psychnurse1998

Thanks Jay jay,...darn law of gravity, gets me every time. Super man defied the laws of gravity, and I guess wonderwoman did too,..no wonder i was confused. But still for clarity, on a younger woman, is the pulse clearer above the breast also, or does it vary?

Great post Mike. I kept telling myself by the left nipple, must be below. I better try above and maybe the heart sounds wont be so diminshed. Over the years my assignments have been mostly male patients so it has not been a problem.

I think its very important to check an apical pulse. Many irregular pulses may be avaraged out in the radial pulse and you wont detect them. Also some of the heart sounds changes that dont take a cardiologist to know something is very wrong, would be missed. Diminshed heart sounds, could also be a sign of cardiac tamponade. I hope someone that works in a cardiac unit can correct me if I am wrong. I found a cd with abnormal heart sounds very informative, and helpful if one has to listen to heart sounds.

Thats great, to have sort of inside knowledge. I think that means you cant test where you work though. I have heard same that hand washing is a common point of failure. One student posted failing for forgetting to deflate cuff on second bp reading. I heard one student participate on Electonic Peer Network Board for several months and she passed fine. Some seem to go in unprepared. One passed after about 3 months on EPN Board but she seem to be a recent graduate of an LVN school that gave her a good Care Plan preparation., she also did well. Some with great acute care experience fail too. I have seen some get a test date within 3 months and have not even read study guide., that surprises me. I saw one student, who seem very active on EPN board discussion and passed without taking workshop, but most grads highly recommend it. One grad was very dissapointed because one graduate school would not accept her because she went to EC. She had a very high GPA, almost 4.0. I lost my job just as I wanted to test, and its very hard getting another Nursing job, that I can do safely. Taking my debt, the high risk of failing, I thought it would be better to drop out. I procrastinated, since 2003, and my chance to test ends in about a year, so I really blew a lot of money on this School, but cant really blame the school. I do wish they didnt charge a student the full fee to retake the test., and to only have to take the area one failed in. Right now CPNE workshop is 825, and Cpne is 1800, I believe, too much money for me at this time.

I believe the original question was regarding Hypertension

The no lift policy seems to deny the reality that one has to lift. When I hurt my back one time, I was prescribed back excerises to strenthen back and abd muscles, to help prevent back injuries, in addition to good posture, and using good body mechanics. I wish I had learned this earlier in my life. The VA in my area has a video they show you in physical therapy after you have had a back injury, I wish every employee would view that.

thanks for the spefic 60 lbs you are require to lift by yourself. I dont thiink you are required to prove, before you are hired, and told.."here is a 60 lb. weight, lift it". However, if you face that 60 pound weight, during your employment, be on notice you will be required to lift it. The implications this has, someone that could never lift 60 lbs might get hired, and it may never come an issue. I have had nurses ask me..could you please help me pick this up? Or as you said, one can make use of the latest lifts available. I was thinking, trying to lift any patient weighing more than 120 pounds would exceed the 60 pound weight limit, without patient assist. Perhaps thats why they have he "no lift policy".

Great points..I had not thought about the risks a lighter patient can also pose. I hadnt heard of a slippery Sam.

I agree. I think many nurses when a patient falls, we assume 2 people should be enough, when maybe 3 or more may be needed. I know someone that got hurt like that and had to quit nursing for another career. And as you stated, using a lift, to help lift a very heavy patient. One facility I know has a 100 pound lift requirement, but I doubt it is enforced since some of the new hirees seem so frail.

Does anyone know how much weight a nurse is required to be able to lift? I know nurses have to be able to lift patients. Also in psych facilities nurses and mental health workers have to restrain patients.

I think you are probably right. I just think even a seasoned and experience nurse needs at least a certain minimum of orienation to a unit to practise safely. If law does not require that of an agency or employer, I think its unsafe nursing practise. I think there used to be community college refresher courses for nurses reentering nursing after a long period of inactivity, I think those courses should also be available. In practise I may have to take a non nursing job, to protect my nursing license.

Thanks Elk Park, I am not seasoned and experienced, and have turned away asssignment from facilities that did not offer orienation, because I could lose my licence working like that. I am thinking of filing for unemployment but not sure if I can get any for turning away those type of jobs.ie without orientation. Maybe this belongs on another thread

With that kind of "OPEN HOUSE", why does Kaiser even have one? The way it was structued , Kaiser does not look to inviting, at least that one you describe doesnt.

