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Content by mommy.19

  1. mommy.19

    Wound Care - Unna Boot

    The unna boot contains sorbitol (osmotic diuretic), glycerin (moisturizer), and zinc oxide-aka diaper cream (as a skin protectant). One layer is sufficient to compress and draw fluid from the extremities-if needed more kerlix gauze wrap can be applied if the patient is HEAVILY exudating for absorbency, however this should hopefully be managed by educating the patient on elevation of the BLE above the level of the heart when not ambulating. I have seen people lose toes over unna boots being applied incorrectly (it was done more than one time in a row to the pt, who had diabetic neuropathy and could not feel the ischemia in the toes). I would definitely have a knowledgeable person instruct you on the correct method of application. And remember, just because someone is an LPN, RN or even a WOCN, doesn't mean they automatically know how to do this. I had a WOCN once show me to wrap from the knee DOWN! Anyhow, one of the only reasons that more than one unna boot would need to be applied is if the pt's leg is too long, and in that case the second unna boot roll would need to start about 2-3 wraps below the first so that compression can be continued consistently; this also applies if more coban is needed over the kerlix gauze layer, start 2-3 wraps below where the last one ended. Hope this helps!
  2. mommy.19

    Wound Care - Unna Boot

    We use unna boots for many people with venous stasis ulcers or just plain edematous, "weepy" legs. Unna boots are NOT, by manufacturing specifications, indicated for compression, however when physicians write, "unna boots to BLE for compression" this is acceptable, and is the most common use in my experience. If any dressing is placed under an unna boot it would need to be something that can remain intact for the duration the boot is left on (sounds like common sense but sometimes it isn't). We use Xcell AM covered with adaptic if the wound is dry or has any type of eschar, or just plain adaptic. Then, the unna boot is applied as explained by ktrn2b, from the base of the toes to about two finger widths below the popliteal space. Some instructions will direct you to apply the boot in a figure 8 type fashion, however this can be dangerous if another nurse who is not familiar with the process removes this unna boot to apply another and attempts to repeat the figure 8. Any gaps left in the boot will trap the edema and may cause more ulcerations or tissue death. An important factor to consider is the pt's ABI--we normally will not compress anyone with less than 0.8 or more than 1.2. We normally use a dressing as described above under the unna boot on any ulcers, followed by the unna boot itself with a 75% overlap on each wrap, then kerlix gauze and finally coban. The kerlix will absorb the exudate that the sorbitol in the unna boot pulls away and the coban will keep the compression of the unna boot in place until removed.
  3. mommy.19

    Skin Tear and Duoderm Question

    I agree with the consensus here, adaptic or mepitel one over the wound and maybe a gauze wrap like conform or kerlix---duoderm is waaaaayyyy too adherent for fragile steroid-like skin.
  4. mommy.19

    Stage III not responding to hydrogel

    Well, hydrogel is for wounds that are small to NO exudate, and is amorphous so it can (and likely will) macerate healthy periwound even if used on a wound with a dry bed. So, it is not likely the person changing the dressing that is causing this maceration. The wound needs something that is appropriate for it's specific level of exudate. CarreBarre listed very pertinent questions and I would definitely address these. I would discontinue the hydrogel immediately if it were my pt. Just my 2 cents!
  5. mommy.19

    Stage 3 with undermining

    Hi Coco, Many things could be preventing the wound from healing including low protein levels, is the pt diabetic or on any immune suppressants? Does the pt smoke? Offloading the area is the number 1 priority with a decubitus, then pinpointing any aggravating factors. Is it infected? How often is the dressing being changed? *Mesalt is generally used for enzymatic debridement and is not sparing to viable periwound tissue, i.e. if the mesalt touches viable tissue it will chew it up just as it would do to slough or fibrin. *If the wound is not progressing after about a month I'd probably change product or try to find any underlying problems aforementioned such as infection, low protein levels, something from the pt's H&P. *Silver nitrate is used to treat hypergranulation and sometimes used in place of surgical or mechanical debridement for "chronic granulation tissue" or the pinkish, slick looking (for lack of a better description) tissue around a chronic wound. I find that this is handy when the patient is not having serial debridements by a physician to mechanically remove the nonviable tissue, but ensure that the Silver Nitrate is deactivated by NS after it is applied or it will continue to cauterize the tissue. Hope this helps a little! :)
  6. mommy.19

    Superficial skin tear on coccyx/buttock

    For something that is causing significant pain, my question would be is the wound infected? Also, if it is on the patient's buttock I would use an offloading type of dressing, maybe like Tielle light border, mepilex border, duoderm, or even hydrophillic foam with a border dressing over it to cushion it. I think it is a little silly for the nursing home to not want a wound dressed, even if it is covered with something not medicated and non adherent just to protect/potentially lower bioburden. And also, if it makes the patient feel better to place a dressing on it, they're hospice for goodness sake, do what you do best and comfort the patient :)
  7. mommy.19

    Can a skin tear evolve into a pressure ulcer?

