Wildschmidt

Thank you all for the input! I definitely would believe that the neuro symptoms were secondary to the heart arrhythmia. The reason we thought stroke initially was because his wife was a nurse and that's what she called it in as. She described it as a sudden onset, collapse, drooling, etc, and of course we tend to trust nurses... That said, the neuro stuff improved so quickly (30-45 min) it must have been secondary to something else or a massive TIA. It seems he's lucky to be alive - AMI going on for multiple days leading to a non-perfusing rhythm which resolved itself within a minute. He was far enough out in the middle of nowhere that we couldn't have converted him if it didn't happen on its own.

Thanks for the info! Do you mean the "seizure" activity that the family noticed was just an electrolyte issue in the muscles, or that the electrolytes can cause actual seizure EEGs? It makes me wonder if the "stroke" the family witnessed was actually a non-perfusing rhythm... He was in the middle of nowhere, so it was 30 min before first responders got vitals on him and 45 before we got there and looked at a 3-lead.

So during school I've been working as an EMT, and I'm super confused about a patient I just saw. Here's the scoop: * family witnessed a sudden "fit" - briefly unresponsive, snoring, drooling, incontinent followed by "jerking motions" with arms for a couple seconds * on arrival he's A+O to everything but events, neuro all checks out (grip strength, pupils, droop, speech) * pt's c/c is "tight" chest, substernal and left with SOB, low exercise tolerance and nausea - This has been going on for 3 days. * pt is also dehydrated ("about 1 cup over a couple days" and slow IV flash) * O2 15 L is maintaining sats at 100% (they dropped below 95 within a minute so we put him back on...) * BGL 125, all other vitals normal/stable, lungs clear and equal * ECG (we only have lead II) shows large Q's (1/3 of R), every T is inverted, and a few PJCs and PVCs * med control advised O2, IV fluid (no change with 800 mL), nitro (no improvement) and no aspirin Help! I'm running calls to learn but now I'm just super confused. It seems to me, he's been having an AMI for a few days (or possible PE since he was traveling) but then presented with a stroke and maybe a small seizure thrown in. We took him to a specialty center where we can't really follow up specifically. SO...any insight? I'm humbled by this patient and appreciate any clues/tips! Thanks!

Check out Edukan.org. They have microbio which is 5 credits including a lab for 625. However, some sections have only a "virtual lab" and some sections require you to find a physical lab with instructor that you can use for exercises. I would be super cautious doing micro without any sort of actual lab experience and it may not be accepted by your program. That said it is cheap and convenient...

There's a good summary of the bill on the AANP website: http://www.aanp.org/NR/rdonlyres/D0BC1356-E320-420E-B9C2-D98E266DF280/3898/finalhcrsummary.pdf It's still long and complicated, but only 13 pages instead of 2000! As an FNP student, I'm hopeful about this bill, since it does seem like much of the money is targeted to primary care and underserved places. Some highlights that I picked out: More loan repayment program, via states, national and service corps Medicaid rates get bumped up to Medicare rates for primary care Increase in Medicare federal funding for primary care Health plans have to spend at least 85% of their $ on health care costs There's other provisions that we'll have to wait and see how they play out, such as the comparative effectiveness research that might control costs. They're also starting a pilot program reimbursing for Medicare "episodes" of service rather than each procedure. And yes, there's definitely some benefits for insurance corps and pharmaceuticals (like extended time before generic meds can be introduced.) Overall, I think the biggest difference will be that many more patients will have coverage, and the coverage will be more similar across the board. This should eliminate some of the confusion and incentives that exist now. (Like patients without coverage going for a "free" ER visit that they'll never pay for instead of preventive services.) This is all focused towards primary care so I don't know what the impact will be for the ACNPs out there. It's not perfect, and it will definitely change incentives, but it seems better than the s$#%show we have now!

