emsillystudent

Hi! Does anyone have a good way to explain hypo vs. hyper-thyroidism and the significance of the lab results? I was trying to explain hypothyroidism and the labs, and it took forever for the pt to finally "get it". I don't think it was because she wasn't smart - I think maybe I didn't do all that great of a job explaining it. I understand it in my head, but I have trouble putting it into words. If that makes any sense. Does anyone have a good, quick way to explain this? I guess I should tell you what I told her so you can accurately judge. So I told her that, basically, the thyroid produces hormones that control the body's metabolism. Without the proper amounts of the thyroid hormones, (t3 and t4), the body doesn't use calories or oxygen appropriately (metabolism), which is why people with hypothyroidism often feel tired/sluggish (this was the case for this pt). I explained that the pituitary gland "regulates" the thyroid by producing TSH. If TSH is high, it means the thyroid is probably hypoactive because the pituitary gland is working extra hard to try to get the thyroid to work. If the TSH is low, the thyroid may be hyperactive - it's producing so much that there isn't as much need for TSH. I told her that beyond that, the reasons for low or high t3 or t4 could vary - maybe the pituitary gland isn't working right and so it's not accurately telling the thyroid what to do, or maybe the thyroid itself just isn't able to secrete the proper amount of the hormones. I explained that further testing is usually needed to determine the cause/significance of the abnormal lab values (iodine uptake, etc), but she really seemed to want more basic info regarding specifics of the individual values. I explained that it is not one value by itself that tells us what the problem is, and that it is up to the doc to order and interpret any further testing he deems necessary. Anything I could have explained better? Thanks!!!

Thanks, guys! My buffer theory is making more sense now that the rest of you are agreeing with me! I just thought I was missing something!

Thanks guys - sorry I didn't give more info before. I had this guy awhile back and I don't remember all his info. He had cancer - I think mets with unknown primary at the time I was there. He hadn't started any chemo yet and as far as I remember his labs were mostly okay. There were some things off in his CBC/diff but mostly it was like RDW and stuff that we didn't really deal with in clinical. I thought of the renal protectant thing, but since I don't know what the plan was going to be for chemo for him, I really don't know. That was the only thing I could think of, but since I never got to follow up with him, I really don't know what happened. Thanks again for the replies!

Hi guys I'm being really stupid, I know, but I'm reviewing my IV fluids (hypotonic/isotonic etc) and why certain things are used at certain times. I'm having trouble with one patient I had in clinical. He had a MIV with bicarb in it, and I don't know why. What does it do and when is it used for a maintenance? This guy was D5W with 2 amps NaHCO3. I know I should know why, and it's probably really simple, but it's not making sense! Can someone please help?? THANK YOU!!!!

I know that one (even many, judging by some nurses I know) will not get you fired or make you lose your license. It's just that I am terrified that some family member (and I have seen some...over-the-top ones) will get p*ssed about something and decide to sue. I know that they have to prove harm and blah blah, but those lawyers can be pretty scary and they can make things look like they happened a certain way, even if they didn't. And God forbid something really should happen...though I would beat myself up way more than any lawsuit would...you'd pretty much just be done, right? It's just that we live in such a litigious society now that I am soooooo afraid that one false move might cost me everything! I'll be calling my insurance company the day I pass my boards, believe me! For a hundred (or so) bucks a year, it's MORE than worth the security!!!!! Thank you all for the replies!

