iluvnoodles

Hello everyone! I am looking into going for a doctoral program in nursing. Originally, I was going to go for ARNP, however one of my colleagues at work is advising me to do doctorates. I am not really sure what the difference is in doctoral vs ARNP. Does one receive a masters degree with a docotorates as well? If any one can give clarify the two or refer me to a website, I would greatly appreciate it. I recently am certified in WOCN and I am looking for the "next". I know that I right now I don't care for research but who knows what I would want to do in nursing in 10years. thank you!

Thank you for responding back. My wound book didn't say how it was caused. Much appreciated!

I just had a recent experience where I questioned the care that I have in providing to my patients has done nothing but bite me in the ass. I have been caring for a patient on hospice who was transferred over to our unit because the nursing staff were c/o his multiple complex wounds. I discussed with out wound clinician about their current treatment orders bc they obviously weren't appropriate, and I a, studying to be a WOCN. So after being on appropriate treatments, sacral wound healing beautifully. So wound clinician decides to focus on trochsnter wounds. each week the Wocn has been debrieding them, so they looked bigger and deeper. A float nurse did the wound care treatment and sent an email to the chief of geriatrics that this patients wound has gotten worse. Ending story she accused me of letting the wounds to deteriorate, and the family no longer trusted me. After speaking with management I knew there was no support. So lessened learn, don't trust anyone and knowing the fact that I took excellent care of that patient was enough. I agree with the previous commenters in that if they are trying to blame you for something you know are not at fault, than it is not the right facility to work for. I have been job hunting as well

Does anybody know what causes tunneling or undermining in a wound?

Hello everyone, I need some help in understanding something.A patient who has diabetes and has glucose levels in the that range from 200's for breakfast and 300-400s during the day with Lantus BID + sliding scale AC/HS. The MD ordered for a controlled carb diet, but dietician believes that his diet should not be modified, because the problem is that the patient is not absorbing glucose. My concern is that the insulin is being adjusted constantly, and his sugar is still ranging as above. I believe that an endocrinogoly consult should be done for the uncontrolled glucose levels. My thought is that the body is already unable to produce insulin, and if it is unable to absorb glucose, wouldn't there be another underlying issue?? The patient has advanced dementia and therefore forgets when he eats. He complains of hunger around the clock. Does not snack in between, unless staff gives him a snack.

I tried to put him back on the nasal cannula, & he would desat once again. Lungs were clear, no changes in mental status. Only issue was that off of the NRM he would desat. He does have COPD, CXR ordered, already on Xanax.

There has been a couple of cases where I have had to use a non-Rebreather mask. So here is a question for the more experienced nurses. I have a patient who is a frequent flyer to the ER. Within 24 hours he starts de-sating in the 80s on 2L. I come and I think to myself "why is it me who finds this or why does it begin with me." So I put him on NRM, I ask another nurse to make sure I placed it on right. His stats stabilize in 97% at 2L. I notify the Arnp/MD that he is stable with the current flow rate. I check on him frequently to make sure is breathing alright, no change in LOC, stats remain as is. On my way home I realized that 2L on NRM did not make sense! I called the nurse who relieved me and asked them to increase the flow rate. If the patient is not exhibiting any signs of distress, is it safe to continue with the current flow rate? My concern is that he becomes nonresponsive. How long does it take to exhibit hypercapnia?

Yes, cuz this is the first time seeing it in long term. If I see it again, Im just gonna ask the doc if they want to continue with 30 days or change to daily.

Hi guys there's is a concern that I have that I wanted to share with everyone. I would appreciate your input. Hospital discharge med lists are noted to have some meds for 30 days. What I am being told is that hospital medlists will sometimes indicate a medication for a certain amount of time, but in actuality it is continuous. For example a medication will say omeprazole x30 days, "but it's actually spouse to be daily". My confusion is that, if a med says for 30 days, than its for 30 days only and we as nurses are not to assume that the doc wants to continue cuz if they wanted to they can easily say daily. When they arrive to the facility, we verify with the attending physician assigned to them and if this doc doesn't make ay changes, than I am most definetly not going to make any changes. My question is, is this is going to be a trend for nursing? Are we to assume that any medication with a stop date actually means daily? I've worked in LTC for majority of my nursing career and this is the first time I am hearing of this. Hearing what the nurses r telling me scares me and makes me question the medications I am giving. I look forward to your feedback!!

I love doing the night shift. It's so much less stress than days. Inrecentlynchanged from 8 hours to 12 hours to have more days off. I'm finding thatbitsnhardermto adjust and I'm feeling even more exhausted. I'm actually looking for a more normal schedule like an 8-5 routine. After seeing that I'm being scheduled an extra 2-3 days on weeks where I work on the weekends, I'm not sure i want to be overworked like that. I've found that 1-5pm is where I've always get the most rest, without pills.

Hello everyone, I need advice on one of my residents. His ostomy continuously keeps on leaking. I started this position of wound care nurse at a LTC facility for about 9 months and am completely new to wounds. I dont really know much about ostomys either. My resident's abdomen is completely raw, due to the leakage. any recommendations on what ointment to apply to help with the rawness? Also what is the best technique to apply the ostomy on a raw skin? Its so bad, the resident wont let anyone touch him.... Thanks!

That's how I felt to but I left after 3 months. I really hated waking up in the morning. I just found a job in a SNF and it's a different stress level. Instead of 5-6 patients you have 20 or more patients and all your doing is pushing the cart of meds and passing them out----that is your stress. The shifts are 8 hours and you pass meds for 5pm & 9pm. For most patients, you try to give them 9 oclocks as well because there isnt just enough time. Charting and documentation isnt as detailed as the hospital, and you dont chart on everyone. Only certain peeps that have certain insurances and if they have a g-tube. Assessments----dont really exist unless they are a new admission or if there is something new about the patient like chest pain, decrease in LOC, etc.basically, you only assess the peeps if they have to be assessed. But wherever you are, nurses gotta protect their licenses right? I haven't hit the 1 month marker yet, and Im still trying to figure out which is worse-hospital with 5-6 patients or having 20 + patients.

I work from 3-11pm shift and the evening nurse told me that the blood sugar has dropped

Is it H*LL like the hospital? I almost thought I was hearing wrong, when the patient ration was 30:1. I still dont know if I heard right. But if training is 3 days to 5 days max...I figured it would just be passing meds. But than, I wanted to those that worked in LTC. THANKS!!

remember safety is always first. patient can be alert but unable to take oral meds safely. Always assess if they have any problems with swallowing.