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zcoq72mehs

zcoq72mehs

CriticalCare
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zcoq72mehs specializes in CriticalCare.

zcoq72mehs's Latest Activity

  1. I already know WGU is a good fit for me; I do not remember asking that precise question, yet it seems that is the perception, and perception is 'reality' for many. I simply want to prepare myself, thoroughly, for the research paper component of ANY nursing program, independent of wgu, but since I am most interested in the wgu program, posted here accordingly. It is true that I am concerned about being 'efficient' within a given term, especially since wgu is not on a given dollar per unit, but my inefficiency lies primarily within the domain of writing. :)
  2. Perhaps; perhaps it is; I realize one program is not all things to all ppl; I am self-motivated and I can find information 'independently' but it does not change the situation. As an example of self-motivation, I will have no problems studying for math on my own in preparation for the assessment exam and/or for testing out for college algebra; the information is available for self-review in video format, ie khan academy. I graduated valedictorian from my nursing program back in 1-1991 and I studied alone (altho I did tutor many others when requested); On my own, I went to the university to research various topics...back in the day when we used index card catalog system and bound materials on several floors on shelves about 9feet high, along with micro-fiche; the technology has changed quite a bit since 1988 (which is when i did most of my university research). I have owned hundreds of nursing and medical texts over the past 25 years and have over 200GB of video materials on advanced nursing concepts.......for 'self teaching'. self motivation and independence is not the issue. examining 100 nursing research papers written in today's environment; that is the issue in my case as I prefer analysis as a means of mastering a given subject.
  3. the 26 half hour lessons on algebra does not load. the statistics link is not coded (not clickable) ??
  4. I do not know how to write essays, research papers, etc; I do best by learning by example, wherein I analyze preexisting information. Is there a compendium of nursing essays/research papers that may be purchased? Analyzing 100 papers on 100 subjects would be a dream come true for my kind of learning and I would gladly pay for such a resource. Because nursing is so specific, I am not content with purchasing 10 books from amazon on this matter. If anybody has resources on this matter, I would be extremely thankful for your assistance. I do realize my request may seem 'over-the-top', but I have been like this all of my life; long ago when I was a critical care nurse (I left nursing for 10yrs), I purchased and read about 10 textbooks on the subject within the first few months...as an example. Therefore, it is unlikely I will be able to break from this form of analysis/preparation.
  5. zcoq72mehs

    Are shy and quiet people not allowed to be nurses?

    I must say that I am absolutely FLOORED as to the number of shy nurses--nothing wrong with that whatsoever, but still flabergasted. It seems to me human resources are in charge of hires nowadays--and it seems they feel that gregarious, outgoing, extroverted nurses are the kinds of ppl that should be hired. Nowadays, some hospital employers give psychometric testing as part of the application process--originally instituted for 'business' type jobs (as if we need to be sales ppl).........it seems to have spilt over to our industry now. keep this in mind moving forward with ur career--no change necessarily other than understanding this idea and observing their behaviour (management, etc) and giving them 'what they need' when u must in order to avoid this situation. take it as a lesson to grow from--this extrovert needed a different salad dressing--observe this ppl and consider it when necessary--just think of it as looking out for ur future in a comprehensive manner. Now, if u DO want to change a bit, i have no idea how to go about it. change on this level is no easy process, and repeated video course watching may provide the highest success to change dressings to suit the purpose.
  6. zcoq72mehs

    Have you used insulin to treat ca channel blocker toxicity?

    it is my understanding that it is not the 'insuling' itself that is doing the job. as u already know, severe cardiac depression is an end-result, and even pacing can thwart capture/positive outcome it was my understanding that glucagon/dextrose was needed for camp/gamp/atp intracellularly and that the insulin drip (anywhere from 10-30units/hr) was to facilitate said intracellular transfer of this energy source. furthermore, this causes an influx of potassium, which acts antagonistically, affecting repolarization in a beneficial manner. so, basically i believe it to be to enable carbohydrate utilization and antagonistic potassium influx, in short. if there are other mechanisms, they have not been clearly researched/understood/demonstrated hope this helps some i recommend potassium with that insulin/dextrose/glucagon, btw it is usually insulin, dextrose, potassium, as a solution, and frequently glucagon to enter thru the back door. iv calcium is also considered along with beforementioned pacing, but u didnt ask that it is speculated that the hypotension may be confounded by inflammatory proceses, but to my knowledge it has not been understood how therapy addresses that--it is possible insulin may interfere with that inflammatory process somehow, but i dont think this has been definitively proven yet.
  7. zcoq72mehs

    nurses dating nurses?