At our rural hospital, there are usually 1 or 2 nurses in the ER, a couple more on the floor, and a physician on call but not always present. No "teams" to do any skills - they have to get every IV stick, know every drug, every procedure, and be able to stabilize any patient by themselves! It's a tall order and I know they have a hard time finding nurses who have that level of experience. I'm still just a student but it's intimidating to watch the level that is required. Oh yeah, and they pay less than any urban hospital and the hours are less flexible. Then policy makers wonder why we have a shortage of nurses in rural areas!!

Chender, thanks for the info about Yale! It's a good point that the BSN from Penn might be useful, since I can imagine wanting to take time as an RN, either during or after the program. The Yale staff have been super nice and helpful, but I think it will come down to flexibility and $ for me. Lunchbox and eazye - I am not looking at UVM, but I have lived in the Burlington area before. So if you have questions just about the city and lifestyle I can answer those. It's definitely more rural and much less diverse than New Haven. You'd more be treating folks who are underserved due to location rather than $ and other factors.

I'm also choosing between Yale and Penn for FNP. I think it's going to be Penn as long as they accept my transfer credit. I really liked the campus and area and it sounds like they're usually better with financial aid. They also seem a bit more flexible with taking time off, going part time, or changing specialties, which is good cause I'm scared of commitment! I've been to New Haven before but I haven't specifically visited the school. What are your thoughts?

Still nothing, and she didn't return email or phone calls today. I'm going to trust I will get it on Monday, but I'm starting to get anxious and frustrated. I need to figure out my job and lease and moving to Philly if I'm going to do the program. And the fact that they told us definitively we would hear today makes me question their organization. Still hoping it all works out...

Me too! FNP! The waiting is over!

It depends how much time you want to spend in schooling, but I would recommend some sort of accelerated program, given that you already have a bachelor's degree. If you go back for an ADN or BSN, not only will you have to take all the nursing and science classes, but you have to retake things like writing and history. Most accelerated programs require some prerequisites, and you can do just your RN or go straight into the MSN. There are also programs where you stay in the same program but they require or encourage you to take some time and work as an RN in between. With these programs your timeline would look like: take prerequ's (usually A+P, biology, chemistry, nutrition, etc.) for 1-2 years, enter program, get RN (1-2 years), work as an RN (can skip or take years if you want, depending on program), finish MSN and become FNP (1-2 years). You can also combine taking your prerequisites with working as a CNA or tech, getting some patient care experience. This helps a lot with admissions and making sure this is what you want to be doing! Obviously, you can spend as much time in school as you want, but this way more of your time will be learning new things and it is more directed towards the FNP which is what you want.

I still haven't heard anything! I'm going to wait a little longer and then try to contact her directly. I don't want to be pushy but it seems like a long time to wait after already being "accepted" into the program.

Is anyone else still waiting to get their plan of study? I'm really excited to go to penn but I need to know if I can do the summer start. And I'm getting more anxious since I need to give notice to my employers here, figure out leases, and move across the country?! I thought we were supposed to hear by today at the latest. I'm tempted to email her and ask, but I know that's probably just more work for her right now. Anyone else in the same boat?

Just got an email saying decisions will be emailed out today!! Try to focus on your Friday work now!! Good luck to everyone...

Whew! I have my pennplan posted with financial aid info and I'm very excited. They have an even smaller contribution than I was expecting - although they also want me to do work study. That sounds like a lot for the first year so perhaps I'll take out a little more in loans or something. Thanks for the link to that admitted students chat from last year. I'm hoping to go to the one tomorrow night as well, although I might still be at work. In terms of the admitted students day - I won't be able to go since I live in Utah (and 4 hours from a big airport!) I was already very impressed by the school this fall and I'll probably just arrive in the city earlier in June or visit sometime this spring to get more settled. Still waiting to hear about prerequs transferring but I've got a good feeling so far... Good luck to everyone else including the waitlist folks! I remember her saying that they admit about 70-80 students and about 60 start each fall, so there seems like a good chance they'll pull some from the waitlist.