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ICU, LTACH, Internal Medicine

Content by KatieMI

  1. KatieMI

    Funniest, Weirdest, Most Unusual Baby Names

    Just in... our best CNA, a bright girl admitted to the BSN program, called late. The day after her 18th birthday she came to courthouse to fill paperwork to change her first name. Currently Shytzilla, wants to be Mary Ann. When she at last made it, she told that a clerk asked her to fill "reason for name change". She wrote that everybody from her own mom to patients she's caring for, name her ******, for short, and she doesn't like it. Clerk pointed out that, by her opinion, it was not good enough for a reason. She suggested "misspelling problems" and poor girl had to re-do the whole thing.
  2. KatieMI

    Funniest, Weirdest, Most Unusual Baby Names

    A little bit regarding of what happens with bearers of unusual foreign names later on... In my former country, the female name "Milena" was not too rare and meant "the darling one". The problem is, in the process of immigration names can be misspelled and such mistakes are impossibly difficult to correct. So, one of my friends lived her first 5 or 6 American years as "Melena", and her job in surgical residency program didn't make it any easier. For the same reason bearers of Russian male name "Valeriy" are advised to change it, because it easily misspelled as "Valeri" (female). Worked with several ladies named "Latrina". One was hurt through her heart after, while traveling Europe, she suddenly found out what her name really means. Highly esteemed professor in my husband's area has Romanian female name which sounds as sexual obscenity in Russian. Eventually, she developed a professional call-name to avoid "accidents".
  3. KatieMI

    Measles, Mumps, Rubella... Forgotten but NOT Gone

    BTW, Branb5435, in the nursing school and up from there if you pronounce the word "evidence", you must present this evidence the very same moment, and be ready to analyze it. Just to let you know, because you may fail a whole course for presenting your own opinion as "continuous research of sources known for myself only".
  4. KatieMI

