CrabbyPatty

I've not experienced capitated care yet. I've only been doing this for a little over 3 years now; have seen one or two charity care cases, so I guess that's the same? In those couple of instances, DNR was never an issue. Great advice to the OP

When a patient is made DNR, we have an order sheet where the MD specifies whether or not pressors are to be given. We aren't withdrawing care, we're just not going to resuscitate. By "capped care", do you mean comfort care? When death is near, the MD will write orders for comfort care only and d/c labs, x-rays, abx, meds, etc. Otherwise the patient would be transferred to hospice. Does this make help? It's late and I'm not sure any of what I said makes sense.

I work for a union in the US and I don't get a pension. I have a 401(k), but that ain't no pension!

Things can't get better if you're not properly diagnosed. Why suffer needlessly?

"nursing pension"???? Where do you get a nursing pension??? I want to work there!!!!!!

Having been an executive assistant for 20 years before I became I nurse, I can say that I would prefer to receieve a resume that was not folded up, just think it looks better, and if HR is getting a ton of resumes at one time, I would think they'd open the larger, unfolded envelope first. However, I'm sure I've folded and mailed my own resumes in the past and I always got the interview. Funny how such a simple task can concern us so much when we're looking to impress a future employer. I've been there. Good luck.

you could be right (about the other article he wrote), but the info he compiled on neurotransmitters seems to be correct. I've spent hours reading journals & medical articles that seem to say the same thing; just happened to post the above link because I was so tired I couldn't focus anymore. Here's more info: http://www.fmpartnership.org/Files/Website2005/Learn%20About%20Fibromyalgia/Articles/Dopamine.htm http://chronicfatigue.about.com/od/treatingfmscfs/a/dopamine.htm http://www.ncbi.nlm.nih.gov/pubmed/17285103 http://www.psyweb.com/fms/fibromyalgia.jsp http://www.neuroassist.com/DiseaseHomePage1.htm http://chronicfatigue.about.com/od/cfsglossary/g/dopamine.htm I'm hoping to find a neuropsychiatrist near me that can help me find resolution to the health issues that are controlling my ability to function.

I have had ADHD for as long as I can remember. For the past 3 years, after becoming a nurse, I have been struggling with: severe sleep issues & exhaustion (no matter how many hours I sleep) newly diagnosed PLMD (severe restless leg syndrome that happens only while you're asleep) worsening of my ADHD (lack of focus, feeling like I'm in a fog ALL the time) - even when I take my ADHD meds increasing pain in my legs, feet, hips, arms, hands & fingers - for several months now extremely cold & painful hands & feet, - peridocally at night - for several months now After seeing yet ANOTHER doctor today and still not getting any answers, I figured there MUST be a connection here somewhere!!! I think it's important to note that at various times as an adult, I've been diagnosed with Chronic Fatigue Syndrome, Epstein Barr, & Mono. Here's an AMAZING article on how neurotransmitters (dopamine, seratonin, norepinephrine & GABA) work in the brain & how imbalances can wreak havoc on our lives by causing ADHD, Parkinsons, Sleep Issues, & Fibromyalgia (this may be the solution to my problems): http://www.enotalone.com/article/4114.html Seems low Dopamine levels might be the biggest culprit. Some people have said they find relief for their fibromyalgia when they take their ADHD meds. Must be the reason my body hurts so much at night when my ADHD meds have worn off. And if my legs are twitching all night because of the PLMD, then low Dopamine is probably the cause of this too! Oh yeah, Raynauds seems to be a neurotransmitter problem too! Can I just trade my brain in for a new one??? Anyone else out there experiencing similar issues?

Did you get an answer to your question? I would think the doctor who prescribed these meds to you could answer this question. My son couldn't go into the Air Force Academy unless he was stimulant-free for a year because pilots are not allowed to take stimulant meds for ADHD, which is absurd! I suppose it's ok if you crash a plane because you're distracted. Good luck to you, it's hard enough having ADHD, but there's no way I could work without taking my meds!

I recently had one of those situations at work and my 2nd patient kept having psuedo seizures every time things would get really bad with my critical patient!!! When my poor patient was moments away from coding, I called the family in (they were in the waiting room) and explained what we were going to have to do to the patient in a few minutes (Code him, chest compressions, probably broken ribs, etc) because his heart was giving out and he was on so many pressors already and we lost his A-line pressure...the monitor was showing he had an MI. The poor wife made him a DNR and he died within 5 minutes, but not before my other patient decides to have another pseudo-seizure!!! UGH!!!!! What a day! Would have gone much more smoothly if I had the support system I needed to care for him, but he still would have died. He was so very sick.

