mwlude

so in this case it might be pertinent to look at your onset times with these medications. The paralytic in question is a non-depolarizing paralytic which typically has a longer onset than say succinylcholine. Its common for docs to request rocuronium to be given BEFORE the sedation package with the idea that by the time it exerts its full clinical effect the etomidate is already in and taking its effect so... no harm no foul, I'm my experience it doesn't make a difference either way, I won't comply typically if we were talking about short acting succinylcholine but for roc I'm usually fine with it. Either way the patient is going to experience pain because remember...etomidate does not provide analgesia... Don't feel too bad.

That's a good observation. The bottom line seems to be that nurses are trying to practice medicine with a small portion of standard medical education. Has anyone ever spoken with an MD or DO that received their training online with no entry requirements or residency? I have not. Also, APNs really don't get to spend more time with patients. I've heard doctorate prepared nurse justify the apn role as "who always knows more about the patient?" "The nurse right". Well the reason the nurse gets to spend more time with the patient is because they only have 1 to 7 in most cases.... This idea cannot be applied to Advance practice roles because you are now the primary care provider with a higher patient load (like that of a doctor...) who may very well have the same time constraints. So now let's have nurses practice medicine after being prepared with highly variable, inconsistent and often inadequate academic curriculums with highly variable entry requirements and NO standardized residency requirement.... case in point, a fellow NEW nurse with a grand total of 4 months of bedside nursing experience gets accepted into a prestgious NP program based on academic performance alone with no other requirements, 2 weeks of onsite work and a "design your own" clinical experience with questionable oversight. Sounds rigorous......

Conformational changes in all proteins within the body, of main concern would be albumin and as you stated enzymes, also membrane bound receptors (usually all protein based). Ion shifts r/t acidosis can cause abnormal binding which may change chemical structures. Couple these factors with all other manifestations of the original disease process which caused the acidosis to begin with (i.e. hypovolemia..poor global distribution/perfusion).

We will be finding out more about that statement hopefully by 2019: NIHR Evaluation, Trials and Studies | 12/127/126

Hello all, This post is meant to seek opinions on a few different aspects of APRN education. After doing a little research and observing the general trend I've noticed a few things and would like to generate discussion and/or argument. It seems as though nursing academia is applying a very similar model of education which has worked for the RN-BSN craze to advanced practice nursing education through online based degrees with home based, self coordinated clinical experiences. It seems also that many schools make no requirement as to prerequisite clinical experience as an RN before admission into these programs. To me this seems driven primarily by quick profit as many ADN/BSN programs are now-a-days. Furthermore there doesn't seem to be a well established system for post graduation residency training which seems dangerous if the person is going to be practicing independently (another trend that is emerging). What are your thoughts regarding the sustainability of this educational model? Its affect on the profession of nursing as perceived by other practitioners? How do online programs regulate all students to make sure they are actually studying the material and not just open booking exams? Is there a tangible difference between the online program and the brick-and-mortar program? Do you feel APRN's need a residency? If we are going to practice with the autonomy of a physician (which is what is happening.) then shouldn't we follow a similar model of education? Do you feel the online model is driven by greed with no consideration for patient safety/outcomes or is this a model that will continue to thrive as a convenient way for working RN's to advance their practice?

This one is for all the RN's who have spent time in academic centers. Here is an opportunity to share your favorite resident stories, however funny or embarrassing they may be! I'll start it off with 25mg of Benadryl diluted in a liter of LR "so the patient doesn't get it all at once"... cute..

I own the procardial C3 and am graduating nursing school in december. Ive used it throughout most of my clinicals and the reason i purchased it wasnt because of the 6 attachments (although i did use it during my NICU rotations). I spent awhile comparing various brands and models of stethoscopes and for whatever reason MDF was the clearest for me even over littmann. The C3 is a really nice stethoscope but the head carries a huge profile and its heavy (if that matters to you). This isnt a problem in hospital but on the ambulance it does get in the way quite a bit when the environment isnt as controlled. My opinion has always been to buy the stethoscope that works best for you irregardless of price. one of the best nurses i know with over 30 yrs experience uses one of the cheapest stethoscopes. Id try them all out first because without a test drive you're shooting in the dark.

I got a job...

