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Dangaard

Dangaard

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  1. hmmm, I'm worried that my tl;dr version may have simplified my questions a bit much. Thank you for the responses though! No this is not homework. I'm doing my final LPN practicum in an ED, and I do know how to use the pumps. Unfortunately we only get taught the very barebone basics. Setting up a standard primary fluid with piggyback meds, I can do no problem. Setting up a second channel and y-siting it in, we don't get taught, and most of my questions like these that I've asked have been met by blank stares or shrugs or misunderstandings so I'm not sure if I'm miscommunicating my questions or if something else is going on. The question about y-siting is more specific to setting up "channel B". I've seen posts here that refer to setting up this channel as a primary, then connecting it downstream to channel A. However, once the med gets to the pump, it won't continue because of the air above the med. Basically I'm just asking if the solution is to just hang a flush and set up channel B as a piggyback. I've never seen meds being run like this though, and in my area, when I asked about it, I was told to just run the next med when the first was done instead. I'll try asking somebody else tonight when I work to get a hands on answer. Regarding the bolus, I was looking for confirmation or denial that say, if you had a 100cc/hr med through channel B hooked up to a 999cc/hr bolus in channel A, the patient will still get the channel B med at 100c/hr even though the channel that's bringing the med into your patient is running a 999cc/hr (1099cc now? not sure.) For adding meds to a bolus, we run our boluses through the pump at 999cc/hr (I know, there's a difference between this kind of bolus and a wide open bolus where you run by gravity and squeeze the bag). So say you have an order for 500cc NS bolus and 10mg metoclopramide. Our pumps run 10mg metoclopramide in 50cc NS over 30 minutes. If you added the metoclopramide into your 500cc bolus, it would finish in 30 minutes, which is the same amount of medication in the same time as if you minibagged it. I asked this question specifically because an RN mentioned it to me as a possibility and I was looking for second opinions. I'm not clear on how backpriming prevents meds from getting stuck in the secondary tubing once the primary infusion begins. Part of the secondary tubing will always be below the bag of primary fluid on account of where the upper Y-site is. My understanding is that once the fluid level from the secondary reaches the top level of the primary bag, the primary will take over, leaving whatever secondary meds left in the tubing to sit and very slowly drop as the primary level drops. Ok, let me rephrase, yes, I know backpriming can remove those meds from the secondary set so you can run a different med through that line later, but how do you get that med IN to the patient, instead of into the garbage? I think the best way to explain my question about the backflowing is in the long winded post. I saw it happen to a relatively experienced RN on a med/surg unit, so it's not like it happened to me and I never got help for it or asked until now. I've also read about the same concern on this board. There perhaps is indeed a backflow prevention valve in our primary sets, and the one I observed just happened to fail maybe? https://allnurses.com/nursing-patient-medications/help-my-piggyback-760299.html
  2. *This got 5000% longer than I thought it would be. Here's a tl;dr version =_= tl;dr version (all scenarios use alaris pumps) -How do you set up two compatible meds to run at the same time into the same peripheral IV without losing meds in your tubing forever? Is it worth doing instead of hanging one med after another? -Similar question as above, except running a med and a bolus at the same time. Also though, does the speed of the bolus affect the speed of the med being administered (my understanding is it doesn't?)? Are there times where you have to be cautious about the differing pump speeds? -Any thoughts on adding a med straight into a (labelled) 500/1000cc bolus? -What to do about meds from a secondary that get stuck in the line after the primary takes over? Don't bother since it's so small? -Problems with backflow from your secondary ending up in your primary. I saw this happen severely with a coloured secondary med once. What happened? Any solution? Does that happen all the time and you just can't tell because everything's clear/colourless? tl;dr version ends. Feel free to skip over the rest of this entire post which I think is mostly just details and rambling. Lets say I have two IV meds to give along with a 1L NS bolus. Both meds are in 50ml NS minibags and are compatible with each other. I want to run both these meds at the same time using the same peripheral IV using 2 Alaris pumps. Trying to set it up in my mind, I have one primary bag of 1L NS for the bolus hanging under a secondary (Drug A) which is y-sited above Pump