NP2BeNY

I've heard of patient's c/o burning but it seems to occur more often in those w/o running NS.

I'm aware of the manufacturer recommendations for these medications, and we have a great many drug resources available to us at work. (Our eMAR also notes recommended administration times), but my point was not if people knew the recommendations, but if they truly gave it that way every time. As others have said, most meds come in a variety of strengths and packaging for a variety of uses.

Just out of curiosity why do you dilute anything except opiate pain meds?Do you dilute toradol, zofran, Ativan, etc?

As others have said, you shouldn't slam anything except Adenosine. While you need not go to an extreme and give say, 4 mg of Zofran over 5 minutes, it is reasonable to give it over a minute or two. Again, as other posters have said there are guidelines for each of the meds we give.

I don't disagree -- the ED definitely should have started the transfusion, from the information presented.

As an ED RN, I'm really enjoying all the over-generalization and ED nurse bashing. We could start bashing you guys as well, but lets keep it civil. For the record, I'm curious as to why they weren't transfused in the ED and if it had been my patient I probably would have at least started the first unit. Then again, I don't know what else was going on with the patient or in the ED at that time. What exactly do you mean by mildly symptomatic? Also, as others have pointed out you can in fact have clear L/S w/ a PE. What was the rest of this patient's presentation?

It's nice to hear that others were in similar situations. I'm looking forward to starting clinicals.

Might I ask why his BP needed 1L of NS so quickly if he was awake and vomiting? If you transport many GSW/shocky patients you might want to do some research into permissive hypotension, and present this info to your medical director for protocol review. To answer your original question, Zofran is an anti-emetic, not an NSAID. NSAID's include medications such as Toradol, Ibuprofen, Naproxen, etc. They are, and do exactly as the name implies. In fact, many times these medications can treat the cause of a patients pain better than opioids, which primarily blunt your response to pain but are usually used when we can't easily fix the cause. I'm oversimplifying this a bit, but that's the gist.

Agreed - the negatives of being regulated under the BON pale in comparision to what the Board of Medicine would do to NP's. I'm sure if they AMA had there way NP's would have an even more narrow scope then PA's.

We share many of the same frustrations -- I attend a "brick and mortar" school near my home. Part of our program is done online. We had to do online patho and pharm this past summer, but our theory courses were in person. In my personal opinion (and what would seem to be the opinion of most of my classmates) we would have been MUCH better served doing the theory courses online during the summer,and spending the spring in "live" patho and pharm classes with an engaging instructor familiar with the material. Fortunately, our professors for this semester (and hopefully the rest of the program) are clinically active NP's who know how to teach graduate students effectively.

Alicia: I'm not an NP yet but in NY and most other states I'm aware of you need an active RN license to hold an NP license.

You did the right thing by calling. In many places, FAMILY MEMBERS are allowed to call for a RR if they are concerned. You are the patient's RN - if you feel the need to make the call go ahead and make the call. As someone else said, you'd rather be called 99 times and not be needed then not be called the one time you were.

I wish it was standard -- I have yet to see a foley kit come stocked with it, and finding the sterile lido jelly "jets" are almost impossible unless you're from Urology.

We do not use nebulized lido for anything that I know of -- our providers tend to use hurricane spray for NG insertion. Works very well!

I appreciate that you are not a new grad, but are ED Nursing fellowships (the ones that usually take new grads) an option near you? You'd have a leg up over the new grads with your outpatient experience. Also, I disagree that UC is the way to go - you have outpatient experience, you've already proven yourself in that arena. What about working in a 23 hour observation unit of an ED, or an admitted patient holding unit attached to an ED? This would offer you the opportunity to network with ED staff and administration so they "know you" when an ED spot opens up. I think the EMS training and experience can only help. I enjoy EMS, and that training and though process has only helped me as an ED RN.