    RiverNurse, Given that the etiology of a decubitus ulcer, one could form almost anywhere. However, without seeing this wound I am guessing that someone has stated the etiology of this wound incorrectly either by accident (did not know what they were looking at) or purposefully did so to avoid repercussions. A skin tear -generally- presents more as a jagged looking rip, not what you're describing. It would be difficult, in my opinion, again, without having seen the actual patient, for someone to have a skin tear in that location. Does the periwound blanch at all? does the patient have any other decubitii that appear similar to this or any other skin tears that resemble it? Sorry, I seem to only have more questions for you :)
  8. mommy.19

    Unna boot

    We apply unna boots in our wound clinic on a daily basis, and usually place a dressing on any ulcerated areas that is deemed appropriate to be left on for up to a week, such as xcell covered with adaptic, or aquacell AG, I have even used santyl on some sloughy venous stasis ulcers under an unna boot and left it intact for a week with great results.
  9. mommy.19

    Apical Pulse Rate

    Only last fall the clinical instructor in a local ICU showed us the importance of being able to assess things in more than one way, i.e. being able to palpate the PMI and derive an apical HR in this way. Now, she said, 99/100 you're going to be using a stethoscope, but there may be a time when it is better to palpate the apical and the radial simultaneously in lieu of listening to one and palpating the other. Just my
  10. mommy.19

    Old New Grad Offered Corrections Position

    I personally LOVE corrections nursing. It's a very different environment (to state the obvious) and you have to really enjoy what you're doing. In my opinion, my personality type jives with this type of position a lot better than many hospital "unit" positions (though my other job is in a Neuro Trauma ICU). I'd advise to go what you're interested in, and if it is an issue of having a secure job, take the one you KNOW you will get.
  11. mommy.19

    TCC RN Course Length Minimum? LPN Schools in Tulsa?

    The only way to "Accelerate" the program is to go to an institution that offers an accelerated program, like OU (13 months for your BSN, but it requires a previous bachelor's degree). TCC is a 2 year, ADN program that can be completed either full time for the 2 years or half time for 3 years. Tulsa Tech and Green Country Technology Center have LPN programs I believe, and you are also eligible at the halfway point of RN school (in most schools depending upon timing and curriculum) to obtain equivalency through to board to sit for your LPN license.
  12. mommy.19

    moving to Tulsa

    I work as an LPN for an agency in Tulsa, and the LTC pay ranges from 22.50-26.50 depending on shift and location. I live in the Jenks school district and I absolutely love Jenks. I feel like it is the only place left around Tulsa besides Bixby that isn't a trash heap. They are building some brand new apartments in Jenks as well and it is right by the turnpike to go to either hwy 75 or to 169, which will get you anywhere. Most hospitals will hire LPN's for med-surg, especially St. Francis (61st and yale). They have LPN job openings at this time I believe, also LTC will always take LPNs, but it's hard and unforgiving work. Apts around Jenks for 2 bed are around $800 if that helps.
  13. mommy.19

    Any nurse externs out there?

    It's pretty much shadowing an RN, learning the duties of the particular area in which you're externing, learning skills, developing assessment skills, etc. Pay is roughly that of a CNA (in Tulsa at least is about the same). If you aren't in classes, like for the summer, they'll have you on a two -three 12/hr shift schedule (if your area or unit operates on 12 hour shifts that is). However, most extern programs for the summer have cutoff deadlines to apply in March or April. Some may take externs on the fly but for mine, I had to apply as if it were for an actual position at the hospital (applied online), then the called for an interview, etc.
  14. mommy.19

    Bad news about TCC RN program

    Program has been great, busy, difficult to manage at times but I'd never take it back to do anything else. Clinicals are a little shifty, just as disorganized as TCC sometimes but it all works out in the end. They want the reputation, and they want hospitals to WANT OU grads. I know places that see people are from TCC and they whisper "oh crap". I mean, I know it is not indicative of the large percentage of people that go there but it could definitely be a reflection of the faculty and those that govern the program. Many places will not allow TCC to do clinicals at their facility anymore.
  15. mommy.19

    Bad news about TCC RN program

    Just had to give a shout out for the OU Tulsa admission faculty/advisors, they love and want to help you! :) Sorry about all the bad luck with TCC
  16. mommy.19

    Is It Possible An LPN Can Make More Then An RN?

