July 20, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Complications of casting include compartment syndrome, thermal injury, pressure sores, bacterial and fungal infections (especially if a wound is present under the casted area) and pruritic dermatitis.

July 19, 2018

The Working Nurse Podcast: DNRs, End Of Life Care & Everything In Between

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Because they are circumferential, casts provide effective immobilization of a fracture, but they require skill and time to apply. Swelling and subsequent pressure under the cast are highest during the first 24 hours after injury.

July 18, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Bursitis is a painful inflammation of the bursa that may be traumatic, infectious or related to systemic illness. Commonly involved sites include the olecranon, greater trochanter of the femur and prepatellar and anserine bursae around the knee.

July 17, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Common sites for tendinitis are the rotator cuff of the shoulder, Achilles tendon, radial aspect of the wrist (de Quervain’s tenosynovitis) and insertion of the hand extensors on the lateral humeral epicondyle (tennis elbow).

July 16, 2018

Inert Information & New Nurses

... except from Distinguishing Between Inert Information, Activated Ignorance, Activated Knowledge

It is impossible to reason without using some set of facts, data, or experiences as a constituent part of one’s thinking. Finding trustworthy sources of information and refining one’s own experience critically are important goals of critical thinkers. We must be vigilant about the sources of information we use. We must be analytically critical of the use we make of our own experience. Experience may be the best teacher, but biased experience supports bias, distorted experience supports distortion, self-deluded experience supports self-delusion. We, therefore, must not think of our experience as sacred in any way but, instead, as one important dimension of thought that must, like all others, be critically analyzed and assessed. The mind can take in information in three distinctive ways: (1) by internalizing inert information, (2) by forming activated ignorance, and (3) by achieving activated knowledge.

Inert Information

By inert information, we mean taking into the mind information that, though memorized, we do not understand - despite the fact that we think we do. For example, many people have taken in, during their schooling, a lot of information about democracy that leads them to believe they understand the concept. Often, a good part of the information they have internalized consists of empty verbal rituals in their mind. For example, many children learn in school that “democracy is government of the people, by the people, for the people.” This catchy phrase often sticks in their mind. It leads them to think they understand what it means, though most of them do not translate it into any practical criteria for assessing the extent to which democracy does or does not exist in any given country. Most people, to be explicit, could not intelligibly answer any of the following questions:

  • What is the difference between a government of the people and a government for the people?
  • What is the difference between a government for the people and a government by the people?
  • What is the difference between a government by the people and a government of the people?
  • What exactly is meant by “the people?

To generalize, students often do not sufficiently think about information they memorize in school sufficient to transform it into something meaningful in their mind. Much human information is, in the mind of the humans who possess it, merely empty words (inert or dead in the mind). Critical thinkers try to clear the mind of inert information by recognizing it as such and transforming it, through analysis, into something meaningful.

Nursing Translation

So what does the above information have to do with nursing training and education? We must understand that new nurses do not know what they do not know. Just because someone passes an exam, doesn't mean they possess adequate critical thinking skills and are experts. Preceptors are there to train new nurses. Preceptors should expect many questions and some mistakes. Mistakes do not mean new nurses are weak, it merely means they are learning. No judgments should be made. We must understand their limited experiences and inert information regarding the nursing profession. We have to allow them time to develop their knowledge base. Critical thinking and knowledge activation take time, it's a process. Memorization from school doesn't automatically translate to understanding. It simply means they retained the appropriate amount of information.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Tendinitis is described as an inflammatory condition characterized by pain at tendinous insertions into bone, occurring in the setting of overuse. It is now believed that the pathophysiology is related to the use affecting the cell-matrix interaction.

July 15, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
A strain is an injury to a musculotendinous unit resulting from violent contraction or forcible stretch. Among nonathletes, strains are seen in patients who overstress a muscle group or try to generate excessive force in an unconditioned muscle.

July 14, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
A sprain is injury to the fibers of a supporting ligament of a joint. The injury frequently occurs during vigorous athletic activity, when forces applied in opposite directions result in a joint being stressed in an abnormal or exaggerated direction.

July 13, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The liver, followed by the small bowel, is the organ most often damaged by stab wounds. The frequency of organ injury caused by gunshot wounds is greatest for small bowel, followed by the colon, and then the liver.

July 12, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Blunt cardiac injury usually results from high-speed MVCs in which the chest wall strikes the steering wheel. Other causes, such as falls from heights, crushing injuries, blast injuries and direct blows, are less common.

July 11, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The true danger of rib fracture involves not the rib itself but the potential for penetrating injury to the pleura, lung, liver, or spleen. Fractures of ribs 9 to 11 are also associated with intra-abdominal injury.

