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ER trauma, ICU - trauma, neuro surgical
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hodgieRN has 10 years experience and specializes in ER trauma, ICU - trauma, neuro surgical.

Worked 4 years ER (Level II trauma) and 6 years intensive care unit (trauma, neuro surgical)

hodgieRN's Latest Activity

  1. hodgieRN

    DNR's that do not mean a thing!! Help...

    If a pt has signed a DNR, it's the health care surrogate's responsibility to care out and respect the DNR when the pt becomes incapacitated. They are supposed to carry out the wishes of the pt and respect their rights. We will get a consult with palliative care and have them talk to the family member who is having a difficult time. Now, I can see the line being a little grey if the health care surrogate initially signed the DNR for the pt (maybe b/c things were going down hill) and then rescinded it. But if a pt has signed a DNR on their own free will, I don't really see doctors ignoring the DNR when a family member speaks up when things are starting to happen. I think disregarding a DNR does have consequences. It violates the rights of the pt. Maybe their should be law suits against family members who ignore a pt's rights and put their loved ones through futile torture.
  2. hodgieRN

    How do I change my outlook?

    I think the instructors may emphasize passing over getting straight A's because there's lots of students who are terrified of not graduating. There's a tremendous pressure that students bring on themselves and it can cause anxiety all through school. I think if a teacher says you only need to pass, it's to help ease the students who are barely passing. If you can get A's, do what you have to. You will have more options in the future.
  3. hodgieRN

    Do i stay or do I go? helplessly stuck

    Did an academic adviser tell you about the direct transfer?
  4. If you don't have a job, you can try to do task-paid stuff like house sitting, baby sitting, dog walking, maybe some cleaning? When I was in school, I did have a job, but was always looking out for some more money. I asked my neighbors if they ever needed anything with the house or lawn. I mulched a couple of yards, mowed some lawns, things like that.
  5. hodgieRN

    Anyone getting calls for flu shots?

    Lol! I love your posts!
  6. hodgieRN

    Why I Refuse Flu Shot

    You mean you've never been symptomatic.
  7. hodgieRN

    fentanyl dosing on a vent

    If we really need to sedate a pt (like with ICP monitors with cerebral edema, or even ARDS pt on pronator beds) we can go up to 600 mcg/hr. I've seen fent 600 mcg/hr, versed 10 mg/hr, propofol 70 mcg/kg/min. That's what it took to keep em down. Crazy stuff.
  8. hodgieRN

    CCRN help!

    Laura Gasparis also has an awesome questions book (I think over 1000 ques.) and a reference guide (pearls).
  9. hodgieRN

    another ICU nurse's opinion

    I've seen a calcium gtt once (for Ca channel blocker overdose), so not sure if we have a protocol. I'm sure we do or pharmacy knows. If the ionized Ca was 3.7 and the goal is 4-5, then from what the dosing say, I would increase it by 1 meq. Would need more info on the starting dose (1meq/hr?) and how often to draw ionized Ca levels. I would assume a CaCl infusion would need a central line. Ca infiltration would destroy skin and tissues.
  10. hodgieRN

    Hyponatremia question.

    There are diseases that can cause primary hyponatremia in normal volume states, however many cause the body to ultimately shift volumes due to ADH. (so basically yes and no). Pneumonia is one (more specifically, viral pneumonia). Certain lung cancers can cause hypoNA like Oat cell carcinoma. The cancer itself produces antidiuretic hormone, which make you hold on to water. Liver cirrhosis is one, nephrotic syndrome (kidney is damaged and leaking too much sodium into the urine). Head trauma is another, but that is also from too much ADH. Hypothyroidism also, but that b/c thyroid hormones interact with the pituitary, which is responsible for secreting ADH. Water intoxication like Esme said. I believe anesthesia causes a release of ADH and hypoNA. The only lab to diagnose HypoNA is a low sodium level on a basic metabolic panel. As for what to order to find the primary cause, well that's the differential diagnosis question. Is it from head trauma, the pituitary, the lung, street drugs, anesthesia...If the primary cause can't be found, then that where endocrinologists come in.
  11. hodgieRN

    Advice for exams?

