Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Hemoptysis is defined as the expectoration of blood from the respiratory tract below the vocal cords. Many definitions exist, but massive hemoptysis is generally accepted as 100 to 600 mL of blood loss in any 24-hour period.

You Do Not Know Anything | #FlexPath MBA Journey

Disclaimer: I’m an actual Capella student compensated for posting about my experience at Capella. All thoughts and opinions are my own.

So, my first course is LEADERSHIP. Here is a breakdown of my academic program...
Three courses from my MSN courses transferred over. So, I'm seven courses away from my MBA!

I hope I don't sound like a fool, but I honestly thought I knew what business involved. No, I do not have a background in business, but I thought I knew a little something. And within just a week of my leadership course, I was proven wrong. Our first assignment was evidence-based management. Sounds simple enough, but it was like a gut punch after eating a large meal. I have a new found respect for people in management positions after starting this course. It's not about the financial terms or operational aspects of a business. It's all about balancing multiple elements from people to products. You are balancing various decisions based on a thorough, multi-leveled analysis. The hard part is locating and sifting through quality research. Making decisions based on evidence, rather than personal strengths and business history is an uncommon practice.

Do you know how many times I've heard nursing managers say, "I made this choice because it has worked in the past" or "This is a strength of mine and will work?" Often, very often. This course is helping me to examine my decision-making process not only as a business student but as a bedside nurse as well. Now, remember, I already have a Master's degree in Nursing. I knew these concepts would be new to me, but I thought they would be somewhat known to me. Not at all! From VUCA to benchmarking to critical thinking processes, it all consists of layers of information. When I started reading the course material, my ears got warm, haha. I've never had to think using this many layers of data before, then consolidating the data into a plan, and making an educated decision. It's an odd feeling. I'm getting used to it now (luckily), but it's new, and I'm stumbling along. I know nursing, I do not know anything about business. I could see how a medical provider could be overwhelmed with managing a business, it's a complicated process.

"We've suggested six substitutes that managers, like doctors, often use for the best evidence - obsolete knowledge, personal experience, specialist skills, hype, dogma, and mindless mimicry of top performers - so perhaps it's apparent why evidence-based decision making is so rare." - Pfeffer & Sutton @ https://hbr.org/2006/01/evidence-based-management

My first paper was a disaster. I read all the course material, but I wasn't getting it. All the basic concepts were foreign to me, and I just couldn't relate to them. I had to read articles three times for them to finally sink in. Then last week, I had an epiphany. I stopped thinking of the course as a "business class" and started thinking of it as "life education." All these business concepts can be applied to nursing and my personal life. After that, things started clicking, and the previous barriers disappeared. I'm talking Lego Master Builder mode. This isn't just a class, and these aren't merely assignments. I'm learning things that will help me professionally and personally.

I'm new to Capella University, but I'm very impressed with the school thus far. Each assignment comes with pages and pages of resources. You are given the tools you need to complete the assignments. You aren't given an assignment and expected to find journals and articles on your own.  For the first assignment, I was given eighteen resource articles to educate myself on the necessary content. Capella offers access to various business journals through their library. My current favorite is the Harvard Business Review.

Overall, these two weeks have been eye-opening, and I'm learning so much!

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Corneal ulcerations caused by overuse of contact lenses are treated with prophylactic antibiotics and avoidance of the lenses for at least 72 hours. A follow-up with an ophthalmologist or optometrist before contact lens use is recommended.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Alkaline caustic agents to the eye cause a liquefactive necrosis of the cornea by reacting with the corneal layers, and destruction is severe and relentless. Acid injury causes coagulation necrosis, which tends to limit the depth of injury.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Funduscopy is used to examine posterior eye structures. Emergency physicians most commonly perform a nondilated funduscopic examination, because there are several eye conditions in which dilation may be harmful (angle-closure glaucoma).

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Fluorescein examination with cobalt blue light from the slit lamp identifies corneal defects. Fluorescein is not taken up by intact corneal epithelium but concentrates in areas where corneal epithelium is breached by abrasion, foreign body or ulcer.

