ghost

70s, non diabetic.

Virgo, the R femur got fractured from a slip/fall at home, not MVA.

I'm confused as to why/how the unaffected limb had compartment syndrome. Unless the unaffected limb had a tibia fracture that went undiagnosed??? Theorizing here.

Angie, You are correct. The unaffected/no fracture leg had no pulse. The fractured leg was the warm/2+ pulse. No surgery yet (was pending clearance) for 2-3 days.

Diagnose this: Pt has a Right femur fracture and is pending surgery. That limb is warm, 2/2 pedal pulses Unaffected limb is 1/2 pedal pulse. In a time span of ------------------------- Think it's a blood clot that travelled from the affected limb to the unaffected limb?

Does this make sense: Pt. is admitted to ER primarily for left leg cellulitis. He is also found to be alcohol intoxication. They treat him with Ativan, Morphine, Dilaudid, and 2 beers (not in that order). When he gets sent up to a med-surg floor, his only orders for the alcohol intoxication are: Librium every 8 hours. Percocet 5mg for pain. Shouldn't there at least be Ativan PRN there???

can't necessarily feel or see a vein? Would like to know if it's worth it to invest in one for those "difficult sticks."

What is the protocol in your institiution during blood transfusions? IE: Stop if temperature changes 1 degree or patient complains of: chills, flank pain, etc. What do you do then? IE: Stop the infusion. Do you just disconnect the blood line completely or just clamp that while allow the piggybacked normal saline to run? Contact blood bank. Etc?

Today Dilantin was held so a PEG tube could be stopped (Stop PEG for 1 hour, give Dilantin, restart PEG after 1 hour). The type of feed was "Nepro" (nutritional info, scroll down). How it was explained is that Dilantin clings to the "milk" in the tube feed and is excreted, thus not doing the body any good. I looked up the ingredients for Nepro and it doensn't say anything about having milk. I also looked up Dilantin and that says it binds to "albumin." Would you hold Dilantin if a patient was on tube feed (no matter the formula)? What other drugs would you have to hold if a patient were on a tube feed? Usage: NEPRO is specifically designed and clinically shown to meet the needs and altered metabolism of people on dialysis. * In a study of Nepro as sole-source nutrition, people on dialysis had: - Improved calcium-phosphorus product - Decreased phosphate binder use - Less constipation1 * For tube or oral feeding * For supplemental or sole-source nutrition Features: # 1900 Cal (four 8-fl-oz cans) meets or exceeds 100% of the RDI for 18 key vitamins and minerals Low in vitamins A and D # High in folic acid and vitamin B6 # Low in phosphorus and potassium # Moderate protein content to replace protein lost during dialysis and to help prevent catabolism of lean body mass # 3.7 g of FOS/8 fl oz (15.6 g/L). FOS are prebiotics that stimulate the growth of beneficial bacteria in the colon # 3 flavors (8 fl oz)--Vanilla, Cherry Supreme, and Butter Pecan # Low-residue # Lactose- and gluten-free # Kosher Caloric Distribution Per 8 fl oz Per Liter % Calories Calories 475 2000 -- Protein, g 16.7 70 14.0 Fat, g 22.7 95.6 43.0 Carbohydrate, g* 52.8 222.7 43.0 Water, g† 166 699 -- *Includes 3.7 g/8 fl oz (15.6 g/L) of FOS. †1 g water = 1 mL water = 1 cc water. Analysis: Hide details for Nutrient FactsNutrient Facts 8 fl oz 1000 mL FAN (label number)7958-047642-01 Cal/mL2.002.00 Energy, Cal4752000 Protein, g16.770 % of total Calories 14.014.0 Fat, g22.795.6 % of total Calories 43.043.0 Cholesterol, mg Carbohydrate, g52.8222.7 % of total Calories 43.043.0 Water, g*166699 Dietary Fiber, g3.715.6 L-carnitine, mg62261 Taurine, mg38160 m-Inositol, mg * 1 g water = 1 mL water = 1 cc water. Carbohydrate includes dietary fiber. Dietary fiber: 3.7 g/8 fl oz (15.6 g/L) of FOS. Hide details for VitaminsVitamins 8 fl oz 1000 mL Vitamin A, IU10004215 Vitamin D, IU2085 Vitamin E, IU1248 Vitamin K, mcg2085 Vitamin C, mg25105 Folic Acid, mcg2501055 Thiamin (Vitamin B1), mg0.62.6 Riboflavin (Vitamin B2), mg0.682.9 Vitamin B6, mg2.18.9 Vitamin B12, mcg2.411 Niacin, mg834 Choline, mg150635 Biotin, mcg120510 Pantothenic Acid, mg417 Includes 750 IU/8 fl oz (3160 IU/L) of vitamin A activity from 0.57 mg/8 fl oz (2.4 mg/L) of beta-carotene. Hide details for MineralsMinerals 8 fl oz 1000 mL Sodium, mg (mEq)200 (8.7)845 (36.7) Potassium, mg (mEq) 250 (6.4)1055 (27.1) Chloride, mg (mEq) 240 (6.8)1010 (28.5) Calcium, mg3251370 Phosphorus, mg165695 Magnesium, mg50215 Iodine, mcg38160 Manganese, mg1.35.3 Copper, mg0.52.1 Zinc, mg5.724 Iron, mg4.519 Selenium, mcg24105 Chromium, mcg Molybdenum, mcg Other Values Density at 23°C, g/mL1.099 pH6.6 Osmolality, mosm/kg H2O665 Osmolarity, mosm/L446 Renal Solute Load, mosm/L491 Cal to meet 100% RDIs1900 mL to meet 100% RDIs947 Total Cal/g nitrogen179:1 Nonprotein Cal/g nitrogen154:1