    I was with my wife for 12.5yrs, very happily married for 10 (raised my stepchildren from 4, 5, 6, to august this year) It can have its challenges. She was an LPN when I met her at the hospital we both initially worked at, and she was working on her masters I do not regret it for one second--a very good relationship. I have dated a couple other nurses with less success, prior, obviously, as this was my first marriage. I feel that you should date whom your heart tells you to date, and if that is one u work with, the stipulation is best that this person is a potential life-long mate, as I have seen others who had 'physical' relationships primarily, that ended up being rather negative. just my 2 cents. if there IS an online source for nurses wishing to date, please share the resource good luck. eharmony may be a better alternative, however, to find compatability, but this is an uninformed statement.
  8. zcoq72mehs

    pharmacology online class

    some are integrated within 'nursing 1' as part of the curriculum wherein you cover a 1000page pharm book in 3wks.
  9. zcoq72mehs

    bloodgases

    part 2, in brief: let's assume we want to improve the oxygen consumption ratio, we do this by addressing oxygen delivery, and thus the original equation i posted 1. we can increase the heart rate, to a point, as CO = HR X stroke volume 2. we can increase the 'contractility' of the heart, thus improving ejection fraction. for some, that is digoxin 3. we can increase preload, the volume returning to the heart, thus a crystalloid (pref. isotonic), colloid (hespan, hetastarch, albumin 5/25%) or prbc's. more volume, more stretch, starlings law (but this may cause a reflex bradycardia via baroreceptors in the aortic arch etc thus may need to address this). blood has the advantage of increasing hgb, oxygen carrying capacity 4. we can reduce afterload, the pressure the heart has to push against (aorta in case of left ventricle), think lowering blood pressure etc. this is the SVR, or systemic vascular resistance. One option may be dobutamine, which slightly increases HR, slightly reduces afterload (svr, bp). In the case of a chronic CHF patient he may have experienced 'dowregulation' (unfortunately, beta receptor sites on cells can 'uncouple'/disassociate and even be reabsorbed--in which case steroids may be in order to get mRNA involved to make new receptor sites). In the meantime, we use phosphodiesterase inhibitors (amrinone, milrinone, etc) and go thru the back door, increasing cAMP within the cardiac cell itself. 5. we can reduce the pressure the right heart has to push against thru the pulmonary vasculature (PVR) via monitoring pulmonary congestion, etc--dont let the cvp get too high, assuming competent valves and normal compliance 6. dont let the pcwp get too high or low, which reflects the pressure of the left ventricle at end diastole, assuming competent valves and normal compliance. if the pressure is too low, think starling law. if the pressure is too high, the increasing pressure in the venticle will back up to the right side, right heart very weak, and also the ventricular wall pressures may cause subendocardial ischemia and further dysfunction keep in mind that we have to balance these inotropes, chronotropes, vasodilators etc with myocardial oxygen consumption--if we have coronary artery occlusions increasing these values too much, even within 'normal limits', will increase myocardial oxygen consumption, reducing glycogen stores within the heart, increasing ischemia/cellular acidosis, further contributing to reduced ejection fractions, reduced cardiac output, cardiogenic shock etc we can recruit more alveoli via peep--watch for overcomliance of lungs, which may compress heart, reducing cardiac output--consider increasing preload to ability to counteract we can increase the tidal volume, keeping plateau pressure below 30-35, depending on the client we can increase the ventilator rate, to a point, but volume first, usually we can reduce oxygen consumption of client by maintaining normothermia, at times mild hypothermia, in case of head injury, etc. possibly barbituate coma, sedation, etc we can paralyze/sedate and consider reverse IE ratio we can consider high frequency oscillatory ventilation it is a science that must be balanced
  10. zcoq72mehs