    Measles, Mumps, Rubella... Forgotten but NOT Gone

    Some folks just don't believe anything till they see it in front of their own face, whether they know as little as pre-nursing student or as much as someone with PhD in statistics. I saw people like that turning 180 degrees during one short night and becoming staunch pro-vaxxers from die-hard opposers... the only problem was that the price of this change, which was the life of a human being. The life of their own child barely hanging there, being exact. My own mom is now one of them. It gives her some sort of peace, although it can't change anything in the life of her child, debilitated for life by one preventable disease, and in the life of her siblings who died from another such disease.
  5. Two more cents :) - school refuses to give prospective students its curriculum (or it is given, and looks very different from the one from local community college/university program, with overabundance of subjects like "advanced English for nursing professionals" or "advanced medical documentation", or there are multiple online courses about things like "death and dying") - some courses' length is dramatically different from ones in the community college (e.g. 3 semesters of medical terminology or nursing math) - time spent in sim lab >>> time spent on clinicals any time after first semester - students pursuing nursing degree are not eligible to sit for nursing assistant exam after certain semester (maybe state-dependent but in Michigan it looks like a cut-off factor) - students are expected to arrange their own clinical activities, with minimal or no support from school Simple way to figure it out: call BON of the state where the school is registered, or go online, and find out how many clinical hours for each subject are necessary to qualify for the license in this state. The general requirements are here: https://www.ncsbn.org/Educational_Programs_Entry_into_Practice.pdf but something can be changed from 2012, or the State BON can adjust them a little. Then directly ask school official how many hours (not credits or semesters) they provide, and where students spend them. If there is no clear response, or there is any wiggling around "life experience" or such, go home and forget about this place.
  6. 8 year-old girl cooking is pretty standard for most of the world beyond The Great Seven, poor and middle class alike. As my grandma used to say, "a girl must sift her first flour before she starts to walk, and knead her first bread before she learns her first prayer". This is still the way of bringing girls up in many, many countries. I was working two jobs before why doing it all, and will have job and full time school in a few years... maybe I'll settle for buying some more basics instead of making them from scratch, but not for more. Unfortunately, I have several special diets to manage including my own, and 80% of what is sold in typical supermarket is prohibited.
  7. 1) Most of them shop for groceries in Walmart or Aldi (where all basics for balanced diet are available). Some get "almost all the things" in local pharmacies, which puzzles me because it is way more expensive. Many - don't know about everybody - have cars in families and so can use them for travel. 2) This school serves classical "small poor city of Midwest" in an area with relatively low cost of living. I do not know exactly how many of them are officially below "poverty line", but generally in this area around 50% of total population is below this income level. 80+% students qualify for free food in school. 3) No, I didn't do any "assessments". That's not my role there. 4). I lived through last decade of 20th century in my native Russia where we also lived day by day and sometimes went hungry. I also visited China, India and Japan, where one bedroom apartment for five people is considered to be pretty much a norm and American-sized kitchens are next to unthinkable. Despite of these environmental and economic factors, and the much higher cost of food there, people in these countries have remarkably different "values" toward food. It seems illogical to me to compare prevalence of obesity and different forms of malnutrition in this countries and in the USA because, for example, ascorbic acid deficiency can happen easily on a "diet" of tea and toast but virtually unknown in Japan where "poor's food" (rice with pickles and seaweed) is rich in it. The difference lies, for example, in the fact that in India still only very rich girl can get married without being able to cook - and even then she's expected to know a whole lot about food and spices. I suspect that not only "environmental and economic" factors and "cheapness" of junk food and frozen meals make the situation possible. As it was already shown here and in other places, all that costs not much less, or even more than "healthier" foodstuff. People found ways to cook during Great Depression, during the wars and in Oregon trail - and saw nothing special in doing that. I think that availability of incredibly easy, (seemingly) cheap, artificially tasty and widely advertised foods for generations in a row has much more to do with it. One has to grow in place where a women of the house can give delicious two course meal to her whole family plus a couple of guests having one small chicken and not much more and be proud of herself as wife and hostess in order to refuse to consider frozen burger as something worth to eat.
  8. The family discussed in the article supposedly lives in apartment, although "crowded" one. Living in motel would be much worse, but still OK for an electrical skillet, 1-burner electrical stovetop and a couple of basic pots (all that available, with some luck and time investment, used in Salvation army stores for about $10 - or in Walmart, new, for total $50 or so). That's what I had back in my own country while living in a dorm with three other girls with very little money. Can't say our meals would worth Zagat's review, but we had three meals daily cooked there, and they were much better than McDonald's. I recently started to volunteer in elective "culinary arts" class in a high school designed for low-income teens to teach them basic cooking and healthy eating. We were told to always discuss "the menu" of the class with counselor beforehead and be careful not to mention things like fresh salmon and chia and zerekh so that not to hurt student's feelings about these nutritional powerhouses. But, seriously, some of these kids have no idea how to hard boil an egg and think that peeling potatoes "takes too long". Their idea of "porridge" is limited to instant oatmeal. They just do not value healthy food and good nutrition as something significant in their lives. And, yes, most of them are at least overweight and most have clinical signs of malnutrition clear without lab draws.
  9. Store-brand 5 pound/bag of vitamin-enriched white flour costs around $1.99 where I live. Same of whole-wheat costs $2.49. Yeast is $ 0.99/pack of three. Salt is almost free. These plus some water, and you'll get more than enough fiber, vitamins-B group, and protein-enriched, home-baked sourdough bread for a family of five for a whole week for less than $7 total, including electricity and water. 10 lbs. bag of chicken leg quarters goes for $6 in Walmart nationwide. Bag of dried beans (equals up to 8 15 oz. cans) costs between $1 and $2 there. I can understand that people may not have money on gourmet or special healthy foods, but their "inability" to get basics like above and cook them is, IMH(onest)O is pretty close to being plain lazy and not willing to learn cooking beyond pushing "defrost" button on microwave. If I can do it all while working full time, they sure could do it too.
  10. KatieMI

