June 23, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Gunshot wounds cause trauma to the surrounding tissue by direct laceration, crush injury, shock waves, and cavitation. The amount of tissue damage is related to the kinetic energy of the bullet, which is a factor of the bullet weight and velocity.

June 22, 2018

June 21, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Pain from disk herniation is relieved by lying supine and is worsened by a Valsalva maneuver, coughing, sneezing, and positions that produce increased pressure on annular fibers, such as prolonged sitting, standing, and bending postures.

June 20, 2018

From Bedside Nurse ➡️ NP Student: ANCC AGACNP Exam Results

So, I freaking passed! And I'm beyond excited. What resources did I end up using...


The Facebook group really offered wonderful advice and had an amazing study guide! READ the study guide. R-E-A-D IT!

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Typical nonspecific back pain is unilateral. Pain may radiate to the buttocks or posterior thigh but not past the knee, implying muscle or ligamentous strain or disk disease without associated nerve involvement.

June 19, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Most episodes of back pain will resolve or improve within 4 to 6 weeks. Therefore, lack of significant improvement in 6 to 8 weeks is a warning sign. Presence of a single clinical finding does not necessarily correspond to a specific pathology.

June 18, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Disk herniation occurs when the tough outer disc layer (annulus fibrosis) thins and tears, and the inner gelatinous matter (nucleus pulposus) prolapses, inflames, and compresses a nerve root. Herniation may be asymptomatic or severely painful.

June 17, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Back pain may be caused by a vascular, visceral, infectious, mechanical, or rheumatologic process. Pain may originate from the spinal cord, nerve root, vertebral column, surrounding musculature, or an extraspinal origin.

June 16, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The GI tract is presented with 9 L/day of secretions and fluids. The small intestine usually absorbs all except for 500 mL. The colon mixes the ileal effluent, ferments and salvages the carbohydrate residues, and desiccates the contents to form stool.

June 15, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
For less developed areas, the WHO outlined an oral rehydration solution made by dissolving 3.5 g of sodium chloride, 2.9 g of trisodium citrate or 2.5 g of sodium bicarbonate, 1.5 g of potassium chloride and 20 g of glucose in 1L of clean water.

June 14, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Oral rehydration is the treatment of choice for mild, acute diarrhea. This can be accomplished with sports beverages, commercial rehydration solutions, or a balanced clear liquid diet at home.

June 13, 2018

Overloaded Circuits | Prioritizing & Remaining Sane


Since I've started my MBA journey, I make myself read at least two articles from the Harvard Business Review every other day. I stumbled across one article that helped me to focus on the right things at work. The article is titled, Overloaded Circuits: Why Smart People Underperform. It's an amazing article about chaos at work and how to deal with it in a healthy manner. As a bedside nurse, I've noticed over the years there have been higher and higher demands on me as a caregiver. From managing central lines to administered breathing treatments, each task adds up and decreases my time elsewhere. Bedside nurses are no longer simply passing medications, we are doing 25 things and expected to do them all without mistakes and as directed. When I worked on a medical-surgical floor, all my patients (all six of them), had medications due at 9:00 AM. Each patient's medication list included a minimum of 10 pills for that timeslot. When I entered the room, I was expected to open each pill packet and explain the side effects of the medication to the patient. No problem, right? Well, 10 x 6 = 60. That is at least 60 separate conversations about medications during one medication pass. Oh, and don't forget the hourly rounding that took place. Do you now I was written up once for doing hourly rounding at 9:02 AM, instead of 9:00 AM? My manager would make rounds and mark on the paper so, she knew if the task late. Yes, nursing is that intense. You have to balance your time and juggle all these tasks appropriately. You just can't go all gung-ho and do them as they come up. You need a plan. Here are few tips that have helped me.