Wow, can I come work with you?????? My ICU experience (almost 3 years now) is just like the OP's!!!

Feel like I'm going crazy!!! I was diagnosed ADHD in my early 20's, although i had the classic symptoms as a child (I was so impulsive that in 2nd grade I went to the bathroom and my teacher came looking for me after awhile to find me climbing over the tops of the stalls because I wanted to see how tall they were!) Anyhow, I didn't start meds til I was in my early 30's when I had no choice but to stay focused to perform a high stress job to supporty myself & my 8 year old son (who was also diagnosed). I got remarried, quit my job & went full-time to nursing school. I struggled even with my meds. I was smart enough to test out of 6 of my pre-requisistes thank God because I might not have passed if I had to sit through boring lecture after lecture and take notes on and read about things I wasn't interested in. During one of those tests, the professor put me in a classroom full of students during a lecture!!!!! I was taking a test so important that it would allow me to test out of a class and he actually thought I could focus (could ANYONE focus) in a classroom full of students during a lecture??? Anyway, despite the ridiculous "accommodations" made by my college, I graduated with a 3.0 GPA despite the hell I went through to graduate. I started nursing in ICU on nightshift. Lots of good reasons for an ADHD'er to work nightshift, especially as a new nurse - so much less distraction than days, no families around to constantly interrupt you, no tests that you personally have to take your patient off the floor for (unless there's an emergent MRI or something) - and I worked with nurses who knew way more than any of the docs, so I learned so much from them! I was ALWAYS busy on night shift, and sometimes overwhelmed because I was a new RN, but I never left late past my shift because I had to catch up on documentatiuon. My problem with Nights was that it REALLY screwed up my sleep-wake cycle. If I worked 3-12 hour shifts in a row, I would literally sleep for 3 straight days, I'd eat cereal and go back to bed. I felt like I was drugged. this wasn't making my new hubby or my teenage son very happy. It took me a year to finally get to transition over to dayshift. However, the only opening on days was a Per Diem slot and I had to float between ICU and telemetry. My biggest problem was the fact that I was STILL exhausted all the time; my circadian rythm was totally out of whack! After almost a year as per diem, a permanent PT slot opened up in ICU., I felt like I was home again. Except that the exhaustion didint get better. I was also recently placed on antideprssants that I later found out can prevent REM sleep. I was still sleeping for days at a time, but never felt rested. My stimulants would get me started in the morning, but by 5pm I was a zombie. So unfocused, in such a fog! Came close to making some serious med errors, caught myself before they were administered, but came toooo darn close!. My Vyvanse dose was maxed out at 100mg (as per the doc). I just kept getting more and more unfocused at work and felt like I was always running in circles not knowing what to do next (no way for an ICU nurse to perform). Finally, after mutiptle MD recomendations, I had a sleep study. I took an Ambien CR beforehand (or else I would not have been able to sleep). The results showed no Sleep Apnea, thank god, but did show that I get No REM sleep and that I have PLMD (periodic limb movement disorder) where my legs jerked 684 times!! OK, now the sleep doctor wants me to go off my antidepressants since most of them can suppress REM. They also want my psych doc to prescribe Nuvigil to me for excessive daytime sleepiness. Oh, and they want me to take Mirapex (which is an anti-parkinsons' med) for the PLMD. Ok, so great. I wean off Lexapro & Concerta. I start Nuvigil 100mg in addition to my Adderall XR 100mg, and I now have the Mirapex 0.125mg to take at night with my Ambien CR. How's that worked for me, you say? It's been around a month for all the meds to become aquainted. Some are gone, some are new. Now, do I feel 100% better??? NOOOOO I have always on my ADD brain had difficulty keeping up with the charting & might stay 45 minutes or so late to catch up. Now, I'm focusing on the damn new online computer charting system that is totally redudent and fulll or errors. So much so that my patient's safety is being compromised!! I had a pt who came to ICU and within 30 mins his SBP was 62, at the same time I've got my manager yelling at me that I should NOT be far behind on my charting!!!! I thought I was going to lose it...Let's think here...what's the priority??? The patient of the PAPER!!!! My whole day and the day after were just a blur. Me trying to keep the patient alive & being pulled aside constantly by management so they could train me on this new documentation system! Oh, & just when it is getting really bad, someone from the bloodbank shows up with a unit of PRBC's for my patient and she tells me that she has to audit me during the whole process; this is while the man's 85 year old girlfriend is at the bedside asking me every 5 minutes "is he going to get better", "why is he in the ICU", "what are the doctor's plans", I'm hanging blood in one line and a pressor in the other!!! Needless to say I cried all way home from work. I felt totally incompetent as a nurse. I got home @ 10pm that night & had to get up @5:30 to start it all over again. 