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Critical Care
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MunoRN has 10 years experience as a RN and specializes in Critical Care.

MunoRN's Latest Activity

  1. MunoRN

    Terrible experience with nursing staff

    I wouldn't describe that as a 'nothing-to-lose' situation since just the initial filing will cost a hefty amount, if she loses, which she will, it could end up costing many thousands of dollars.
  2. MunoRN

    Low blood sugar, juice or D50?

    There are multiple practice organizations with recommendations related to treating acute hypoglycemia, all recommend that D50 only be used when other options aren't appropriate. As an example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474629/ Dextrose is a sclerosing agent, which is why uncontrolled diabetes results in damage to vessels. It's similar to injecting stomach acid intravenously.
  3. MunoRN

    Rapid response

    Actually treating the patient's dyspnea would be a much better alternative to trying to trick the family into thinking it's been treated., particularly since the patient is still your primary obligation. The rate of progression of the different processes that occur in the dying process have varying timelines, but when the hypoxia and hypercapnia components align in an optimal way, altering that to reverse the natural hypoxia is more harmful than beneficial. Dyspnea results from hypercapnia and/or a sensation of physically constrained ventilation, hypoxia by itself does not produce dyspnea, it results in a decreased sense of awareness which includes a decreased sense of dyspnea. Artificially keeping a patient's oxygen levels higher than they would be otherwise, which then results in an increased ability to sense suffering, is not good practice, however common it may be.
  4. MunoRN

    What to do about DNP and flu shot?

    The lowest effectiveness in recent history was the 2014-2015 season with 19% effectiveness, other than that overall in the last decade effectiveness has ranged from about 30 to 60% effectiveness. I'm not sure where you're getting your "9-18%" number. Vaccines expose you to far less neurotoxins than are commonly found in fruits for instance, and I'm curious what it is you think "they" don't understand about the immune system.
  5. Pulse and heart rate (EKG rate) are two different things, so I'm not sure what you mean by saying "the documentation of the patient's heart rates were wrong due to the use of the pulse oximeter for vitals". When it's getting an appropriate reading, the "pulse" a pulse oximeter shows is a fairly reliable measurement of the pulse at the specific location it's being measured, this might be completely different from the "heart rate" which is often used interchangeably with the EKG rate (number of QRS's per minute). Just because the pulse is different from the HR, that doesn't mean the pulse wasn't accurately read.
  6. MunoRN

    Rapid response

    Trying to convince someone that dyspnea doesn't result from hypoxia can certainly result in far more arguing that is worthwhile at the end of life, and the placebo effect can be worthwhile if someone believes the misconception that strongly.
  7. MunoRN

    Rapid response

    The effects of hypoxia are initially a euphoria / intoxication followed by drowsiness and then sleep.
  8. MunoRN

    Rapid response

    Although it's a common misconception, supplemental oxygen doesn't relieve air hunger since hypoxia isn't the cause of air hunger. It does however take away some of the more pleasant aspects that naturally occur in the dying process, making it an inappropriate treatment at the end of life.
  9. The idea that this originated in a wet market or that snakes were the intermediate hosts both appear to be false, although these initial claims were clearly not based on race but rather on bad science. And as you correctly point out, bats are eaten outside of China and not just in Palau but in most of the 'non-western' world, which would also contradict the idea that suggesting bat-eating had something to do with this was somehow specific to the Chinese race and therefore racism. Xenophobia is the fear of something foreign that is not based on rational reason. The fear of the hygiene and sanitation practices of a wet market are clearly not irrational, there is a clear basis recognizing pathogenic risk, although it is correct that this risk is misidentified since it applies primarily to bacterial risk, not viral risk. So the perceived risk based on bacterial pathogens is incorrectly generalized to viral pathogens, but that still doesn't make it racist. As I pointed out earlier;
  10. MunoRN

    Rapid response

    "DNR" only applies once a patient has already gone into cardiac / respiratory arrest, so those treatments would still be appropriate. But you also stated the patient was 'Comfort Measures Only', which would have contraindicated the albuterol and steroids (and the home O2 by the way). The appropriate Tx would have been repeat doses of morphine until the respiratory distress was adequately resolved.
  11. The OP's epidemiological fallacies have been well explained and supported, but those claiming racism/bigotry/xenophobia etc. and lack of cultural awareness have yet to offer any evidence, maybe you could explain your basis for these claims.
  12. MunoRN

    CVOR: How many nurses to an OR?