    Prescriptive Authority for Nurse Practitioners

    For example, a nurse practitioner in Florida caring for a patient with a persistent cough and sore throat cannot prescribe cough medicine with codeine for the patient’s comfort (Nursing License Map, 2012). Therefore, the patient must see a physician to obtain a prescription for relief from a sore throat and cough, which both delays treatment and increases health care costs associated with a second visit. Here is one point I find interesting. We already have health care providers (MDs/DOs) wast majority of whom trained and practice strictly within model of health care services which openly encourages over-testing and over-prescribing and who, by their wast majority, are opposed to using alternative/naturopathic therapies and have little experience in patients' teaching. Should nurses just become second-tier providers within the same model, especially if we already know that the system itself is broken (as evidenced by epidemic of over-prescribing and overusing of addictive painkillers, for just one example)? In the above example, if patient complains on recent seemengly uncomplicated sore throat with cough, he/she probably shouldn't be prescribed codeine if "comfort" is the only one indication found during assessment. He, on the other hand, can significantly benefit from education about comfort non-medicinal measures (avoiding fumes/stopping smoking/air humidification/etc) and appropriate over-the-counter meds which can safely help him to cope with cough, and an APN/FNP is just the right person for doing this. On the other hand, if the patient has some special needs (like if he'd got a important speech to deliver and so absolutely must stop coughing to keep his job) or his symptoms do not react on treatment as expected, then he should be evaluated by a physician (or specialist mid-level provider) anyway and indications for codeine can be reconsidered. While educational standards for advanced nursing practice should probably be raised, I really doubt that it must be done strictly within the allopathic model's framework.
  11. Because there's feedback which teaches and motivates and feedback which degrades and humiliates. I think we all here know the difference, as well as the fact that "teacher" who preferably uses the latter form of feedback is probably well below of the "crier"'s level in terms of emotional maturity, stability and professionalism.
  12. Dear OP Preceptor, I thought quite a lot about writing a responce but i think I ought to do that. Even if just for the sake of your own safety one day. What your wrote is just such wonderful eye opening indeed because one little thing. Or couple of them. If you were just so brutally honest to your bones and your single and only one wish would be to make your students and orientees excellent, safe nurses while keeping your license safe, you would probably not: - get people spending their precious time spying on your behalf ("I will find out. I have eyes and ears you don't know about"). - take people aside to speak with them "as two adults ought". Because the single reason things like it are done is to get rid of witnesses. - tell people that you are "fully aware of the tone" you use. - warn people not to cry, even if they have d*** good reason to do so. - require your students to, in practical terms, read your mind and become proficient in it in no time: " I'm giving you hints on who to trust and who to watch as well as your Reliables, those fine folks that always seem to be Johnny on the spot with whatever strange thing you need". - describe healthcare as you do it (" medical personnel are predatory pack animals. When you cry, they scent blood and bay for their pack mates to take notice. They watch. Stalking. Lurking. Marking you as weak, ready to cast you aside to larger predators, or, more readily, pick the psychological meat from your bones themselves"). If so, how comes that you're so comfortable in these jungles? Do you want every your student to eventually become a psychological hyena? I could find many more of these little threads. They are hidden in almost every sentence of your article. I do understand that you have some very good reasons for thinking the way you do. You have your own life experience and your own personality and I cannot comment on it. I just want to tell you, honestly, that if you may not love to make people miserable just for the sake of it but you very well may to enjoy your power over them anyway. The only problem is that power you think as about solely beneficial still can kill. And if you drive just one recent grad who, for some reason, feels revulsion to your way of life as a lurking predator, to despair, to abandoning Nursing or to something worse, it will cross over a lot of good things you did. Nobody deserves to be treated badly just for being sensitive and emotional person, for having other learning style than the one you prefer to use, or for being unable to figure out your "bad days". (P.S. nowadays dictophone apps can be downloaded for free, and pen with invisible microphone and camera costs $20. I personally would use them only as the very last resort, but I also know a lot of people who document every moment they spent with their preceptors and who hire personal injury lawyers before applying for jobs. And a personal injury lawyer is worse animal than all your healthcare workers put together).
  13. KatieMI