    Well, it sounds like you are definitely studying enough. Sounds to me that you are interpreting the test questions wrong. Most people have a a hard switching to the critical thinking questions. Maybe you are having issues with the NCLEX style questions. It sounds like you are learning enough material. In nursing school, the material is only half way. You have to apply the material in a scenario or use it to weed out other answers. Above all else, make sure you are reading and understanding what the question is asking. The scenario in a question might make you feel like you have to pick an answer that's best for a pt overall, but the the answer is the answer to the question, despite whatever the scenario is. For example, a question might say " A pt has a blood pressure of 91/52 and a HR of 61. Has history of cardiomyopathy. What med do you give to alleviate cardiomyopathy? A) ace inhibitor or B, C, D, etc. The answer is A. That's one of the treatments. Now, you might say...That's a trick question...you don't give an ace inhibitor because it's blood pressure medication, and if you give that, the blood pressure will drop and the pt will die. The 91/52 has absolutely nothing to do with the question. Nothing. It's irrelevant. The question is what med do you give to alleviate cardiomyopathy. Just answer the question. Nothing more, nothing less....unless it question asks for it. They will throw in irrelevant information, curveballs, etc. Now, if it mentions that the pt is unresponsive, cold, clammy, and the question is asking the priority, than the answer is different. Take a step back and look at the question from a different angle. Ask yourself, is this a question about assessment, maybe intervention, maybe evaluation? Is this a question about safety? If it is an assessment question, then the evaluation answer is wrong....even if the evaluation would, in fact, be the right choice if you were evaluating it...but it's not an evaluation question. Think of exams like trick questions. Let me give you an example that is way over the top. You have 4 items...a car, a cell phone, a computer, and a chair. One of these items is the smallest of the 4. How many fingers are on your hand? See what I mean???? Is this a question about the smallest item or a question about fingers on your hand? Now, a cell phone is absolutely the smallest item, but that is not what the question is asking. The good thing is, that one answer that seems really weird or out of place, might be a clue to the right choice. If you saw the choices it would be a) car, b) cell phone, c) computer, d) 5. 5 doesn't fit the other, but maybe there's a reason it's there. If you go back and read the question, then it makes sense. You can learn all the material you want, but you have to learn how strategically take exams and dissect the question. Hope this helps.
  12. hodgieRN

    Splinting Post-Op

    If it is not abd surgery, maybe they are referring to ortho surgery? There's lots of splinting with hip, elbow, arm, hand, pelvic, leg fractures. There's splinting in vascular surgery too. If someone severed their brachial, the arm would be splinted until the graft heals.
  13. hodgieRN

    Why do you choose to start IVs in certain veins

    Consider the size of the vein b/c medications can burn and veins can blow. If you have to give IV potassium, the higher up the arm, the less it will burn. Veins become thicker as you move up. Hands will burn more than AC's. Hand IV's can become dislodged easily since pt's obviously use their hands. Forearms will stop the pump from beeping. Never forget that you can use the upper arm. You may find that there's nothing AC or below and find a pipe right on top of the bicep. Plus, you'd be surprised that people do draw blood from the forearm with fluids running through the hand. If it is higher, than there's less of a chance for that mistake. Lastly, different spots hurt more than others. Top of the hand can hurt. So can the inner forearm and the wrist. A pt may tell you that you only get one chance, and your only option is to go for the sure thing in the AC. It all depends.
  14. hodgieRN

    Central lines

    The big factor between the two is right in the title. PICC's are peripherally inserted central line catheters while a central line is just a central line (usually in the femoral, subclavian, or jugular). PICC just means it was placed in the arm, therefore, peripherally. If you think about it, peripheral means in the extremities. Anything not in the extremity is considered central. They both end up in the same place (the superior vena cava or at the cavoatrial junction). Both can be used long term. Tunneled describes the path to insertion. If it is tunneled, then the catheter is tunneled under the skin to the site (just like a tunnel leading to a cave...the entry point is different then the end point). Non-tunneled means the catheter enters the vein directly under the skin. This is a tunneled Port. See where the port was inserted and the tube tunnels under the skin to the neck. There are different reasons for a PICC vs CVL. Some PICCs have valves in them so they don't clog. PICCs are usually put it by IV team (sometimes in radiology), so it's more convenient for doctors to order a PICC and not have to insert a central line. Only docs and CRNA's can insert CVL's (basically). PICC's usually have two lumens (sometimes 3) so the catheter can be smaller and it's more more convenient. CVLs usually have 3-4 lumens, so the cath is bigger. You can give meds and blood faster in CVL's (if necessary). If a pt is really sick and on multiple IV drips, a two lumen PICC line is not enough. A 4 lumen CVL allows the nurse more access (since many drugs can not be mixed together). If you want a central venous pressure (CVP) aka right atrial pressure, a CVL is best. Yes, you can use a non-valved PICC for a CVP, but sometime you have to take that with a grain of salt. PICCs are longer, smaller, and can get sludge or crystalization over time. A nice, big, patent CVL is more accurate. And, when speaking in terms of infection, I think PICCs are a little more easily managed. I'm not gonna talk infection rates with studies but I will say this....Femoral CVL's have about 24 hrs before infections dramatically increase b/c it's located in the groin. Skin folds is the groin are not clean. If a groin CVL was put in, it's because it was an emergency and you are buying time for a PICC. Tegaderms on a neck CVL can sweat off, or have hair underneath them, or get kinked during turning. And forget trying to manage one with a c-collar on. A PICC dressing is away from everything and the tegaderm is usually always intact.
  15. hodgieRN

    getting sick from microbiology

    You need to chill or else you are going to convince yourself that you have every cancer that you learn during lecture. Most times when people are "sick," its viral. You are 10 times more likely to catch something in the community then in micro lab.
  16. hodgieRN

    Question about hand hygiene

    It literally impossible to only wash your hands according to guidelines. Hand sanitizer makes it more realistic. You are supposed to wash before and after just pushing a button on a pump. Even after you use gloves. If you don't use sanitizer, then you are either skating or washing 500 times a day.