to learn it myself and now I'm sharing it with someone else, because they were smart enough to ask and then smart enough to listen. You're right, you should ask a experienced cardiologist.... so they can turn around and tell you the same thing. Have a blessed day! I just want to applaud the OP for using their resources to investigate such a thought-provoking question that obviously showed good critical thinking b/c they thought deeper than just "textbook" explanations. Once again, that's a beautiful skill in nursing that Harley Fan has obviously mastered. It's the funky stuff that keeps it interesting so keep on keeping on! Embrace it and have fun with it. Keep an open mind so your mind can absorb information that's new to you, and most of all keep that teachable attitude. You can't lose with that! Buh-Bye!

PAC's in Afib? Of course not. PAC's with Afib. Yes, as was stated earlier by myself and a few others, you can have Afib with runs of PAC's or just frequent PAC's. There's is a difference b/c in Afib=no p wave=obviously not an atrial contraction of any sort. PAC's with Afib=a p wave occured from somewhere= there's atrial electrical impulses from somewhere trying to be recognized once again. So yes the underlying rhythm may be Afib, but once you see a p wave present (and it's probably best to be in lead II for this particular rhythm interpretation) you no longer can call this Afib. It has to be Atrial Contraction and obviously premature since the underlying rhythm is still irregular. Where I've worked this is seen all too often. Remember, afib doesn't always necessarily mean the atria are incapable of emitting electrical activity; the only thing that is definite is the interruption of a normal conduction of the heart's electrical activity, which should originate from the SA node but doesn't. Sometimes with a chronic Afib'er, you put them on Amiodorone, Cardizem, or some other antiarrhythmic and/or Digoxin, and then you see more PAC's then ever b/c you've now broken up that incorrect pathway of electrical impulses that heart was using and rate control has now allowed SA node to get back to being the impulse generator again. Seen all the time in nuc med with stress test, and in CCU, and often seen by paramedics in the field if a person has just been in a lot of trauma.

The PAC's are no longer a part of the A-fib rhythm. Of course the PAC's are true contractions and no longer a fibrillation. However, occassional or even frequent PAC's do occur with A-fib b/c they are ECTOPIC beats, electrical impulses originating from a different foci, but what it indicates is the heart's attempt to convert back to sinus. It's just taking baby steps first. Gotta crawl before you walk. It's totally normal to see when you're trying to pharmaceutically cardiovert.

Oh that's the beautiful thing about rhythm interpretation--it's open for interpretation. Then you get to have an interesting discussion about the "interpretations" like the one we're having now...until an experienced cardiologist comes in and says, "Nice try but you're all wrong. It's really ___." (LOL) Just comes with the territory. Fortunately, when you have funky stuff like Afib/PAC's/Afib w/ PAC's, the treatments don't differ too much. For instance, a pt who is sinus with freq. PAC's which later converts into A-fib will most likely go on an antiarrythmic like Cardizem for rhythm conversion and a beta-blocker like Metoprolol for rate control. As you know, beta blockers slow down HR, sometimes as an unwanted side effect, but in the case of A-fib, you want to slow down the heart to allow those "fibrillations" or "quiverings" into true strong contractions. You may see PAC's w/ Afib as a sign of the midpoint of the heart getting ready to convert back into sinus rhythm (or brady since you now have a slow HR, but at least it's SINUS), just like you when you saw the PAC'S as the indication of A-fib conversion. It's simply just a reversal of the previous processes.

I'm not exactly sure about your question Tweety, but I think you're asking about how can you tell what beat is the premature atrial contraction if the PAC makes the rhythm irregular and the A-fib itself also makes it irregular? To answer that question, remember that although both PAC's and A-fib both make a rhythm irregular, between PAC's and A-fib, only the PAC's will have an actual p wave indicating the atrial contraction. True Afib will NEVER have a true, distinctive p wave b/c the atria is FIBRILLATING, not contracting. So in Atrial Fibrillation with frequent/occasional Premature Atrial Contractions, look for distinct p waves to tell which are true PAC's. I hope this helps to clear things up. If it doesn't, I'm sorry, but someone else might get it for ya' next time.

And no this was NOT a dumb question at all. On the contrary, it actually shows good critical thinking skills. Way to go!

Yes, that's correct. In fact, sometimes frequent PAC's are an indication of an underlying or impending atrial arrhythmia like A-Fib coming on.