SierraBravo

I LOVE, LOVE, LOVE this!

At end of life, patients will more often than not spike a severe fever (>40*C). It's likely not due to sepsis but rather the normal physiology of the body during the process of death.

Wow. Just. Wow.

A career in healthcare might not be your best option unless you can manage your disability and become somewhat of a "people person" as being a nurse or physician requires daily interaction with not only patients and families, but also various other members of the health care team.

Nice job. However, the CO2 level is primarily looking at acid/base balance, not necessarily lung and kidney function. The patient might have a mild alkalosis going on, but the rest of the labs look OK. Have you considered why the patient is on both a heparin drip AND warfarin? Remember that heparin drips are titrated based on the patient's aPTT, not the PT/INR. If the patient is on a heparin drip, why haven't they drawn an aPTT level?

I didn't learn this in my BSN program, nor have I learned it in my MSN NP program. To be honest, I don't even understand how you could even possibly palpate a cardiac valve? The aortic and pulmonic valves are underneath the rib cage, so how would you palpate those? This is so bizarre. Did you mean to say auscultate instead of palpate? Because then that would make sense.

I refuse to use the term "this writer" or "this nurse" or anything to that effect in my notes. It irritates the living daylights out of me. Whenever I read those terms in a note, it's like nails down a chalkboard for me.

1. The maximum rate that you can push lorazepam is 2mg/minute. And incidentally, it must be diluted with an equal volume of NS before pushing it. So if you have 1mL of lorazepam to give, you need to dilute it in at least 1mL of NS before pushing it. 2. Ibuprofen is not an anti-pyretic, so do you think this is an appropriate pharmacological intervention for someone with a fever? 3. First of all, you have to give the medication via the route that it was ordered. If you want to give it by another route, your provider must change the order to reflect the new route of administration. Like others said, it's not your call. However, if they do decide to give the furosemide IM, consider ADME (absorption, distribution, metabolism, excretion) with respect to that route of administration. Would absorption be different when giving the med IV vs. IM?

Can I like this 1000%? And I agree with everything everyone has said. Can't wait to finish my Masters and be a NP so that I don't have to deal with being a bedside nurse ever again.

THIS!!!

Do we work on the same unit?

Unless you're going to work in an ICU or step down unit, what would be the purpose of becoming familiar with ventilators? And if you're not working in an area where you will use that skill often, then just learning about it without practicing it often will not be very useful. So I guess I'm confused...

Just out of curiosity... Is this a for-profit nursing school?

If I were you, I would investigate the job market for PNP's before you begin the program. In my area, those jobs are virtually non-existent. You might be better off going for the FNP.

Part of the reason that it's so thick is because it is stored in the freezer in the pharmacy. I don't know how volatile it is in terms of waiting for it to come closer to room temp which might make it less viscous. In any event, while the treatment is undoubtedly painful, it's better than developing complications from untreated GAS.

I'm really sorry that you're experiencing this. That first job is so critical because it kind of forms the basis of your nursing career. And so it makes me sad when I hear stories like this because I think that all new grads should be supported and given the chance to grow and thrive as a nurse. I would speak with your boss and let them know how you're feeling and what you're experiencing. If that doesn't go well, escalate it up the chain of command. Orientation is a 2 way street. You have to put alot of time, effort, and work into learning how to be a safe and effective nurse, but your preceptor(s) and unit should also be willing to put that same amount of effort into your growth and development. On the surface, it doesn't sound like a good place to work. But give it a chance and some time. Maybe you will be pleasantly surprised with the way things evolve on the unit. Best wishes!

I seriously hope that the OP was trained and qualified to remove a PICC line and did so with an order. The fact that he/she says they are a new nurse leads me to believe that they might not be qualified to do this procedure, but maybe I'm wrong. For the sake of the patients that had their PICC lines removed I hope I am wrong. OP - how long have you been a nurse? And have you received training to perform this procedure?

There are plenty of online NP programs from accredited institutions. If you're in NY, you're limited to about 1 school that you can attend for an online NP program (SUNY Stony Brook). But other states are far less conservative than NY. It's worth a look. Obviously when you get to clinicals you will have to deal with your work schedule somehow...

As you stated, an alteplase infusion and an alteplase dwell are two completely different therapies. I've on seen alteplase infusions on a step-down or ICU unit. Actually, I've seen it on a stroke telemetry unit. But anyway, good question. The patient is not likely having facial swelling due to the clot in her mediport. The patient likely has a clot in an upper extremity vein or a neck vein. I would be asking for an ultrasound of the upper extremities and neck. So I would still instill the alteplase into the mediport to dissolve that clot because that won't be absorbed systemically. Unfortunately, resolving the clot in the mediport likely won't have any effect on the facial swelling. Of course, you have to look at the clinical picture of the patient. Are they septic? Sepsis causes micro clots to form. Do they have DIC? Are they in a hyper-coaguable state right now? Do they have cancer? Lots of variables to sift through to determine the etiology of the facial swelling. You know, the facial swelling may not even be due to a clot, it could be due to a blockage of lymph fluid.

I absolutely love your post. Your commentary in parentheses actually made me laugh out loud. Thanks for making my day!!!

Thank you for that information, but I don't think I'm misinformed. In NY at my facility passing medications is well outside the scope of practice for a PCT or a CNA. Then again, I don't work in a nursing home. I've been in many hospitals and I've NEVER seen a PCT or CNA passing meds. While it may be accepted in nursing homes, I think it's far less of a common thing seen in acute care (if at all). To the PP that asked if it's within my scope of practice to fire a PCT... No, I'm not able to directly fire a PCT because I'm not a member of the management team. However, I am a charge nurse. So it is well within my purview to send that person home from work and initiate an investigation and subsequent termination proceedings.

I disagree. Unless you work with pediatric patients, there is little use for PALS. I have BLS and ACLS and never have I been in a situation where I wished I knew PALS, too. Then again, I work with adults.

Yes, NY is an "employment at will" state.

NCSBN website. Do questions. Alot of them!

This was stated so perfectly! If I could like your post again and again, I would.