PANYNP

7) If you have to draw blood on a super tough stick, look for superficial veins on the foot and use a 25ga butterfly. Caution: Check your State Nurse Practice Act before even thinking of phlebotomy or IV stick on a patient's foot. Task frequently is limited to anesthesia providers only.

Intended to say "punctate lesions", rather than "punctuate" lesions. Spellcheck, ugh.

Seeking expert wound care advice, as my home health agency neither employs nor consults with a WOCN. Patient was referred by PCP. Patient is a 62 yo well-nourished community-dwelling semi-retired moderately active non-smoking non-diabetic female with known venous insufficiency. No history of lymphedema. ABIs are 0.9 bilaterally. Pt presents with a 3-week history of a 10 cm x 5 cm area containing approximately 12 punctuate weeping lesions on her R posterior calf. She states this area of skin irritation with weeping began during a Prednisone taper following severe bronchitis. Pt was evaluated in Wound Clinic and was treated with Aquacel Ag and application of an Unna boot. Due to severe sensitivity to the zinc oxide component of the Unna boot, a recommendation was made to discontinue the Unna boot and continue with application of Aquacel Ag to affected area q other day, cover with ABDs, apply Eucerin to non-affected area, cover with one layer of Tubigrip foot to knee, and elevate extremity as much as possible. Pt states that Aquacel Ag and dressings become saturated with serous fluid within 3 hours of dressing change, with accompanying maceration and circumferential skin irritation at ankle. Pt is capable and compliant with carrying out her own dressing changes, but is concerned with lack of wound healing progress and required frequency of dressing changes, as well as cost of supplies. Looking for suggestions on alternative to Aquacel Ag or any other ideas to promote healing.

Namenda also is neuro-protective; not strictly for dementia. This individual may have been part of a geropsych registry and was being observed for neurological progress/lack of progress while on Namenda.

COB nursing professor here. Is it possible to take Stats at a community college this summer and transfer it into your program? Before you commit to doing this though, be 100% sure that your school will accept it as transfer credit. Agree with other posters that all three courses taken together would be doable, but it might not be pretty, particularly with 2 labs, and one additional course to bring you to FT status. Best of luck; welcome to the profession!

Our hospital's team of psych clinical liaison (psych CL) nurses, whose primary role is to tend to hospitalized inpatients related to emotional and spiritual concerns, also is available to groups of staff for critical incident stress debriefing, such as following a "bad" code, or issues with abusive patients or families. I don't believe I've heard about individual counseling, though, for all the reasons listed by everyone else.

My apples and oranges comment was intended as a response to Workinitnurfava who commented that an EMT should be able to transition to RN.

Totally different worlds. Apples and oranges. In fact, it might behoove OP to limit or eliminate entirely any discussion of her pre-hospital experience when applying for or starting a new position. Speaking as a COB former nursing faculty member, my colleagues and I typically dreaded having pre-hospital personnel (EMTs, other first responders) as students, both clinically and in the classroom. While we have unlimited respect for the work they do, it rarely is a seamless transition for a pre-hospital provider who enrolls in a nursing program. More than "not knowing what they don't know", there are different limits to professional autonomy. OP ultimately will be successful as a nurse. It takes patience and finding the right ego-free fit.

COB here. So very sorry that you experienced such a challenging and frustrating patient care situation that was exacerbated by what appeared to be a lack of support by an unsympathetic and unhelpful middle manager (nursing supervisor). I agree with others who recommended that you follow through with a request for clarification of the meaning and intent behind this nursing supervisor's remark. Her role ideally should encompass not only monitoring of functioning of patient care areas and patients' condition by assessment of nursing work conditions, but also supporting staff who are challenged by difficult and/or disruptive patient care situations. Although daily rotation of nurse caregivers disrupts continuity for patients, and may contribute to their increased anxiety while hospitalized, nurse caregivers' level of anxiety and risk for disengagement and development of compassion fatigue also are factors that must be acknowledged in order to maintain a healthy workforce of nurses who actually want to work as nurses. Recently a master's student who works as a staff nurse in long-term care related to me that her administrator told her that "residents have a right to fall". When I looked in the literature for a rationale for this statement, very limited anecdotal evidence was available that seemed to indicate that a failure to implement fall precautions was acceptable in that these precautions impinged on an individual's free will or "right to fall" (injury and liability notwithstanding). I wonder if the nursing supervisor's observation that "it is her right to abuse you" comes from a place of similar sideways thinking. In any event, an academic medical center in Western New York, where I spent many years in practice, has a MIPS service - Medicine in Psychiatry - that includes a 20-bed inpatient unit for patients with mental health diagnoses who also require inpatient hospitalization. In an ideal world, this setting may have been the right type of placement for your challenging patient. In the less than ideal world in which most of us live, I encourage you to continue to question and assess your patient care environment for safety and comfort (both patients' and your own), analyze your own responses to your daily experiences, and reach out to the community of nurses, both locally and globally, as you've done here, for solutions based in both practice and science. We're counting on you, as a young nurse, to maintain your passion for providing mindful patient care. Typically I don't say "namaste", but it seems to fit here. Namaste.

Preach, Sistah!

We gave verbal report and Still were out of there by 2320. Loved 3-11 when I was in my 20s: the party shift. We went out almost every night after work.

Machines are reliable as long as they are calibrated. Need to know how often biomed engineering comes around to check all devices on which we base patient management decisions, i.e. drips etc.

COB here. Does anyone remember using Kpads for treatment of DVT? Kpads were light green rubber heating pads that we would place inside a pillow case. They would be ordered from SPD, who would bring them to the floor. First, we would wrap the patient's legs from knee to ankle with long lengths of moist Kerlix, soaked in warm water in a small green sterile basin, then place blue Chux around the patient's legs on top of the Kerlix. Then we would wrap the pillow-cased Kpad around each of the patient's legs and hold it in place with additional lengths of Kerlix that we would tie in three places to keep everything held together. Warm and soggy. The order would read something like "Kpad to lower extremities, and elevate for 1 hour tid". This treatment was intended to improve venous return via warmth and elevation.

I'm not sure whether it's permissible to endorse a book on this site, but here goes. Take a look at Carolyn Buppert's "Nurse Practitioner's Business Practice and Legal Guide".

Re drip rates - if you travel as a volunteer on a health care mission trip, which many nurses do, to Central America or rural Africa, you will find yourself counting drops.