1. Medication Slow Down
When you are administering medications DO NOT rush. I can't stress this enough. Medication errors occur due to many nurses rushing, in order to meet the increasing work demands. Depending on that drug's half-life, the patient could be feeling those side effects for up to 48 hours. Don't do it to your patient, and don't do it to yourself. Medications should be triple-checked. Trust me, I've been a nurse for almost seven years,  rushing will get you into trouble one day. Maybe not today, but one day. I know, it's annoying and involved but it's all on you. Scan that armband and check those allergies. This is the only time I say, DO NOT multi-task. Reschedule other tasks or ask for help, but don't cut corners here. You shouldn't be multi-tasking and administering medications. This is a task that requires your undivided attention and focus. Calling a doctor and documenting a sentinel event because you were rushing can cost you your career. Take medication administration seriously. I'm all about multi-tasking (in general) but ask my co-workers... if I'm giving a drug or changing a drip rate, I check three times. I give that drug my full attention. I leave that room knowing, not hoping, I did the right thing. Why? Well, a nurse gave my dad the wrong medication once, he was unconscious for two days. It's a big deal, even if you don't think it is.

2. Who Gets Attention
If you have a crashing patient, don't worry about getting family members water and a blanket. At some point, I had to sit a family member down and explain my job objectives and priorities. If my patients are stable and safe, I will provide you with all the comfort measures you (as a family member) are requesting. But, right now my patient is crashing. You are no longer a priority and if that is unsettling to you, let me direct you to my charge nurse. You are not my patient. I'm my patient's advocate and directing all my attention to a family member is inappropriate and unsafe.

I know, sounds rough but it's not. Sometimes people get upset because they don't see the context of the situation. I've told many family members this, and they get it. It's all in the presentation and delivery. My goal isn't to belittle or demean anyone. It's all about education and information. I'm a nurse. I'm here to care for acutely ill individuals. I will assist you (family member) AFTER my job objectives have been satisfied, and my patients are safe. Do you know there was an active code blue going on and a family member was complaining she didn't get a blanket yet?! Yes! I'm telling you! If you don't explain yourself from the jump (during the shift introduction), you will be fighting this uphill battle all shift. Here the speech I give during the change of shift.

Hello, and good evening, my name is Nacole, and I will be your husband's nurse this evening. My shift is from 7 PM to 7 AM. My job objectives are to manage your husband's hemodynamics, respiratory needs, and bedside nursing duties. These are my priorities, as he is in the ICU and he requires certain levels of care and attention. My goal is to promote health and wellness, and these priorities are apart of that plan. If you need anything, don't hesitate to let me know. I do have another patient who also requires this same level of care and attention. So if you need anything, please press the call light, and I will arrive or someone else will if I'm busy. I will be back in 30 minutes to administer his medications and to give him his bath. Again, my name is Nacole, and I'm here for you and your husband. Do you have any questions or needs at this time?

Yes, it's long, but I leave that room KNOWING the family member understands my frame of mind, upcoming activities, and my professional priorities. There will be no confusion or misunderstandings. I explained my position from the beginning. Every time I do this, the family members understand me and are less inclined to demand things in inopportune times. It's all about communication and expectations. Once you manage those, your shift will go a lot smoother (in my experience, anyway). The problem occurs when you say nothing, and you're gone for 2 hours. Yeah, you're working hard, but they don't know that. I make them aware. I also keep family members up to date on the many activities I'm performing. So, they are involved and understand what is being done for their loved one. The key is to verbalize your hard work and let them know just how awesome you are.

Note: Ask the charge nurse or co-workers if they can assist the family member with their needs (if you are busy). But, most of the time, they are also drowning and busy. I've floated to some floors that didn't EVEN have a charge nurse. Ask who you can, but know they also have patients and responsibilities as well.

3. Take Deep Breaths
I don't know if it's society as a whole, but there are a lot of angry people out there. Over the past months, there has been a wave of angry, violent, unreasonable people coming to the hospital (patients and family members). It's increasing, and I often find myself in the bathroom simply taking deep breaths. Understand that people who are belligerent, know you're at work. They know you can't "do" anything about their behavior. As a nurse, all you can do is call security. Then what happens? They say sorry, and that is that. They thrive off the ability to lose it completely, and there be no real consequences. You can't kick them out, this is the healthcare setting. They are allowed to be there, warranting they don't get trespassed (which happened 1% of the time and involves repeated, sustained verbal, and sometimes, physical abuse of the nursing staff).