    I had no clue there was such a stereotypical disparity between the ideal of an LPN vs. an RN. It has been interesting for me to be an LPN while going through RN school. Telling some people I'm an LPN and telling others I'm an RN student....really an interesting sociology experiment, but not fun to see how I'm treated as the "LPN", I'm treated better as the student! Ridiculous.
  17. mommy.19

    lpn to bsn @ ou tulsa - questions

    St. Johns takes care of their own, I can say that from experience. (and congrats on getting in, it IS the best program in the state, hospitals always hunt for OU grads, I graduate in May, and I couldn't be more excited!!!)
  18. mommy.19

    A witness to CPR

    It could have also been a result of ruptured esophageal varices, as well as the aforementioned ribs causing trauma to the lungs.
  19. mommy.19

    Polycystic syndrome

    PCOS (named by the appearance of the unruptured follicles in the ovaries -aka cysts- giving the ovaries a chocolate chip cookie appearance) used to be referred to as "syndrome X" or metabolic syndrome. It is now officially referred to as "anovulation" or, absence of ovulation. As TiffyRN said, it is often difficult to find which situation came first, ovarian dysfunction/decreased estrogen production or insulin resistance. Most, but not all women diagnosed with anovulation are overweight and have extreme difficulty losing weight and conceiving. They are NOT diabetic by virtue of being dx'd with anovulation, however "pre-diabetes" aka impaired fasting glucose (above 110 mg/dL in most institutions) is an issue with these women. In the absence of normal levels of circulating estrogen, endogenous androgens are no longer opposed as they would be with normally functioning ovaries. This gives rise to the symptoms of weight gain, hirsutism, abdominal obesity, lethargy, as well as a slew of other s/s. Also, since insulin stores in fat, the more weight gained, the more insulin resistant the tissues become. Metformin increases target tissue sensitivity to insulin allowing blood sugar levels to return to a more normal level, even allowing most individuals to lose some amount of weight, making less fat available for insulin to be stored in. Treatments also include oral contraceptives to take over for the dysfunctioning ovaries that are no longer correctly producing estrogen. What a mess, eh?
  20. mommy.19

    Tulsa Community College- Fall 2009 Start

    Honestly I didn't study, I'm a little hard headed and told myself that if I hadn't learned enough in my first year of my BSN program to pass the LPN test...then I wasn't doing something right. It took me from May 31st from submitting the equivalency paperwork until the day of getting my ATT and taking the test (Aug 14th I believe) to getting my license on Aug 31st. Cost 45 for equivalency, 200 for actual test, and 85 for licensure. Not cheap but glad I did it.
  21. mommy.19

    Ou Absn

    I can't speak for the Duncan campus but I externed with many OUABSN Tulsa graduates and found them to be extremely knowledgeable, and spoken very highly of by other staff. I don't think specific programs put out specific types of students, I realize there can be a mass stereotype but try to look past that. Even the traditional programs are really unorganized and from day to day it's a challenge to keep up with what's going on. There are several ABSN students that couldn't deal with the program and joined the traditional. It's not for everyone, but some people I've heard have done it with a family and FT job (they must have never slept!).
  22. mommy.19

    Tulsa Community College- Fall 2009 Start

    Didn't go to TCC but tested for LPN halfway through, was expensive and time consuming but DO IT. For some reason it made me more confident (and I don't mean gave me a big ego) but allowed me to realize that I'm competent in exam taking, at least, lol, and also hopefully safe to take care of patients. But hey, many people don't need to take a test to tell themselves that, I'm just wierd.
  23. mommy.19

    OU Traditional Nursing Program

    Well, to be honest with you, I really don't know! I just wrote a response to what the prompt said and moved on with it, thinking, they can't REALLY judge me from these TINY statements...can they??? lol
  24. mommy.19

    Opportunities for new grad LPN

    One of my really good friends in the BSN program with me at OU Tulsa, well her sister is an LPN, has been for about 8 years, her peak pay has been $20hr and for her that includes hospitals, ltc, snf, etc. This is in the Tulsa area. Sorry I don't have more info.
  25. mommy.19

    New LPN....charge nurse in SNF?

    Did your interviewer seem at all concerned about no experience, or were they just very confident you could handle it? Did they give you a clear job description and pay rate? Just being nosy :) ******* I promise I am not stupid (many people probably read this post and thought 'what little brains she must have"). I was excited when I interviewed and she offered a job, but then she started asking me delegation and managerial type "what would you do in a confrontational situation" questions. Then she said she was asking me, because she wanted to hire me as charge. I about pooped myself, and said I'd definitely try my best (I do have other managerial experience, and I am in no way saying it would fully prepare me for managing other nurses). Anyway, my big question was about, could I learn to actually do well in this job, or am I setting my employer up for disappointment and myself up for failure? She sounded pleased with my honest opinion of my experience level, and seemed unconcerned about my age, but was concerned I was only using them as a "stepping stone" to better things. Anyway, I'm done with my rant but I'll definitely keep you posted, she didn't say anything about pay or an actual job description (I'm actually still waiting on my license in the mail...imagine that.) She said to bring her my school schedule when it was concrete and tell her for sure what nights I could work, and she'd "give me a shot". Believe me, I have my reservations about it but I would feel odd without at least giving it my best.