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ICU, LTACH, Internal Medicine
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KatieMI has 7 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

I have been through the Hell and came back out singing.

KatieMI's Latest Activity

  1. In my time, I loaded them on a cart, brought in the corridor near hospital library and quietly left there with a sticky note "free books for everyone, BSN/MSN from X university just done". Did not bother to tell anyone. No idea what anyone was thinking when both carts were found but saw some people reading them during quiet times in a week or two 🙂
  2. KatieMI

    You Don’t Know How to Argue

    Here we go about circumferential argument. If schools will open for in-person studies, then incidence of COVID19 WILL go up and there WILL be additional deaths. There can be more or less of them depending on where schools are open and what is done or not to decrease personal contacts and transmission but some of them will happen because of additional exposure. There are no reasonable measures allowing kids back to classrooms while 100% preventing risk of transmission. If schools will stay closed for personal studies, at least these potential cases and deaths will be prevented. Therefore, regarding schools opening, there is a dichotomy. It is very real, not false. And this is why the question about schools opening is so incredibly painful and difficult to solve. "Multiple ways to manage" will PROBABLY alleviate the risk, to uncertain degree, but even this is not guaranteed and will not prevent all possible transmissions, symptomatic cases and deaths. That's it, pure and simple. It is just darn math. We can manipulate numbers but only to a certain degree.
  3. KatieMI

    You Don’t Know How to Argue

    What I always wanted to know is who, exactly, determines what fallacy and when, if it even exists in a given discussion, is taking a place. In the current situation, the facts as far as we know them, stay pretty simple. X % of population in any given place in the USA is currently infected with coronavirus and able to actively spread it. Any gathering of any number of people increases risk of transmission. Getting people together in closed space not specifically equipped for limiting transmission automatically makes it easier to transmit the virus and to infect more people who will transfer it to others. Opening of any such closed spaces, being them schools or theaters or anything else for in-person mass use WILL cause increase of cases and deaths, the only question is how much of them. Of course, the risk will likely be less in rural North Dacota as compared with Brooklyn, NY, but it still be there. This is just darn math, nothing else. There is no way around it. There are no "other options", only multiple ways to manage the risk. And therefore the above is not a fallacy. Likewise, circular argument (or rather what appears to be one) has at times to be used in discussion when the opponent has lower educational level and cannot connect the dots after the round #1. You pretty much have to tell the same circular story again and again with more and more details till the opponent finally gets it. It is tedious and pedantic but at times there is no other way. I also very much would like to know where all those knowledge and skills supposedly obtained by painstaking review of Aristotle go when "this patient is satisfying the criteria" and "this is according to policy" are used as the sole reasoning to do utterly stupid things instead of applying basic critical thinking.
  4. KatieMI

    New grad FNP - Health Risk Assessments?