Ive worked full time as a PCT in my local hospital and part time on the ambulance here while attending a full time traditional BSN program with all your standard nursing school requirements and the following is my experience: -i had a ton of 24 and 36 hour stints without more than an hour of sleep intermixed. if you are going to do that, dont let anyone know because no one would say that it is safe especially if you are in clinicals during your last 12 on. this may be unavoidable once or twice during school but really try to avoid it. -I found the calendar on my smart phone indispensable ( if you dont have one, get one and learn to use it well) google calendar is great because it will sync with any smartphone and you and your husband can edit it from any PC on the planet and it will update on your phone. utilize technology! -try to eat healthy but i will be honest and say that i just ate out every meal or in the cafeteria at the hospital and as i graduate in december the number one thing i cannot wait to do is begin picking up the peices of my overworked and out of shape corpse and rebalance my life. its only for a short time and its worth it just charge it. -last and most importantly school is number one, if you start failing do not hesitate to pull the plug because being a pct for the rest of your life would leave you wanting more, always remember that. what you are doing is the best thing you can do for your career and it will put you ahead of the game big time, any other extracirricular activity in nursing school is a waste of time when compared to actual bedside experience beyond clinicals.

If you have the money to spend on it DO IT. If you can only choose one, ACLS is the way to go. PALS is only useful on units where you'd be dealing with pediatric patients like ED or a peds floor. PALS doesnt apply to NICU either, NRP is the standard resuscitation cert for that unit and L & D\post partum floors. I personally went ahead and got ACLS, PALS and NRP. NRP was offered free thru our school as part of our L &D rotations so why not and ive been in a enough codes by now adult and pediatric to really benefit from the other two. My thinking was that I am now more marketable to any floor that happens to be hiring. on another note, becoming a BLS instructor also adds huge points for various reasons and sets you apart further because new grads with ACLS are becoming the standard due to competition.

Thanks for your informative replies Kel, The main reason we want to move to MA is because...well...why not? In all honesty we want to really take full advantage of the "perks" of nursing and that includes being able to work anywhere (or used to include that eh?). we traveled to boston this year for the 4th and LOVED it. Also the bulk of my family lives on the east coast. Im viewing this as a bit of a reconnect if you will. where do we plan to live? In Boston! We have made peace with the fact that it will be uber expensive to live in the city but we want the experience of it all. Our dreams are not necessarily to work the major medical centers there in Boston so much as the experience of the north east as well as starting our careers as RN's.

Awesome! that sounds encouraging. honestly my plan right now is to not even waste energy on applying to the big hospitals in Boston. do you think my experience will help get in the door at a smaller hospital? also, from a local's standpoint, what would be the best way to go about starting the process? I know there is no GN status in Mass anymore and the vibe im getting is that a person cant really even move without an active MA license so it seems that calling hospitals is not that effective. also, where i am from it is acceptable and has proven effetive for me to walk into the hiring managers office with resume in hand. Ive heard the culture over there is much different and this same tactic will likely have negative results. My plan right now is to start calling HR's and go from there... what advice do you have?

Hey all, This forum seems to be a pretty good indicator of the Mass new grad climate so I'll get to the point: My Fiance and I are planning to move out to Boston after graduation this year... About us: Both will be BSN New grads from a state school out west. Both have healthcare experience. graduating in December so licensed in MA by Feb. ABout me: 3 years exp. as a CNA/PCT in LTC/Tele/ICU. about a year each. 1.5 years exp as an EMT in a busy and progressive 911 system. AHA BLS instructor x 1 year. ACLS PALS NRP significant volunteering with local SAR group including "Medical Coordinator" position. Sigma Theta Tau/high GPA ABout her: 1 year exp. as a nurse Tech in the ICU of a level 1 trauma center. 1 year volunteering at same facility. ACLS NRP We are willing to look at almost any facility within an hour of boston and not picky as to unit. what are our chances given the current economic climate in Mass?

As stated above, you are referring to the "A and O status" of this patient. commonly taught as Alert and oriented to person, place, time and event. who they are, where they are, what time (day, month, year, president?)it is and what the heck is happening or has happended to them. i dont usually report A and O status as A+O x 1 or 2 or 3 because thats almost meaningless. I always report WHAT they are oriented to. "the patient is alert and oriented to self only." saying "alert and oriented times one" leaves room for interpretation and as you can see...everyone learned it differently so my "alert and oriented times one" wont necessarily be my cross shifts "alert and oriented times one".

Choose your stethoscope based on what sounds good to YOU. if you can hear what you need to out of it then thats all that matters. I went with an MDF procardial C3 or whatever its called for a few reasons. i spent a length of time listening with various stethoscopes and the one that hit the mark with me (over all the littmans) was MDF. super loud and clear. a few things that can effect sound quality are tubing length and wall thickness as well as diaphragm and type of metal used for the head piece. regardless of what people say do not go cheap right off unless you either cant afford a high quality stethoscope or the cheap ones work best for you. this is a tool you will use for the rest of your career in healthcare so get what you want to start. They only get stolen if you are careless and leave it all over the place so it can be stolen. good luck!