    bloodgases

    some good answers. but it aint if it is less than 7.4 as that is out of context. If all values are within 'normal limits', we dont ask that question--that question is used primarily to determine patial/complete compensation issues. 'normal' values (it is relative, as this may not be normal for a given disease process, in which case Hx is needed for proper context): ph: 7.35 -7.45 (some books use 7.37) pco2 35-45 hco3 22-26 p02 80-100 (not 60) sa02 95-100 (not 90%, not 92%. something physiological/environmental is in place if it is less than 95) Base excess (BE) -2 to 2 anion gap, without potassium, 12-16 (unlike the poster, acidosis does not have to be lactate, so we use this gap to look for poisoning, ie ethylene glycol, etc, and then check direct osmolality, should be less than 295-300mOsm) first first: if all values are wnl, dont procede with the analysis below first: ph less than 7.35 = acidosis ph more than 7.45 = alkalosis write answer down on paper second: pco2 less than 35 = alkalosis pco2 greater than 45 = acidosis explanation: co2 in the blood forms with hco3 to form h2co3, or carbonic acid. If we can increase the respiratory rate or volume (alveolar minute ventilation--said this for a reason, not just minute ventilation as it does not compensate for dead space), we can remove this co2 so it does not form carbonic acid and thus increase acidosis. this system kicks in within minutes-hours (carbonic system and protein system actually in seconds) write answer down on paper, labeled respiratory ______, as i just explained it is tied to the resp. system third: hc03 less than 22, acidosis hc03 greater than 26, alkalosis explanation: kidneys can excrete Hydrogen (thus it can not form with co2) and retain K or Na accordingly. Therefore this is 'metabolic' control, kicks in within several hours to few days label it, metabolic ________ note: you may have a mixed metabolic and respiratory component if they are in the both direction, ie both acidotic or both alkalotic This next step is where we use 7.4 as the ABSOLUTE value. 7.4 is used to determine partial compensation or complete compensation If there is an acidosis or alkalosis, and the ph is exactly 7.4, we have complete compensation. Rare. If it is respiratory acidosis, but the hco3 is above 26, we have partial compensation (the metabolic system is trying to make the blood alkalotic to make the ph 'normal', ie 7.35 to 7.39) if it is respiratory alkalosis, but the hco3 is below 22, we have partial compensation (the metabolic system is trying to make the blook more acidotic to make the ph 'normal') if it is metabolic acidosis, but the pco2 is below 35, we have partial compensation (the respiratory system is hyperventilating trying to blow off co2 so it can not form carbonic acid, thus resp. alkalosis) if it is metabolic alkalosis, but the pc02 is above 45, we have partial compensation (lower rate or volume of breathing, trying to retain co2 to make more acid to make more normal ph). metabolic alkalosis is almost always BAD NEWS--be forewarned and on guard. It gets more complicated than this, but i dont want to type more and cause more confusion I believe my answer is the best thus far. I could be wrong. :) it should get u 95% accuracy. if the sa02 as measured via abgs is below 90, as far as the texts are concerned, we have hypoxia, as is the case with p02 60 or below, we correlates with the beforementioned on the oxyhemoglobin dissassociation curve. but it is more than this. use the other poster's formula with the fio2 multiply-er to determine what the true po2 should be. personally, i feel u should be wary if it is below 95% and 80mmhg on the po2 assuming room air. to determine the underlaying cause of the hypoxia, consider ketones, lactate, anion gap to assist in determining said underlaying cause, in addition to ventilation/perfusion mismatch or shunt and poisonings (carbon monoxide, cyanide, drug od like tricyclics, ethanols/ethylenes, etc) furthermore, as the other poster stated, we need to determine: adequate heart rate (HR) adequate cardiac output adequate hemoglobin (not hematocrit) (ie 12-18, but rarely transfuse until below 8mg/dl) adequate 2,3 diphosphoglycerate (banked blood is depleted, thus massive transfusions with be deficit and the blood will not want to release the oxygen off the hgb, a shift in the oxy-hgb curve, increasing affinity of hgb and o2) all the beforementioned is best evaluated as the poster said, not via oxygen delivery: cardiac output X HGB X 1.34 (or 1.37 depending on book) but by oxygen consumption this is because THIS patient may NEED more oxygen. the delivery equation assumes normalcy. would you want a 'normal' oxygen delivery if you were on a treadmill running as fast as you could for 1 hour? No. you would need a much HIGHER delivery, and thus the correct measure is the extraction ratio, usually quickly calculated by considering the abg sao2 and the svo2 subtraction However, the equation estimation is thus, based on FICK: (cardiac output X sao2) - (cardiac output X mixed venous blood o2 (obtained via pulminary capillary wedge port, wedged) as u can see, that roughly correlated with the beforementioned sa02 - sv02 :) that is all i can think of at the moment during my work break. be well
  11. zcoq72mehs

