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russianbear

russianbear

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russianbear's Latest Activity

  1. russianbear

    Goals

    Please help me establish goals for my AGNP clinicals. They need to be measurable. I'm just running out of ideas.
  2. russianbear

    Struggling with pharm

    Yes. Only real suggestion was to take more time on the exams.
  3. russianbear

    Struggling with pharm

    I failed pharm and am repeating the course. I’m struggling again. Guys, I have no idea how to prepare differently. I feel comfortable with the material until I get the exam results. Even in clinical I am consistently choosing the correct medications. Where do I look to fix things? How can I alter my preparation?
  4. russianbear

    Acute care or primary care

    Due to money issues I have no choice but to do the primary care program. Even that is going to make money tight in my home. There are just no grants or scholarships available.
  5. russianbear

    Acute care or primary care

    bump please
  6. russianbear

    Acute care or primary care

    Please help me choose a program. I was accepted to two different programs. One is ddult/gero primary care. The other is acute care adult/gero. The problem is, I want to continue working in the hospital, but the acute care program costs about $15,000 more. I am paying out of pocket. Loans are not an option. The primary care program I should have enough to pay for. The acute care would be cutting it close. Basically I'd be one financial hit away from having to drop out (big medical bill, car repair, etc). I'm torn because the acute care is more up my alley, but I have to consider the finances. I'm not sure the job market for these specialties either (northern Ohio). Any advice is appreciated. Thanks.
  7. russianbear

    Hyperosmotic

    I know those feels.
  8. russianbear

    When Your Patient is an Addict...How to Deal

    Again, I am trying to distinguish between people with medical issues versus those who do not.
  9. russianbear

    Hyperosmotic

    So with HHS they may or may not be acidotic?
  10. russianbear

    ER

    Because I cannot wrap my head around how someone could even ask if we ever give blood because a family member tells us the patient's blood type. As if we would ever bypass type and screen except for emergencies.
  11. russianbear

    Hyperosmotic

    I don't recall the numbers exactly, but she had no history of diabetes. Blood sugar was over 700. Although there, I do believe the attending's diagnosis was hyperglycemia. could you explain that please? Like, how you're not considered a idiotic liar f your pH shows you are, or at the very least you're showing compensated acidosis if you're hyperosmotic?
  12. russianbear

    Hyperosmotic

    So, the other day I was giving report from the ED to ICU. Lady was elderly. Blood glucose over 700, etc. I told the arrogant nurse she was in compensated metabolic acidosis. He said, "She's hyperosmotic. She can't be in metabolic acidosis." True?
  13. russianbear

    When Your Patient is an Addict...How to Deal

    The problem this debate always brings up is hat the people on the side of never question narc orders and requests by patients fail to distinguish between cases where pain is legitimate vs seekers. I've never heard anyone advocate for holding meds nor questioning administering pin meds to post op patients, patients with cancer, trauma, etc. The animosity comes from the people who come to he ER with vague complaints, not verified by diagnostics, and yell and scream and threaten until they get what they want and do this frequently because they know eventually the docs will give in as opposed to telling them they will not prescribe them controlled substances th do not have a need for.
  14. russianbear

    When Your Patient is an Addict...How to Deal

    I'll give you an example. I can think of several patients who, the moment the attending sees their name puts in various orders for controlled substances before even knowing why the patient is there. That's how littl of a f*ck some people give about the problem we've caused. So I ask you, just because it's John Doe, we automatically order Dilaudid and Percocet. What is the medical justification for that? Is that prudent? Every now and then we get seekers in who don't know we have access to records of other hospitals in our system. The providers rarely check that prior to ordering Dilaudid. Not so they ever check OARS reports. However, when we let the provider know that the patient was in a different hospital the day before exhibiting seeking behaviors, the providers do cancel narc orders.
  15. russianbear

    When Your Patient is an Addict...How to Deal

    How many people do you know personally who have died because of an epidemic that we play a role in? How high are your deductibles and premiums because of waste? If it affects me, I'll speak up, thank you.
  16. russianbear

    ER

    How is this a question? We would NEVER give blood other than O neg without having a type and screen. PERIOD. Doesn't matter who tells you the patient's blood type; the family, the patient himself, our orange president, nobody.
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