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1. 250 2. 15 seconds 3. All of them 4. All of it 5. None. You are already late. 6. It will only be opened once- by the entire varsity soccer team , looking their buddy with the sprained ankle. 7. She won't. she will end up registered as a patient. 8. All of them. And then it will be out of batteries. 9. Yes. With his head. If he falls head first, his head will hit the door if it is closed, which it will be. 10. No, but who cares? 9309

The fact that you are as concerned as you are is an indication of your commitment to provide good care. You are probably much less likely to make a consequential error now. 9309

Having a child with weight issues is one thing. Having a child who is morbidly obese from eating family size packages of snacks, drinking half liters of mountain dew, and being sedentary is another thing. Parent is both a noun, and a verb. 9309

compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful http://www.merriam-webster.com/dictionary/addiction

Fwiw- I think this brings up an interesting topic. At what point does somebody's personal choices affect their professional performance? Some people would say the two are completely seperate, but I am not sure I agree. Take, for example, a driver's ed teacher. If he had a reputation for reckless driving, or doing stunts on the street, he would be innefective as a driver's ed instructor. While he would tell his students the importance of obeying traffic laws, they would know he was not serious. In fact, he might even be a negative role model. There are countless examples of how somebody's personal choices might affect their professional effectiveness. (A rehab counselor who is a known barfly, etc...) The same could be said for the RN who is a diabetic educator, but is morbidly obese. No matter what he or she says about diet and excercise, the effect will be diminished. While patients will not doubt the veracity of the statements, the message will be watered down. As long as I don't pay for their health care, I don't bedrudge anybody their right to smoke, eat, or drink themselves to death. Curiouse what others think. 9309

Fwiw- I

There is some logic to the above, but- I wanted it sent to me. While it's possible that somebody else could open my mail, that's a federal crime, and my signing a release has nothing to do with it. As far as being fired for looking at your own chart- Why? what was the basis? 9309

Ok, just a short rant. I need a copy of my own health records from our occupational health. (Immunizations, etc.) I called, and asked if they could send a copy to me. The secretary was more than happy to help, as long as I fax a release. I did not give her a hard time, or even mention the silliness of that rule. Think about it: Why would I have to sign a document allowing them to release information to me. I am obviously entitled to the information. What is the possible downside to releasing my information to me? Is there a concern that I would sue the office for violating my privacy rights? As in: "You have no right to give me my healthcare information! I now know things about me that I have no right to know." The problem is not the minor inconvenience to me. The problem is that people do not feel empowered to use commmon sense. Maybe I am missing something, and this requirement actually makes sense. Any thoughts? 9309

Regarding a written note- In some sysems there is a place for "comments" which could be used to cover anything not covered elsewhere. As far as CYA with a written note, it may or may not. If the information is documented elswhere,a note won't help in any way. In other words, if you are charting by exeption, and have checked that respiratory is WNL, writing that pt is breathing easily at a rate of 16, LSCTA, no SOB or DOE doesn't add anything. A narrative note should only cover issues not adressed elsewhere. Just my humble opinion. 9309

Suboxone is taken sl. The idea is that the narcan will not be effective if taken sl, alowing the bupenorhine into the system.. If crushed and injected, the narcan will bind with the receptors instead, limiting abuse potential. The naloxone component in SUBOXONE is included to help discourage diversion and misuse. Naloxone has very limited bioavailability when administered sublingually, as intended. However, if SUBOXONE is crushed and injected, the naloxone will precipitate opioid withdrawal. In the absence of an opioid, the antagonist has no effect. http://www.suboxone.com/hcp/suboxone/ So- here is my question: Narcan can be given sublingually. http://groups.msn.com/paramedicemtgathering/medicaltopics.msnw?action=get_message&mview=0&ID_Message=6687&LastModified=4675677423197787354 I have heard other references to sublingual administration of narcan, but can find nothing documented anywhere. SO- Is Narcan effective SL? 9309

