rnin0513

We use methadone a lot in cancer pain, especially bone pain. We usually start out very low (2.5mg bid) and overlap with their current pain meds for the initial loading 72hrs. I've had pts on as much as 120mg a day. Great alternative when MSSR isn't getting the job done.

We don't have comfort kits unfortunately (don't get me started) but I have great success in lorazepam for terminal RESTLESSNESS at very end of life (the picking, reaching, life review stuff). For agitation/combativeness we use Haldol but I have way more success with ketamine nasal spray. Which also works really well for bone pain too. Sometimes our hands are tied in facilities. Some DONs are way behind the 8 ball in allowing antipsychotics in "their building" even though it's being used off label. Sx management has its frustrations for sure!

We see our patients twice a week, 4 days a week. So a caseload of 8 would equal 4 patients per day. For me, that would be a dream day. Our ratio is 10 but with PRN, sick nurses, etc., I often see 6 per day. That's difficult to do AND get your charting done. To me, 4 is perfect.

If we must do it thru a PIV, we always start an additional line w/an 18g.

Dispensing at bedside is part of our mandatory 3-check system. The first check is the MAR to the PIXIS screen. The second check is the meds from the PIXIS drawer to the MAR. The third check is when we dispense at bedside from the package. I always do a 4th check as well by looking at the blister packs, etc. before throwing them away. Medication errors are my biggest fear! I'd rather get yelled at for being slow than accidentally give K+ instead of Lasix or something horrible like that. Halfway through the program and I'm STILL nervous about passing meds.

Omg, that was so stinkin' hilarious! I'm a student now but was an ER scribe for a long time. I've heard EVERY ONE of those statements. And believe it or not, I'm going to be in ER nursing. The comedy is never ending...the dilaudid one cracked me up too. "Hi, I broke my fingernail tonight and nothing works for me except dilaudid." Bahahahaha....

I LOVE my ceramic Fossil! I had to look everywhere to find exactly what I was looking for. Pastel pink with military time, date and day of the week with a second hand for pulses. And just the right about of bling to not look to tacky at the age of 44. The weight was a little weird to get used to - took about 2 wks but now I can't imagine life without it!!

I'm 43 and finally getting my RN! I'm interested in pediatric hospice or pediatric palliative care. Will I need any additional education, certification, etc? As a new grad will I have trouble getting into that field? I live in a relatively small town with no children's hospital but two hospice companies - is that where I would start? I always see Peds OR Hospice but haven't found much info on them together. Any input, advice, etc would be appreciated! Thanks so much. =oD

I'm currently taking A/PII and Chem at the same time. It was a little overwhelming at first but my A/P teacher is HARD! Chem is just a dirty word for MATH, lol which I don't really have problems in. I'm currently getting in A in both classes but I'm working my butt off for it. It's doable - I'm glad I did it because it saved me an entire semester in the long run. GOOD LUCK!!

MAJOR congratulations!! I apply between Jan and March and hopefully be able to post the same thing. Good luck!! =)

I'm over half through with Chem and often have wondered why it's not called Math, lol. Lots of algebra type work. While I find A/PII harder, I'm actually doing worse in Chem because it's incredibly detailed. Just read your problems very carefully and don't forget your significant figures and units of measure. My prof is a real stickler for that. Good luck, I'm sure you'll do GREAT!!