Hematocrit13

Apologies if this has been asked and answered, I have yet to read every single reply. Along with some colleagues, I am considering working in a Covid-impacted area, but beyond the state hospitals in Washington state, I have not been able to find out how to know where to apply. Would be very grateful for posting of resources that point us in the right direction. Thank you.

Thanks. The BBB was unable to help. HI, No, I never found any that were exclusively online. I did find a training that had a large online component with an in-person kind of check off scenario. The online training was one of the best I've ever had in anything, the in person check-off - orders of magnitude less so! In Clearwater, Florida.

Absolutely.

Yeah, that's right: the times they are not judging you, they really couldn't give a C#*$ about you.

Can you expand upon this?

OMG

This is information that should be collected as a routine matter, preferably by management.

But this man died due to poor medical (mal)practice not poor nutritional advice, no? The advice he got regarding nutrition, from the little we have been presented with, seemed pretty good. Added up, I have probably spent months if not years, total, learning about food and its impact on our bodies. I do consider myself quite up to date on the latest research, and yes, the latest trends. I have implemented a lot of what I've learned on myself and have developed flyers and learning tools to inspire others. I would probably self-eject from a classroom setting if I had to listen to traditional nutritionists talk and lecture, as I think I know a fair amount and have learned a lot on my own. In other words, I'm not someone who is impressed with certificates and licenses regarding nutrition. But I allow that that opinion may be misguided. I would never recommend anyone to come off any medication. HCT

Hi, There's some key missing information here. Nurses should know that not all hypertension is directly weight or diet related. And not all strokes are hypertension-related. What were the BP meds? Did the patient or client discontinue them all of a sudden? What was the tapering schedule? What were results of his blood pressure throughout his time with this nurse, including after discontinuing the medications? Are we meant to infer that his stroke was BP related? Thinking of myself in that nurse's position, I would certainly have referred the man to his primary care physician in terms of advice of getting off any medications. Getting a person off any medication is not a nurse's call. Assuming his hypertension did not go away after lifestyle changes and did indeed cause his stroke, staying within the scope of practice would have protected her and presumably the patient. HCT

The question I have, is that Medicare is not free. It's pretty bare bones on its own and supplemental is all but mandatory. I admit that I don't understand everything about Medicare, but still.

Great comments here! I watched the program, and many of the issues and questions raised by the commenters are in fact addressed in the program. The music is maybe overdone and maybe too ominous, but I recommend viewing it.

I'm just getting to the part where they're comparing Seattle to Rhode Island. No doubt this problem has a few factors, but at least initially, I'm skeptical of the comparison if for no other reason than the weather.

Or, we have to work together (pay attention) not to lose it. We're only "providing" it after we've lost it. Yes indeed, follow the money. You got that one right!

In a blow to the makers of losartan, amlodipine, lasix, hctz, Januvia, Novolog, metformin, simvastatin (to name just a few), "[t]wo of the country’s leading medical groups on Monday issued a call to arms against the soda industry, urging legislators and policymakers to embrace taxes, warning labels and advertising restrictions to deter young people from consuming the sugary beverages that are increasingly linked to the nation’s crisis of obesity and chronic disease." https://www.nytimes.com/2019/03/25/health/soda-taxes-sugary-drinks-advertising.html "[T]he American Academy of Pediatrics and the American Heart Association issued a set of bold policy recommendations they say are necessary to stem the epidemic of Type 2 diabetes, cancer, cardiovascular disease and other diet-related illnesses responsible for tens of thousands of premature deaths and billions of dollars in annual health care costs." To which I can only say, it is only 25 years past due. And it ain't even done yet. Stay tuned.

Thanks, yes, I did and have dug in a bit further. What I was trying to detangle in the part I added in my post above ("ETA") was why we have not been giving the series to an adult who presents to us as either not knowing his/her status or stating they've never been vaccinated, and in answer (to my own question) I surmised that the working assumption must be that they were vaccinated as infants.