    The Benefits And Drawbacks Of Private For-Profit Schools

    Couple of other things I've noticed about the subject: - because they are smaller, private non-for-profits tend to apply the same required courses to all students, whatever they're actually studying for. One school I know has LPN, BSN and medical assitant students attending same "Pharm I" lectures, with the idea that NCLEX is the same for everyone and medical assistants "may benefit from that". The difficulty level of the lectures was geared toward medical assistants, as nobody of them would be able to pass the course otherwise. BSN students were given "Pharm II" course, but LPN students were not allowed to do it. - for the same reason, private for-profits may have less local connections for arranging students' required clinical experience, externships, observerships, etc. Besides sub-par clinical placement, it can lead to the situation when students are told to find something to do in order to cover theur clinical hours requirements. - while these schools may not require pre-requisits and tout themselves as "all-included" programs, they can "offer" mandatory courses which are obviously not necessary and not required for certification (like Advanced English Composition... one cannot write a SBAR note without it, I guess), "Medical Economics" and "Death and Dying". And they charge for it, too. -some private for-profits cater mostly for students from the same environment (ethnic communities, career changers, etc.) They do not often advertise it, and they cannot, legally, deny admission based solely on that, but it can make studying very uncomfortable for students who do not belong there. Last but not least: sim labs are nice to have, but they are not at all necessary and no substitute for ol' fashioned hands-on clinical training. The questions applicants probably need ask before paying that kind of money for a nursing licence should be: certification of the school, where most of the students come from, NET/TEAS/etc. scores, NCLEX passing rates, clinical palcements (for all terms, and by whom they are arranged) and professors' qualifications. If these questions cannot be answered right away and in details, then get out of the place and spend your money somewhere else.
  14. KatieMI

    Tattoo cover up

    Dermablend (and other like products) may be great but patients may have allergies on their components. I once got systemic reaction because of that; having this product permanently applied on wrist area, it would be really difficult to avoid contamination of water while giving baths.
  15. I had to make that decision not so long ago, and eventually decided to get BSN first. I was concerned that having MSN without any previous nursing experience will make me more a nuisance than a highly qualified specialist (providing I will be able to find a job at all under such conditions). I wouldn't be able to go to direct-entry MSN without getting student loans; with BSN, I hope to avoid them altogether. And last but not least, BSN lets me wait for a year or two to see which Masters to choose while taking some grad courses and easing future studying.
  16. KatieMI

    Who does Dental anesthesia?

    Some dentists do a month or so of anesthesia during their advanced training. If I'm not mistaken, for some specialties (like pediatric dentistry) it is required by their Boards. In some places, they employ CRNAs. I would make sure that oxygen, SaO2 monitor and something to check pressure with in the room, as well as emergency meds available in that place.
  17. KatieMI

    LVN to MD

    No it won't, and neither will anything from your journalism degree. For sure, and absolutely. You'll have to get another full-term undergraduate degree in bio, chemistry or whatever your medical school wants to see before going there, b/o hem, bio and all other stuff put together you've learned for your LPN is like 5% of what you're supposed to know as a medical student.
  18. KatieMI

    Baker College Questions

    Take a look on SVSU in Saginaw if you're interested in BSN. 6 semesters long, no wait list, reasonable admission requirements, gorgeous new lab and good conditions overall.
  19. KatieMI

    How to tell a dark-skinned pt is pale?

    Ashen gray skin; pale palms, buccal mucosa, gums and conjunctival mucosa. Dark purplish color, first seen on lips, means cyanosis. Most very dark-skinned patients have indeed very dark but beautiful "warm" color when they're feeling fine and same dark but "cold" color when they're pale. It is kind of difficult to imagine till you see the real human being. In some places Macy's has cosmetic lines oriented for dark-skinned customers and they could let you see the difference between "warm" and "cold" variations of one tone, which are quite close to real thing.
  20. Just to let you know, as a nursing student I'm getting about ten times less questions like "WHO did you say you are?":eek:, "WHAT did you say you're doing?":mad: and (the most maddening) "what're you paid THAT kind of money for?":devil: than my husband, who spent good quater of a century working on his two PhDs and results of whose (and his colleagues') sleepless nights and 80+ hours working weeks are literally all around of each of us. I have enough of my own problems in life besides worrying about someone who just can't get it, whether we're speaking abou nursing, science or ballet, or whatever else. So I just ignore such folks... wish my hubby could one day do the same:redbeathe:redbeathe:redbeathe.
  21. KatieMI

    Discussion, please share your opinions on this.

    Just my another:twocents: The only one reason why bullying persists in nursing (just as in amny other professions) is because of it is allowed to be this way. Just like some drivers go crazy because they feel, or think, that cops never watch this or that part of the highway, some other people think that they may treat others the way they feel like and go away with it. And there are places where they can do it, for this reason or another. So, the remedy should be just like the one we civilized human beings used so many times before - stop tolerating it. Just like 100 years ago it was OK to lash a child for misbehaving, or 60 years ago it was OK to treat people badly because their skins were of different color - those evils were (OK, mostly, but I hope to see them ended with and buried deep:redbeathe) conquered because those things stopped being "socially acceptable" by wast majority of those involved or just hanging around.
  22. KatieMI

    Discussion, please share your opinions on this.

