MargRN

Anyone seeing 5000+ d-dimer that's attributed to spike protein production & post covid infection and/or covid vax? No clots?

I’ve started my PACT RN position a few weeks ago. It’s a great team focussed clinic. I learned LPN processes first to learn some computer processes. I’m shadowing a PACT RN now. I haven’t done clinic nursing in a while but will get in a groove! I interviewed in September. Unofficial offer at very end of October. Lots of homework to complete on my part. Official offer in January. Started in February. In orientation we were told they’d like to make hiring process less tedious and long.

Still pleased???

Very intriguing! Any updates from new hires a few years ago? Any further descriptions to share? Favorite aspect of job? Least fave? Any recommendations for YOUR deciding factors to switch from private to federal? And completing the 9 dimensions of nursing?

https://www.va.gov/PBI/questions.asp This link was helpful for me. I’m not sure I felt prepared to answer the questions. For my interview I had three nurses questioning me and there were multiple questions in each question. I had notebook to write key words down as they read the questions. I tried to share a variety of examples to answer their questions. It was a different kind of interview. I’ve not had multiple interviews as I don’t move around much. I am not sure I’m switching positions from my hospital role in private sector. I’m intrigued by VA opportunity and benefits. Also have read here (older posts I searched) that hiring process is months long. If offered a position then you’ll complete a lengthy thorough Nine proficiencies examples to turn in and help HR (I assume) determine you’re level and step for pay. I’m a BSN RN since May 1995. will see how things go. Hope this helps some.

Yep. Dealing with humans can be a drag when they're rude or thankless. I just focus on the positive thankful people we help. Do you work at a clinic or from home, thetank RN?

Thank you, DM!!! I'm intrigued enough to look into it. Get some info and share my info.... get an idea of what it is by possibly shadowing. Not for sure. This position states it's to become a "work from home" position which is also very intriguing. I have an office space at home. Just very intrigued. Thanks again for insights!

Whoops!

Can you share more about your likes, dislikes, how your shift flows? 23 years experience as RN. I worked as cna in nursing school before becoming a nurse. I'm curious about a position posted for PT telenurse. TIA!!!

I am subbing this week for the health aide - first time in a "school nurse setting" for me. I have RN, BSN but no course work toward school nurse certification. I'm basically just helping out and getting a taste of what school nursing is about. I know the district RN who is the sole RN for the HS, JHS and 4 elementary schools... runs from school to school and is BUSY! SHe's retiring in another school year and thought I might like school nursing. SO we're helping each other while her health aide is at some training for a few days. I felt out of my element... but also have enjoyed it pretty much.

Where can I find this info or do you know this info? I could ask my nurse manager but I thought I'd try the internet as a resource first. THanks in advance!

I was going blank but I don't think I've heard of a PP since nursing school days. Hmmmmmm... I'll check into that some more. THANK YOU! :)

I have always seen accuchecks ordered ac and hs or BID with instructions before breakfast and just before supper. My MIL lives in another state, has history of mini-strokes (memory trouble), has artificial heart valves and just got a new diagnosis of "sugar diabetes" which her mother had as well. Her info is vague but she has said that she checks her sugar after breakfast and after supper. I asked her if that's what the doctor told her to do... specifically "after" part. The info I've read said before meals unless specified differently from your MD. I just don't understand the physiological implications of doing it after a meal versus before. She's not on insulin. I thought she was on an oral med for diabetes but she didn't know name and something caused constipation and upset stomach and she said the doctor stopped it. I'm concerned with what's going on but I don't "get" the after meals part for accuchecks. Can you help?

from my days on oncology. I'd just forgot about it. Kind of a "duh" moment. I'm actually off to work 8 hours tonight and better run along. Thanks for replying. :)

My bro-in-law's mom just passed away and he said that they (hospice) gave her MSO4 with a "couple drops under her tongue". I've never seen that. Are pain meds given IV routinely or via nebulizer or subQ? I'm not a hospice nurse. I used to work oncology. It was emotionally tough at times but the staff were all really close and supportive. I miss them but when we had babies, I resigned to be SAHM. That was 7 years ago. I'm presently working per diem at a small hospital and have been there for almost 3 years. I rarely start IVs. ANd I think I'm afraid my clinical skills - particularly starting IVs - is a fear I have in relation to being a hospice nurse. But I also have confidence that this skill can "come back" with the opportunity to actually do it. Anyway... what exactly does a hospice nurse do? My family often tells me that they think I'd be a good hospice nurse.

I always thought that 110lbs or less meant a person was unable to donate. ANd I am referring to a healthy person. What about a gal who is nearly 6 feet tall and weighs 127? Does the height/weight ratio play into this? I'm curious personally not necessarily professionally. And the Red Cross site just stated the 110lbs info. TIA! :)

My understanding is that they're benign and it's a premature beat next to the QRS complex. I will never understand telemetry and rhythms. In 95 when I was in my senior year of nursing school, I took the Critical Care course and we studied the strips but it was so confusing to me. The instructors told me that I'd learn more by actually doing it in my job. Well then I worked Oncology and our tele patients were monitored by the tele nurses on another unit. They called our charge nurse who then told me what needed to happen. I just never learned a lot about strips. Then we had three kids and I've been home with them and recently went back to work per diem as a registry RN where we have more minor illness/etc to care for. Any suggestions? I've pondered going to work for a larger hospital which offers a great orientation and actual CLASSES (Classes Offered: Cardiovascular system, Respiratory, Neurological/Surgical, Renal, and Hemodynamics). But I presently only work 1-2 times every week or so. And it may only be for a 4.5 hour shift to help out. THis is good b/c we have little girls that I want to stay home with as much as possible. I'm rambling. Any help with the bigeminy though?

they state that I may not accept an assignment there within the following twelve months after my contract ends without going THROUGH THEM. Is that a normal thing for travel nurse companies to do? I know you're asking about travel nurse companies and I don't know about them but I do know that agency nurses are not allowed to take an assignment at a facility where they worked as an "agency RN" for 6 months (I think!) after leaving a particular agency. I think the idea is for the agency to hold onto the nurse a little more in order that the nurses don't just up and leave for a regular job at a place where they were assigned as "agency" and really loved. KWIM? HTH!

