Phishininau

I'm aware that ofirmev doesn't have to be a substitute. I was trying to offer an example in that if you want NSAID coverage and you believe the increased bleeding risk mantra with relation to single dose ketorolac. In my practice I use both occasionally, but usually stick to one NSAID.

Ketorolac (TORADOL) isn't contraindicated in all of those cases. You should reduce dose from 30mg to 15mg when the pt has elevated renal numbers, or delayed creatinine clearance. It also is not contraindicated in pts with abnormal bleeding any more than aspirin or other NSAIDs are. Perhaps the article that ortho surgeons keep citing as a reason to not give Ketorolac should be read a little closer. One time dosing does not increase bleeding risk appreciably.In my practice I use ketorolac in almost all ortho and gyn cases. It has a pain relief equivalency of 6-8mg morphine. I reduce the dose with older pts and those w renal compromise. Renal failure I hold it. Ofirmev is a decent substitute when ketorolac is not used, but it is quite expensive right now.

Honestly, it's like comparing apples and lightbulbs. They are in no way similar, except that they are both in the field of nursing (barely, IMO). I never opened a book for my BSN - only had to review class notes for a test. The board prep for the NCLEX was a joke, too, in comparison for the board prep I did for the CCNA exam. It is not similar.

I plan to pay back student loans. That is a luxury that I have yet to afford myself.

I have heard of people taking all 170 and passing, and I have heard of people taking 100 and failing. The computer will shut off when you either prove your competence or prove your incompetence. This can happen at any point after 100 questions. Unfortunately, a certain percentage of people take all 170 questions. This is a method of statistical control inherent in the computer adaptive testing system. I would not stress over it right now, since there is nothing you can do to change the result. Enjoy the next few weeks! All that being said, and my pep talk aside, I take my board exam in about 6 weeks and if I were in your shoes I would be popping nitro tabs. :-) I am sure it will all turn out ok for you in the end. The pass statistics for that exam are actually pretty high.

Bicarb accounts for 50% of the body's buffering system. When a patient is in a low output state, lactic acidosis, or anaerobic metabolism, increases. The increase in acid content will cause a decrease in cardiac output that in some cases can be refractory in treatment. Bicarb administration will increase the buffering content of the blood for a brief time, and other treatments will be more effective. I have actually seen an increase in SVR and MAP with the use of bicarb in a patient that was "maxed" out on pressors, but if the heart is not beating and circulating said pressors, there wont be a response. Many nurses I worked with advocated the use of bicarb in the severely acidotic patient as a stop gap to other treatment, and for that it can be effective in the short term. However, you must consider that with the infusion of large amounts of bicarb, > 100mEq in a single bolus, you can cause hypernatremia and shifts in serum osmalality that will get you in more trouble that you were in to start with.

Pretty much the right info is given here. Dobutamine has historically been considered a strong B1-selective agonist. Now however, that opinion has changed slightly. (Goodman and Gilman's The Pharmacological Basis of Therepeutics is cited for a good bit of this info.) Dobutamine is a racemic mixture, which means that there is a mixture of (+) and (-) stereoisomers, or two mirror image molecules in mixture. The (-) isomer is a potent A1 agonist, and can cause quite a large increase in SVR via A1-mediated vasoconstriction. The (+) isomer, however is a strong A1 antagonist, and counteracts the effects of the (-) isomer. Both isomers are strong B receptor agonists, slightly preferential to B1.. The activity of the (+) isomer is about 1000% more potent at the B receptor than the (-) isomer is at the A1 receptor. So, the balance of A1 vs B stimulation is off, in favor of B stimulation. Although B1 is preferred by dobutamine, the stimulation of B2 receptors does exist. B2 agonism will cause vasodilation at the skeletal muscle, forcing blood to engorge muscle in preparation for increased activity expected with increased sympathetic response. This pooling of blood will decrease the preload slightly, and in some patients will be enough to notice a change in the SVR/ABP. The A1 stimulation in some patients is not enough to counteract this decrease in preload. There will also be a reflex withdrawal of intrinsic sympathetic tone when cardiac output is increased. The result of these items will cause the ABP and SVR to drop, profoundly in some patients, with use of dobutamine. Further, dobutamine is preferential in increasing inotropy, or contractility, over chronotropy, or heart rate. This is thought to be the effect of stimulation of the A1 receptors in the cardiac muscle. At equal inotropic dosages of dobutamine and isoproterenol (a B agonist useful at increasing heart rate), dobutamine produces less of a rate increase than isoproterenol at the sinoatrial node. The increase in atrioventricular and intraventricular conduction is the same. So, if you are looking for rate increase, isoproterenol is a better choice. Dobutamine does not stimulate the dopaminergic receptors, and will not increase renal blood flow any more than proportional increases associated with increases in cardiac output. Tolerance to dobutamine will result from the downregulation of B receptors, causing the clinician to increase infusion rates. As a result, the earliest signs of dobutamine toxicity are seen - tachycardia and arrhythmias. In this case, it would be prudent to change to a phosophodiesterase III inhibitor, such as milrinone. Milrinone should not be confused with dobutamine. They are different in chemical structure, action, or effect. Milrinone causes the inhibition of phosphodiesterase III, which is an enzyme that breaks down cyclic adenosine monophosphase, or cAMP. cAMP causes an increase in myocardial contractile force, as well as arterial and veno-dilation. The combined effect of these three actions improves cardiac output via an increase in SV and a decrease in SVR. The increased inotropic effects are greater than those seen with dobutamine and the decrease in SVR is greater than seen with nitroprusside. Milrinone is a better drug choice, in my opinion, for the patient with severe heart failure than dobutamine. This turned out to be a very in depth response to a simple question, and I apologize for that.