Defining Painstipation

Note: I was compensated by Salix Pharmaceuticals for this post. However, all opinions are my own. 

As a critical care nurse, I’ve cared for many individuals living with chronic pain who suffer from opioid-induced constipation. From what I’ve heard from patients, it is very frustrating and I’ve even seen some people in tears. Recently, I learned about a new pharmaceutical drug that may help these folks named RELISTOR® (methylnaltrexone bromide) and I wanted to share some information with you.

INDICATIONS 

• RELISTOR is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids.
• RELISTOR tablets and RELISTOR injection are used to treat constipation caused by opioids in adults with long-lasting (chronic) pain that is not caused by active cancer.
• RELISTOR injection is also used to treat constipation caused by opioids in adults with advanced illness or pain caused by active cancer and who need increases in their opioid dose for pain management.

IMPORTANT SAFETY INFORMATION 

• Do not take RELISTOR if you have a bowel blockage (called an intestinal obstruction) or have a history of bowel blockage.

Please click here for full Prescribing Information for RELISTOR tablets and RELISTOR injection 

“Patients may not mention opioid induced constipation with their practitioner, so we need to have a “do ask, do tell” policy. It’s important to realize that it starts with conversation. I like to use the phrase “Painstipation.” These are chronic pain patients who are experiencing constipation due to their opioids.” - Dr. Joseph Pergolizzi, Senior Partner & Director of Research, Naples Anesthesia and Pain Associates

Defining Painstipation:

Painstipation, also known as opioid induced constipation (OIC), is the constipation caused by opioid pain medication, which is often taken for chronic pain.

On March 6, 2018, Salix brought together a group of chronic pain patient influencers, HCPs and advocacy organizations to discuss OIC. At the event, Salix shared responses from an OIC online survey that it sponsored in partnership with the U.S. Pain Foundation and asked the influencer attendees to transform the numbers into abstract artwork. These paintings were then unveiled to a group of HCPs later that evening. Attendees also got to hear from Dr. Joseph Pergolizzi about the benefits and risks of RELISTOR and the importance of patients and physicians adopting a “do ask, do tell” policy when it comes to OIC.

The responses presented below are from a national, 1-week online survey sponsored by Salix Pharmaceuticals, in partnership with the US Pain Foundation and conducted by Wakefield Research, which evaluated responses from 441 US adults, aged 18 years or older, who were living with chronic pain, on opioid therapy, and suffering from opioid induced constipation (OIC).

• More than 37% of these patients reported changing the dosage of their opioid medication to try to alleviate the pain or discomfort from OIC
• 77% of these patients reported suffering from OIC for at least one year
• These patients reported waiting an average of 18 hours to have a bowel movement after taking their constipation medication
• 43% of these patients reported suffering from OIC for more than 3 years
• 53% of these patients said they would have preferred for their OIC medication to induce a bowel movement in less than 4 hours
• 47% of these patients reported taking between 6 to 10 total prescription medications on a regular basis
• 20% of these patients reported taking more than 10 prescription medications on a regular basis

INDICATIONS

• RELISTOR® (methylnaltrexone bromide) is a prescription medicine used to treat constipation in adults that is caused by prescription pain medicines called opioids. 
• RELISTOR tablets and RELISTOR injection are used to treat constipation caused by opioids in adults with long-lasting (chronic) pain that is not caused by active cancer. 
• RELISTOR injection is also used to treat constipation caused by opioids in adults with advanced illness or pain caused by active cancer and who need increases in their opioid dose for pain management. 

