BAndersonRN

Fresh air is always nice! And it would be nice if we could open windows in the hospital, however just as TazziRN mentioned, the ventilation and climate control systems that are used in the present day are much more elaborate and advanced than what they had 150+ years ago in Florence's time. Not only is there potential problem for patients exiting out windows, but also the possibility of pollen, mold spores, air pollutants, insects, and other potentially irritating substances that would then easily gain access to the hospital. It would also result in the heating and cooling systems working overtime and just overall isn't really that good of an idea in modern day hospitals. Florence was trying to stress that improving air circulation by opening windows would allow for ventilation of stale, stagnant air. Back in those times it was thought that cool night air could cause pneumonia (actually some people still think this today..."Don't go out into the rain without a coat on, you'll catch cold" etc...) so they would keep the windows closed to prevent drafts, cool air, etc since they thought that this was the culpret in causing disease.

Well, I must admit, if this really happend its a shame... Very disheartening to hear that so many professionals from the same hospital are binging on illicit drugs together. I'm gonna go ahead and suggest that the story sounds a bit far fetched though (BS???). Kinda tough to swallow that the OP is able to recall the Jobs as well as professional credentials (ie BSN, MSN, etc.) of all eight members involved in polysubstance abuse including cocaine, ecstacy, methamphetamines, nitrous oxide, EtOH, etc and using it all together in the same night across the street from the hospital... and that 6hrs had elapsed and the OP remained in the situation and even observerd the "ER charge nurse MSN" instructed the others to "do [coke] as much as they can to be sharp for work" Sorry but I just don't buy it... Good attention getting story though...

Sorry to hear that you're having a rough time with your new job, and new role as a nurse!!! It sounds to me as if the facility where you are working is probably not the safest of places, for patients or staff! I do have a question for you though.. If you just passed your boards two days ago, how is it that the facility you are working in has had you off orientation and on your own now for that past eight shifts??? Correct me if I'm wrong, but have you been taking patient assignments and providing nursing care for the past eight shifts???

Although I don't always conciously use a particular theory in my day to day practice, I do like Orem's self care model (essentially do for the patient what they would do for themselves if they were able to) and a new theory that I have been studying in my RN-BSN program is Dr. Betty Neuman's Systems Model. I find that the Neuman Systems Model can be applied in virtually all settings.

sure, im speaking primarily from my own experience in working as a neuro critical care nurse, most if not all neurosurgeons that i've worked with place their patients on dilantin or cerebyx if the patient has sustained any type of bleed where blood would come into direct contact with the cerebral cortex (ie sah, sdh, ivh, ich) (dr. christopher baker, orlando neurosurgery assoc.) i will add that you are correct in mentioning that if there is no prior hx of siezures some studies do suggest that in the long term (emphasized on the "long term") treatment of patients there is no evidence in prevention of seizures. however, some studies also suggest that if seizure prophylaxis is initiated early in the course of an intracranial hemorrhage (limited to 1 week post injury) there is a decrease in risk for seizures early on in the course of treatment. "therapeutic goals are blood pressure control, prevention of seizures, treatment of nausea, management of icp, prevention of vasospasm, control of pain, and maintenance of cerebral perfusion."([color=#333399]george jallo, md, assistant professor of neurosurgery, department of neurosurgery, division of pediatric neurosurgery, johns hopkins university school of medicine. 2005) "a systematic review of the use of drugs to prevent seizures after head injury identified ten randomised controlled trials and had data on 2036 patients.7 four unpublished studies with another 630 patients could not be included. there was consistent evidence that the early treatment with antiepileptic drugs, most commonly phenytoin but also carbamazepine and phenobarbitone, decreased the relative risk (rr) of early seizures (0-34 (95% ci 0.21-0.54). treatment of 100 patients would result in the avoidance of early seizures in ten patients, but mortality was not decreased (rr 1.15 [0.89-1.51]). there is even greater uncertainty from these studies about the effect of antiepileptic drug treatment on a combined outcome variable of death or significant neurological disability (rr 1.49 [1.06-2.08] for carbamazepine and 0.96 (0.72-1.26] for phenytoin). furthermore, there was no evidence that the decrease in early seizures was accompanied by a reduction in late post-traumatic epilepsy (rr 1.28 [0.90-1.81])." (taken from:chadwick,d. (2000) the lancet. seizures and epilepsy after traumatic brain injury