I have done 8-10 of them over the past year, and honestly it is a pretty cool concept. 90% get relief almost immediately, and 90% of the remaining 10% get relief with the second attempt. Its really neat seeing the pain go away, just sort of drained from their faces.

The Montgomery interviews this year will be in Montgomery at Baptist South. This is the first time that the Baptist and Jackson staffs have been involved in the interviewing process for the Montgomery component. The drawback to this, for those of you that stress over interviews, is that I expect it to be less congenial than the interviews that were conducted in Birmingham, in the past, were known for being. I would expect to get asked some basic stuff: support system, experiences, finances, family, etc. However, I think there is a good chance that you will get some "grab bag" type clinical questions. ('Which Beta blocker should be used preferentially in pts with Asthma?" Things of this basic knowledge set. FYI...not all the interviews are known for having no clinical questions. I think Mobile actually has a pretty grueling interview process. From what I have heard, it can be quite intimidating. The bottom line is that they will pick the 6 of you that they think will pass classes in school and not embarrass UAB in the clinical setting. That, I believe, is the ultimate requirement.

Beer. Lots of free time. The resolve of an iron curtain.

It would be the same path as anyone else. Nursing degree (BSN or ADN with an appropriate bachelor's degree) then some ICU experience, GRE within five years, and good grades. That will equal an interview and then hopefully admission. I am not trying to sound like an ass. I was a non-traditional student, having taught high school for three years, and I assure you that the path is no shorter or easier. You need to know that going in.

1. Grades do matter, but there is a school somewhere that will take almost anyone with reasonable grades. You just have to find that school. At my program, the C would be "frowned upon," but that said, if there are myriad A's to go along with it, it wouldnt be so bad. 2. 3.6 is a decent GPA. It wont be the highest of the applicants or the lowest. In my class you would be right in the middle. Remember though, that schools calculate several GPAs to predict your success or failure. They calculate nursing school GPA, math and science GPA, and last 60 hours GPAs...all along with your cumulative GPA. 3. You can take the GRE right before you apply, but my advice would be to take it much earlier. That way, if you do not do well you will have time to retake it before your application is due. Think "safety net."

100% front loaded means that your are completely finished with the coursework (didactic) before you matriculate into the clinical setting. Any percentrage front loaded is the percentage of the didactic program that you complete before matriculating. Then there is the fully blended program that will begin clinical rotations almost on the first day of class. UAB is a partially front loaded program, I would say 70-80% (although I have heard 65%). All that we will be taking after we start our rotations is pretty much the special populations classes and one more patho.

My interview didnt require a single clinical question. However, I think as an ICU nurse you would need to know the difference between SIMV, AC, and CMV. That would be a good start to read up on. We use pretty much all CMV in the OR, SIMV and AC are used more for longer term ventilation.