A, which then attaches to the patient. That's not a problem. Then for Drug B, I have it attached and primed through a primary infusion set hooked up to Pump B, which is then Y-sited with the primary from Pump A below the pump. With that, I have the problem that once the end of Drug B hits Pump B, it will complain of air in the line and will no longer infuse, meaning I've got maybe close to 10cc of diluted drug out of a 50cc bag not getting to my patient (let's assume there's no extra in the bag to compensate). Is there a solution for this? Is the solution to piggyback Drug B off of a another 50cc NS and get pump B to infuse 10-15cc NS at the same rate that Drug B is supposed to be infused at to flush the line? Give the time and trouble used to set up an extra primary and secondary then, is it just more efficient to hang the next bag of meds when the first is done using pump A? Alternatively, what if you need to run meds at the same time as a bolus? Bolus goes through pump A, and then med goes through pump B? Do you run the med as a primary, or as a secondary so you can flush your med after? Also, when is there concern over the infusion rates when you y-site below the pump? Say you're bolusing at 999cc/hr through line A, and running meds at 100cc/hr in line B, which is y-sited to line A below the pumps. Am I correct in saying that line B is depositing meds into line A at 100cc/hr, so therefore even though line A is running at 999cc/hr, the patient is still only getting the meds at 100cc/hr? Is there a time when different rates of y-sited lines becomes a problem? On another note, a nurse once suggested to me to utilize 500ml and 1L boluses to administer a NS compatible med over that time by adding it straight to the bolus. Labelled of course. Any thoughts on this? Couple more questions! In general with secondaries and minibags, since the pump can't know which bag to pull from and simply goes off of whatever fluid is at a higher elevation, isn't there typically some meds from the secondary bag still stuck in the secondary line once the primary takes over considering part of the secondary line will always be beneath the primary bag of fluid? I presume in most cases this amount is negligible? Also how do you know your secondary isn't just backflowing into your primary bag? Most secondaries are the same colour as the primaries, but I distinctly recall seeing somebody hang a secondary bag with yellow tinged antibiotics (pretty sure it was ABX), then looking later and seeing plumes of it wisping up into the primary bag. The lines are the same lines that I've always used and seen, so I presume there are no backflow valves. I'm not sure if that happened while pump was actively running, or if it just happened that somebody removed the lines from the pump with the secondary unclamped, thereby allowing backflow into the primary. Do you actually have to clamp your primary line above the first y-site to prevent any backflow every time you run a secondary? As an aside, I stopped to watch that particular situation as the pump ran, and I was surprised to see the only thing filling the drip chamber was the clear colourless primary solution. The primary had actually flown a little bit up the secondary tubing, and as the secondary fluid flowed down its own tubing, once it hit the bifurcation with the primary tubing, it flowed upwards towards and into the primary bag, and primary solution kept flowing down. Maybe density and solubility was at play here? I'm not sure. Sorry for the massive wall of text full of questions? I mean, I can set up simple piggybacks just fine, but nobody has ever shown me how to properly y-site two pumps together, and then I find that nobody can particularly explain how any of it works, other than it just does and don't worry about it. Fluid dynamics isn't really my strongpoint so I'm having some difficulty self learning it =/
  3. Years ago I was required to withdraw from a BScN program. I wasn't ready for the program on a mental health and responsibility/accountability front and flunked out of it. I've come a long way and am now in the tail end of my practical nurse diploma program. My question now is if I should list the clinical experiences from my 2 years in the BScN program on my resume. While the experience is an asset, the implications of having 2 years of BScN clinical experience which abruptly ended in a resume doesn't seem to be of the good variety to me. I understand that on top of the clinical experience I gained, the life skills and progress I made in responsibility and accountability among other areas due to my failure are actually great strengths. I don't know however if it would be better to completely exclude the BScN experiences on my resume to avoid having employers look at it with suspicion. In that case would I bring it up during interviews were I could explain what happened and how I'm a better nurse now because of it? Or would I even try to avoid talking about it entirely to avoid potential negative opinions associated with failing out of the program in the past?
  4. Dangaard