    Straighterline courses

    thanks to all who shared insight into this resource. it would be a good deal for any college who would accept. i wonder if WGU would consider these, as somebody posted that question in another thread. i was skeptical
  12. zcoq72mehs

    how to approach manager and give resume?

    interesting dichotomy here. i can understand both POV's the decision would be a difficult one. i suppose if u had no chance at all in the first place, having waited some time after the online process, one could take the risk
  13. zcoq72mehs

    $15,000 for Preceptorship?!!!!

    thank you. do you have the exact link to this resource u mentioned? if not, the main site link? i would like to read about it.
  14. thank all of you for sharing
  15. zcoq72mehs

    Passed my CCRN exam!

    congratulations. yes, i have always been told the exam is tough. that nti course was from a 2007 workshop. the cd versions are synchonized audio/slides (9cds) the dvds is a 3dvd set and i dont know how it is presented i do not own the set yet.
  16. zcoq72mehs

    Learning and Retention

    welcome to the majority of humanity. make no mistake: there are ppl who can remember 90% of information easily for years--but they are the exception wozniak of poland studied this phenomenon long ago, and he created a repetition algorithm that many have borrowed (sem2) if u want to keep knowledge into long term memory, consider a fujitsu document scanner with flatbed that supports twain support, and scan the info into ur computer in editable format, and copy the info into anki anki will support a repetition algorithm that should seal the data into long-term memory now, there are a couple ways to improve long term memory exogenously. some ppl consider bacognize (worked for med students). it will take 250mg bid for 3wks to kick in, and it can be purchased from swanson vitamins. verdue sciences are the maker of this concoction, other brands ineffective (as is the case with curcumin products, except by verdue) I am not giving medical advice. some ppl consider magnesium l-threonate, 5 gms a day, in divided doses, but definitely not more than 7gm a day. this is the only oral mg supplement that can cross the blood-brain barrier in meaningful concentrations, where it sensitizes neurons in a way that frees up more acetylcholine--without an ability of the brain to counter-act the effects. It produces increase neural connections additionally. it can be purchased from swanson vitamins, but not in high-doses that would be necessary. it also takes 3-4 wks to peak. you can by a kilogram from cerebral health at about $400 i think--in this way, u can take higher doses. this will not increase ur working memory, but should enhance ur long term memory perhaps 10-20% that combined with anki should put u head and shoulders above for long-term recall to improve working memory is much more difficult, exhausting, and time consuming, and i do not wish to discuss it. :) the brain is plastic and capable of change just like your bicep is. with proper exercise, u can increase the amount of data that u can work with at any given few seconds (working memory)--in this way, u can handle information at a faster rate, moving it into short-term memory where recital/repetition/rehearsal will move it into long-term memory to improve short-term memory, it is nice to use the method of loci and peg system and free associations created by the ancients. think dominic o'brien's system or similar mnemonist and memory champion. they can remember several decks of cards in correct order nearly instantaneously using such 'visual memory' systems--ever notice u dont forget how to get home or to class or to a friends house? using visual memory as a band aid with associations and memory systems is this bandaid be well