IMPORTANT SAFETY INFORMATION

• Do not take RELISTOR if you have a bowel blockage (called an intestinal obstruction) or have a history of bowel blockage. 
• RELISTOR can cause serious side effects such as a tear in your stomach or intestinal wall (perforation). Stomach pain that is severe can be a sign of a serious medical condition. If you get stomach pain that is severe, does not go away, or gets worse, stop taking RELISTOR and get emergency medical help right away. 
• Stop using RELISTOR and call your healthcare provider if you get diarrhea that is severe or that does not go away during treatment with RELISTOR. 
• You may have symptoms of opioid withdrawal during treatment with RELISTOR including sweating, chills, diarrhea, stomach pain, anxiety, and yawning. Tell your healthcare provider if you have any of these symptoms. 
• Tell your healthcare provider if you have kidney or liver problems. 
• Tell your healthcare provider if you have any stomach or bowel (intestines) problems, including stomach ulcer, Crohn’s disease, diverticulitis, cancer of the stomach or bowel, or Ogilvie’s syndrome. Tell your healthcare provider if you are pregnant or plan to become pregnant. Taking RELISTOR during pregnancy may cause opioid withdrawal symptoms in your unborn baby. Tell your healthcare provider right away if you become pregnant during treatment with RELISTOR. 
• Taking RELISTOR while you are breastfeeding may cause opioid withdrawal in your baby. You should not breastfeed during treatment with RELISTOR. You and your healthcare provider should decide if you will take RELISTOR or breastfeed. You should not do both. 
• Also, tell your healthcare provider about all of the medicines you take, including prescription and over the-counter medicines, vitamins, and herbal supplements. 
• In a clinical study, the most common side effects of RELISTOR tablets in people with long-lasting (chronic) pain that is not caused by cancer include: stomach-area (abdomen) pain, diarrhea, headache, swelling or a feeling of fullness or pressure in your abdomen, sweating, anxiety, muscle spasms, runny nose, and chills. 
• In a clinical study, the most common side effects of RELISTOR injection in people with long-lasting (chronic) pain that is not caused by cancer include: stomach-area (abdomen) pain, nausea, diarrhea, sweating, hot flush, tremor, and chills. 
• In clinical studies, the most common side effects of RELISTOR injection in people receiving treatment for their advanced illness include: stomach-area (abdomen) pain, gas, nausea, dizziness, and diarrhea. 

You are encouraged to report side effects of prescription drugs to FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For product information, adverse event reports, and product complaint reports, please contact:
Salix Product Information Call Center
Phone: 1-800-321-4576
Fax: 1-510-595-8183
Email: salixmc@dlss.com

Please click here for full Prescribing Information for RELISTOR tablets and RELISTOR injection

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
If the patient cannot distinguish letters or shapes on a chart, visual acuity must be determined qualitatively. Any printed material suffices. The result may be recorded as, for example, “patient able to read newsprint at 3 feet.”

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Visual acuity is quantitatively assessed by use of a Snellen chart test at a distance of 20 feet or a Rosenbaum chart at a distance of 14 inches. Young patients who cannot yet read letters and numbers should be tested with an Allen chart.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Completely asymptomatic “red eye” is almost always a spontaneous subconjunctival hemorrhage, which is benign but often alarming to the patient. Spontaneous subconjunctival hemorrhage may follow coughing or straining.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nystagmus occurs when the synchronized vestibular information becomes unbalanced. Typically, it results from unilateral vestibular disease, which causes asymmetrical stimulation of the medial and lateral rectus muscles of the eye.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Dizziness is categorized into vertigo, near syncope, and disequilibrium. Vertigo is an illusion of motion, typically described as the room spinning. Near syncope is feeling faint or lightheaded. Disequilibrium is a sense of unsteadiness when walking.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The serum glucose level should be determined in every seizing or postictal patient. If the diagnosis of a seizure is uncertain, lactic acidosis may be detectable for up to 1 hour after the seizure resolves.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Status epilepticus has been classically defined as at least 30 minutes of persistent seizures or a series of recurrent seizures without intervening return to full consciousness. The time criterion has now been shortened to 5 minutes.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Cyanosis is a blue or purple appearance of the skin or mucous membranes. This clinical finding is caused by inadequately oxygenated blood perfusing peripheral tissues or the presence of abnormal hemoglobin forms.

My FlexPath Journey With Capella University

Disclaimer: I’m an actual Capella student compensated for posting about my experience at Capella. All thoughts and opinions are my own. 

