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valx92

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valx92's Latest Activity

  1. valx92

    Thomas Jefferson 2020

    I know for other schools they look at the GRE, but I went to an info session for Jefferson over the summer and I asked about it and they said they don’t look at it. So it might help you elsewhere, but if you’re thinking of this school in particular I wouldn’t bother !!
  2. valx92

    DKA/HHNK

    This is why I was wondering if a protocol worked in other institutions, because of those kinds of nuances. I'll just be doing some reeducating. Thanks
  3. valx92

    Thomas Jefferson 2020

    I applied in early November, I received an interview Dec 9th but I was out of the country so I deferred it to the next interview date which is this Monday, hope that doesn't hurt me. When I scheduled my interview there were more dates in January so maybe they're still looking to send out interviews for those dates. They're still accepting applications until February so I cant imagine they're done interviewing yet !!
  4. valx92

    DKA/HHNK

    Hello all, I work in a medical ICU in a primarily cardiac hospital. It is rare we see patients in HHNK but it does happen. Most recently, a patient was admitted at 4 am and not initiated on fluids until day shift arrived at 7 am. Of course there is a knowledge gap that will be addressed, but I am just wondering if other hospitals have a DKA or HHNK protocol or policy place, and if it is something we should be looking to initiate in our ICU so this does not happen again. Thanks
  5. valx92

    Lowest bicarb on abg

    “Undetectable.” Guy’s ph was 6.5 and blood sugar was 11. He somehow managed to survive another 12 hours. Only 23 years old
  6. valx92

    University of Maryland CRNA 2020

    Did anyone upload “additional documents”? Not really sure what kind of thing schools are looking for there
  7. valx92

    Childcare & STEMI Call Question...

    My boyfriend is a cardiologist who frequently takes call in the ICU. He just doesn’t schedule himself for call on days he has his daughter. If they try to schedule him, he just says no. His mom and I both help out a lot as well. I think once you have kids, you’ll find a way to make your job work around your family.
  8. valx92

    Flash Pulmonary Edema after Blood Transfusion

    We usually give blood while the patient is on dialysis. That may have helped. Or a dose of lasix or bumex immediately following transfusion if she is still making urine. Hard to say based on this info.
  9. 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."
  10. 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.
  11. valx92

    What is a good quality stethoscope?!

    I have the littman master cardiology. worth every penny
  12. 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.
  13. 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.
  14. 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.
  15. 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!!
  16. 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.
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