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valx92

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  1. valx92

    Doctors Say the Darnedest Things

    The infectious disease doctor was rounding on a 87 year old patient who had been started by one of the fellows on antibiotics for possible gonorrhea. The ID doc writes in his progress note: "at this time I will discontinue antibiotics as it is unlikely the patient has gonorrhea. If indeed it does turn out to be gonorrhea, I will still continue to hold antibiotics, and instead prescribe a round of applause."
  2. valx92

    Volunteering?

    Hello! I am currently a bedside nurse who is interested in getting into the legal side of nursing; however, I don't want to envelope myself into a part of nursing that I wouldn't enjoy or thrive in. I feel like ultimately I want to get into the politics of healthcare reform, so I am considering going back to school for my law degree. So, my question is, what kind of positions could I volunteer for in order to be certain that this is the type of work I would like to do? Any advice would be greatly appreciated.
  3. valx92

    What is a good quality stethoscope?!

    I have the littman master cardiology. worth every penny
  4. valx92

    reading EKGs- an advanced privilege?

    i guess technically the orthopedic doc would be allowed, but i hope he wouldn't do it without consulting cardiology.
  5. valx92

    To Be (Monitored) or Not To Be (Monitored)

    At my hospital there's an order whether the patient needs to be transported on tele or not. There's a protocol in place they must be transported on tele if they're on a drip like amio, lido, cardizem, primacor, etc. Usually those are the only patients that we transport on tele, but sometimes they are considered very high risk for some other reason and the doc will place the order. If there's no order to be transported on tele, but I feel it necessary, I do it anyway. Someone with a nstemi going to the cath lab wouldn't be considered high risk and wouldn't need to be transported on tele. However, if they are being transported on tele then they are accompanied by someone who is both ECG and ACLS certified. This is 99.99999% of the time a nurse; however, we have one PCT who has both certs. As for patients being monitored.. when a code is called at my hospital our code team is 1-2 micu nurses, 2 doctors, an anesthesiologist, a pharmacist, a respiratory therapist, the nursing supervisor, and the nurse responsible for that patient. any other nurses from that floor will start off the code until the code team arrives, then they go back to watching the floor. We also get one nurse from another floor who's responsibility is not to be a part of the code, but just to watch the floor and the monitors. It has happened before that i have been the staff nurse responding to a code on another floor and as i was watching the monitor another patient went into a stable vt and required immediate attention as well but that's why i was there. Everyone is there for a reason and needs to be monitored, can't ignore the rest of the patient when a code goes on.
  6. valx92

    reading EKGs- an advanced privilege?

    I'm an RN at a small hospital on a tele unit. As an RN the doctors trust me to read an EKG and alert them for anything alarming but I couldn't sign it off. We have a few PAs and NPs and their scope of practice is very narrow. They can't sign off on EKGs either, it has to be either a fellow or an attending.
  7. valx92

    new grad need some advice

    I recommend Basic and Bedside Electrocardiography by Romulo Baltazar. One of the docs gave this to me when I said I was interested in getting better at reading 12 leads. I read mine all the time it makes 12 leads interesting and understandable. I've gotten pretty good and I've even been able to teach a thing or two to the nurses who have been at my hospital for much longer than I have because of things I learned in this book. But depends on how interested you are to find how much you'll read and how easily you'll pick it up I think!!
  8. valx92

    Telemetry Nursing Questions

    1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning? Some hospitals have policies for this, but at my hospital it's more of a use your judgment kind of thing. Generally we already know that the patient is having these runs of VT and that's why they're in the hospital anyway. So if the patient's asymptomatic, it can probably wait til morning. I might ask to have their morning labs drawn early if I'm really concerned and then go from there based on what the labs show. Or if the patient is having consistent runs of VT and there's no known history of it, I'll probably go get a pressure to see if it's worth waking up the doc over. Either way I'd say check on your patient and give the doc a call in the morning just to let him know what was going on. 2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure? Pretty sure there are different policies at different hospitals for this too. Our patients have to put on a clean gown before they leave the room, and anything they touch gets wiped down really well. If it's airborne they have to wear a mask when they leave the room too. That's about it. 3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon? Depends on what kind of surgery/procedure it is and what's going on. Did they have a cath and now they're bleeding from the groin but otherwise stable? I'd apply pressure and call the doc. Did they have a cath start bleeding from the groin and now SOB low spo2 with a pressure of 60/30? Call the RRT. Same thing with a surgical patient. Just depends on how stable they are really. If it can wait for you to call the surgeon, call the surgeon. If the patient's critical, call the RRT. 4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa? At my hospital they have to sign a release stating who can get information, so if they came in from a nursing home, we ask if it's OK. But in such a case, they're usually going to return to the nursing home anyway, so for continuum of care purposes, it's pretty important for the people at the nursing home to understand what's going on so we encourage the facility to be added to the list. I've never had anyone say their nursing home can't get information. 5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything? At my hospital our parameters say hold the metered dose and give the sliding scale coverage for NPO. If I know this patient pretty well and I was concerned about the patient's sugar dropping too low with the ordered sliding scale dose, I'd probably hold both and let the doc know what I was doing. We aren't supposed to hold basal insulin for NPO either, but sometimes, again, if I know the patient tends to drop when they're NPO I'd discuss it with the doc and maybe decrease the Lantus dose. I'd never hold/decrease an insulin dose without discussing it with the doc first though. 6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started. Yes.
  9. valx92

    Acute Care NP??

