adria37

Why did he get the DVT in the first place? Risk factors? Obesity, smoking, travel, dehydration, surgery, malignancy? Did he have a hypercoaguable workup? Bleeding in the joint? Clot extension? I would ask for a face to face or a phone call from the NP to discuss your concerns before I started with a new provider.

Cancer in the bone, gallbladder disease, normally elevated with rapid bone growth, hepatitis, mono, gosh there are lots of reasons, parasites etc.

I would do stool for occult blood, erythropoietin level, B12, folate levels, don't forget anemia of chronic disease and MDS in your differential. I suspect her anemia was secondary to infection, CRF, with what you are describing and the rest of her CBC is wnl's. I would not refer her unless her anemia worsened, failed to correct, or she had evidence of a GI bleed.

I would check to see if when a narcotic is written is there any documentation of sedation and constipation management and on the next visit see if pain relief is addressed again as well as constipation/sedation.

I took both the AANP and the ANCC exams for FNP. AANP you sign FNP-C and ANCC you sign FNP-BC (C=certified and BC=board certified). The AANP seemed more difficult and clinically focused. I believe I could have taken the ANCC exam and passed without ever attending FNP school.

Surely they were not getting IV contrast too? I wonder what happened at the meeting.

An allergic response can also cause ITP to develop and worsen but based on his low plt count prior to Cipro IV I would still lay it at the sepsis unless his reaction to Tequin was ITP. He is on dialysis was the previous reaction diabetic related? Tequin was removed from the market based on it's effect on glucose. I would do my research so you do not get blind sided in the meeting. It usually does not bode well for the nurse to be called to a meeting with a doctor and director. I would have my rationals for what you did. I do not think he was confused about quinine at all and would not even go that approach, IMHO

If their kidney function was bad why in the world would they give Cipro in the first place. ITP can be worsened by infection (IE will be). I would expect a doctor know this about ITP. http://www.emedicine.com/emerg/TOPIC282.HTM

Most chemotherapy drugs have nadirs at 10-14 days any open area is fair game. I would be interested in what the cultures grew, I bet a staph epidermis. If you used sterile technique then I would not feel bad about it. TPN is a great medium for bacterial growth too.

I would question why they had the port. (cancer, chemotherapy, etc) They probably had a suppressed immune system to begin with and an infection a week later would really be reaching IMHO.

I can see it coming, I don't smoke but I really think allowing companies not to hire based on LEGAL behavior is wrong. Obesity causes more health problems, burdens the system more, and costs more than smoking. I am waiting for companies to not hire a person based on BMI. "Obesity is associated with a 36-percent increase in spending on healthcare services, more than smoking or problem drinking. More than 40 percent of U.S. companies have implemented obesity-reduction programs, and 24 percent more said they plan to do so in 2008." http://www.consumeraffairs.com/news04/2008/04/obesity_workplace.html

I am so sorry you are going through this. I know it is extremely frustrating. You need and your father needs, to be at a place you guys are comfortable with the level of care he is receiving. I am surprised that your father's physician, the one who is managing his hepatitis C, did not discuss the development of hepatocellular cancer as a complication of hepatitis C. I believe that the numbers are close to 25% of patients with hepatitis C develop liver cancer. That might be the reason they are throwing the diagnosis around so flippantly, but again that is no excuse. My :redbeathe goes out to you and your family.

I don't believe a protime is not measured in seconds either :)

That has to be a mistake IMHO to have a PT of .06 and INR of 1.8 INR = PT- test/PT-normal Normal is roughly 1 and blood that takes twice as long to clot than "normal" would be 2. I would question the test.

First, this kind of behavior towards a fellow nurse/human being is what drove me to become a NP. Snarky behavior is not becoming. And Coltsgrl I bet the very ones protesting the loudest were the ones in their nursing class asking those annoying attention seeking questions. Yes, every class has one!

I had one drug question that I can remember on the ANCC exam. The lab questions were simple to me with obvious out of norms. I guess everyone is different but I really believe I could have passed the ANCC exam without ever going to school to be a NP but I do have a degree in nursing education and a good grasp on research and theory. The ANCC exam just seemed easier and required less thinking. I also knew I passed the AANP exam and was not a bit nervous so that could have been why it seemed like it was so much easier.

I have it and love it. I bought a subscription as a student then when I started practicing my workplace paid my subscription. I especially like the CEU's I have 45 hours already this year just in research on UpToDate

I took both of them for FNP and in my experience the AANP exam was much more difficult that the ANCC exam.

I took the ANCC exam for FNP on 6/21 and still have not received a certificate from them. I am not upset because I took the AANP exam and have already received that one, maybe I should call them too.

We have LPN's in our oncology office. They work the phones, schedules, paperwork, drug approvals, do the doctor's schedule, we could not make it without them.

No not at all, it is their loss :) but so far I have had positive responses from patient's. I think it is because NP's in general are not as rushed.

I have researched this extensively because it happened to a friend of mine. The risk is the patient may develop phlebitis, it is the reason it is not given IV. The person my friend did this to was fine btw. I am sorry this happened to you.

I just took the AANP FNP exam and passed. I really don't think there is a way to study for this because the questions are high level and scenario. I didn't think it was that hard. Good luck!

Best guess from what you posted if I were having to do a differential diagnosis on a quiz 85 y/o MI probably secondary to severe anemia probably secondary to CLL

it is commonly found in elderly patients. http://www.emedicine.com/med/topic370.htm Here is an eMed article.