Spider Cat

I've seen lots of input on crocs but has anyone worn Holey Soles?? If so, which do you prefer? Also if anyone can recommend a web site I would be ever so grateful.

Hi all - I'm hoping some of you lab experts out there can maybe give me some insight on my own lab values since I feel like my own health care group doesn't seem to be taking things too seriously. I had a routine annual physical and labs done a few weeks ago and all was well except the total bilirubin which was 2.0. I got called back in for a follow up for it and they had me go for the differential values (I think thats what it is??) At any rate the direct was 0.4 and indirect was 2.0 making the total even slightly higher than it had been about a couple weeks earlier. Liver enzymes and everything else are WNL. Does anybody have any ideas on this?? The nurse practitioner just keeps saying "I hate bilirubin" and I'm hearing the doc that she must have asked about it in the background saying the same thing. I had to call 3 times before anybody would call me back on it and I feel like a serious problem is going to get ignored because everybody "hates bilirubin" and doesn't want to be bothered to figure it out.

I am starting full time nights (5 - 7.5 hour shifts). I was working 3 - 12 hr night shifts and I got by with my sleeping by taking 2 Tylenol PM's on the 3 days I had to go in and slept like a log. Now that I am on 5 days I'm starting to wonder if taking 10 Tylenol PM's every week will cause some long term health concerns. Just wanting some advice from some pharmacology gurus out there.

are the core curriculum and study guide on the site enough to study and pass the exam or should I look for something else to study also? If something more - can anyone suggest something??

I'm so excited to see this forum!! Something I would like some info on is how to "trouble shoot" different things. A few things I have encountered on the floor is being unable to draw blood from a picc line/central line, leaking foleys, foleys that don't drain properly, too much residual with tube feeds, etc. It's so hectic all the time that it's hard to catch someone to enlighten me when things aren't working in text book fashion so to speak. If someone could add some comments on how to trouble shoot anything you might be able to think of I would be in heaven - and on my way to being less stressed out!

Sorry this is a late reply - but how about checking for residual on these??

Can someone give a quick and easy explanation on small bore feeding tubes? Should placement be checked by instilling air, should residual be checked by drawing back (I guess in the same manner as a peg tube would be), and how often should you do this with both a continuous or intermittent feeding administration. I have been told to very carefully instill air to check for placement and don't draw back to check for residual because the tube is so small it could easily be drawn out of place. I guess some are checking for residual though because an amount is documented. But I think I have read you should do both. Hoolahan had a very good reply somewhere here about feeding tubes but it was a very long and kind of complicated reading for someone new and confused like myself !!

Could someone help me finally understand what the ups and downs of PT's, PTT's, and INR's are? When we have someone on a heparin drip their PTT levels are drawn every 6 or 12 hours depending on what their previous levels turn out to be. When INR's are drawn certain levels are considered "therapeutic." What does this all mean????

When we have pts with a fever often times I'm told to have them cough and deep breath and encourage fluids to help bring it down. Can anyone enlighten me on how all of this works to lower a temp??

Can anyone explain to me what this test is?? My lab book just confuses me more than I was to begin with. I guess I shouldn't feel too bad though because the doc that had my pt didn't even know what is was

What are some parameters I should look for in a pts condition when deciding to request a PRN resp treatment??

I live in a very depressed area of the country and am trying to talk my husband into moving "where the grass is greener" so to speak. Any recommendations where this green area might be?? In other words - good money with a reasonable cost of living. A friend's relative just told me Florida hospitals pay about $ 32/hr with a $ 10,000 sign on bonus. But another friend said the cost of living is outrageous which I guess cancels out any gain in salary. Just dreaming of sunnier weather I guess .....................

Can anyone help me understand the theory behind this - I had a pt with a foley that didn't seem to be draining right and the pt was also complaining of "feeling like they had to go to the bathroom." The RN I was with came in and moved the tubing around a little and also said maybe the balloon wasn't inflated quite right. We got about 800 cc's of output after all this and everything seemed ok - ?????