    Hi all, looking for a little advice. I graduated with my BSN in May 2014 and I have been at my first job on a cardiac step-down unit since November 2014. I want to further my education, and my end-goal is to work as an NP in a hospital with a focus in eps/cardiology. Since I've only been out of school for just over a year now, some of the adult-gerontological acute care nurse practitioner programs seem like a bit of a stretch for me to get into. I'm going to apply wherever I can, but I'm worried I won't get in without two years of experience, a CCRN, or having worked in an ICU. I submitted an application for transition into my hospital's MICU, but the rest I can't really do much about for another year. I don't really want to wait to apply until next year, because I'm just worried that the longer I wait, that life will take over and it will get harder to return to school. Would I be better off applying to a school for adult-gerontological primary care nurse practitioner and making the transition with a post-master's certificate later? Am I better off waiting another year to apply? Also, why does it seem like at some schools the acute care NP programs are an MSN, and at other schools they're DNP degrees. Am I missing something? Any help or advance would be appreciated. Thanks in advance :)
  10. valx92

    DESPERATE for help & advice!

    I found that I obtained strategy tools better by doing Hurst review than by doing Kaplan, but I found Kaplan's questions closer to the NCLEX questions. If you get the Hurst online course you get access to all different videos that are broken down by topic. I'd watch a video from Hurst then I'd go over to my online Kaplan review and do the focused review questions on that topic. I did that for all of the topic videos then after I was done reviewing all of those, I started Kaplan's question trainers and touched up on things I thought I needed help with after each. I did a bunch of Kaplan's q bank questions throughout as well and I passed the NCLEX on the first try! I found it helpful to have two different strategy tools rather than just sticking to one because they both had different advantages!! Also sounds like you had a lot going on right around the time you took each test! Make sure you're giving yourself plenty of time to study before you take it! Good luck!
  11. valx92

    Elsevier CAT exam

    I took the CAT exam! It moves up and down the way the actual NCLEX does like how if you get one right it will give you a harder one and if you get that one wrong it will give you an easier one. By way of questions I'd say study just like you did for the HESI. I found the CAT had a lot of maternity questions but that might just be my experience. It doesn't actually pick out your weak points like some people say it does. It can go for a minimum of 75 questions like the actual NCLEX but I only know one person who shut off that early. I shut off at 82. Most people I know shut off by 95! Having just taken the NCLEX, I don't think it's a very good simulator of it but it is very similar to the Hesi Exit so if you did well on that you should well on the CAT exam too! Just make sure you keep reviewing!
  12. valx92

    What does a day in the NICU look like?

    theres a stickie on this already if you click here: https://allnurses.com/nicu-nursing-forum/day-life-nicu-309385.html
  13. valx92

    How to become a neonatal np?

    I understand why it would be worrying that I wrote that I want to be an NNP! ...what do they do? But that isn't exactly how I meant it. I knew a general of what an NNP does, but I was looking for more of a day in the life of kind thing. I did find a thread on that, and I am sure that I want to be in the NICU, but now I'm not so sure about taking the NP route. It might be enough for me to be an RN. I do understand your concern that it might be better for me to be a physicians assisstant, and I do know one (not one in the NICU, but still a PA) so I might talk to her about whether she thinks it's the right choice for me, because she knows me better than any of you. I'm not trying to say that any of you are wrong, I'm just saying she'll know better what's right for me. I am glad for all the of the different points of view and this conversation is really interesting; so if you have more to say on the subject, by all means go ahead.:)
  14. valx92

    How to become a neonatal np?

    Thankyou! But, why would you choose to get a degree then go to nursing school when you could just flat out get a nursing degree? Just getting your nursing degree would be faster right? Does doing it the longer route do anything better for you, or is it the same either way?
  15. valx92

    How to become a neonatal np?

    Hi! So i'm a high school junior and it's time for me to start looking at colleges and know what I want to do. Ultimately, I want to be a neonatal nurse practitioner. So I've been trying to research it and I'm really confused. I was wondering if anyone could tell me what exactly you have to do to become a neonatal np and then what exactly you do as a neonatal np? Thanks.
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