    Help with economic anxieties for an Alberta LPN student?

    tbh that's one of the scariest things for me as a student right now. I can study and prepare to the best of my abilities and perform well in classes, but time management isn't something they can really teach, and it's really not something I feel like I'm getting enough exposure to. At the end of my med/surg rotation, we had 2 patients while the typical patient load was 4-5, even on the surgical unit I was on where there was regular and frequent complex wound care. Even with two patients, out of each 4 week rotation, we only got two(!!) days in each rotation where we were giving meds to both patients along with doing assessments, daily care, and documentation (our group of 6 was split into two groups on different units and the instructor had to split med admin days between the two groups since we are not allowed to do third checks/drawing up with staff). Even then, since so much of our scope is (mostly legitimately) off limits as students, we still left a lot of things to the primary nurses. Central line meds and care, PCA checks, and certain "higher stakes" assessments to name a few. And yet with less than half the workload of the floor nurses, we struggled. Albeit, a lot of time was spent waiting for an instructor for various things, but in theory if we were perfect, we should have been doing nothing almost half the time if we only ever did the basics. Instead we did less than half the workload and still rushed to do things and try to take breaks. I was confused because I thought that was a big problem but at this point it seems like that's where the college wants us to be? And yet there's only 1 community oriented rotation left before final practicums and I wonder where the hell I'm going to develop better time management skills to essentially double my speed/efficiency. We're told that by the end of final practicums we're expected to handle 90% of our preceptor's work load and I feel vastly unprepared for that, let alone the full workload that an employer actually would expect of me. I wish I had been pushed more to handle a higher work load but I don't feel like I've been given any tools or training to be able to do it. We don't get watched while we do anything for any kind of feedback other than regarding safety. Obviously safety comes first, but we don't get feedback regarding time management other than if we have trouble with it, we're told "work on your time management," with no further guidance on how or what we can do about it. Org plans sure, but it's one thing to make a detailed org plan, and another to know how to do everything in the org plan within that time frame. Hell, our instructor never even asked for our org plans to look at so I never got any feedback on if I scheduled something for too long, or guidance on time frame goals I should work towards. As long as you did everything it's like there was no concern, even at half work load. Ugh, anyways, totally different concern from original topic. Trust me I do not feel like I'm entitled to instruction from floor nurses. I feel bad for them sometimes for having to deal with us, even if mentorship is a scope expectation. I do however expect instruction from my instructors. Sometimes I feel as if the college is setting us up for failure by providing such low standards.
  5. Dangaard

    Help with economic anxieties for an Alberta LPN student?

    Thank you both for the info. I guess for now there's really nothing I can do other than keep doing my best in school and hope that performing well in school might help make a difference in getting a job. I still have a ways to go anyway and I'll just have to deal with the job market when I'm actually in a position to worry about it. Definitely not a good feel though
  6. Dangaard

    Can licensed RPN of ON work in other province like AB?

    I was under the impression that LPN/RPN scopes were vastly different across different provinces?
  7. Dangaard

