KarangRN

Have any of my fellow colleagues in the state completed an online RN-BSN program? I have the itch to go back to school and finish up my BSN. Just trying to do some research on whether to go back to campus for my degree or try the online approach. I'm leaning toward University of Phoenix but I want to research all my options. Thanks Guys :)

We really just need a simple one to check for pulses when the staff nurses can't feel a radial or pedal pulse they can do a doppler. Thanks for pointing me in a direction so I know where to start research. Does it matter what mhz because I've seen 5 and 8...I can use a doppler but I admit I am no expert when it comes to specific specifications.

Our DoN gave the go ahead to get a doppler ultrasound for the facility. Do any of you use a doppler in your facility, and if so, what kind do you use? Any recommendations? Thanks

The plan is for continuous infusion. At this point we have the resident on around the clock routine Roxanol and Ativan in addition Fentanyl patch increased to 200mcg and it seems to be keeping her a lot more comfortable. I'm having our pharmacy order those SQ needles in case we do go down that road I'll be ready and have the equipment available.

Thank you, its been a while since we've had someone with with a portacath but I know we have some huber needles in our IV cart.

I hope these are not stupid questions but here goes hehe: When starting a subcutaneous infusion, can you use both a regular IV catheter and the butterfly IV catheter? At our facility we have both the BD Insyte Autoguard IV start catheter and the BD Safety Intima (butterfly). Keep in mind that we do not have a specific policy for subcutaneous infusions but only a broad infusion policy from our pharmacy. We have an end of life resident at our facility and we are having some difficulty controlling her pain (she is currently on fentanyl patch 175mcg and roxanol 1m qhour prn). The idea for SUBQ PCA came up and I want to have as much information as possible before we cross this bridge with the IDT. My second question is that comes from the literature that I have read when priming a subcutaneous infusion. You cannot prime the Autoguard until you retract the needle and you cannot prime the Safety Intima until you unscrew and pull the needle with the safety device. How do you prime these sets with either IVF such as NS or morphine sulfate if you are doing SUBQ PCA infusions? Is it ok to have some air in the line prior to attaching the IV tubing with the Safety Intima butterfly catheter before starting the infusion? I've started tons of peripheral IV's in frail and elderly residents. Is it more or less difficulty than that? Thank you! Any information would be appreciated.

wow i should count my blessings, our admin lets us have kinda decent ratios for direct patient care... This is for a 120 bed SNF/ICF facility with 2 units 60 beds each 06-1400 & 14-2200: 1 charge nurse (RN), 2 licensed + 6 CNA's per unit 22-0600: 1 charge (RN), 1 licensed and 3 CNA per unit It still gets hard sometimes depending on the SNF acuity. Our current census is 113 (our local hospital is slow and we try to take SNFs before community ICF referrals I think), which makes the admin kinda antsy but our ED always believes patient safety first.

WTH...docs orders always trumps what the DoN wants, nuff said. If a doc orders me to send a person with a little pinky sore to the ER I would try my best to paint the picture for him but if he continues to say send to the ER...baibai~ DoN can yell at me all she likes. If she wants to argue she can argue with the doc.

At our facility we have an IDT Nutrition at Risk committee with our Reg. Dietician as chair and we decide on who to upgrade or downgrade to weekly vs. montly weights. Anyone on the team, soc. svcs. included can ask for weekly weights but if its brought up in committee we discuss before putting them on nsg. measure weekly weights. Not sure what it is in other states but in Hawaii tube feeders are weighed weekly as well as anyone that is being observed for significant weight change. Also SNFs get weight weekly until either downgraded or the NAR committee determines they are stable enough to go to montly weights...we just gotta document in the chart, mds and care plan our rationale. When someone goes on a diuretic for the first time they go daily, then weekly weights. We monitor them for a few weeks then decide in the NAR committee if they can come off weekly weights and go to monthly. Our floor nurses are also good about seeing weight fluctuations or new onset/exacerbation of CHF and will automatically change a person who is on monthly weights to weekly or even daily weights. And of course the PCPs can order daily/weekly weights but if they stablize after an intervention we generally ask them to DC daily/weekly weights.

CapeCodMermaid: I mean I applaud housekeeping for regular rug shampooing and are pretty good at taking the bins out, spraying deorderant and stuff, but our cert. wound nurse loves sween and we drill it into the cna's to use that during all change rounds like a moisture barrier and turning...so when u step onto the unit smells like sween cream :)

Just make sure the aides use sween cream and the whole facility will smell like sween cream

How is the Littmann 3000 compared to the Littmann 4100?

I work at a 120 bed SNF facility. The DoN is my boss, monitors my calendar and does my evaluation.

Howzit everyone. I'm Carl. I was born on Oahu, raised in Waianae and moved to Hilo before high school. I attended Hilo High School (GO VIKS GO). I joined the Army National Guard right after high school to pay for college because my parents didn't have enough money to send me to school themselves. My mother is diagnosed with severe Schizo-affective disorder, which is why I guess I was interested in going into some kind of medical field. I'm a 31 year old RN that works at Hale Anuenue Restorative Care Center (a 120 bed skilled nursing facility) in Hilo on the Big Island. I started my ADN at HCC in 2000 but withdrew on my last semester due to family problems. I did take my NCLEX-PN and worked at Hale Anuenue as an LPN from 2003 until I finished my ADN-RN in 2006. Moved up to Eve Shift Supervisor after that but I had a chance to work in the ER at Hilo Medical Center in 2007 so I took it. After 6 months of stress and a crappy preceptor, I decided that particular ER wasn't for me. My heart has always been in critical care but I love geriatric and long term care nursing too. I came back to Hale Anuenue in October 2007 and worked back as Evening Shift Supervisor. I feel that even though I only spent half a year in ER, the experience I've gained there benefited me on the unit. Three weeks ago I was offered to do MDS. So right now I'm doing MDS, and since the hours are compatible with me going back to school I am seriously thinking about finishing up my BSN online next year. Perhaps even moving on to grad school hehe. Nice to meet all of you and big aloha to all you nurses no matter where you are from. We are all colleagues and the main focus is our patients.

Is it safe to push Digoxin via IV if the patient is not on the monitor? I work at a skilled nursing facility. Coming back on from the weekend I heard in report that an MD ordered IV digoxin on one of the residents on the unit where I work. Scenario: the resident is a no intubate, no CPR but may send to the ER (our code status where I work is weird with a lot of gray areas I know). When I heard this my first gut feeling on hearing those would be to question the MD about my reservations about pushing dig IV w/o a monitor. I've done half a year in ER but I got out because it was too stressful for me to handle. Nevertheless I would have questioned the doc on that one. Just bouncing this scenario off wondering what you guys think.