Thanks for that information about the vaccine being a toxoid, that fits the pieces into place. If as you say, "An unvaccinated adult should receive a series of 3 doses of tetorifice toxoid, aka vaccine, spaced 4 weeks between dose 1 and 2, and 6 months between dose 2 and 3. " why does the CDC site say, " Tdap vaccine can protect adolescents and adults from tetorifice, diphtheria, and pertussis. One dose of Tdap is routinely given at age 11 or 12. People who did not get Tdap at that age should get it as soon as possible." What the CDC is saying seems on the face of it a bit vague and perhaps incomplete. But why no mention of the the tetorifice toxoid, I wonder? ETA: What I'm thinking now is that the assumption is probably that everyone has been vaccinated as an infant and therefore what you mentioned above would not apply.

(So many comments that I've not quite gotten around to reading yet!) It's interesting to read that immunity is not conferred after acquiring tetorifice. And yet it is from the vaccine. There's no doubt that my knowledge here is incomplete, but what I'm concluding is that the disease (maybe) does not quite allow for an appropriate immune response? Though I'm not sure why that would be. While the vaccine does. That is just my conjecture at this point in time. In doing some reading, I've also gleaned that unvaccinated adults (never been vaccinated by DTaP) not only need a booster, but also preformed antibodies to the tetorifice. I did not know this! And I've given many TDaPs to adults who either have never been vaccinated or do not know their status.

I am having a very difficult time finding the recommended The Fluid, Electrolyte And Acid-base Companion for under $2,000. It must be out of print. I would appreciate any updates on availability of this book. Thanks!

Hello everyone, I work in a clinic and occasionally, not often, it happens that one or two patients want to meet with me privately. I recently met with a 50 year old female patient who says she occasionally has SOB, some palpitations (PVCs, according to a recent progress note) and transient chest pain, including a burning pain. She inquired about which tests she should get to rule out heart disease. Naturally, I advised her to talk to her provider, she said she does and will, but she just wanted to see what I thought in the meantime. Her blood pressure is fine, she does have severe sleep apnea, which is treated with CPAP. There is a strong family history of heart disease, but no diabetes or kidney disease, and her labs are all apparently fine. She says in the past her doctor ordered echocardiograms which she’s had two of over the last 4 years. They show some mild regurg in one or two valves (she can’t remember), and everything else with the echos are normal, but she worries nonetheless, concerned about the occasional pain below the left breast. Would either a stress test or halter monitor be something I could suggest she talk to her PCP about? She was asking how she can tell if there’s any blockage, inflammation or anything else wrong with her coronary arteries and if she should get anything like a CT. She seems to know that there are several tests to ask about because she also asked about the coronary calcium scan, but I felt bad because at the time I couldn't tell her much about it, or many other tests, frankly! I will strongly recommend she talk to her doctor, obviously, since I am far from an expert, but I thought I’d tap the resources here to see if anyone has any suggestions about how to shape this conversation, so I can maybe be a bit more prepared when she returns next week. Also, I myself will let the doctor know that she dropped by, and what her suggestions would be for this patient.

Medscape.

Great post, would love to hear some follow up, and wondering what you might think is different at your institution than at those responders who don't (always) feel the same way. My initial thought was, if management was put under as much scrutiny as nurses, we would have better run hospitals.

Overcome fear by seeing the ridiculous yet the funny side of every experience. -Edgar Cayce Just "discovered" Cayce! Wow.

Sorry - what is HCA?

Distilled or sterile. Does not have to be exclusively sterile. If you choose to make your own saltwater solution, it's important to use bottled water that has been distilled or sterilized. Tap water is acceptable if it's been passed through a filter with a pore size of 1 micron or smaller or if it's been boiled for several minutes and then left to cool until it's lukewarm. --Mayo - but honestly I would never use tap water again. I stopped after first reading about the case in Louisiana a few years ago.

But doctors need to be a lot more mindful about telling their patients to use one. You can't just say "try a neti pot." You have to also follow it - and use with sterile or distilled water. And she/he might even mention the risks associated with tap water. And how do you wash it out? Detergent? Tap water? Distilled? Unsure. I've used mine now only a handful of times a year, and always use distilled. But I warm it on the stove, after cleaning the pot I'm warming the water in a LOT (with distilled water). It becomes a chore. So I've opted for the saline spray from CVS. A bit less environmentally friendly, maybe, because of the plastic, but less labor intensive.