Kaelif2015

Hi all kind of a weird question. My 6 year old son is on guanfacine and was recently upped to 2mg. His BP hasn't been handling the increase well, he's often in the mid to low 80s systolic, usually 60 diastolic, intermittently symptomatic. I've been pushing fluids as hard as I can, he's well hydrated. He did seem to be doing better on the 2mg as far as ADHD symptoms so his provider wants me to try to work him up to 2mg and just watch his BP closely. I asked about parameters for when I should give 1mg vs 2mg, and he avoided the question and said "it depends more on his symptoms" which I understand up to a point, but it's not smart to give a kid who's BP is 82/60 something that will push it lower. I've never worked with peds so I'm not familiar with hold parameters for that age group. Per Up To Date the criteria for hypotension in a 6 year old would be a systolic of 82, but I'm assuming my hold parameters should be higher than that. Do any of you work at a facility where you have hold parameters for pediatric BP meds and if so what are those? Just so I can get a feel for what is normal.

Im considering pursuing my psych NP but I know most psych NPs are med management focused and I would really want to incorporate a lot of therapy into my practice, I was wondering if this is a realistic goal?

Hi! I've been working as a CM for about 4 years in primary care and insurance settings, always telephonic. My problem is I've never been good at interrupting or cutting someone off, I'm probably TOO good of a listener and tend to just let people vent which, as you can imagine, leads to lengthy conversations and is extremely time consuming. Overall this has been an asset in that my patients really open up to me, trust me, give me information etc. However I feel like I cant keep it up, I dread making calls I know will take a long time because I just dont have the time or emotional bandwidth. I try to say something to confirm I heard them and am engaged in the conversation but then refocus on the topic at hand, but this doesnt seem to work often and people tend to keep on their rabbit holes. I dont want to lose the rapport I have with my patients but I also need a reliable way to keep conversations more focused and brief. does anyone have some good tips??

Hi! I'm interested in getting my MSN and becoming an RN instructor. My question is what is the average number of hours worked per week for these positions?. I'm ok with working 45 or even 50 hours a week sometimes but currently working what's fairly regularly a 60+ hour per week job and i really need better work/life balance than that, and dont want to go through the time/money to advance my degree if that's generally what's available