    One job which is quite similar but better in so many senses is doing "face-to-face" for hospices. It is also about visiting homes whuch can be, er... different, but at least you perform real physical and use VERY real clinical knowledge. And most people realize how much you are needed and behave accordingly. You'll need DEA # as you are going to prescribe a heck of controls but you are paid per visit and get real experience. Plus that feeling of helping people at some of the most difficult momenrs of their lives.
  5. One thing for you to remember iron-hard: - there is no such thing as "good" and "bad" physiologic process. Blood pressure, coagulation, cholesterol, etc., CANNOT be "good" or "bad", just like rain or the Sun. They are here, and we are managing them when and if needed. If you find yourself not knowing and understanding questions like this, it means your level of knowledge is critically deficient. I hope that what I wrote above helps in some way, but it won't substitute for your patho and pharma books and lectures, which you must dust off and re-read till you understand every single word. I purposefully did not go into INR question. Knowing and understanding all the above, it won't be too difficult for you to figure out what INR is and how it changes. To show your work: if patient experiences liver failure, where INR will go, and why? Counting for your other posts as well, I wonder what kind of school "never taught you" about this basic info stuffed tightly into NCLEX. Accounting for how frequently a nurse should use knowledge about coagulation and how many patients are taking meds affecting coagulation, it looks like you might want your money back.
  6. Continuing: Without much ado about biochemistry (most interesting part for me, but it is another giant talk): Both clotting pathways work similarly. Each is a row of chemical reactions when one component (they are all proteins which present in plasma in non-activated condition and they all got names which always start from F, for "factor", and continue as a number in Roman numericals, like FII, FX, FXII) activates the next one, which activates the next one, and so forth till FX, or "Stewart-Power factor", becomes active. FX is the central key component which ties extrinsic and intrinsic pathways into one and, with help of other "F"s, makes a plasma chemical named "protrombin", his other name "FII", into its active form "thrombin". Trombin activates another plasma chemical named "fibrinogen" into its active form "fibrin". Fibrin looks like thin and very sticky threads. These fibrin threads stick to exposed tissue, vessel wall and blood cells and form thrombus which cloths the vessel. Now, several "F" proteins are made in liver. Several of these liver-made proteins, namely FII(protrombin), FIX (which only works in intrinsic part) and that all- important FX guy need vitamin K to be made. Coumadin blocks action of vitamin K, therefore if patient takes coumadin, factors FII, FIX and FX are not made and blood won't make cloths. Just in case so that all this big system won't start running at a random place and time, organism has at least one chemical blocking each step and every chemical in coagulation cascade. These chemicals do not work like an avalanche and instead stop every cascade step as they go. At norm, coagulation and anticoagulation systems balance each other. If you cut your finger, local activation of coagulation cascade happens and only the wounded vessels are quickly clotted. If some platelets stick to the aterosclerotic plaque in your aorta (all humans have them after early childhood, so do not worry), local anticoagulation kicks in and cloth won't form. But, there are conditions which move balance toward coagulation. These are: - slow, static blood flow (for whatever reason- immobility, dehydration, low blood pressure) - inflammation (caused by whatever) - pregnancy - trauma - too much platelets - various debris swimming in blood (think about metastatic cells, bacteria or microscopic pieces of broken bone) - and quite a few others. Some people genetically have proteins in their plasma which activate coagulation (if you ever hear about "factor Leiden", that's one of the most common of them, but there are over a hundred of them known for now) In these cases, coagulation becomes our enemy, because blood starts to get clotted rather randomly and in dangerous places. Since leg veins are wide and "soft", blood flow is normally slower there and cloths happen more frequently. They flow into vena cava, then in right heart, then into pulmonary artery and make PE, which is not good. If a cloth starts to form into arteries which supply heart muscle, there will be myocardial infarction. If it happens in brain artery, there will be an ischemic stroke. In these cases, we can administer drugs named "anticoagulants" (btw, please try not to name them "blood thinners" - they do not "thin" anything, they prevent clotting). Each of them works differently with different "F" factor(s) or with platelets which initiate extrinsic pathway, blocking their work in various ways. They can be "natural" (human blood contains chemicals very much like heparin but there is no way to boost their production in human body so far, so that medical heparin is made from internal organs of domestic cattle) or totally artificial like coumadin.
  7. OK. Get me coffee (black, lots of sugar) and one for yourself, too, make yourself comfortable. There will be a long talk (and likely several posts). To do its job - to deliver oxygen, antibodies, cells, nutrition and all that, and to flow out various chemical trash, blood must stay within the vessels. Therefore, if a vessel gets a hole, it must be quickly patched so that blood won't leak. Also, if there is something sticking into or out of the vessel wall, this thing must be covered in some way so that it doesn't dusrupt blood flow. The two things above are, from the body's point of view, very important. To get them done, the body has several overlapping systems. The name for ALL these systems are COAGULATION CASCADE. Why cascade? Because it works like an avalanche in the mountains. Once one part goes on, it activates the following step and each following step goes the same till, from the point of the view of the body, problem is solved and problem blood vessel is CLOTTED off. And, in case of blood vessels injury, in is "good" thing. Otherwise, blood would just flow out and you'll die from blood loss after scratching your finger. You just saw above that, basically, there can be two causes why a blood vessel might need to be clotted: either it is injured and blood leaks out, or there is some injury on the vessel wall, like piece of fat (yep, those "cholesterol plaques" in vessels are just areas of yellow hard fat which stick out into the vessel). Therefore, there can be two ways to activate clotting cascade. They are named "intrinsic" which starts from damaged vessel wall, and "extrinsic" which starts from another tissue damage but NOT damaged wall.
  8. KatieMI

    RN's required to be sitters???

