changeofpaceRN

I know very little about cardiac care (and I've never done hospital nursing) but I have a few questions google cannot answer... I thought why not try here ... Is the chest tube used post CABG the same type they use for a chest tube when they relieve pleural effusion? I'm assuming it is the same idea so.. that's why I really don't know. Has anyone had to leave a chest tube in for more than the 24-48 hour timeframe (post CABG) due to continued drainage? I'm going to post in another forum but may as well continue my questions for anyone who knows more. If there is low urinary output for a few days leading to no urinary output (due to kidney failure) fluid builds in the body.. would this cause abdominal swelling and/or epigastric pain if pleural effusion is not relieved?? Where does all this fluid go if it is not coming out via GI/GU system?

I work as a case manager for a state program (first case management job so other "types" of case managers are new to me). In this state program, we follow those with disabilities so anytime one of our consumers is admitted to a hospital, we get involved to ensure appropriate services are in place upon discharge. Anyway, I have run into a case manager at a local hospital that refuses to discuss the patient with me and will not send any type of records over (regardless of parent permission, id codes). She has referred me to medical records which is a battle in itself. Any suggestions on other avenues I can try? Perhaps I didn't explain it well enough? What sort of info do you need in order to discuss the patient- I thought the patient's code number was enough?

Thanks for the advice. That is the thing with law- it is up to interpretation and even the BON put that in writing when I asked for specifics. They also told me I can submit a declaratory statement to the BON for further review. Luckily, I'm still a 6 months-1 year away from seeing anyone as a coach so I have time to get answers.

Again, thank you steeleworks for your valuable input. You have brought up so many things I haven't considered yet... There is such a gray area in some parts of this. Sure a nurse can use their education to talk about healthy eating but at what point does it cross over to a dietitian? I am trying to work out all those kinds of scenarios since my state is so strict. The program I was eyeing talks about using your license in conjunction with the certification- well, perhaps I will have to find another program that doesn't make you use your license just in case I have to keep them separate. I found the area in my nurse practice act that says what I can do- of course, nothing in that section that is related to billing or alternative therapies. Do you do a H&P and health assessment? I wasn't picturing getting fancy in that aspect. I was considering making up a questionnaire and coming up with goals/steps and suggestions/actions for the issue at hand (based on what is subjective to avoid any issues on the objective end). I am now reconsidering that due to your comment about nursing diagnoses and care plans... because that makes sense! That being said, I am still in my information gathering stage so all of this is very helpful. I wasn't planning on advertising that I am a nurse at first due to my state. Now I don't know because education is education anyway you look at it.. You should write a book, I would buy it :-)

Wow what great advice. I strolled onto allnurses in hopes of finding some answers and sure enough, I am in luck! I've been searching my state's statutes and trying to figure out what is allowed in my state vs what is not (everything here needs a license of some sort). I'm still searching and I will find an answer one day. But what I don't understand is if a nurse writes a nursing diagnosis and care plan for a client, doesn't the nurse still have to be under the direction of a physician? I don't see how a private practice RN can run by itself. Are there any resources to address these kinds of concerns on what a RN can and can't do without their doctors approval? Of course the scope of practice varies by state but my scope of practice is as vague as vague gets....

I can't imagine how you felt but I can certainly understand your anxiety. I was in a situation like that a few times too. I came to the realization that it is MY license on the line and I don't play around with people's lives. If you are not getting the support you need from your workplace, consider your options. I considered mine and went into case management. Now, I'm a manager and work from HOME. Now, I LOVE nursing whereas before I was going to quit and never go back. Before I switched jobs, I couldn't sleep, I would cry before my shift, get into fights with my husband because I was so bitter, angry and anxious. It wasn't fair to myself, my kids or anyone else. It was the best decision I ever made. Perhaps a different unit would be good for you.