Ack! I don't think I mentioned that his HR at the hospital has ran upper 60s to mid 80s since he's been there. Hence his actual HR was 84 not 42 when I was listening.

I am an RN and my assessment skills need improvement. (I know there's always room for improvement but I feel like I should have understood this.) I work registry on a small med/surg unit. Anyway... when visitimg my retired parents yesterday, Dad asked if I had my BP cuff to listen to his pressure. At first I got 104/62 on his left which is LOW for him. He also said that just didn't seem right. So I said that we'd wait a few minutes and I'd listen on his right arm. I got 152/70 on his right. What is up with that? I can't fathom that I would not "hear" it correctly. He said that this is more in line with what his battery-operated cuff has shown. Also, when listening to his BP, his heart rate seemed really slow. So I auscultated his apical rate at 42. This was freaking me out. He said that he is so easily fatigued. I thought it might have to do with Toprol XL 200mg QD that he's been taking since Feb of this year. He has been having generalized fatigue since then. (And I know not to give Toprol if the patient's HR is below 60 so this concerned me even though his "bradycardia" seemed unsymptomatic other than generalized fatigue.) OK so here's what his heart sounded like to me. A loud tone followed by three soft tones. I only counted the first loud tone. I asked Dad to get checked at the ER if his heart rate was actually 42. That's just too low. And let Mom drive until he was checked. The ER doc told Dad that I was not counting correctly. I don't mind being told I did something wrong but I don't understand it. Had I been working at the hospital and heard this heart rhythm, I would have had another nurse listen. I probably would have had telemetry to watch. But at Mom/Dad's house I had my ears and just don't feel like my assessment skills are good or perhaps rely too much on the other info like labs, tele, etc. which I obviously didn't have at my folk's house. KWIM? Have you ever had such differences in the sides in terms of palpating the pulse? Have you ever heard the "loud-soft-soft-soft-pause" heart tones? I told my DH that I'm supposed to be an RN and he of course reminds me that I am an RN but this "mistake" and not "getting it" really unsettle me. Advice? TIA. P.S. They kept Dad last night and had him on tele for the night. He said all EKGs were normal and he has bloodwork at 1430 today and if all is well he can be DCd. I'm assuming the bloodwork is cardiac enzymes. He said his MD mentioned an arrythmia but said that the Toprol should take care of it. I don't know what arrythmia. I live 90 minutes away and debated whether to go and listen to DC instructions and DH stay with our little ones but decided that I would stay home. Dad said not to feel badly about mis-counting but I know that I scared him yesterday but I was scared if his HR was only 42. Sorry so long-winded!

to certain medical conditions? When I was in nsg school, (graduated in 95) I used to visit the hospital library which was resourceful. I called them and found out that I can still use their facility even though I no longer work there or attend school there. But is there an online "index" of sorts to research various articles? I'm specifically interested in PE secondary to DVT. And this is for both my nursing skills/knowledge and for my family. TIA! :)

I only work registry but I am going to talk to the manager about making a special policy for IV Vit K administration. THe patient did fine - this time. She was not on telemetry as it had been DC'd earlier in my shift. This has been a learning experience for me but it concerns me too. Thanks again!

I read that it has been fatal with IV administration. That's why I was asking the other nurses and reading reading reading. The MD had ordered it on this same pt earlier in the week. (Yes, it was due to her INR) I diluted it with 11cc NS and pushed 1cc ever 2-3 minutes. It was OK. But when the nurse coming on said, "I refused to give IV Vit K"... that freaked me out. THanks for replies and the cardiac info is interesting but I hardly ever have those meds b/c those patients go to a larger facility.

I have reviewed my nursing books. I understand the heparin protocol and then Lovenox and maintenance with Coumadin. I encourage folks to get up and walk around versus sitting in front of TV all day long or stop and get out of their car if they're driving more than an hour. (to promote circulation) I have had several patients/families ask me how long does it take for the clot to dissolve. We have recently had several patients with positive D dimers. (which the lab tech tells me is read by them and majority are positive "which doesn't mean anything") So I'm confused about D Dimers. We have many COPD exac patients. I know that our doc has really ordering numerous "PE Protocols" and patients have CT of chest with and without contrast. (So I make sure they have an 18 gauge loc) Some have the VQ scan too. My understanding is that the VQ scan is done when their BUN is too high for their kidneys to tolerate the CT dye in order to rule out a PE. I am really not finding reading material to help me with my research. When I was in nursing school (thru a hospital program that used to offer diploma RN and by the time I went there, it was a BSN program) - anyway... the hospital had a wonderful medical library with journals and it was easy to find journal articles to help explain various situations. But this is in another city and I haven't ventured there to see if an "alumna" can use the library. I no longer work at their hospital since we moved away. I just feel like I need more info so I can better care for my people. I work in a very small hospital. (We average 5-10 patients with an RN, LPN and CNA on day shift and an RN and LPN for the night shift) Input? Thanks!

I would never give something contraindicated such as that. Just the Vit K IV is not something I'm used to doing.