Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Hyperkalemia causes cardiotoxicity by increasing the resting membrane potential of the cardiac myocyte, causing “membrane excitability” and conversely, sluggish depolarization, as well as decreased duration of repolarization.

The Nurse Nacole Podcast: It's Not You, It's The Learning Process

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Hyperkalemia usually develops from impaired renal excretion or intracellular release. However, in advanced chronic kidney disease or end-stage renal disease, dietary intake of potassium may be a significant factor in its development.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Hyperkalemia, defined as serum potassium level greater than 5.0 mEq/L, is the most dangerous acute electrolyte abnormality, potentially leading to life-threatening arrhythmias and death.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Metabolic alkalosis occurs from loss of H⁺ or retention of HCO3⁻. It is usually a consequence of prolonged vomiting or nasogastric suction or compensation for chronic respiratory acidosis.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Alcoholic ketoacidosis (AKA) causes an elevated anion gap metabolic acidosis. AKA can occur when a long-standing ethanol user abruptly stops drinking. Ketones are generated by a combination of malnutrition and dehydration.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Diabetic ketoacidosis (DKA) may be manifested atypically with chief complaints of vomiting, abdominal pain and/or altered mental status. DKA is often caused by medication noncompliance, but may complicate any physiologic stress.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Diabetic ketoacidosis (DKA) is a common acid-base disorder defined by hyperglycemia, ketonemia and acidemia. Patients with DKA classically complain of progressive polyuria, polydipsia and malaise.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Causes of lactic acidosis (increased production of lactate) can be divided into hypoxic or hypoperfusion states (shock) and exogenous cellular toxins, such as cyanide and carbon monoxide.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Metabolic acidosis, defined by a reduced serum bicarbonate concentration, occurs when acids are added by intrinsic processes or from exogenous sources, acid excretion is impaired or there is inappropriate loss of alkali.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Pregnant women may hyperventilate throughout gestation and normally have a PCO₂ between 31 and 35 mm Hg, serum pH between 7.46 and 7.50 and serum bicarbonate concentration between 18 and 22 mEq/L.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
If respiratory alkalosis persists, the kidneys excrete bicarbonate and retain chloride, leading to a compensatory metabolic acidosis, with reduced serum HCO₃^-, hypokalemia and hyperchloremia.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Blood pH alters the binding affinity of calcium for albumin. When the pH lowers, calcium loses some affinity for albumin (increasing free calcium). When the pH increases, calcium binds more strongly to albumin (decreasing free calcium).

What Does Complete Look Like? | Nursing Hacks # 17

I recently finished my ARNP critical care orientation. I started with an ASN, got my BSN, and now my MSN. With each pathway, I found a common issue in the learning process. Many people would ask me to complete a task. I would attempt to complete the task, but there would always be some missing piece I never completed. The more this occurred, the more frustrated I began. I recently read the book, Dare to Lead by Brene Brown. This book is fantastic and opened my eyes to clear communication.

One aspect of the book that drew me in was the concept of completion. When I would be asked to complete a task, the instruction would be somewhat vague, and I never truly knew what finished looked like. For example, I was asked to complete the admission forms for a new admission. I'd complete the required forms, but there would special things I didn't do that everyone "knew to do" with new admissions. No one discussed this with me, but I was expected know it.

I would perform the task to the best of my knowledge. But there was always something missing or half-done in the eyes of my preceptor or attending. As you learn, you get feedback and corrective measures. That process can be overwhelming and honestly frustrating at times. But what was more frustrating was the lack of understanding regarding what "complete" looked like. After reading this section of the book, I now approach tasks differently. After I'm given a task, I always follow up with these questions:

C - 1. What does complete look like?
What checkboxes are your reviewing in your head? What do you expect to be done?

T - 2. Expected time frame to complete things?
How long do I have? Are you under any time constraints?

A - 3. Any additional things I need to know about?
Are there any special caveats I need to know before starting?

The frustration comes in a lack of overall understanding. The funny thing about communication is that one person can think it's happened, while the other person is completely clueless and lost. Just because words are spoken and someone nods their head, doesn't mean he or she properly understands the scope of the task. I've seen preceptors give nursing students a simple instruction. The nursing student then performs the task but misses a key element. This is often due to a lack of understanding regarding what "complete" looks like.

If all this sounds annoying, over the top or "too much," then you are probably a person who has to clarify instructions multiple times. You might often find yourself disappointed in the actions of others. Take the time to explain what you need. Don't assume people know the intricacies of your request. Explain what you want, and be clear the first time. Learning is a frustrating process. Someone who doesn't have the time or patience to explain what they want really doesn't help.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Suicidal aspirin ingestions often produce the classic syndrome of tinnitus, hyperthermia, confusion and a variety of metabolic derangements, ultimately leading to seizures, coma and cardiovascular collapse.