limabean

Hey rngrl...I took the PCCN not too long ago so I can give a little advice. I studied my nursing med surg book. I know it sounds awful. But I just went through the list of items from the PCCN review list and looked up these topics. I really think that is what helped me the most. Also I listened to some review cd's which were great. Type in a search for "PCCN". A couple of us had some discussions some time back about it. Good luck!!!

What is the general rule for testing PT/INR levels on someone newly prescribed coumadin? My aunt went to her pcp recently and he did an ekg that showed afib with rvr. He started her on coumadin and toprol and sent her on home. He told her to come in 3 days later to check the pt/inr levels. Then she went almost 2 weeks before getting another level checked. He calls her at home tonight and tells her to go to the ER immed to get a vit K injection. I dont know yet what her INR level was but she said he sounded very stressed! I have been trying to tell her all week that this is not a benign drug that you dont have to worry about. We check pt/inr's daily on our pt's that first start taking it and then weekly for awhile....also it is adjusted constantly. I'm just wondering, am I overreacting or shouldn't you be tested more frequently? Not asking for medical advice ...just wanting to know what you all have found to be the accepted protocol for coumadin levels. Thanks.

I was wondering what type of pain prevention is an infant given during circumcision? Somewhere in the back of my mind I remember hearing that it is up to the physician performing the circ if the infant gets any analgesia at all. Like I said I dont know if this is true...just wondering.

Absolutely write him up! We have a transporter very similar to this at my hospital. He refuses to sign anyone out (which may not sound like a big deal, but when you go into your pt's room and he is not there it can kinda freak you out sometimes). Also he always wants to take the patient by wheelchair. More than once he has come to the nurses station to ask if the pt could go by wheelchair...we say no...then he goes back and asks the pt if he thinks he is up to going by wheelchair. Usually the pt will say yes b/c they do not want to be a problem. What the transporter does not realize is that we usually have a very good reason to say no to the wheelchair. You are ultimately responsible for your patient...so write him up and maybe even call and speak to his direct supervisor.

Sorry it took so long to post a reply...I was at work all day. It is definitely not a foley type. It has a small flat piece that lays against the skin to help keep it secure....I didnt see any sutures though. No abdomen distension and good bowel sounds. It was not leaking nearly as much today as yesterday. I was able to speak with the surgeon this am...he seemed to be okay with it leaking the amount it was. He was just concerned that it was not leaking stool, and it was not. Thanks for all your replies...I learned a lot about g tubes...I had no idea there were so many types.

I had a pt today with a peg tube that had some leakage around the site. A KUB had been done yesterday and it showed the tube to be in good position. Well when I changed the dressing there was what looked like some tube feeding around the site and on the dressing. Then later when I gave a med thru the tube (which was red), I decided to see if it was still leaking. Sure enough when I lifted the tube upward the red drainage started seeping out. The surgeon had come by early am and had commented in the progress notes "No drainage around g-tube site". (Which by the way wasnt true b/c I changed the dressing about 30 mins later). So I called the doc on call and he said he thought it was alright and that the other surgeon would re eval in am. My question is...how much is too much drainage from the peg tube site? What could be causing this? Thanks.

I dont even know what words to say after reading your post. I am devastated for you. I think you are so courageous for coming on this site and posting your experience. You never know what other nurse in a similar situation may be helped by your post....knowing that he/she is not alone. I pray that you are getting the support you need from your family and coworkers. Your words are one of my greatest fears come true. The very scary part is that it is sooooo easy for something like this to happen. How often we nurses are all in a hurry, or tired, or just being human beings -- we can make a mistake. I am so sorry this has happened to you - I'm praying for you. God bless you.

BLS is "basic life support." If you need to take the BLS for healthcare providers, this covers adult and pediatric CPR, foreign body airway obstruction, and use of an AED (automated external defibrillator.) Some other classes are taught to the public which just cover CPR and choking. If you look on the American Heart Association website you can click on : find a class near you. Also some of your local hospitals may have information posted on their websites about CPR classes that they offer. www.americanheart.org

Those kind of stories are great to hear! Just when you start to wonder sometimes if many docs have a heart... We have a doc that has been known to go to a patients house and bring them in to the hospital b/c they are unable to pay the ambulance cost and they have noone to bring them in. I sure do wish there were more people out there like them!

I had a patient who had chronic pain and was on pain meds all day long prior to discharge and while in the hospital. Well he was discharged and his significant other was going to drive him home (1hr away). As I was giving out discharge instructions (post heart cath) the driver's head was nodding off and eyes were closing. She seemed to me to be on something...very giggly and then when listening to instructions she would practically fall asleep. (I could be wrong but that was my judgment). Well I called the doc to let him know that I did not feel comfortable letting the pt go home with this person as a driver. So he meets me in the room to "assess the situation." He asked her her name, where she was, if she had taken anything that would impair her driving ability and if she thought she could drive the pt home. She was able to answer all of these questions. So the doc says it is ok to let him go with her. So we let them go. I just had a bad feeling about it. Did I do the right thing by calling the doc or was it my responsibility to judge a person's ability to drive my patient home? Just curious in case this ever happens again. Thanks.

thanks nurseboy!

Celia....I have not heard of NTI - what is it? Tele... It was pretty tough wasnt it? Just studying for it really increased my knowledge base. I hope you did good!

