TerriM67

I am in the same boat that you are. I am currently attending an Emergency Room FNP program. Once I complete the program this December I am staying on for an additional 9 semester hours to complete a post master's in ACNP. The program I am in has me taking extra classes in ER procedures and decision making with many of my clinicals based in the ER. Because I am staying at the same school I will not have to repeat any redundant classes for the ACNP. I will need to take critical care classes and critical care clinicals. Essentially it comes down to part-time school for the spring and summer semester. There are a couple of emergency nurse practitioner programs in the country that will allow you to complete the dual certification. Emory has an ENP program and will allow a post master's in ACNP. I think the University of South Alabama has an actual ENP/ACNP dual certification. There are others but I am not sure where they are. The ERs in the area that I live will not hire anything other than an FNP or pediatric / adult certified NP even if they are a primarily adult ER because of the EMTALA rules of seeing anyone or anything that walks in the door. The hospitalist groups prefer Adult NPs while the Intensivists are looking for ACNPS. Good luck to you. Terri

Addison's patients are dependent upon cortisol replacement for survival. Anytime a known stressor is added such as a medical procedure, their corticosteroid dosage should be doubled (minor stressor) or even tripled (major stressor). An IVP is not the most comfortable of procedures. Some patients report burning and/or discomfort from the dye. A patient with Addison's can not release their own cortisol in response to the stress of the medical procedure. Unless the patient has other contraindications such as an allergy to the dye or renal insufficiency, my understanding is that you have to make adjustments to their corticosteroid dose. Perhaps those more educated in endocrine/renal issues can provide a better answer.

Thanks so much for your help. I love the chart!

That was my thinking. The regular insulin peaks around 2 hours while the NPH is kicking in so I chose the answer of between 8-10 AM on my test. The correct answer was 4-6 pm and I am just not understanding why. The manufacturer's rep even stated that the mix peaks at about 2 1/2 hrs so I am feeling a bit lost.

I am a current Emory NHWSON senior. My acceptance letter came right around Christmas. I had submitted my packet Sep/Oct 2008. At that time Emory conducted an early decision review of packets submitted prior to Nov. I am not sure if they still do that or not considering the school has a new dean as of this year. The admissions office did tell me that if you are not considered for early decision you will be reveiwed again in Jan along with everyone else. I don't know if that answers your questions or not. Good luck to you!

Hi, I am a nursing student trying to gain insight into when the highest risk for a hypoglycemic episode occurs after administration of a 70/30 NPH/regular premix? I have been through as much literature as I can find and am still confused. Basically how many hours after an AM dose should I be expecting a hypoglycemic reaction to occur? Thanks so much.