    Tattoos

    I'm just a student but I thought I'd add my two cents. I think more and more these days, as long as tattoos are not inherently offensive/controversial in their content and location, they're being considered acceptable socially, as well as in the workplace. I say location because facial tattoos still probably have a bit of stigma associated with them, but that's not relevant here. For you specifically, I think regardless of whatever personal experiences other people have with acceptance of tattoos and wearing long sleeves, since there's always going to be a bit of an unknown with what is and isn't acceptable with tattoos, I'd suggest you find out what the faculty(ies) considers to be acceptable. If you plan on getting the tattoos before your fall term starts, find an email or phone number for both faculties and inquire what their policy is on tattoos, as well as the policies of the agencies they hold their clinical rotations with. If you can't find a direct email for a program advisor or similar position, email or phone a general reception number to request contact information. I hardly expect that this is the first time this concern has been raised so they should have the information you're looking for somewhere. In terms of my limited experience, long sleeves are generally prohibited for infection control. In my faculty they are not allowed at all except for religious exceptions. Tattoos though, I've never seen a concern with them. One instructor at my college has bilateral sleeves visible and she's been a NICU nurse for 15 years (not sure how long she's had the tattoos). She's also one of the nicest people I've ever met and I personally wonder if she's even capable of getting mad at a student who needs to be put in line. The unit manager for patient care at my last rotation on an acute surgery unit also had quite an extensive tattoo on one of his arms. He was incredibly helpful, easy going, and knowledgable in regards to us students despite being constantly busy with his duties and often also being the charge nurse during the day. While the stigma of tattoos and untrustworthy people has definitely eroded considerably over the last few decades, you'll certainly come across people who still view tattoos as inappropriate or deviant. Then again, you'll also come across plenty of people who think not being white or having an accent or being a woman in a position of authority is also inappropriate. Difficult people will be difficult, and changing values and beliefs does not happen overnight. I personally think that one aspect of being a part of something that some minority doesn't approve of due to stigma or stereotype is being confidently and un-apologetically part of it. Even more so when that something is close to what you perceive to be your identity. Obviously it helps if your familiy or faculty or employer is supportive, but when it comes to patients, it doesn't matter if you have tattoos or scars or whatever it is that makes that patient think that you're not what you're supposed to be in your appearance. You have the right to privacy, and you have the right to respect. Tattoos don't stop anybody from being an excellent nurse, and you're not obligated to explain anything about your personal life to a patient. You do have every right to tell a patient that a comment that they made is inappropriate or to explain that your tattoos don't have any impact on your ability to be an excellent nurse for them, and if they can't accept that, then a different nurse will have to help them, just like if you come across any other abusive patient. Now I don't know kind of content you want to get tattooed on your arms and if you're concerned the specific content will be "flagged" so to speak or if you're more worried about tattoos in general, but that's just what I think. Probably a bit more than 2 cents by this point haha.
  8. I know this is something of a recurring question around here, but after reading a number of threads here and there, I'm still at a bit of a loss. I'm an LPN student in Edmonton set to graduate end of August and I've started to get stressed about what I'm going to do in terms of jobs in this economy when I graduate. I see a lot of advice to relocate or apply to rural areas, but I don't drive and I'm not in a position to relocate. Plus I'm reading that people are saying that even though they do drive and can relocate, they're still going jobless. I feel like the chances of me getting an lpn job as an external applicant with no work experience in this environment is basically 0 at the moment. What kind of options do I have? I keep getting asked by instructors if I'm going to upgrade to RN, but I almost feel like it would be even harder to find a job as an RN going forward considering the LPN scope creep and "financial benefits" to hiring more LPNs. Not to mention I need a year's worth of FT experience to even do the bridging program which I'd need a job for anyways. What exactly does the hiring freeze constitute? My impression was that it's only the replacement of vacated positions, and basically only filled by internal applicants? Where does that leave me? Should I expect to look for jobs that aren't nursing? Is it still possible for a new grad to get casual and float positions with enough hours for a liveable wage? Are there any relatively short full time schooling opportunities where I can live off student loans and add something to my credentials? When I mentioned my concern to my last clinical instructor, she said I needed to be more optimistic, saying that I have a lot to offer and that she thought I'd be able to get a job wherever my final preceptorship would be. Is that still something that happens? Am I being too pessimistic about this, or is my instructor out of touch with the current job situation and/or just trying to encourage me? I mean I can't imagine it would be a good thing for a faculty to tell its hundreds of graduating students that they're SOL. Edit: I'm also not expecting the job of my dreams or anything. Sure I think I'd like to work in adult acute care in one particular hospital, but LTC or community placements that don't require driving are definitely opportunities I'd take even if LTC would normally be a last choice for me. Still iffy about maternity or peds though . I just want a job where I can do what I went to school for and start developing some beginning nursing skills/experience. And be able to feed, house, and clothe myself. That's a definite bonus. Any help would be greatly appreciated. Realistic encouragement or clarification of realistic expectations would (I think) calm my nerves a bit.
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