I can not believe they had the nerve to call her right after you had called them on their mistake! Like that would somehow cover their butts! I would raise a major stink about that and insist on speaking with the physician. He needs to know about it so maybe he can set up a different system that will prevent huge lab errors from occuring. I'm surprised she wasnt comatose with a BS that high. Sorry that happened to her.

It is a standing order at my hospital for a patient to get at least an INT. We dont start one only if the doctor says not to....as in your situation. The reason is b/c you need to have an access in case of an emergency situation. I think if the patient is sick enough to be admitted then they need an IV. You dont want to have to start an IV in the middle of a code if you dont have to. However, if they are just there for a short time and the doc says no IV needed then I wouldn't start one. Also with your pt he was a dialysis patient so I'm sure he had an access that could be used in an emergency situation. I'm sure policy is different everywhere.

Hey guys....someone I knew had the David Woodruff audio CD's. They were a big help!! I only had the pulmonary one's and I made a 92% on that part. I listened to them in my car when I was going anywhere. Also definitely study hard for the cardio. I felt like the whole test was cardio. Especially angina and MI and CHF. Know your ABGs in and out! Also study fluids and what the different types are used for (1/2NS, D5W, etc.) ...I have always had a hard time with that. I think one of the best things I did was study my med surg book. I read the entire cardiac section a few days before taking the test. If I had not done that I dont think I would have done as well. It brushes you up on some of the basic stuff, like preload and afterload and drugs. Oh and I did not take the pccn self assessment test on the website, but I think it would be valuable. Feel free to email or pm me with any more questions! Good luck to both of you!

Hey telefloornurse....I was just wondering if you have taken your exam yet and how you thought it went. I just recently took my exam and I thought it was pretty darn tough but I passed. Good luck if you are still waiting!

I am wondering if the pain I am having in my leg is a varicose vein? I really dont know what it is b/c I have never had a varicose vein before. I can just barely see a vein under the skin...it is not bulging or anything. But it aches! Like a dull crampy pain. It is getting worse, and it is also painful when I am resting. It is right in the popliteal area, now progressing up the back of my thigh. Does this sound like a varicose vein kind of pain??? I'm going to the doc tuesday.

I'm not really sure yet about the details. I dont know if we will be using the automatic cyclers. I will know more after I go to the inservice in a couple weeks. I believe the inservice is being taught by our unit educator, but we'll see. And from what I understand we will probably not have that many PD patients in at any one time. But many of the nephrologists in the area have decided to only use our hospital (our floor) for their PD patients once we start taking them.

Thanks for replying NephroBSN....no, we do not perform hemodialysis. We are the only floor that takes the ESRD patients (we send them to dialysis and manage their other multiple problems on the floor). We will now be getting peritoneal dialysis patients which the hospital has not been able to do thus far. Like you said most pt's know how to do their own peritoneal dialysis, but we will have to know how to manage these patients. And many of the patients that will be admitted to the hospital will be too sick to take care of it themselves. The nurses on our floor will be the only ones in the hospital able to take care of these patients and perform the PD. I am just curious to learn how in depth this is. We are going to be given a 4 hr inservice on how to do peritoneal dialysis soon. Thanks again.

We are about to start doing peritoneal dialysis on my telemetry floor. We are considered the cardiac/resp/renal floor so we get a little bit of everything, including stable vents, trachs, all dialysis patients, heart caths, etc. Our current nurse to pt ratio is at the most 1:6 on day shift. I have no experience with peritoneal dialysis and I am just wondering how difficult you dialysis nurses think this will be with possibly 5 other patients? Maybe it will not be so bad, I dont want to judge until I've experienced it. However, I would like a little "heads up" on how you all think this will be. Thanks for any input.

Oh my gosh....I thought I had it bad sometimes!!! I have never heard of anything like this happening on a stepdown unit! I dont know what else you could have done, except maybe have another nurse check on your other patients while you were running the code. But hey, it looks like nobody was really willing to help much at all. I definitely dont think it was your fault. No matter how much training the nurse before you did or did not have, there is no excuse for that much misinformation in a report. Something needs to be done about that! I am amazed at the number of things that were compeletely wrong with this patient that she did not pass on to you. It is almost like she gave you report on another patient! Thank God the open heart patient had a nurse like you to take care of him, otherwise the hospital might have a major lawsuit on their hands and more importantly a patient might be dead.

That is a rough situation to be in. But you know if it were the other way around and you had slandered the doctor (like telling a patient they should not go to that particular doctor) then you would most likely be held responsible by your hospital. Money, money, money is all the world seems to think about. And the physicians are the ones that bring in the money. It is easy to say that you should not let this one go...but it is going to be rough if you choose to follow the legal path. Good luck to you....you dont deserve the treatment you are getting!

tele....why are you taking the paper and pencil test if you dont mind me asking? Is there an advantage? I also bought the CCRN book called "Pass CCRN." It is helpful but I have found that it has so much information I find it hard to decipher what I need to study. I was able to borrow some review tapes and CD's to listen to and they were VERY helpful.

hello...I am taking the PCCN in May also. I wish I could offer us both some advice. I was hoping there would be some responses to your question, but I dont think many people have taken the exam. Have you looked at the AACN website? It has a list of all the topics to study up on. Good luck to you! I hope we both pass!

caroladybelle, I purposely never did say "If we are wrong and there is no God it will not make a difference" for the very reasons you stated. I do not believe there is a "faith faucet" that can be turned on and off, and I believe that God would not accept a belief in Him if we were only doing it for our own benefit. The questions I asked are just the basics of what many Christians believe the bible to say. I'm sorry if my statements came across differently.