There are so many things that RNs can do. What are things that you absolutely need an order for: Ie. 100% O2 mask (order) vs O2 nasal cannula (no order needed)

Writing little notes for myself and study group about order/what to do when taking labs. Was wondering if I wrote the instructions clear enough or if I needed to add something. Thanks!

Am I missing anything here. Also is there anything that just sounds confusing? Blood Culture: -draw blue bottle (aerobe) -then yellow (anaerobe) -1 minute or 10cc each. If really sick, there is no bacteria. Think yeast. Order for yeast, mold or AFB: -red bottles (Myco) -held for 6 weeks (AFB) -held for 2 weeks (yeast) Culturette Tube (absorbs only 3 drops) -throat (not for wound, urine, etc.; send actual tissue, fluid, etc.)

How do you get organized? I can never find what I need at the time that I need it! I only have those two big pockets in my scrub top and at any on time i have: -prefilled saline syringes -tons of alcohol pads -alligator clamps -IV start kits -scissors -tape -pens -papers -etc! I've seen some nurses using their scissors (don't know what type) to hold their tape...the scissors clamp onto the bottom of their shirt.

What shoe size are you. Did you have to size up or down if you are a half size? Thanks!

Hey thanks! I'd appreciate the review on the new shoes. Especially since you're a 7.5 like me. I know what you mean about picking shoe sizes...why can't they make them in half sizes? Would make life so much simpler :)

What shoes do you wear that give support and don't chafe? I've been looking at http://www.allheart.com/dickiesshoes.html at the clogs with strap but their sizing is just way off (small medium large instead of real numbers).

When you get a patient and you use the IV Start Pak to start an IV in one arm. Do you use the other arm to stick them to draw bloods (ie. vacutainer)?

Having finished up my BSN degree and waiting for my GN internship, I came across a community college's "IV Course for LPN." Do you think this would be beneficial to take before going into the GN internship. In college I didnt get much of a change to practice starting IVs (only 4 times). I would like to be more confident going about that skill going into the internship. Thoughts?

I'm going to interview with different nurse managers for a GN position. Any tips/sample questions to ask them? Just so I can see the differences between units, what they need etc.? Thanks!:monkeydance:

For impetigo, has anyone heard of using Lotrisone cream? I've read that ususally Mupirocin is used becuase mupirocin is a bacterial antiinfective and impetigo is a superficial skin infection (versus Lotrisone which is an antifungal medication). Is there a positive effect of combining oral antibiotics with such a antifungal cream?

When you are using an IV pump and pressing the buttons to set it up, let's say the Doctor's Order: 500 ml NS with 20 mEq KCl q6h and you type in that the rate is 83 ml/hr What do you put in as the volume to be infused? 500 or 475? This website says to type in 25-50ml LESS than what you have because if you type in 500, air will be put in the person's veins and you want to know before the bag actually runs out...I dont know in real life situations if you do that because in clinicals, I never had an IV pump. http://classes.kumc.edu/general/IVPump/IVSimulation.html

What do you usually have to label on the IV bags when you hang them? I remember (correct me if I'm wrong) IV bags are: -date hanged -time hanged -amount started -cc/hr -I also semi-remember being told my a clinical professor to write down what the amount should be at 1 hour after you hung it. Bandages (ie. tape when IV is started) -date -time -your initials

Any new grads or were new grads who started out in Shands @ UF Gainesville? I understand it's a huge complex and wonder how they are with new grad nurses and orientation? How do you like working there (what area do you work in)? Do you recommend starting out there?

I just read on another thread that: "I strongly recommend that you do not accept a first new job in a float pool. Stepdown/telemetry units are highly stressful and extremely difficult for most new grads. They just do not get the support and training as the people going into the ICUs out of nursing school. If you are looking for a job in an intensive care area make sure you are going to be given a good 6 month training program." Is this true? I was thinking of going into a cardiac step-down floor.

Is there a big difference between working as a GN vs RN? From the post below, it makes it seem as if you are employed as a GN only if you have graduated, but not have taken the NCLEX yet (no license). But for my resume, I'm going to apply for a GN position even though I'd of have a license already. Mainly because I think you get a good orientation to the floor before being on your own. Any thoughts on this?