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flutist RN

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  1. flutist

    Gear for new (overnight) LTC nurse?

    I always had a scrub jacket with lots of pockets. I like lots of pockets so I can hold the med room keys, the home phone, pens, alcohol swabs, other random stuff. I never found the need to have my own vital machines. Every home I've worked in had an adequate vitals machine per floor but your home might be different. I always had my stethoscope. Didn't use it every shift but force of habit to bring it after working in the hospital.
  2. flutist

    What does the floor really think of nursing students?

    For the most part I enjoy having nursing students on my floor. We usually have first or second placement so they are doing vitals and personal care. It is helpful as long as they are willing to help out and learn. It does get frustrating when they all stand in the nursing station and shift change when we are trying to get our report first.
  3. flutist

    Ridiculous medical mistakes on TV

    We occasionally have a doctor start an IV but we are a small hospital with no IV team and the two docs who start IVs are also anesthesiologists. Have never seen a doctor ambulate a pt, sleep in a pts room to keep.an eye on them (I wish), give medications (besides pushing certain meds that we can't push on our floor). The biggest thing that frustrates me is when the keep using the debrilator ever 10 seconds. "Shock, Shock again, shock again" No you need to wait two minutes and you can't shock asysyole.
  4. flutist

    Narcotic infusion Calculation

    Hi, I am going to be doing some volunteer nursing in Africa and they have sent me a medication calculation quiz to fill out and I am stuck on one question since I haven't had to do this type of med calculations in a long time. I was wondering if I could get some assistance with it. IV morphine infusion (this is the standard morphine drip order) Use 50mL syringe: add 1mg/kg morphine and total to 50ml with NaCl 0.9% (max 50mg/50mL). Run at 10-40mcg/kg/hr=0.5-2ml/hr (run as per anesthesia order). Question: Your last patient has come back from PACU with a morphine infusion. He weighs 42 kg, so PACU has mixed 42mg morphine in 50mL normal saline for syringe pump infusion. (See above for standard morphine drip orders) a. What is the concentration of your infusion in mg/mL? b. The doctor has ordered 20-60 mcg/kg/hour. What is your dose range in mL/hour? c. You are allowed to give your patient a 1-3mL bolus every 15 minutes if needed for pain, with a 10mL maximum. How many milligrams of morphine would you be giving with each 3mL bolus? For a) I got 0.84mg/mL but not sure if that is correct. Then for b and c I am lost on where to start. If I could get some assistance on what calculation to use to help answer these questions, that would be great. I really need to understand how to solve these questions, not just get the answers. Thanks :)
  5. Hi I have been working in a 60 bed long term care for 3.5 years and I have applied to an associate director of care position which is a new position for the facility. I was wondering if anyone has some interview tips or sample questions for me. Thanks
  6. Rural acute care hospital. Days 5:1, nights 7:1. We have a lot of awaiting LTC pts
  7. flutist

    Worried That Doctor's Orders Will Hasten A Patient's Death

    Oxygen is generally used in palliative patients as comfort only. We aren't treating the numbers (O2 sat) anymore. If they appear to be short of breath and the oxygen seems to help calm them down, then it is used. Sometimes it agitates patients to have the nasal prongs in the nose, so it might be taken off. It's hard to know why they did it in your grandma's case. There is so much that can be done in the home to allow a patient to die at home. Generally in palliative care, IVs are not used but subcutaneous injections are used. A subcutaneous line is put in either the abdomen, upper arm, or upper thigh so that they are not getting poked with a needle each time. Usually pain medications are pushed through as needed, at regular intervals, or as a continuous infusion. This can be done in the home, as well as having oxygen set up on the home.
  8. flutist

    crushing meds, best foods to disguise taste

    I would say chocolate pudding would best mask the taste of most medications, although you said that they are looking to avoid sugary foods. Maybe some yogurt would work.
  9. flutist

    How Do You Sign Your Narcotic Book?

    We did the sign every page for a while when we switched pharmacy. Now we have a page (usually 3 or 4 pages) at the front that we sign each count. We have an individual page for each medication.
  10. flutist

    Medical Missions

    I've been looking into mercy ships. I believe the shortest commitment is 2 months up to years. It is a faith based ship and it requires at least 2 years experience, with surgical or OR experience being an asset.
  11. flutist

    Arterial Blood Gases

    I work in a small rural hospital. No arterial lines or respiratory therapy. The MD does the ABGs.
  12. flutist

    "Smart" students make bad nurses?

    I've noticed it to be a pattern but that doesn't mean some people can't be a 4.0 student and be great in clinical as well
  13. flutist

    pradaxa question

    I would say xaralto or Apixaban would be better alternatives that can be crushed.
  14. flutist

    8 or 12 hour shifts

    I've worked both. I didn't mind the 8 hour shifts when I was part time. Then I went full time and didn't like working the 8s. It felt like I was alway there. Then I worked a hybrid of 8s and 12s. I still only had 2 days off at a time. We now do 12s and I live them. It's a long day, but I feel like I can get all my tasks done for the day. I'm single with no kids so working all day is fine for me.
  15. flutist

    where can I get my Littmann stethoscope engraved?

    I had asked at Things Engraved (canada) which is one of the mall kiosks. They said that they wouldn't engrave it since they didn't know how and didn't want to wreck the stethoscope.
  16. flutist

    Transcription Error- was I also in the wrong?

    I agree that it is not practical to check all medications against the original order. Impossible, especially in LTC where one nurse has 30 resident, all with at least 5 meds. Even on a medical floor where you have 5 pts, it would be impossible to do it before the am med pass. My floor has three checks of the original order. On a day shift, two registered staff check the original order and then night shift does a third check of the order.