    Mr. Dellasega has NO IDEA whatsoever what medical school and, in particular, residency, really is. Remember that example of ego-protective "sublimation" from textbook, where a guy who is just more aggressive by nature becomes a surgeon and thus gets opportunity to use his aggressive tendencies in a socially appropriate and acceptable way? Now imagine a dozen of such guys, all hating each other, and each of them having a dozen of little guys to use as he pleases, literally, with power short only from direct and public physical assault (harrassment and tortures being permitted and encouraged). These little guys are denied any form of legal protection, any right to complain, any hope to get out of there before end of their terms and any chance to change anything and their lives and lives of their loved ones are depending on good or evil opinion of those all-powerful big guys. And that's not a horror movie but a description of an average residency program. The bullying and hazing there can be at the level of a fine art, and the level is times and times higher. And, after all, no nursing students, nor nurses are LEGALLY connected with the place where they feel bad, bullied, harrassed, etc. One always can get out, maybe with some losses, but it is always possible and doesn't mean instant termination of the career. Residents in many places and positions do not enjoy the same privilege.
  23. KatieMI

    Substitute Teacher Gives Boy Medicine Overdose

    I'm speechless. When I grew up with life-threatening food allergies, my mom didn't let me go alone anywhere at all until I was about fourteen or so and was able to take care about myself. Name it "helicopter" and "overprotective" if you wish, but I'm here and alive. One time she was doing CPR on me for 30 min or so alone before paramedics came. One girl in my daughter's class recently had chemo for cancer. Her mom, on top of caring for her and her other 3 kids, took evening classes in local program in order to be able to do things like IV port care and sterile dressings. I'll never, under no circumstances, let a person without appropriate knowledge give my daughter anything at all, even pre-filled, pre-packaged and bearing a foot-long note. People start homeschooling their children for much less significant reasons; it is just beyond me how a one in right mind can let a person without a trace of medical education to dispence thing like flecainide to their own child.
  24. KatieMI

    Were my patient's rights violated?

    I'm so sorry but your rights as patient were not violated. There are only two situations where a doctor (and every other health care professional, as well as a teacher, a firefighter, a social worker and whole row of other professionals) is obliged by law to inform authorities and thus break patient-physician relationship: danger for self (mostly suicidal patients) and danger for others. Both can be assumed, perceived, proposed, believed and so forth, and those potentially dangerous actions might be performed actively or not. The "accuser" will enjoy legal protection under "Good Samaritan" law even if his/her allegations were proved wrong at the end. But if, by any chance, something happen with your patient and somehow a lawyer gets to know that your doctor knew about your addiction and didn't act, then the doctor may lose his licence. He actually did a kind thing to you - he could call Boards and say nothing to you at all. Sorry to say it all, but that's just the law of this land.
  25. KatieMI

    Alternative uses for Synthroid?

    Giving Syntroid in usual dose to an euthyroid patient is pointless - his own thyroid gland will just shut down itself for a while, and the net effect will remain just the same. Using thyroid hormones for losing weight/increasing peristalsis/"increasing energy"/making one looking as a mute cinema star (you know - long fingers, huge eyes, flat shape and lots of "nerves") actually requires creating a jatrogenic hyperthyroidism with all its sequela, some of them potentially deadly. The patient in question might have subclinical hypothyroidism b/o lithium he received sometimes in the past for his bipolar disorder (as it was mentioned before, up to 30% of patients treated with lithium develop hypothyreosis, and not all of them recover). Also, subclinical hypothyroidism is common among autistic patients, and among critically sick, especially post-operative patients as well. To treat subclinical hypothyroidism (if patient has no symptoms and sometimes even normal thyroid profile, but abnormal thyroid functional tests) or not is a big open question now, but since it is known that hypothyroidism causes, among other things, poor wound healing and depressed immune functions, it is imaginable that Syntroid in standard therapeutic dose can be given if doctor suspects subclinical hypothyroidism. IV form is probably because of patient's psycho history and possible non-compliance.