kainos

Don't forget to study pharm...

So would your boss have preferred you to dig through the sharps container looking for the PICC after the MD deposited it there???

I have wondered about these types of cases also. It appears that there is often a not-so-subtle conflict of interest with employee/occupational health outfits. Their revenue is obviously tied to employers being happy with them and using their services. How do they get employers to be happy with them? By pushing hard to reduce the amount of time employees are on worker's comp and light duty! I have seen distugusting examples of these rent-a-docs saying employees who are still obviously severely injured are somehow capable of returning to full duty! I'm sure you can challenge the opinion of these docs by getting a second opinion from a spine specialist and perhaps getting a lawyer. It shouldn't be difficult to defeat the incompetent "opinion" of a general practice rent-a-doc with the opinion of a recognized specialist, but I don't know how the power dynamics play out in those cases.

Okay - you'll really want to read this... Metabolic acidosis actually causes a relative serum HYPERkalemia (not hypo). Read the section "General Physiologic and Metabolic Effects": http://emedicine.medscape.com/article/906440-overview#a0104 It also explains how this hyperkalemia affects the ECG. This makes sense now. I remember my teacher telling us that if a pt has DKA, even if the potassium lab is high (it likely could be high d/t the acidotic state pushing potassium out of cells), the pt will still require potassium replacement because once the DKA is corrected the potassium will be pushed back into the cells and then the serum potassium level will drop into the hypo- range because of the potassium that was lost via diuresis during the DKA episode. I think my pt's potassium was low because they drew that lab after they had already been correcting the DKA.

Hmmm... I just had a peds clinical pt (12 yo male) who came in with DKA. He was hypokalemic (lowest was 2.4) and hypo- (not hyper) calcemic. Maybe that's just an anomaly - any thoughts? I think I remember my Mosby lab book suggesting that hypo occurs with both Ca & K in DKA d/t osmotic diuresis. I guess diuresis totally changes the game when it comes to DKA & e-lytes.

Our nursing school was SOOOO picky about exactly what needed to appear on the vaccination form: the name, address & phone # of the provider; the full signature (not just initials) of the licensed nurse along with credentials; FULL details of each vaccine, etc., etc. If just ONE of those pieces was missing, the entire documentation was worthless. It was just easier for me to get titers drawn. I got my vaccines in late 70's - my "record" was a little baby book my mom filled out. Half of the vaccines had scribbled nurse's initials, the other half had no initials. When I have kids, I'll record an HD or IMAX video of each injection and bring a notary public with me to get some hard-core documentation. My kids will thank me when they need it later in life

I know of a woman who was in a coma and was regularly handled in a very rough manner by a certain tech who changed her linens & repositioned the patient. During one of these rough handling sessions, the woman awoke enough to plant her first firmly in the side of the tech's face!

Wouldn't it be nice if nursing schools devoted a little less time to NANDA scrabble and PC social studies topics and a little more time to useful stuff like reading ECGs?

I totally want to post that Bristol chart in our break room!

No corn-laden option yet, but maybe I'll suggest that in our next staff meeting. Perhaps we should have a numerical corn density rating to accompany that (kernels per gram)?

I was charting a BM in our computerized charting & it asks me (from a drop-down menu) what the "texture" of the BM was. There were options like hard, soft, liquid, etc. One of the options for texture was "fecal." Can anyone describe what a fecal-textured BM is Gotta love computer charting!