The problem is that The way most of us waste drugs is a bit of a farce. When I come on in the morning, how do I know what is being wasted? all I know is that about 1cc of some clear liquid is going into the garbage. Could be tap water. The only legitmate way to waste drugs is for the witness to actually watch the drug being drawn from a closed container. That being said, I regulary do the same thing. I figure one day it wll bite me in the caboose. 9309

Studying for the test is a great learning experience. It will make you a better nurse. FWIW, I found the test hard, and passing it was very rewarding. 9309

Do you feel that you (a nurse) are treated as a professional or do you feel like you are?? I am a professional, and am treated like one. People appreciate competent care. Do you feel that you frequently have to look busy to keep the powers that be happy? No. If things are quiet, they are quiet. when the defecation hits the oscillation, I take care of what need to happen. 9309

If you are heading for ED or ICU- Make sure they have a good training program. There are many that say you should stay out of these areas untill you have at least two years med surg. I disagree. If the unit is set up for new grads, and has a good track record with their program, you can do fine. BTW- if you are thinking nurse/medic flight, etc., you are probably best off in the ICU. 9309

Hey- thought I might chime in. A long time before I went to nsg school, I considered law school. Did well enough on my LSAT's to get in, but changed my mind. It was not an either/or choice for me, I decided on nsg school several years later. I am valued and appreciated by pt's families and co-workers. As far as being respected by DR's and administrators: I do my job well and treat others with respect. I expect, and receive, the same in return. Regarding money- I am a per diem nurse. I get benefits through my wife. I have a two year degree which cost me about $10,000. I usually work 3 12's a week, and have plenty of time to do what I like. I can afford to take time off nursing to do less lucrative work, or to vollunteer. IF I wanted to work 60 hrs a week, I could. I would earn $85-100,000. This is based on my per diem pay of $30 an hour. $30 X 60 hrs X 48 weeks + $86,400 (I included 2 wks vacation, and 2 wks personal) I based the above on doing no overtime, and working at two facilities, no overtime. It's a good job. I help people and they appreciate it. I am well compensated. I have plenty of free time. The job is as challenging as I make it- Unlimited opportunities for learning. I get to wear scrubs every day. Good luck in your decision making. I so frequently hear the respect issue come up, that I had to respond. If you are respected and valued in other areas of your life, and you are a good nurse, you will be respected and valued as a nurse. 9309

It's a great idea. While not working as a traveller, I am doinf something similar right now. I am working at a coastal hospital in maine that pays per diems well. I will be living aboard my small sailboat for the summer in a local marina. I could be on a mooring right acroos from the hospital, and commute by dinghy. It's a great idea. Good luch. 9309

However you do it, you should know what the volume of the line is. I have seen some practices that demonstrate that the nurse has nor taken this into account. For example: The closest port to the patient may have a 1 cc volume. Very slow push of 1 cc of medication, followed by a much faster flush. The nurse believes he/she has delivered the med to the patient slowly. What they have done is delivered the med slowly to the iv tubing, and quickly to the pt. Another example would be using a high port on a slow running iv, and having no idea when it is actually making it to the pt. Lets take an iv of ns running at 60 ml/hr. (an unusual rate, but good for this example) Getting 60 ml an hout, would be 1 cc a minute. If my distal port is 10 ml away from my pt, it will take 10 minutes to get there. As far as being well diluted using this method, I am skeptical. I think that for the most part, it probably travels as a bolus, with some dilution happening. In the right situations, I will use a maintenence fluid line for meds, but it is a conscious decision taking into account the above factors. 9309

