DiggySRNA Posted November 30, 2021 Share Posted November 30, 2021 (edited) 15 hours ago, SedRate said: Good times. I've never really considered becoming an RN until Covid happened. I'm riding this money train until the CEO goes bankrupt lol. Edited November 30, 2021 by Diggy 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 30, 2021 Moderator Share Posted November 30, 2021 On 11/8/2021 at 11:13 PM, jmj11 said: I was in Morocco a few years ago and there was an ad on TV that kept running where Dr. Oz was promoting a supplement that caused an adult man to grow up to four inches (in height you dirty minds) and it featured a man about 3 inches shorter than his girlfriend and then after three months on the supplement, he was taller than her and she was looking at him with stars in her eyes. It was dubbed over in Arabic, but it was clearly Dr. Oz promoting this worthless crap there. At that moment I realized he would sell his soul for a dollar. heard it here first https://www.cnn.com/2021/11/30/politics/dr-oz-senate-campaign-pennsylvania/index.html Quote Link to comment Share on other sites More sharing options...
trazodone Posted November 30, 2021 Share Posted November 30, 2021 once saw a patient with their significant other who was scratching off scratch tickets the entire visit...it got louder as the visit went on and eventually I asked if we were winning and waiting for it to end before continuing on with the less important medical stuff. 3 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 4, 2021 Share Posted December 4, 2021 Pt with h/o advanced adenomas, perforated diverticulitis s/p sigmoid resection with colostomy in place. 300lbs. A1c 10. O2 dependent COPD. FNP orders cologuard. Positive. Orders another cologuard. Positive. Refer to GI. 1 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 4, 2021 Share Posted December 4, 2021 Urgent message from FNP about a mutual pt. “Pt is anemic, what should we order next?” Hgb wnl. Hematocrit 33.6. 2 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 4, 2021 Share Posted December 4, 2021 Just yesterday, pt chronically anemic with known bone marrow dysplasia. A tad more anemic but not bad, Hgb 10. Hx of GIB and PUD. RECENT hx of heme positive stool - visible. He tells me onc is planning bone marrow bx, but no one has checked his stool again or asked about the NSAIDs he has been taking….. So, how about we look for obvious cause of blood LOSS before we do a bone marrow bx?…. Just a thought Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 4, 2021 Administrator Share Posted December 4, 2021 4 hours ago, ANESMCR said: FNP orders cologuard. Positive. Orders another cologuard. Positive. Refer to GI. Do they own stock in Cologuard or something? 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 4, 2021 Moderator Share Posted December 4, 2021 5 hours ago, ANESMCR said: Pt with h/o advanced adenomas, perforated diverticulitis s/p sigmoid resection with colostomy in place. 300lbs. A1c 10. O2 dependent COPD. FNP orders cologuard. Positive. Orders another cologuard. Positive. Refer to GI. 4 hours ago, ANESMCR said: Urgent message from FNP about a mutual pt. “Pt is anemic, what should we order next?” Hgb wnl. Hematocrit 33.6. Ugh. Just ugh. Those APP make us all look bad. 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 4, 2021 Share Posted December 4, 2021 2 hours ago, rev ronin said: Do they own stock in Cologuard or something? Either that or her life insurance policy 1 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 5, 2021 Share Posted December 5, 2021 Murphy’s Law of COVID medicine and rationed procedures…. We are sending home FIT kits instead of low risk screening colonoscopies since early 2020. An inordinate number (in my mind) are coming back positive and GI is overwhelmed with need for colonoscopy now when they are trying to limit procedures due to staffing, hospital overload and COVID exposures. Thankfully a minimum of bad findings but just bizarre….. My insurance won’t cover Cologuard…. Got the standard little tube take home kit. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 5, 2021 Share Posted December 5, 2021 16 hours ago, ANESMCR said: Urgent message from FNP about a mutual pt. “Pt is anemic, what should we order next?” Hgb wnl. Hematocrit 33.6. Pizza? 1 1 4 2 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 5, 2021 Moderator Share Posted December 5, 2021 14 hours ago, Reality Check 2 said: Murphy’s Law of COVID medicine and rationed procedures…. We are sending home FIT kits instead of low risk screening colonoscopies since early 2020. An inordinate number (in my mind) are coming back positive and GI is overwhelmed with need for colonoscopy now when they are trying to limit procedures due to staffing, hospital overload and COVID exposures. Thankfully a minimum of bad findings but just bizarre….. My insurance won’t cover Cologuard…. Got the standard little tube take home kit. the bigger issue here is the people that would have never gotten a colonoscopy and now will do cologuard Also, with a > 99% neg predictive value there is a fair number of false positives - worth it in my mind - But I do tell patients this so that when I tell them + and need colonoscopy they don't immediately think they have cancer.... seems to defray the worries 1 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 5, 2021 Share Posted December 5, 2021 Regardless it’s contraindicated in a pt with h/o advanced adenomatous polyps. Might as well order a guaiac on her. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 5, 2021 Moderator Share Posted December 5, 2021 42 minutes ago, ANESMCR said: Regardless it’s contraindicated in a pt with h/o advanced adenomatous polyps. Might as well order a guaiac on her. agreed and with IBS/OBD and GIB hx would never order a cologuard - just GI referral Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 14, 2021 Share Posted December 14, 2021 Lady was convinced she had worms in her poo. I’ve been shown pics of feces many times (of course mostly by women), but this woman had an entire iPhone photo album, approx. 30-40 photos. She had enough to create Bristol mosaic masterpiece. 3 3 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 14, 2021 Moderator Share Posted December 14, 2021 17 hours ago, ANESMCR said: Lady was convinced she had worms in her poo. I’ve been shown pics of feces many times (of course mostly by women), but this woman had an entire iPhone photo album, approx. 30-40 photos. She had enough to create Bristol mosaic masterpiece. But did she have worms ?? Inquiring minds need to know. 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 14, 2021 Share Posted December 14, 2021 3 hours ago, ventana said: But did she have worms ?? Inquiring minds need to know. TBD. Looked like a well rounded Mediterranean diet to me. Maybe some yucca fries too. No overt worms. 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 19, 2021 Share Posted December 19, 2021 Pt goes to UC with new onset painless jaundice. LFTs in the thousands. CT first, then U/S... No stones, no dilation, no mass. NP orders labs and sends home instead of admission telling pt will be notified of results. Feel like there should be a thread for these NP shenanigans. 1 1 Quote Link to comment Share on other sites More sharing options...
