DustinRN

My hospital is in the process of obtaining magnet status and they have already begun demoting LPN's to glorified CNA positions. The word is they're fixing to stop hiring associate degree RN's and hire only BSN RN's.

he was diagnosed with colon cancer today. If you will say a prayer for me too. I think I'm hurting just as much as he is

Hmmm...not sure, the vet techs are the nurses of the animal world.

As the Duragesic patch.

There is no way in god's green earth that I could ever work 60hrs week! Muche less 5 12hr shifts in one week! :stone

You were making $35/hr at your previous job as an RN,--being a new nurse? Salary.com is dead on the money when it comes to my area. I make +-$50 of what they listed as a fairly new nurse. I'm due for my 1st year raise, however.

Is he on dialysis?

While I feel empathetic toward this woman's loss, I hope she doesn't get paid jack. Take away all the legal mumbo jumbo and the husband was simply holding his wife still. In nursing school we were always taught to include dad in the whole birthing process if possible. This is just a sad situation.

My thoughts and prayers go out to all London citizens.

Toradol isn't recommended for more than five straight days due to its risk for major side effects. Its dangerous effects are directly proportional to the dosage and length of treatment.

I've never used this technique, but I'm sure there are some advantages to understanding it.

Thanks guys/gals!

I've done 7 cases so far and I'm just trying to figure out how people can remember all these algorithms for each individual case. A lot of things are starting to run together. Do most of you remember the algorithms by heart or do you just have a general knowledge of the treatments for that case? I'm just worried that I will totally forget everything once I actually do have one of the cases while at work.

This question is from the ACLS provider manual. In case you don't have the manual I will write the question out. You have to have the ECC guidelines 2000 manual to get the answers to these questions and I don't have that manual. I'm going over case 4 PEA and I'm not sure what the right answer is for this question. Thanks You are called to the ED to assist in the attempted resuscitation of a patient in pulseless cardiac arrest from unknown causes. When the patient arrives in the ED, chest compressions are being performed, and the patient is receiving ventilations through a tracheal tube placed by EMS personnel in the field. The patient is transferred to a gurney; you confirm that chest compressions are producing palpable femoral pulses, but no pulses are palpable between administered compressions. The patient is attached to a cardiac monitor that confirms the presence of organized QRS complexes. What is the first thing you should assess in an attempt to identify a reversible cause of cardiac arrest in this patient? A. check tracheal tube placement with primary and secondary techniques and evaluate breath sounds to rule out tension pneumothorax B. check arterial blood gases C. check serum electrolytes to rule out imbalances D. obtain a serum sample to identify drug overdose if anyone has the ECC guidelines 2000 it says the answers will be on page 151. My first guess for the FIRST thing you would do would be A, but I'm not sure if that's the answer or not. I have no way of knowing unless one of you can tell me. Thanks!

I've never had a patient with TVP or TCP. Are there no spikes on the ECG to show you when the pacemaker is firing? I've never had a patient with one so I'm just wondering.

I won the stethoscope as a prize at work. We bought raffling (sp?) tickets for numerous prizes at work, and I happened to win the black edition master cardiology. I already have a model 4000 electronic stethoscope from littmann. Thanks for the question.

I have just put a black edition master cardiology stethoscope on ebay if any of you are interested. The perfect stethoscope to start off your days as an RN! Item number: 5571986077

