MunoRN RN

Critical Care

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All Content by MunoRN

  1. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    If those DNR orders were written when the MD could discuss the patient's wishes with them then that really shouldn't be happening, even more so if coding the patient could be considered futile. There...
  2. MunoRN

    Management of heart failure patients presenting with severe sepsis/septic shock

    MunoRN replied to mgp6's topic in CCU, Coronary, Cardiac

    The goal of the initial fluid resuscitation in sepsis is to provide enough volume to facilitate perfusion and provide the pressors with something to squeeze. What volume of fluid a patient needs to...
  3. MunoRN

    Can a doctor "order" a nurse to not assess something?

    MunoRN replied to SilleLu's topic in General Nursing

    A nurse doesn't need the physician's permission to use their judgement or act on that judgement in providing nursing care. I've never seen an actual physician directed order to turn q2, turning and...
  4. MunoRN

    Pain Med Orders and Critical Care Pain Obsevation Tool (CPOT)

    MunoRN replied to rabitona's topic in Critical Care

    The CPOT based order I've seen are usually to keep giving sedation until the score is less than 2, for instance. Such as 25-50mcg fentanyl q 5 minutes, 0.5-1 mg ativan q 10 minutes for CPOT >1....
  5. MunoRN

    Patient fall without bed alarm

    MunoRN replied to Texasnurse81's topic in General Nursing

    If there was good evidence that the fall could have been prevented with a bed alarm then they might have a case, but the overall evidence says that bed alarms don't prevent
  6. MunoRN

    Firearms

    MunoRN replied to cracklingkraken's topic in General Nursing

    Hospitals don't ban firearms on the property because they serve purpose of self-defense, they ban them because they do the opposite. Of shootings that occur in hospital ER's by patients or visitors,...
  7. MunoRN

    New employer requires I bring my antidepressant Rx and get "cleared" from my MD

    MunoRN replied to ORRN21's topic in Health, Stress Management

    I'm not sure how people think HIPAA comes into play in this situation, anyone pursuing a safety-sensitive position can be asked about any drug that is FDA-required to list impairment as a side effect...
  8. MunoRN

    New employer requires I bring my antidepressant Rx and get "cleared" from my MD

    MunoRN replied to ORRN21's topic in Health, Stress Management

    At every hospital I've worked at you get tested for both illegal drugs, and opiates/benzos, legally prescribed or not. This isn't for "every potential employee", just for safety-sensitive positions....
  9. MunoRN

    Firearms

    MunoRN replied to cracklingkraken's topic in General Nursing

    I feel like I know you well enough to not really be sure if you're being serious, but there are a number of ways a person isn't allowed to drive a car, some examples; they have not proven they are...
  10. MunoRN

    Apothecary measures in medicine

    MunoRN replied to comocean's topic in Nursing Educators, Faculty

    Defunct apothecary measurements such as grains have actually been banned by USP for some time now. As an interesting point in pharmaceutical history, the apothecary system has a place in nursing...
  11. MunoRN

    Firearms

    MunoRN replied to cracklingkraken's topic in General Nursing

    We don't comprehensively ban cars because someone might speed, nor do we comprehensively ban guns, but we do say there are some people who should no longer be allowed to drive a car, there are places...
  12. MunoRN

    Firearms

    MunoRN replied to cracklingkraken's topic in General Nursing

    I've never understood this rationale. Someone who drives over the speed limit clearly doesn't care about what the legal speed limit is, should we just do away with speed limits? Someone who robs...
  13. MunoRN

    Firearms

    MunoRN replied to cracklingkraken's topic in General Nursing

    I own firearms but I don't think I would take one to work based on experience. The main thing to consider is that concealed carry at work in a hospital doesn't necessarily produce a safer...
  14. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    I think my link above might be broken, here it is again: Hiring an End of Life Enforcer - NY
  15. MunoRN

    New employer requires I bring my antidepressant Rx and get "cleared" from my MD

    MunoRN replied to ORRN21's topic in Health, Stress Management

    After a conditional offer of employment has been made, an employer does actually have the right to ask what medications you are taking if you going to be working in a "safety sensitive" position such...
  16. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    You can also hire a professional proxy, which I wasn't sure what to think of at first but after having a few patients who used them it can actually be very beneficial. I thought families might be...
  17. MunoRN

    Opinions please!

    MunoRN replied to mmw11's topic in General Nursing

    I would point out to them that the patient's BG levels didn't change after you supposedly stopped giving them insulin, so clearly the patient suddenly stopped requiring insulin on the same day you...
  18. MunoRN

    Medical Decisions

    MunoRN replied to poodah33's topic in General Nursing

    I use the web-based version through work, our subscription includes smartphone access as well although I don't use that myself (my phone sucks). I use UpToDate for a variety of things, part of what...
  19. MunoRN

    Medical Decisions

    MunoRN replied to poodah33's topic in General Nursing

    I think the OP was referring to medical references, which are used for both nursing "decisions" making as well as medical, maybe they just misspoke. Personally I prefer UpToDate, which is typically...
  20. MunoRN

    HIPAA and the Undocumented

    MunoRN replied to nurseactivist's topic in HIPAA Challenges

    That refers to fraudulent SSN use for the purpose of employment, which this person is not using it for, and this incident happened in Texas which is an e-verify state. More importantly though, the...
  21. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    An overview; The Responsibilities of Medical Durable Power of Attorney for the Elderly | LegalZoom: Legal Info A DNR order is even less subject to being overturned since it is not an advanced...
  22. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    At least in my part of the country, case law is pretty clear. I know that cultural views on futile of life care are not the same everywhere in the US, so maybe the legal precedent varies as well....
  23. MunoRN

    HIPAA and the Undocumented

    MunoRN replied to nurseactivist's topic in HIPAA Challenges

    I'm not sure it's really a clinics primary responsibility to investigate and report fake ID's. They certainly have the right to ensure they will get paid, although this patient has been going to this...
  24. MunoRN

    HIPAA and the Undocumented

    MunoRN replied to nurseactivist's topic in HIPAA Challenges

    I wouldn't care since that by itself cannot be used for anything. Just being able to randomly list 9 digits doesn't really have anything to do with identity theft. If I throw together the numbers...
  25. MunoRN

    The Slow Code: Justified?

    MunoRN replied to TheCommuter's topic in Patient Safety Issues

    The POA doesn't actually have the right to override the patient's clearly stated wishes in any state. Their legal responsibility in every state is to abide by patient's clearly expressed wishes and...