I've also heard that Dilantin was used at one time to treat tachyarrhythmias since it slows the influx through the Na+ channels. Because Dilantin (phenytoin) does have the ability to cause cardiac depression it should be given no faster than 40-50mg/min IV push, and as everyone else has mentioned it is only soluble in normal saline since it will precipitate in many other IV solutions. This is because Dilantin itself is highly insoluble and therefore must be mixed in propylene glycol (same chemical found in antifreeze) to improve the solublility of the IV form. Another drug that was mentioned earlier in the post was Cerebyx (fosphenytoin). This drug is actually a pro-drug of phenytoin, it is metabolized in the serum and converted to phenytoin (Dilantin) in the body. Fosphenytoin is much more soluble in solutions than phenytoin is and therefore does not need to be mixed in propylene glycol for IV administration. Cerebyx is dosed in PEs (or pheneytoin equivalents, ie. 50mg phenytoin= 50 PEs fosphenytoin). The benefit of using Cerebyx is that it doesn't have the same cardiac depressant properties as Dilantin so it can be given much more safely (and may be pushed faster too, up to 150mg(PEs)/min) to patients who may not be quite hemodynamically stable, the downfall is that Cerebyx is much more expensive than Dilantin (Cerebyx is about $80 per gram compared to Dilantin which is about $5 per gram). Seizure prophylaxis has been demonstrated to be effective by using either drug in patients sustaining a CHI/TBI, subdural hematoma (SDH), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) as long as it has been initiated early on in the course of treatment for the patient.

American Heart does offer CPR for the healthcare provider online. Its a great option if you don't have all day to sit through a class since you can take it on your own time. You do however, after taking the online class and written exam, have to have your skills checked off by an american heart assoc. instructor... I think you have up to 30 days after taking the online portion to have your skills verified... go to http://www.americanheart.org to check it out... hope this helps... more specifically http://www.americanheart.org/presenter.jhtml?identifier=3019205 its actually a BCLS for healthcare providers renewal.. you can also renew your ACLS online too....

P.S.... if your only looking to make money in the "medical profession" (say more than $100,000/yr.) and you don't want to become a CRNA, I would suggest going ahead and getting yourself an education... in Medicine :) With your "RNBSN" you can go right ahead and apply to school! Good Luck!

Are you sure you are an RN, BSN??? Or are you interested in becoming a nurse? I would strongly suggest entering the profession for reasons other than solely money! Becoming a nurse anesthetist takes a lot of time, work, and energy. Not only do you have to have a BSN to get accepted into an anesthesia program, but you will also need to have some considerable experience working as an RN (at least one year, if not two) in a critical care environment where you are managing invasive hemodynamic monitoring, advanced airways/ventilators, vasoactive gtts, etc. and not to mention a masters program will want to see in its applicants a motivator other than money for becoming a CRNA..

I currently work at Florida Hospital Orlando and Love it! I've been there for just over a year now and my only complaint about the organization is the documentation (too much double documenting) other than that they are a great system to work for. The staff is friendly, pay is competitive (for FL anyway), and they are very big on continuing education (which I really admire about the organization!) If you are going to work at Celebration I think you will really enjoy it. I haven't been through it yet, but from what I understand its not quite as busy as the downtown hospital and its one of the newest hospitals in the system. Its very modern, and a lot of people comment that FL Hosp. Celebration resembles a Hotel rather than a Hospital. Hope this gives you a little insight, let me know if you have any other questions... -Brian

I agree with everyone else!!! I started out as a new grad RN on a neuroscience unit. I feel I've learned as much priortization/ MedSurg skills starting out there as I would have on a regular MedSurg unit (plenty of Assessments, IVs, Dobhoff/NG tubes, Dressing changes, meds, EKGs and patho in addition to all of the comorbidities that a lot of Neuro patients present with!!!). If your heart is in neuro then by all means go with where your heart leads you! No reason why a new grad shouldn't persue their interests (keeps you motivated to learn if its a topic/subject you find interesting... and for that you'll succeed in whatever it is you choose!) Good luck and welcome to Nursing!

We of course only wedge per doctor's orders, but typically for a stable pt we wedge Q8hrs (and of course if they're really that stable we d/c wedges or d/c the swan all together if we're not infusing anything through the proximal port). As far as a pressurized line for the swan we only use saline due to the possibility of heparin induced thrombocytopenia (apparently using just plain old saline is just as effective as a heparin solution).

Florida Hospital in Orlando, FL has a great Residency program for new grads wanting to enter into critical care. Last year when I started I had no problem getting a day shift position in the Neuro Critical Care Unit.. and I know that in the Neuro ICU we have 2-3 day shift postions still open...if you don't mind moving to sunny florida check out the web site... www.linktoyourfuture.com

The internship programs they offer are pretty good. Primarily builds on nursing theory relevant to the unit/area you plan on working in. I recently completed the CCNIP (Critical Care Nurse Internship Program) and found it to enhance and encourage critical thinking skills used in the critical care environment as well as introduce concepts such as invasive hemodynamic monitoring, ventilators, and vasoactive gtts. As far as having a nurse's union, Florida Hospital does not have one (they are a non-profit organization). Good luck in finishing nursing school! Hope you find nursing to be an exciting, challenging, and rewarding career as I have!!! Let me know if you have any other ?'s regarding the hospital and the internship programs (i'll try to answer them as best I can.. )

In addition to a cardiac workup, i would strongly suggest a neuro workup as well. Change in hearing out of one ear? Still dizzy? In addition to the possibility of vertigo, also sounds like it could be s/s of acoustic neuroma (benign tumor on the eighth cranial nerve). Can be diagnosed with an audiogram and MRI.. Let us know how things are going.. Hope your feeling better soon!