SedRate Posted December 19, 2021 Share Posted December 19, 2021 Contacted by EM physician that he saw our pt who is 1 wk s/p hip nail. Pt was sent in by SNF NP for possible compartment syndrome. No pain out of proportion, NV intact, good pulses, skin warm, etc. Pt did have moderate leg edema and some hip pain... Quote Link to comment Share on other sites More sharing options...
Hope2PA Posted December 20, 2021 Share Posted December 20, 2021 5 hours ago, SedRate said: Contacted by EM physician that he saw our pt who is 1 wk s/p hip nail. Pt was sent in by SNF NP for possible compartment syndrome. No pain out of proportion, NV intact, good pulses, skin warm, etc. Pt did have moderate leg edema and some hip pain... I don't typically respond to these, however couldn't resist. Two-three years ago(pre-covid) a family member went to ER after falling and knee was very swollen, there was a very bad storm and they couldn't get to ER for almost 7 hours after initial incident, concerned with fracture. . NP walked in and said, Oh my, you know you may loose your leg, his looks like compartment syndrome, lets call ortho for consult and potential surgery! After expressing concerns with her response, ER doc came in checked them out ordered x ray and maybe other tests, all was fine, but scared the crap out of patient and family unnecessarily. The x-ray tech was more knowledgeable explained concerns, within scope better than NP. Quote Link to comment Share on other sites More sharing options...
SedRate Posted December 20, 2021 Share Posted December 20, 2021 4 hours ago, Hope2PA said: I don't typically respond to these, however couldn't resist. Two-three years ago(pre-covid) a family member went to ER after falling and knee was very swollen, there was a very bad storm and they couldn't get to ER for almost 7 hours after initial incident, concerned with fracture. . NP walked in and said, Oh my, you know you may loose your leg, his looks like compartment syndrome, lets call ortho for consult and potential surgery! After expressing concerns with her response, ER doc came in checked them out ordered x ray and maybe other tests, all was fine, but scared the crap out of patient and family unnecessarily. The x-ray tech was more knowledgeable explained concerns, within scope better than NP. *facepalm* Quote Link to comment Share on other sites More sharing options...
Colorado Posted December 21, 2021 Share Posted December 21, 2021 On 11/28/2021 at 6:17 PM, SedRate said: Walked into a pt's room to discuss surgery and before I could even introduce myself, she instructed me to change the channel until it settled on an acceptable news station. Another pt's son asked some questions regarding the specifics of the surgery we performed on his mom. As I was explaining, he kept turning his head to look at the TV. Maybe I'm a donkeys rear but I turn the TV off shortly after I enter the room. Its an ER, not a damn entertainment room. Its a decent measure of pain level though if you're engrossed in HGTV so much you can't bother to pay attention to your provider. Exceptions: Elderly, frail, children, and autistic patients. They get to keep the TV. Quote Link to comment Share on other sites More sharing options...
Colorado Posted December 21, 2021 Share Posted December 21, 2021 On 12/5/2021 at 8:07 AM, ventana said: the bigger issue here is the people that would have never gotten a colonoscopy and now will do cologuard Also, with a > 99% neg predictive value there is a fair number of false positives - worth it in my mind - But I do tell patients this so that when I tell them + and need colonoscopy they don't immediately think they have cancer.... seems to defray the worries I work with a lot of uninsured patients and nearly all of our low risk patients ask for FIT tests rather than colonoscopies. Positive initial FIT test? It depends, some go for colonoscopies and others I double check reasons for false positives and recheck a second FIT test. If I find a reason for the false positive or the 2nd one is negative, then we repeat the FIT the following year. Hard to tell my uninsured patient who can barely afford basic living expense to splurge on a colonoscopy when it turns out to be just a false positive.. I always try to talk my patients into at least one colonoscopy early on. Quote Link to comment Share on other sites More sharing options...
SedRate Posted December 21, 2021 Share Posted December 21, 2021 11 hours ago, Colorado said: Maybe I'm a donkeys rear but I turn the TV off shortly after I enter the room. Its an ER, not a damn entertainment room. Its a decent measure of pain level though if you're engrossed in HGTV so much you can't bother to pay attention to your provider. Exceptions: Elderly, frail, children, and autistic patients. They get to keep the TV. Agree. And same. She was elderly. I usually at least introduce myself and then proceed to turn off the TV. But before I even made it all the way into the room, she instructed me to do that. *Facepalm* The other guy wasn't even involved in the discussion as he was watching TV, but then turned to ask questions as he kept watching the TV. Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted December 21, 2021 Share Posted December 21, 2021 12 hours ago, Colorado said: Positive initial FIT test? It depends, some go for colonoscopies and others I double check reasons for false positives and recheck a second FIT test. If I find a reason for the false positive or the 2nd one is negative, then we repeat the FIT the following year. Why? I truly want to understand the logic here. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.