Nursing & Business

May starts a new chapter in my educational journey. On May 5th, I graduated with a Master of Science in Nursing degree. Today, May 7th, I will be starting my Master of Business Administration (MBA) program at Capella University through their self-paced, online format called FlexPath. When I started graduate school to become a nurse practitioner, my first clinical rotation was with a fantastic pediatrician (Fall, 2015). She and I have become friends, and she even cares for my son. I learned so much from that clinical rotation. From hand, foot, and mouth disease to managing an asthma exacerbation, I learned all the typical medical problems children could face in their development. One day while I was reading up on skin infections in the pediatric population, and my preceptor said, "You need your MBA. You have no idea how hard it is to be a healthcare provider and lack business fundamentals." At the time I thought she was crazy. Who would want to do that? How did that relate to healthcare?

Well, it wasn't until a few months ago when I realized she was right. I was in my emergency department clinical rotation (Fall 2017), and my preceptor was explaining how budgets, resources, and management factored into her providing healthcare. All the stuff I initially thought was irrelevant were now integral pieces of me practicing as an advanced practice nurse. From fiscal obligations to team organization, my preceptor showed me all the non-medical related matters she was expected to manage or work within. When I self-reflected on this information, I found myself lacking the ability to understand specific business concepts and felt that a business degree would help me in that regard.

Getting an MBA isn't about having more credentials, it's about elevating my knowledge base in order to help my organization. For example, my husband is a manager. He has even done that Six Sigma thingy. He's a smart cookie. I'm an intensive care nurse. I know inpatient healthcare. But when my husband sits down and talks to me about return on investment, capitalization factor, gross profit versus net profit... I'd get lost. I don't know anything about business. I thought that wasn't a big deal until I went to a clinical rotation and heard my preceptor explaining these very concepts and how they factored into how she cared for individuals. Have you ever heard of the RVU Compensation Model? I sure hadn't, but it's how some organizations pay healthcare providers. How can I lead a team toward being productive and financially responsible, if I have no idea how to do that? Healthcare is about people helping people. But in order to do that, you must have a solid foundation of resources and business. They go hand in hand. And in my opinion, having an advanced practice nursing degree and a business degree will get me there.

I am ready to enter this new chapter in my life. Business is a whole new world for me (did the Aladdin song, "A whole new world," start playing in your head too?).  I'm excited and nervous all at the same time. But it's a good excitement. I'm going to learn what is needed to operate a business and what skills are necessary to manage a team of individuals. It's different, but it's similar. Nursing is all about management diseases. Now, I will be studying how to manage the people who manage the disease. My husband told me this one day, and it blew my mind, "Employees worry about this week. Managers worry about this month. District managers worry about the next few months. The higher you go, the more expanded the view gets. It's not about who is smarter. It's about who can see the bigger view and work toward the appropriate goals." I want to expand my view, and I feel Capella’s MBA FlexPath program will get me there.

Planning My Education

I've been doing online educational programs for about seven years now. I know what I need in order to be successful and I know what I need from a school. I need an accredited school, that is organized and that can offer me courses on my time. When I was studying as an undergraduate I would pick classes based on one thing, "Will this work for me?" There isn't a point in registering for a course you won't be able to attend (physically or online) because of your work schedule or other responsibilities. I use that same viewpoint in picking schools and classes. Does this school understand what I need and who I am? I'm a wife and mother with a full-time job, I can't be expected to chat daily for attendance purposes. I don't need a bunch of filler assignments that don't count as a grade. I'm a grown adult, and I want to be treated like one. It took me some time, but I eventually found a school that meets those requirements through Capella and their excellent FlethPath learning format.

Why FlexPath?

No Fluff, All Business
FlexPath has competency-based approaches but removes pre-set deadlines and weekly discussions. You're evaluated by how well you demonstrate competencies, not by how long it takes you to learn them. Who doesn't love that? I wish all schools did this.

Set Your Own Deadlines 
You'll work with your FlexPath coach to complete a personal course completion plan, setting your own deadlines to complete each assessment. This is great because I work nights/weekends and have a special needs son so, I need to custom plan.

Real World Assessments 
You can demonstrate competencies by applying your knowledge to everyday, professional situations like case studies, research papers, or presentations. You ever complete an assignment and know you'll never revisit the information you've learned? Not here.