July 10, 2018

The Working Nurse Podcast: Medication Conversations Part 3

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Ribs usually break at the point of impact or at the posterior angle or posterolateral area, which is structurally the weakest area. The 4th through 9th ribs are most commonly involved.

July 9, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Flail chest results when three or more adjacent ribs are fractured at two points, allowing a free segment of the chest wall to move in paradoxical motion, with the flail segment moving inward with inspiration and outward with expiration.

July 8, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The human spine consists of 33 bony vertebrae - 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused into one), and 4 coccygeal (usually fused into one). These 26 individual units are separated from one another by flexible intervertebral disks.

July 7, 2018

Failure, Failing, Failed | Crisis Management

Failing happens to everyone, but for some reason, we only focus on the triumphs and achievements of others. It's as if it was so traumatic, that we never want to talk about it. Well, let's talk about processing those horrible moments that we all face.

JUST FEEL (0 - 24 HOURS)
So there you are, sitting in shock. It just happened and yeah it totally sucks. Now is the time when you shouldn't make any big decisions. Now is not the time to finalize ANYTHING. For god's sake, please, please don't start writing emails. I failed an exam once and immediately wrote my professor a 1500-word email about how the exams were unnecessary difficult and ridiculously vague. Oh, did I mention I called my professor's teaching style dull and simplistic? Yes, I was livid, and I SENT that email! There I was, fuming. I worked my ass off and studied for seven straight days. I did the assigned reading. I went to all the voluntary discussions and study groups. I did everything and for what? For a 72?! A 7-2?! Oh yes, your girl was livid. And my emotions poured into that email which obviously wasn't a smart move. There are many reasons why we don't pass an exam or course. Exams are moments in time, flashes of your education. Some days are better than others. Exams don't determine intelligence. Exams are milestones and set points. Don't give them too much power. So, you failed an exam or a class? It's now time to feel. Feel the grossness and the disgust of the moment. Roll around in it and sulk but do not act in this state, this isn't the time to be making decisions and letting people know how you feel. Embrace the lame. Take bath or shower and just let the sadness do what it does.

REFLECT & REVIEW (24 - 72 HOURS)
Alright, now that all your feelings are out there and they have been processed, it's now time to find out what the hell happened. Usually, I request an exam review or ask to speak to my professor about what happened. I do this AFTER 24 hours have passed, and my emotions aren't as raw. The goal is to find out what happened. You can't work on something or fix a weakness if you don't know what the problem is. I know, it's hard to realize you aren't perfect. We immediately get defensive, but you have to find out what you need to work on for this event to have value. If you ignore this step, it might repeat itself. For example, I failed the electrolytes exam during my ASN program. I was annoyed about my grade, so I passed on the exam review and just kept it moving. During my MSN program, I also did poorly on the electrolytes exam as well. Is it a coincidence? Oh no, the same problem repeated itself because it wasn't reviewed initially. This time though, I did my exam review (during my MSN program) and found the problem. Having an hour conversation with my professor opened my eyes to the areas I wasn't properly grasping. It's hard to seek assistance when you're pissed, but it has to be done. You must remain calm, now isn't the time for blame. It's time for learning. Learn from this event.

MOVE ON (72 HOURS +)
Okay, you had a crisis, reviewed the event with the appropriate parties, and now it's time to move on. You can't allow yourself to dwell on it. If you failed an exam, there is probably another exam right around the corner. You must move on and start worrying about the next challenge. If you failed a course, its now time to see what options you have and what your next move needs to me. What's done is done, you can't change the event's outcome, but you can continue to reach your goals, and that means you need to keep looking forward and planning. That doesn't mean dismissing the entire encounter altogether. It merely means you need to move forward emotionally. This is the hardest part for me, as I dwell and fixate on what I could have done. Obviously, this isn't helpful or productive. You have to make yourself move on from this. This isn't the end, it's just a bump in the road.

We can't expect to be experts on something we are studying to become. There will be fails or near misses. I had many, and I'm still standing (for the most part). As I said before, an exam or event doesn't define who you hare and doesn't determine what you are capable of. It's your hard work and dedication that determines that.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Noncontrasted CT of the head is the diagnostic standard for identifying intracranial injury in the ED. This scan delineates intra-axial and extra-axial bleeding, cerebral swelling, ischemic infarction, increased ICP and pneumocephalus.

July 6, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Decorticate posturing is abnormal flexion of the upper extremity and extension of the lower extremity. Decorticate posturing implies injury above the midbrain. Decerebrate posturing is the result of a more caudal injury.