Okay, as a student, I see a lot of things that surprise me. And recently I've been a bit nervous about mistakes and "near misses" that I see made by other students, nurses, and even a couple of my instructors! Some of these are minor, like giving an inhaler late or whatever, but some of them are pretty big. That got me thinking, what would be an example of a career ending mistake? What if a pt falls on your shift? I had a pt once who had fallen earlier in the day before I had him, and I know that Medicare won't cover anything that happens because of a fall in the hospital. That doesn't really seem fair, becasuse the nurse who had this pt I am talking about also had another climber and three other pts to deal with. This guy had a bed alarm on, and was as close to the station as it was possible for him to be (other rooms were full), but when his alarm went off, nobody was able to get to him in time and he fell. Luckily he didn't get hurt, but the family was really really mad. It seems to me like they pretty much did all the could to prevent his fall (he had to be out of restraints because he was getting ready to be sent to an nursing home and couldn't have restraints on for a whole day before or they wouldn't take him), and his family had been providing a sitter at night for a week or so by that point. But this happened during the day. Stuff like that can happen so fast...I mean, if a nurse has 5 or 6 pts at a time, it is physically impossible for him or her to be with every pt all the time, so how come Medicare won't pay for that, or how come nurses could get sued for that? I'm sorry, I don't mean to scare anyone, and I know I'm rambling! My point is, can someone give me some real life examples of reasons nurses have lost their license, and what they can do after that happens? I mean, do you just go out and get a job at the grocery store, or what??? Lastly, I know there are lots of threads out there about insurance, but I do have a couple questions I couldn't find answers to, if you don't mind answering them for me. I don't want legal advice, don't worry!!! I just wonder...the hospital where I want to work discourages nurses from getting personal insurance because they say that makes them a "target" for lawyers - if something happens and the lawyer finds out that one of the nurses has insurance, they will target him or her. But then, I also have heard that if a hospital gets sued, they might try to pin the blame on the nurse, and if that happens, how in the world could that nurse live? If a jury found him or her liable for whatever happened and awarded $5 million to a pt, and he or she doesn't have insurance and has lost his or her license, what in the world would they do??? Anyhow, I don't know if any of that's true or not. So what do you guys think? Do you have your own insurance? Why or why not? How expensive is personal liability insurance (just ballpark, of course), and is there a reputable company that anyone knows of that I could look at? Again sorry for the rambling and thanks for your help! The closer I get to graduating, the more I start to panic about this stuff, and I've got a little ways to go yet!!!!!!

Thanks! So why does just part of the muscle stay contracted? I didn't realize that was possible. I thought all the muscle fibers kind of worked together. It seems like a knot is sort of right in the middle of everything.

Okay I was just wondering - when you get a "knot" in your back or neck, what is it? You can feel a bunp under there, and it gets better when someone rubs it (well, for some people, I guess, maybe not all of them). Anyway, there can't really be something in there, so why is it that you can feel them? And why do they fell better or get better when you rub them? Thanks!!

Thank you guys all so much for your help! That really does clear things up. I knew that it must be one of the TPN components that caused a problem, I just didn't know which one. And thanks for letting me know what would happen if you did give it through a peripheral or a midline. I find it srange that my facility says no midlines for vanco, but it's ok to do it through a peripheral stick. I guess that must be because in a midline you would be less likely to notice problems right away?? Anyway, thanks again, that clears a lot of things up for me!

Wow, you're quick. Thanks!!! At my hospital, if they try to start a PICC but for some reason the tip isn't in the SVC, and they can't advance further, they use it anyway but call it a midline. Since I have no experience working with them, I can only talk about what I have overheard. They say that you can draw blood from a midline, but that it often quits drawing after a relatively short time. After that, they continue to use it to infuse, but not to draw labs. So I guess it's more central than a peripheral stick, but more peripheral than a PICC or other type of central line? Not really sure how they classify that one!! What you said about TPN/PPN makes sense, and I'm pretty sure that the orders to say Total and Partial. Why, then, can PPN go through a peripheral line? Is it a concentration thing? All I know is that it's a really big deal that you can't give TPN through a midline, and I just can't seem to grasp why that might be. It's probably something really obvious, that's why I'm nervous to ask anyone I know - I don't want them to think I'm stupid!!

First of all, hi! I've been reading these forums for a long time, but this is my first post. I am relatively new to nursing, and I have a few questions. I recently started working as a unit secretary, and I was entering some pre-printed orders (no, this facility isn't paperless yet!) into the computer, and I saw the TPN/PPN orders. The order sheet is basically a bunch of boxes where you can have a standard formula or enter certain amounts of the TPN or PPN components. I didn't really understand the difference between the two. I'm too nervous to bother the nurses at work to ask them this, and we're nowhere near this in my classes yet. But I'm very curious. What is the difference between TPN and PPN? Why can you only give TPN through a central line? What would happen if you gave it through a peripheral IV or a midline? Also, I thought I heard someone say that you can't give vancomycin through a midline. Why is that? If it can go through a central line or a peripheral, why not a midline? Would you be able to give chemotherapy or any other harsh drugs through a midline? TIA for all answers, and NO, THIS IS NOT HOMEWORK!!!! I'm just too scared to ask anyone at work because I feel like I should be able to figure it out for myself!!! :imbar