    I bet that if in every single case you offer to trade sitter shift for the worst assignment in the unit, there will be a small line of nurses eager to switch. Boredom vs. PTO, it is anyone's choice. I could afford it and I always picked PTO. But I knew many others who would do night 1:1 sitter at any time and quietly use the time for schoolwork.
  9. KatieMI

    Too strong of a personality?

    It is a question to those who are so unhappy about said "strong personality". I tried to figure it out several times. Usually all "concerns" come toward things ranked from enviable to petty to plain stupid. Someone knows too much, does too much, wants to know too much, asks too much, has a car too expensive, wears scrubs too poshy, closes door the wrong way, eats wrong food for lunch, breathes 0.00075777553 times/min more than we all always do here. And speaks too openly about things everybody else used to turn heads the other way.
  10. KatieMI

    Is it worth it to be an NP?

    Considering what you wrote in your post, you should find some other thing to do. Unless you want to become a VERY unhappy Nurse Practitioner, it isn't gonna worth it.
  11. KatieMI

    Inappropriate documentation?

    Diagnosis of hospital admission was not factual. The OP documented the "diagnosis of discharge from SNF". Patient could be admitted for something which might be sounding completely unrelated like UTI or metabolic encephalopthy or severe anemia, not mentioning that he might be not admitted at all after being evaluated in ER. Being one of quality benchmarks, the difference between "admission to ER" diagnosis and "hospital admission" diagnoses carries some implications for Medicare/Medicaid payments as well as abundant potential for lawsuits, both against the facility and providers. As an RN cannot diagnose patient, it would be appropriate to write "called report with Mary Doe, ER RN, patient is going to be admitted to ER hospital (name) for evaluation after fall". And, yeah, the DON in question seems to be a little too private and a little too free with her powers, to say the least.
  12. KatieMI

    NP forced to work as an RN

    Yes, it is completely legal. You are still an RN, you keep your RN license and title, therefore you can work as such as long as they pay you same money you were hired for. If you do not want to do this, just say so. Ypu gave right to refuse. You can lose your job as a result. This is why especially novice NPs need to carefully read their contracts and, among other things, request description of "all duties that could be assigned" and specify which "assigned duties" they do not want to do. No explanations are required. Otherwise, they might find themselves doing everything from rooming patients to calling pharmacies and mopping floors under premice that "you're a nurse, aren't you". Even worse, an NP working as an RN has to do so under RN scope of practice while carrying base of knowledge and skills of an APP. During near and at- sentinel events, this combo can produce fishy-smelling legal situations.
  13. KatieMI

    Nurse Practitioner -FNP

    Many physicians and practices do not care for a second about NP credentials. FNPs are trained in school to manage "baseline" pediatrics, they can be trained further, Peds NPs are relatively rare and mostly pursuing jobs in hospitals or specialties. FNPs fill the gap in primary care offices.
  14. KatieMI

    Nurse Practitioner -FNP

    Neonatal - no, at all. Peds - with some luck, yes but only outpatient.
  15. KatieMI

    Please advice me

    Well, under this circumstances you need to pass NCLEX first before thinking any further. If you feel you need a refresher course, take it. Another option is to try to find ADN to BSN bridge program and attempt to convince them to admit you there by re-evaluating your coursework. It will greatly help you to pass NCLEX and make base for U.S. nursing education.
  16. KatieMI

    Please advice me

    So, did you pass NCLEX already, or just got your education equivalence for BSN?

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