    Mike, are you under the impression that otherwise your gown would remain on during a surgery like this?
  13. There was no claim or even subtle suggestion that the virus occurred because the people in these markets are Chinese, that would be what racism is. Claiming that circumstances which promote bacteria also promote viruses is incorrect, but not racist. I get that you don't think it's appropriate for the OP or anyone else falsely accuse someone of something, so ...
  14. There have been some flawed conclusions jumped to that could be explained by some degree of unreasoned thinking and justifiable but exaggerated beliefs, but I don't think it's racism or bigotry. Xenophobia is closer; Chinese wet markets are strange to westerners, it's a marketplace where unusual things occur, it's a bizarre bazaar. But the risk perception of them isn't just explained by it being unfamiliar. Wet markets are pathogenically high risk, but more so in terms of bacteria than viruses. Bacteria love chunks of dead and dying cells, virus not so much. It's the live animal markets that are the virus nurseries, which may often, but not always be co-housed with a wet market. While viruses are happy to wait for their next host on a piece of meat, they're not necessarily significantly more happy than on other welcoming surfaces or modes of transmission. The riskiness of these sanitation and cross-contamination practices are common enough that it's part of the dogma of a few religions, as is the idea that snakes are always up to no good. This might be why we jumped to the conclusions that this originated in a wet market, and that a snake was the intermediate host, even though there's reasonable evidence to at least doubt both of these conclusions. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext https://www.businessinsider.com/wuhan-coronavirus-may-not-have-originated-from-wet-market-2020-1 https://www.nature.com/articles/d41586-020-00180-8
  15. From the court case you reference below which started by reviewing existing case law, and upheld the established precedent that gender can be a preference in hiring nurses for labor and delivery: "Accordingly, the Court finds that the legal authorities agree that sex based hiring of obstetrical ward nurses may be a BFOQ." What the appeals court determined was that while a hospital could preferentially hire female nurses into labor and delivery positions if they could show reasonable business necessity, it could not apply this as a blanket policy for the entire obstetric department, which included the nursery, where the plaintiff had worked in a nearby hospital without issue. They also upheld that the hospital must have more than just a 'sense' that patients would have a preference for female nurses in L&D which is all the supporting evidence that Camden-Clark Memorial Hospital offered. The court reviewed the established standards to support that claim which actually can be as little as a few staff members confirming this would a frequent issue, hard numbers aren't even needed, which I would agree is a soft basis for establishing that part of the BFOQ requirement. I'm not sure what you mean by "past preferences do not substantiate proof for the whole laboring population". Data could certainly be argued to be too out-of-date, documented views of patients from 30 years ago probably wouldn't be considered representative of today's patients, but a current representative sample would be well within the established precedent for level of evidence required to claim a BFOQ. https://caselaw.findlaw.com/wv-supreme-court-of-appeals/1017040.html
  16. This was your comment on the role of patient preference, maybe I misunderstood you. Many of the same patients that may not feel comfortable with a male nurse might be comfortable with a male OB provider, which I get would seem to contradict their claim of feeling uncomfortable with a male RN except the MD and the RN provide two fairly different roles to the patient in the labor process. The MD is effectively there to serve a utilitarian purpose, whereas the nurse often plays a role similar to that of a doula, and is often seeing as being a far more intimate role to the patient than that of the MD.

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