I had a patient on Friday, Saturday, and Sunday night. This patient has had an aneuresym clipped from an infratentorial bleed. This patient is severely confused and wants to get out of bed. The pt pulled it's IV on Saturday night and pulled out his Art line on Sunday night. Anyways, Saturday night I maxed him out on Morphine which was ordered 2-10mg q 2hrs. Well, I had maxed him out on MSO4 with two doses of 5 and 5. Making sure to keep an eye on his blood pressure because the MD wants him between 120 and 160 systolic BP to prevent vasospasm. He is getting MIV at 250 cc/hr to keep his BP a little elevated. Needless to say he didn't respond to the MSO4. So, I gave him 5mg of Haldol, which was also ordered. About 5-10 minutes later he goes straight to an atrial fib/flutter wave form at 210 bpm. So, I give him Labetolol which is the only thing that I have ordered that will bring his HR down at all. The Trandate was being used to control the BP not to deal with the heart. I haven't had the time to look it up, but I believe Trandate has a greater affinity for B2 receptors than B1 anyways. Well I have him the Trandate and he gets down to an atrial fib/flutter switching back and fourth between the two at a rate of around 160bpm. I page the Neuro Surg and he says give him 20mg of Cardizem and call me back to let me know what he's doing. Well I give the Cardizem and he drops his rate to about 145bpm, still going back between the two rhythms. Well the Neuro Surgeon says start him on a Cardizem gtt at 5mg/hr and titrate to keep the HR less than 120. Well that was all fine and well, but the point is the Cardizem gtt didn't keep him below 120bpm, until he decided to calm down and rest from all the exhaustion of fighting us. So now he's maxed out on Cardizem at 20mg/hr and his HR dependent on how agitated he is. So now I'm not touching him with Haldol because I'm afraid that is what put him in that rhythm to begin with. Upon the stat EKG prolonged QT interval was one of findings on the graph. Does anyone else have experiences like this with Haldol? I mean I was about a nervous wreck when I left the hospital that morning. I know before he came in he was having some ectopy isssues with PVC's and PAC's, but I'm just convinced that I did it with the Haldol. I'm afraid to use it now. Anyways, I was just like some feedback on what other neuro nurses think. It's been a while since I've posted over here.

While I've never seen a reaction to protonix; I would be cautious with the next does if there is one. Does your insurance company cover Nexium. If so then give that a try. Same mechanism of action.

My dad was friends with David aka "Jr". He was the paramedic on the flight. It's a sad day for Regional hospital. I will keep them all in my prayers. The ceremony at the helipad was quite emotional as you can imagine. They had four medical helicopters fly over as the session came to an end. It's a heartbreaker.

Well that irritates me that my med-surg book doesn't mention anything about impaired clot breakdown. That would be interesting information to know. Thanks, Susan

I have a question on pt's taking Xigris. The drug rep came today and explained to use the benefit of using Xigris for septic shock or sepsis instead of Heparin. It has shown to decrease the mortality of the patient by 30%. Okay, here's my question: When did sepsis patients start having problems with hypercoagubility? I understand about putting them on heparin to prevent clots from forming while there resting in the hospital, but do pt's get hypercoaguable with sepsis? He showed us a little dvd of a patient with sepsis that had normal blood flow through the hand. Then he showed us a patient with advanced sepsis that had "chuncky" looking blood going through their arteries. I had no idea that sepsis made a patient hypercoaguable. Does anyone have a different opinion? Thanks, Dusty

Try this article from the Littmann website. Short vs Long Tubing Quite often health care workers raise questions regarding tubing length based on early publications claiming shorter tubing length provides better acoustic response. Some instructors have recommended their students buy the shortest tubing possible. In an attempt to clarify the information surrounding tubing length, Littmann stethoscopes has tested their product line to offer the following information about tubing length. To explain our test results, it will be helpful to compare the tubing of the stethoscope to a garden hose. For example, an increase in the length of a garden hose will decrease the pressure at the end of the hose as a result of frictional and other internal forces. The same effect occurs when the tubing length of a stethoscope is increased. However, in the case of stethoscope tubing, change in length is relatively small; this decrease in acoustic pressure is not detectable by the human ear. Additionally, as tubing length increases, resonant frequency decreases. Considering this fact, an increase in tubing length provides a better response to the lower frequency sounds (an advantage in auscultation). Many heart sounds fall below 150 Hz and are considered low frequency. Because it has been shown that the human ear is least sensitive to low frequency sounds, improved low frequency response is an advantage. Taking these two factors into account, there is no detectable difference in acoustical performance between Littmann stethoscopes with shorter tubing vs. those with longer tubing. In fact, there may be some enhancements to low frequency sounds. When purchasing a stethoscope, the health care practitioner needs to consider their own needs and practices. Longer tubing might be more appropriate for people wearing the stethoscope around their neck as it drapes better. The practitioner's height and arm length should also be a factor to determine optimal tubing length. Many practitioners would like a little more distance from sicker patients while auscultating. Longer tubing also reduces the amount needed to bend over the supine patient which can stress the practitioner's lower back.

Thanks for all the encouragement! I'm sure I will have plenty of questions once nursing orientation starts.

By the way guys/gals I passed the NCLEX. I start orientation on June 21st in Neuro/Trauma ICU. Thanks for all the encouragement. :balloons: