H_2_O

Which is what I thought should have been done in example #2. Seems pretty basic to me, I'm just still so new I'm a little nervous to put my 2 cents in on some of these things and I'm wondering why none of the doctors pick up on this.

Or is it someone on a drip does not need to be eating? The hospital is a small community hospital serving mostly upper middle/upper class patients. No residents, interns, etc. Only docs, NPs, PAs. And wow about the D5.

I'm about halfway through my first year in the ICU at a community hospital and have had a few patients on insulin drips for various reasons over the past couple of weeks. As a new grad, I'm always trying to learn, and always wanting to make sure I know why I'm doing something. So I'm always asking questions and fortunately, coworkers are very helpful. However, the issue that has seem to come up with insulin drips lately is something it seems nobody in the unit understands or can explain, and has me questioning if some of the physicians even really know what they're doing. The issue revolves mostly around the actual purpose of the insulin drip, and whether or not patients on an insulin drip are allowed to eat. I'll try to briefly explain two scenarios: Example 1: 32y/o type 1 diabetic turned off his insulin pump while sick. Arrived in DKA with sugars in the 600s and on an insulin drip running at a constant rate of 5 units/hr. Doctor called later to see if the pt. is "ok," didn't even ask what his sugars were (they were running 200s to 300s) and said to start him on an 1800 ADA diet. Later the doc shows up and tells me he doesn't care about the sugars, just the acidosis (which had been resolving). He told me in DKA the insulin drip is just for the acidosis, not the sugars. Pt. went home with sugars under control and normal acetones later that night. Example 2: 72 y/o COPD'er that was started on 40 of IV solumedrol, sending his sugars into the 500s. Patient was put on our insulin drip protocol, which is rather confusing and assumes the patient is NPO. Sugars are down to 169 after being 200-300 all day (so he's almost off the drip). Primary doc arrived and said continue with the insulin drip, then put him on sliding scale when he's below 140 for two hours. When the pulmonologist arrives shortly after, and the patient begins complaining to him that I'm "starving" him by keeping him NPO. Pulmonologist then tells me to start him on an 1800 ADA or he's "going to go hypoglycemic and code" and "he will die". Cuts the solumedrol down to 20 but leaves me out to dry as far as the insulin drip goes and hurriedly runs out the door. So I call the primary, tell him what pulmonary said. He says OK, put him on medium dose sliding scale with q3h cbgs and let him eat. Three hours later he has a sugar of 453. I call the primary and he said to go ahead and give 20 units per sliding scale and check him again in 3 hrs. This was right before shift change so no idea what happened later... Also, what about giving lantus while on an insulin drip? Some say yes, some say never. My coworkers, some who have 30+ years ICU experience in major hospitals, all tell me they have never have a clue what the heck these doctors are doing with their insulin drips and that it defies logic - especially when it comes to eating on the drip. They tell me that in the old days, patients on insulin drips were ALWAYS npo. Any explanations out there???

Perhaps one of you peds nurses can help me out here, as I cannot find this info ANYWHERE - textbooks or internet. How is a typical pupillary asssessment on an infant (i.e. birth - 6 mos) performed? Knowing that it will be only PERRL, because accomadation has not developed yet, what is considered normal reaction (i.e. pupil diameter)? What age do you begin to test for ocular movements?

I went through this initially as well. Part of it came from instructors saying "spend as much time with your patient as possible," which makes you feel obligated to be in the room all the time, hanging out. Even if the patient is comfortable and doesn't need (or maybe want) you in the room for any reason whatsoever. Staying task oriented, I think, might help you with this. Go into every room with a specific goal (i.e. to do an assessment, ambulate the patient, etc.). If you don't have a reason to go in, don't go in. If you have nothing else to do, tell your instructor the patient is resting comfortably and you'd like something to do, or ask the nurses on the floor if they need help with anything. Typically, I don't even think of going into a room until I have report,and have given the chart (especially history, orders, and labs) a brief lookover. Gives me a little to chat about with the patient if small talk is necessary. Very important to just pretend to know what your doing, even when your not confident (within limits, of course). And most of all, let the patient do all the talking. Trust me, this works. I've found 75% of the patients will talk my arm off. I can barely edge a word in. People love to talk about themselves. Sometimes it's interesting, sometimes it's boring. But it takes the pressure off you, and you simply listening is therapeutic for them.

PM sent!

I too would love to know the reading assignments for first semester. Never too early to get started. Anyone? You could send by email if you have to.

^^^^^^^ Not forced...just lose your livelihood. So what's next? "Do it or lose it" abortions for nurses who become pregnant when a hospital is short staffed? After all, if they don't like it, they can get a job someplace else, right? An extreme example (maybe?) but one's apparent desire to put one's body at the mercy of one's employer requires nothing less. Green hair, 15 earrings, and TB tests are much different than fast-tracked vaccines. You're comparing apples and oranges. I suppose one would toss a patient out in the street if he refused to submit to the vaccine as well?

Irritable? No, just quite satisfied in the fact my earlier assumption was correct.

You can "feel" whatever you want. The article just confirms what I had stated in previous threads: Someone (an unknown group of individuals/entity) made the decision to stop testing for swine flu because "99% of tests were coming back positive for swine flu." This was the exact quote given to me by three healthcare professionals from three different states, interestingly enough. My hypothesis (of about a middle-school level) was that because they stopped testing for swine flu and decided to label EVERYTHING swine flu, numbers of people ACTUALLY INFECTED were most likely grossly inflated. Of course I was ignored - along with common sense - in favor of mass hysteria.

As the mass hysteria subsides...a return to reality: http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml

I graduated with a Bachelor in Communications several years ago and am currently enrolled in an ADN program (I would've done a BSN but was unable to obtain financial aid). Looking ahead, my ultimate goal is nurse practitioner. My question is this: 1)As an RN with a Communications BS, will I have to complete a BSN program to gain entry into a master's program? if so... 2)As an RN with a Communications BS, what sort of coursework will I be completing in an ADN>BSN bridge program? I know there's no exact answer to these questions as each school is different, but a little insight would be nice.

bingo. the same question was asked on another thread as well: if they've stopped testing (because suposedly "99%" of the cases are swine flu), how the hell does anyone know if it's actually swine flu? thus, the formula for the present diagnosis probably now works something like this: kid with "symptoms" + panicky parent = swine flu i understand it's a good idea for folks who are feeling symptoms of whateveritis to treat it like swine flu. but officially generalizing every ilness as swine flu only fuels mass hysteria. the number of those who actually have contracted the virus is likely quite inflated. i'm not understanding why common sense is being thrown to the wind in favor of panic. not to be a conspiracy theorist or anything , but has anyone followed the money here?

Too funny. This is the line being fed in multiple areas around the country. "It's all swine flu, 99% of it." I sure as hell am not buying it. Maybe just a way to jack up the numbers of swine flu victims? Naww.....They wouldn;t do that! In other words, we're not testing so... Paranoid parents + kid with "symptoms" = swine flu. Bring on mass hysteria.

Absolute reckless insanity, isn't it? Ethically/morally/scientifically OUTRAGEous. This all comes down to individual rights - specifically the right to control one's own body. They aren't going to get away with this. Especially if they attempt to mandate the vaccine for the general public. Sparks over a tinderbox.