Do not feed into this game they are playing, do not do it! Don't allow someone's behavior to make you react. This is your job, remain professional at all times. If you have to step away, please do so. But don't lose who you are and don't go down to their level. Because the family member can say, they were "emotional." You don't get that luxury. You can't control how others react. You can only control how you respond, step back and reset. You are a nurse, not a punching bag. Don't allow someone to abuse you verbally. Take your break, walk away. It's not a healthy environment. You don't get an award for being verbally abused for an entire shift.

I love nursing, and you love nursing, but don't sacrifice your physical and mental health. Don't allow yourself to get stretched and pulled. Figure out your priorities and focus on those. You can only do so much, you can only be one place at a time. Do what you physically can and ask for help for the other things. We are only human, there is only so much time in the day.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Several medications may improve gastrointestinal bleeding (GIB) outcomes. Somatostatin, octreotide and vasopressin cause splanchnic vasoconstriction that reduces portal hypertension and the risk of persistent GIB and rebleeding.

June 12, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
A bedside balloon tamponade (Sengstaken-Blakemore Tube) should only be considered in exsanguinating patients with likely variceal bleeding when endoscopy is not immediately available. Complications are common and significant.

June 11, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In patients with suspected upper GI bleeding, guaiac testing can be performed at the bedside to evaluate for occult blood, even when stool appears normal. The test makes use of the pseudoperoxidase activity found in hemoglobin.

June 10, 2018

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Death from exsanguination resulting from gastrointestinal bleeding (GIB) is rare. However, there are two causes of GIB that may rapidly cause death if not recognized and mitigated, esophageal varices and aortoenteric fistula.

June 9, 2018

Where Is The Tube? | Nursing Hacks # 4


As a critical care transition nurse (from PCU to ICU), my preceptor trained me to check diagnostics and progress notes for tube confirmations BEFORE continuing use during my shift. There have been times where I've entered a situation unaware of changes in a tube's location, and the change subsequently caused significant issues. For example, a patient was intubated yesterday, and the endotracheal tube was confirmed 2 cm above the carina, positioned 24 cm at the lip via CXR. When I go to perform my initial assessment and lean over to see that endotracheal tube, it better be at the 24 cm mark, or we have a problem. If it's not, I call the respiratory therapist and confirm the discrepancy. A combative patient can dislodge or advance an endotracheal tube without the nurse knowing. This isn't a competency issue. People are moving parts, they are not static. When I receive bedside report, I write down the details, but I make sure to confirm with diagnostics and visuals. Here is another example. The morning nurse placed a nasoduodenal feeding tube. The tube was confirmed as post-pyloric at the 85 cm mark via KUB XR. Upon your initial assessment, you find the feeding tube at 55 cm. The tube feeding pump is going as planned, no alarms will sound but obviously, the tube has been moved. It probably isn't post-pyloric anymore, you're probably feeding gastrically.

When I receive bedside report, I assume everything is messed up until I confirm it's not. Nothing personal, just nursing. Communication is complex and interruptions are plentiful. Inaccurate information isn't intentional. But it's your license and inheriting problems is common. Tubes slide, things move, don't be the last person to find an error 10 hours into your shift. Nothing beats good old eye-balling and research. These tubes are in people, don't assume they will remain in place. Oh, and by confirming placement, I mean reading the impression section of the diagnostic report. Don't over think it, scroll down and read. You don't have to be a radiologist to read two sentences. Remember, if you are using a line or tube, continued use is confirmation you're 100% aware of its location and trust the destination is appropriate. If you have reservations about the final destination of the device or product, you probably shouldn't be using it. You can't continue to use something and say, "Oh, I assumed it was right. I never checked." If you don't know, find out.