A&Ox6

Does anyone know of someone who would share a recent syllabus for the patho and pharm courses so that I can start prepping?

Got my acceptance this week to the PNP primary care post graduate certificate. I got my schedule and it looks reasonable.

Thanks. I was feeling a little lonely

Rebooting an oldy, but I am missing y'all. Repping my school nurse pride in pink. (No, I am not back in school nursing, but once a school nurse always a school nurse.)

As a foster Care nurse, I think this is a great idea. In fact, o sometimes feel like my two main roles are psych and women's health

I am not really sure why you are upset about my post. I responded to a poster who bolded my use of client stating that she doesn't have clients. I responded stating that she may not have clients, but I do because of my work. While I currently work in foster care for medically and emotionally fragile persons, I have had experience in school, acute psych, and urgent care. I also was crosstrained to ED and med surg so that I could float. Therefore, I have worked with adult patients and individuals who come to the ED on a nightly basis for the turkey sandwich. I stated that I cannot do what ED/ICU nurses do as a way of recognizing that this is not my area of expertise. There has bewn a long history of elitism of some "designer" specialties in nursing. My statement was a preemptive attempt at explaining that just like I don't do what you do (because I don't) you don't do what I do. I don't really understand your statement regarding foster kids and ED. I understand that foster care is different in every state, but my clients are not all "wards of the state" from a medical perspective. Some biological parents remain as medical consenters. As such, a child in foster care is not always brought by a guardian to the ED. In fact, some of our foster parents are also ineffective in this manner. It may not be good, but it is reality. While I know that this OP referred to a simple headache, this thread has evolved, and many other examples have been addressed. Some of those examples included migraines, back pain and sickle cell. In general, many clients with SCD are labeled in EDs as med seeking. this actually does affect my child and adolescent clients because they receive mixed messages regarding treatment of a vasooclusive crisis. Regarding you not wanting to work in foster care, I will just say that very few nurses like to work in foster care for many reasons including low pay, limited appreciation and sometimes stigmata that rub off on us. However, I truly believe that I am doing important work, which can potentially improve the outcomes for our clients. Therefore I am glad I do what I do.

I will be completely honest, I cannot even understand this post because of the unconcealed animosity. In my line of work (foster care) I have clients And not patients. Secondly, I am not saying that ED is not overwhelming and difficult. I am saying that you may be misjudging some of my clients' actions. I am also saying that your frustration with the system only works to alienate those who truly need care. Lastly, just I only mentioned floating to the ED because I have seen and experienced some of what you deal with and I have the utmost respect for you. However, as a nurse who has worked in a number of second-class nursing positions (school nurse, psychiatric nurse, and foster care) I am really frustrated by the opinion that ED/ICU/other specialty are the ultimate in nursing. Just like I could never do what you do, I would wager that you would have a very hard time with any of my positions. If you would like to rewrite your response to me in a less inflammatory and condesce so f manner, I would be glad to respond in kind.

It should work, but for some reason it didn't. I think part of the issue was that I didn't know how to work the exam table in the "clinic" as I had never been in there before the exam. Now I am really scared that the same will happen on the final.

[quote= Just to be clear - I'm NOT accusing you or anyone else of anything. I'm merely stating the situation as is. Because this isn't limited to migraineurs - sickle cell, fibromyalgia, chronic back pain, RSD, neuralgia... you name it. ALL manner of chronic conditions are sent to the ED - the place least equipped to manage it appropriately. Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency. cheers, I appreciate your response, but I think there are some errors in what you are saying. First of all, I work with children with sickle cell disease on a regular basis to help keep them out of the hospital. We focus on self management and the like. However, as pain can be a sign of VOC (vaso occlusive crisis), we do need our clients to get emergent care for this pain. While the hematologist should see the child at regular intervals and soon after an episode, it it's unrealistic to expect that they see the patient within the needed timeframe if this occurs at night or on weekends. My clients do tell me that they avoid emergency rooms, even in an emergency because they are often labeled as drug seeking or not requiring emergent care. Going back to other chronic conditions. Every condition had signs of am emergency. As an example, I have chiari I malformation. I am well managed, and not yet a candidate for surgery. However, I know that if I experience certain symptoms such as severe headache with stiff neck, hemiparesis and new symptoms, it could be a sign of an acute herniation. I understand that emergency nurses are stressed and often have too many patients too deal with. In a past job I was often floated to the emergency room. I just want to remind you that individuals with chronic conditions may or may not seem to need emergent care, but oftenthey are following a treatment plan. Also, remember that providers who see clients on an outpatient basis need to send individuals to emergency rooms because of the nature of office hours. Lastly, some clients go to am emergency room because they have poor health management. Finally, I will agree that not everyone who goes to the emergency room needs to go, but please don't take it out on those with legitimate chronic diagnoses. Why should sickle cell and migraines be treated any differently than diabetes and hypertension. All for can be managed in an outpatient basis but may have specific symptoms that necessitate emergency room visits.

We have never used them either. No idea why the DOH decided to give them to us now.

As a migraine sufferer, I too take issue with the title of this thread. I have had migraines that caused me to temporarily lose vision, migraines that caused syncope, migraine that seemed like a hallucination as well as other status migrainosus. However, due to the current attitude towards young females with migraines, it took many years for chiari I malformation to be diagnosed. I also have had psych consults called when I came in for left sided paresis and syncope. Only after I was psychiatrically cleared was any bloodwork and imaging done. The interesting thing is that my migraines respond only to infusions of magnesium and dexamethasone. I cannot take any opioid due to anaphylaxis, I have to be careful about APAP because of liver functions related to overmedication as a teen by a doctor, and I can't take too much NSAIDs due to multiple bleeding ulcers. I am lucky that I have not had a migraine emergency in almost a year, but I think it is very important to remember what a headache could be: Meningitis Cerebellar Herniation(chiari) Concussion (delayed symptoms) Stroke Hematoma Sinus Infection Hemorrhage Trigeminal Neuralgia Opthalmic issues

That is really interesting. Something to add to WILTW. Now the question is how to face the challenges.

I am honored to be filling in for our beloved ixchel's WILTW thread once again. As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons. Brain Development I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact. The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up. Standardized Patients As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P program I thought I knew what to expect. The experience was good overall. However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas? Female Condoms This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time. What did YOU learn this week?

I would probably say that it is a great thing to have. Just make sure that you have a protocol that allows you to use it in an emergency even without a patient specific order.

I am a foster care nurse, and unfortunately some of these stories are an everyday occurrence in my line of work. I think that one of the hardest things for me was a kinship foster mom who cared for 6 of her grandchildren, all removed from their parents for shaken baby.