2nd day was very similar to the 1st because of the patient's ever changing condition and all the new charting we had to do, along with taking care of my other very sick patient! Went home defeated. Got into a fight with my hubby. He announces at dinner that he wants a divorce (with my son sitting right across the table)! I make an appointment to see the psychiatrist whos been treating my depression / ADHD and now part of my sleep disorder. He's 15 minutes late getting me in to see him, I tell him the latest news with me, he tells me that he can't do anything more for my depression and I need to check myself into a psychiatric facility to get it resolved!!!! As he's saying this, I'm about to fall on the floor!!!! I told him perhaps the circumstances in my life at this moment might be worsening my depression (he took my antidepressants away almost 2 monts ago!) I said the my lack of sleep is only exacerbating my ADHD symptoms and I'm having too many near-misses at work. I said I'd like to get a medical leave from work until I can get my sleep problems under control. He asked me what more was being done about that and I told him I had an appointment with a neurologist the next day. He stood up and was basically shooing me out of his office as he handed me a refill for my Vyvanse!! Same dose as always, what's this going to do to help??? He asked me to bring up Klonopin with the neurologist to help me sleep and deal with depression. Well, went to the neurologist who informs me that although my sleep study was done at the sleep center she works for that my dianosis given by another doctor there is totally wrong. She says I don't have Lack of REM, nor do I have PLMD. She explained them away and said it was probably because I was uncomfortable during the sleep study; I took an Ambien CR before the study and I never left the prone position, it wasn't like I was tossing & turning! She wants me to stop ALL meds and retrain my circadian rhythm. Ok, I would love to retrain my circadian rhythm and I would LOVE to get off all the meds, but I DO honestly believe the sleep study report that shows I get no REM sleep & showed that my legs DID twitch 684 times! In the meantime, I feel like I can no longer provide care to my patients in a timely & safe manner! I feel like I'm in a fog most days @ work and just can NOT concentrate or stay focused with ANYTHING. And having been reprimanded for the 1st time ever by my boss, in front of the entire unit, makes me think I need a breakl. Not to mention that EVERY time I drive home from work for the past couple of months, I honestly feel myself dozing off! Effective today I requested FMLA for myself, on the basis of my sleep study results & the fact that it is still not resolved and when coupled with my ADHD, my ability to perform my nursing responsibilities in such a highly critical environment is impaired. There is no room for error in ICU nursing. I just need to get a doc to back me up!!! I've got to find the right doc who knows what they're doing! Any ADHD sleep disorder docs out there??????

Is Hypertensive Crisis the only thing to worry about or can it cause others? If it's absorbed into the GI, I believe it can cause MI & Stroke. Not an expert on this one, I've just seen what happens when people ingest it in normal ways (snort it, shoot it up, etc). Crazy because people assume it can't possible do any damage in you butt! Wow!

Just had to add that I have had for the past few days, a patient who developed a Kennedy Ulcer overnight on her sacrum / coccyx that was GIGANTIC! It was 15cm x 15cm and classic butterfly shaped. She also had AWFUL heel ulcers that were new; they were soft, black, looking very much like a "blood blister". Her heels were completely offloaded and I had even taken any bedcoverings off her feet so that NOTHING could apply pressure....well, within hours, these crazy ulcers were developing on the tips and tops of toes!, then tops of feet! Back for another day with her tomorrow. I've been trying for almost 2 days to educate our MD's about this crazy phenomenon.

Although I feel it's better than nothing, the rotation function on the bed is for pulmonary issues and does not replace turning patients to prevent skin breakdown. At least that's what our management told us after a study at one of our sister hospitals.