I work with a 5 electrode monitoring systerm. I put the extremity electrodes on the 4 corners of the torso. I put the V lead electrode on any of the six V-lead positions, V1-V6. I almost always use V1, but if there is a reason to choose a different lead, I will. This question is not about which V lead to use, but about what I see as a very common practice: People frequently put this electrode somewhere in the middle of the chest. I often see it at about th3 6th intercostal, right in the middle. Why? Is there some valid reason to do this. I have asked people why they do this, and usually get one of two answers: 1 "I am monitoring the V-lead" If I ask which one, I get a blank look. 2. "It's how I was taught". If I ask which lead they are monitoring, I get a blank look. SO- Is there a valid reason for this practice? It is so widespread, I figure maybe I am missing something. 9309

Hi all- ER pt- slim 19 y/o female. She had seen her doc, and been given a halter monitor, recently removed. Her complaint was tachycardia. After the monitor was removed, she was told to go to the ER for rates over 120. She showed stating she had been 135, but on arrival she was around 100. that's the background, here is the question: She was irregular with an underlying sinus rythm, and brief periods (2-3 beats) of slower sinus rythm. The ER doc said this was respiratory variation. It looked like resiratory variation, except that the p wave of the slower beats were smaller, and distinctly different morphology. Does this make sense for respiratory variation? 9309

Do you dispense meds, and if so, is it legal? Where I work, we do it regularly, and it is apparently illegal. A RN or LPN legally may NOT dispense drugs at any time. Dispensing means the pouring or placing of drugs from stock supplies into bottles or containers, the labeling of such items with the patient's name, medication, dosage and directions and the giving of such bottles or containers to personnel for administering to patients. This is the role of the pharmacist and may not be assumed by nurses. It would be legal if it was packaged and labelled by a pharmacist, but it isn't. We package and label it ourselves. Curious what others do. 9309

Where I work, a doc needs to come in to admit the pt. Frequently, they are tied up untill after normal office hours. They show up after 5:00, then sometimes don't give up the paperwork till they are done dictating- sometime after 6:00. I try to speed things up, but there isn't much I can do sometimes. I get what it's like on the floor, and try, when possible, to not send a pt close to shift change. I work till 11p, so if we aren't bust, I will hold a pt till after shift change, and try to get the more immediate stuff started. 9309

Whatever you come up with, the head should not be restrained if the body is not. If the backboard straps can come off, the head should be free. 9309

I disagree. It is objective information. Documenting objective information should always be safe. Make no judgement or interpretation, just write what you saw, heard, or did. Documenting that the woman was unreasonable, or an idiot, could be problematic. 9309

i did a bit of reading on trendelenburg. http://ajcc.aacnjournals.org/cgi/content/full/14/5/364 use of the trendelenburg position has a history of widespread, ritualistic acceptance19 and is probably a good example of a nursing intervention that is based on tradition rather than on scientific evidence.18 a sustained, systematic effort, which must start at the level of early nursing and medical training and be part of continuing education, will be required to gradually dissipate "reflex or routine" use of the trendelenburg position for resuscitation of patients who are hypotensive. http://www.caep.ca/page.asp?id=df61785b363d4460835a593243e70058 canadian association ofemergency physicians did a pretty thorough literature review. most of the best, most experienced, nurses i know utilize trendelenburg. i don't- i am hard pressed to, given what i have read. 9309

I am relatively new (4 years) and have worked only in a couple of places. I have seen some things I question, and wonder if they are common practice. 1. Electrode placement on a 5 electrode system. Particularly the "V-lead". I see this placed in various places, other than one of the 6 chest leads (V1-V6). I see it between V1-V2, or below the xyphoid process. I even hear it referred to as "the V lead". It seems you should chose a lead you want to monitor based on pt condition. 2. Trendelenburg, Far as I can tell, no study has shown any benefit to Trendelenburg for shock, and some have shown harm. There seems to be no evidence supporting this practice. I don't do it, but occasionally other nursed look at me as though I don't know enough to use Trendelenburg. 3. IV gtt's by gravity. Let's say you have a 50 ml bag of antiobiotic being given to a pt who will be discharged. No maintenence iv running, no need for fluids, you just want to give the ABX. Given the fact that the tubing can hold as much as 15 ml, how do you administer the full dose? 9309