I have worked for agencies as an Lvn, the biggest problem I have, is they give you little or no orientation. One place I worked if the other Lvn doing her own assignment hadnt not helped me know where everything was, I would have never gotten through the shift. One assignment did give about 4 days of orientation. The other problem is often times, regular employees figuire agency nurses are earing big money, so why should they help them. I hope its different when you work as an Rn throuogh a registry.

Great question Kim. There are probably others more qualified to answer the question. I am on Hctz or Hyrdochorthiazide and was thinking others were better bp meds. My pharmacist also said it was the first drug of choice. I have had patients with severe htn that are on multiple drugs. That part I am not sure of, but but at least two of my patients had also abnormal heart rythyms in addition to htn, which hctz did not address. As to the last part, visualizing arteries and or arterieroles as balloons about to pop, if no intervention is taken immediately, I would think a 25% drop would prevent that, followed up with further drops. I think one immediate result with severe htn is that more interstitial fluid if forced between the cells than has time to return back into circulation to be return to the heart. So you have the possibility of fluid in the lungs [cant remember technical term] or leg edema. I hope someone else replies and corrects me. I sure dont want to give incomplete or incorrect advice.

thanks for pointing out that there is no nursing shortage in sacramento. its even worse if you are an Lvn in Sacramento, with Sutter and Kaiser phasing out Lvns. I have not had a full time job since december. It doesnt help that I turn down registry jobs that dont offer orientation. This is the first time in my life a run down, skill nursing facility never call me back. Also first time such a facility had 3 other applicants filling out applications at the same time.

A friend of mine is very supportive.. She says think of the MONEY HONEY! If that doesnt get a spouses/special persons, attention, well, I guess I cant underestimate the power of sex.

From your post I can see why there would be a high burn out rate for nurses. I assume they turn to travel nurses because the regular nurses go elsewhere, and it seems even some travel nurses dont want to return to Kaiser. I wonder is it a very much different scenerio in most acute hospitals today? I can only ask one more question, do you get an adequate orientation to Kaiser as a travel nurse? I am not an Rn but as an Lvn working for a registry, most places I have gone too, do not give much of an orientation, and since you are earning "top" pay, regular employees arent too eager to help you at times. Or they are so busy themselves they cant help you.

My point if you leave it to truck drivers, Nurses, Airline pilots, train engineers,, how many hours is best for them to work per day, you will not have safe outcomes., because everyone will do what is best to pay the bills. or other, but not what is best for the patient, or other. The animal nature within us takes over in some situations., and in some people. Someone else pointed out, a 12 hr shift can easly turn into a 13 or 14, you cant just walk off after 12 hrs just because you have a 12 hr shift as it is with any nursing shift.

sure why not let the truckdrives, air line pilots, train engineers decided what is best for them too..what a safe outcome we would have. If it works for nurses why not for everyone...

I agree Mischief I tried point out the same idea in 12 hr shift post. It seemed like most of the nurses responding, that work didnt agree on my post. After 8 hrs, I am tired ready to go home., and most of my co workers look tired. But some were signing up for 16 hr shifts.and even working on their days off. I still maintain, the high cost of lilving is the driving force, to get someone to give up, 8hr shifts and their days off. Wages are just not keeping of with the high cost of living.

thats what i dont understand are there some hearing aid that you dont have to take off to do vs...? if so is it better to have the littman 3000 electronic stethoscope?

i hope I understand what you are saying and that this is related. I once read a book, by Adler..How To Read A Book. One of his suggestions was to read from original thinkers, not from second hand sources. For example read from Aristotle himself instead of by someone else that read Aristotle. That way you can sort out for yourself..one those that may have not understood Aristotle, those that hated his views and want to distort them, and those that are nuts about him and may strecth the truth a bit. How many Americans have ever read from an original thinker? And how many have let politicians, priests, ministers, or educators do their reading for them? And digested what they read.

But Jedda you are in Saudia Arabia..isnt that where they cut your hand off if you make an error?

I was offered a job as an independent contractor in a prison. 35 bucks an hour. I realize I give up my rights to workmans comp. Last time I filed 1099 I ended up paying taxes instead of getting a refund. This job is also asking me to pay for my own liability insurance. I will have to pay for my motel bill and other expenses, which I plan to deduct at the end of the tax year. I get the feeling I am taking a big risk, but maybe a short term monetary gain is worth the risk. Does anyone have any regrets for working independent contractor?