Faculty Feedback 
Submit your completed assessment to a faculty member and receive prompt feedback. You can use this feedback to revise your work and resubmit up to three times. That's one thing I wish ALL schools offered. How can a person truly improve without feedback?

I am beyond excited to start my education at Capella University, and I hope you follow my MBA FlexPath journey through my monthly posts and updates. I hope you, yourself, grow your knowledge base when you're ready in whatever courses or classes you feel will help you to reach your professional goals. Thank you for reading and let's do this!

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Fever is distinct from hyperthermia. Hyperthermia is an elevation of the temperature related to the inability of the body to dissipate heat. Most cases of temperatures higher than 41.0°C (105.8°F) are a result of hyperthermia.

BAYADA Home Health Care & Nurses Week 2018

Being a medical professional, especially a nurse, requires so much time and care. I want to take some time during Nurses Week to give a shout out to nurses everywhere for the fantastic work they do each and every day. Nursing isn’t a career. It’s a calling. One area of nursing that especially hits home for me is home health care because it's a unique connection with individuals in your community. When my husband had a heart attack, a home health care nurse visited and educated us on diabetes management and care. My husband was diagnosed with diabetes mellitus type-2 during his heart attack hospital admission. I was a nursing student at the time and was drowning emotionally from the sheer experience of my husband having a 4-way coronary artery bypass grafting (CABG) surgery. I needed help. We needed help. I knew about diabetes, but the nurse educated us on things I didn't learn in nursing school. From medications to possible side effects to potential complications, the nurse reviewed everything. She was so patient and kind. She even called weekly and allowed us to ask her questions. She made the entire process less scary. Diabetes is a life-long disease process, and she gave us the tools to manage it successfully. You can't put a value on that type of education and care.

Being a home health care nurse is especially rewarding and unique because it provides the opportunity for close ongoing interpersonal connections with your patients and their families. It’s a meaningful connection that is exclusive to home health care. As a nursing student, I had the ability to shadow a home health care nurse. I initially thought it would be exactly like inpatient-setting nursing. You perform the head to toe assessments, chart your actions, and administer medications. I was very wrong. When the home health nurse arrived at the patient's home, I could see there was a deep relationship there. The dynamics were nothing like the inpatient-setting. The relationship was filled with familiarity and admiration. The nurse knew the patient's need before he could even ask. She wasn't just a nurse to him. They were friends. They shared intimate moments and valued each other. They joked around, and she educated him with each assessment. It wasn't just about nursing. It was about the relationship itself. He trusted her wholeheartedly, and she respected that relationship. I had never seen anything like it, and haven't since then.

To all the nurses out there, you should be feeling appreciated every day, not just during Nurses Week. Or, if you’re not working full-time and aren’t getting what you need from your employer, you should be looking into other employment options. That’s why I’m partnering with BAYADA Home Health Care this Nurses Week – because BAYADA puts their nurses first. BAYADA Home Health Care values its employees by offering competitive compensation and benefits, including ongoing education and leadership opportunities, and much more. The company is grounded in what is referred to as “The BAYADA Way,” which is rooted in the belief that clients come first, employees are the company’s greatest asset, and everyone should be treated with compassion, excellence, and reliability.

For this year’s Nurses Week, BAYADA is encouraging you to “Share, Care, Dare” – share your stories about how nursing has touched your life in one way or another; consider home health care as a way to care for your loved ones or as a career choice; and dare to change your career path by applying to BAYADA. Visit http://bit.ly/2JJfK5S to learn more about the other ways the team takes care of caregivers. Check out this self-care kit BAYADA Home Health Care sent in honor of Nurses Week full of self-care items. BAYADA knows how to take care of its nurses so they can take care of their patients – they even made a custom nursing bag based on their nurses’ feedback to make life easier for them. I'm loving this kit – happy Nurses Week, everyone!

Note: This blog post was a paid sponsorship by BAYADA Home Health Care

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
There is no consensus on the threshold core temperature that defines fever. The Centers for Disease Control and Prevention define fever as a core temperature greater than 37.8°C in the absence of fever-reducing medication.