I also would like to look into this but don't know how, what, or who to contact about it. Does anyone have an address, phone #, web site or anything to get info on local reservations? I know there are a couple in the area but have not a clue where a clinic or whatever would be for them.

Another question about Davita - how long is their orientation period and what does it consist of?? For the class room end of things, is it done locally at your own clinic or do you have to fly to their main head quarters or somewhere for it??

Any advice from anyone on strategies for starting an IV on those elderly and other difficult people with "no veins?"

What are everybody's favorite shoes?? I prefer walking shoes over regular nurse's shoes but have yet to find a pair that are really comfortable. I have heard New Balance is the way to go. What models of New Balance would be worth considering or any other shoe for that matter.

I just started working this shift because I wanted more days home with my family. My problem is on my first day on the shift I can't sleep. The second day is no problem because I am so dog tired from the first day. I usually have my weekend days together (every other) and then during the week 2 days together - usually T-W or W-Th. I can't really ask for 3 in a row because my partner on the day side of things doesn't want it and I can't make waves (I quit and this was their offer to stay). Plus this other person has been there about 20 years and I don't want to rock the boat with her. There has to be some way to do this! Since I have 2 "first" days every week I have to find a solution.

Can someone explain to me what diminished lungs are and what is the significance of this?? Everyone I ask either doesn't know or they just say it means you don't hear the usual clear swooshing in and out (probably not a good way to put it). Great Video on Lung Sounds

I am starting the night shift in a couple weeks. Can anyone recommend some earplugs, etc that I can buy online. Any other suggestions for sleeping during the day would be greatly appreciated.

Thanks for everyone's replies. I feel less stressed already. It's just when you are new you worry about everything ten times more than you need to. And I guess it's fear of the unknown like everything else is.

Hi all - I'm a new grad and have been working med-surg for about 5 months. I guess JCAHO is coming in a couple weeks and I am a wreck. I am just starting to finally not feel quite so stressed out with my new job and now I feel totally imcompetent now that I know they are coming. I don't know what to expect. Is it anything to worry about?? The management gave us this large print out of all the stuff they expect us to be able to flip off the top of our heads and some of the stuff I have never or hardly ever heard of. I work 3-11 and much of the stuff gets done on days so I have no experience with it. Help !!! I'm thinking of calling in sick at least one of the days they are there!!

I just graduated from NCCC in May (Sanborn, NY). We started out with about 130 freshman and a little over 50 ended up graduating. Their pass rate for the NCLEX was something like 97 percent and they beat us up the whole way through. Most of us thought that is was just to keep their pass rate up and for accreditation reasons, etc. I wish I had gone somewhere else but I did pass the NCLEX the first time!! Also in order to graduate we had to pass a practice NCLEX exam. Not sure if this is anything like you are referring to though.

I agree - getting the advice of an experienced nurse is so very helpful. It's just hard when they all have a different answer for everything!

I am a new grad and have been working for only a few months. The biggest question I have on the floor that I haven't been able to get a good answer on is administering pain meds. I had two pts last night - one with Dilaudid and demerol - the other with dilaudid and darvocet ordered. I thought if you gave Demorol for instance you had to wait for the time limit prescribed (q3h or whatever) to be up before giving something else unless it was specifically ordered for breakthrough pain. Some people have told me this because they are both narcotics, others say to wait for an hour or two before giving something else (if the first thing isn't working for the pt). As far as tylenol and percocet and lortab not being given together I can see the rationale for that but not the previous issue. Also have been told Toradol can be given anytime during administration time of any other pain med. I don't want to over medicate anyone but then on the other hand I want them to have the pain relief they need. The above questions concern someone not on a PCA or epidural. Not much in nursing seems to have a black and white answer to it! I'm so confused!!!!! :confused: Another question is - could someone rate some of the common pain meds as far as most effective to least effective.