Week 11: A Wonderful Week and Medication Administration

Last week, I was really discouraged at the end of the week because it had been a long, stressful, fairly unpleasant week. The teachers had yelled at us due to miscommunications (every class...), I failed a nursing skill, and we had a test I needed to be studying for. And, we got dispatched to a surprise cardiac arrest (as in, we were told it was an allergic reaction instead of a dead person) five minutes before we could call out of service Saturday night. Ok, so that was actually pretty exciting (it was my first code!) but the adrenaline crash afterward was pretty horrible... lol.

I just learned about how to put .gifs into Blogger so this post will be full of them... :-D

However, this week was wonderful - I aced my test on Monday (yay!), passed my skill test (yay!), the teachers were nice to us this week (yay!), my group got a lot accomplished for our nutrition project presentation due the week of Thanksgiving (yay!), and I got hired to photograph a guy proposing to his girlfriend on Saturday (yay!). This week was a wonderful respite from last week. :-D

Anyway, this week we learned about medication administration. I thought it would be fun to share some of the weird facts I learned this week:

Don't ever give ear drops to someone if they're cold. You need to roll them between your hands for a few minutes to bring the drops to room temperature. The middle ear is super sensitive to temperature and cold ear drops will cause the patient to have nausea, vertigo, and debilitation for a few minutes!

Fainting goats :)

When giving an injection, it should take 10 seconds to inject 1 mL. Yesterday, we had to pretend to give an injection of 2.5 mL so yes, it took us 25 seconds to give this shot!

1...2...3...4...5...6...7...etc...

If a patient uses a Metered Dose Inhaler (MDI), they need to rinse their mouth out two minutes later so fungus doesn't grow in their mouths.

There are between 600,000-1,000,000 accidental needle sticks of health care providers reported each year...

Insulin has to be given by injection instead of orally because the GI tract digests insulin before it can do any good.

I couldn't find a good gif for this so I decided to post a funny gif of the Kardashians because they're dumb.

Well, folks, that's it! :-D

...Until next week!

Week 10: Infection. Inflammation, and Bacteria - Oh My!!!

In week 10, we studied infection and inflammation.

Of the two, inflammation is the more general and can occur with or without infection. Slam your toe against a wall? Inflammation! Get a splinter? Inflammation! Get Tuberculosis? Infection and inflammation! It's a party! Ok, maybe not...

Anyway, inflammation is what causes the pain, redness, and swelling from an injury or illness. Let's say you were building a wooden fort and accidentally hammered a nail into your finger. Ouch! From the outside, your finger really hurts, a giant nail is sticking out of it, and it is probably bleeding.

This is actually a prank kit you can buy - the nail is not actually puncturing her finger!

On the inside, your white blood cells (WBCs) are flooding to the scene of the trauma, trying to ascertain whether any bacteria entered. Most likely, there are several foreign bacteria who entered with the nail. Your white blood cells start attacking the bacteria and call for help. One type of WBC releases histamine (which constricts veins, decreasing venous return), heparin (which decreases clotting abilities), and kinins (which dilate arteries).

The arteries bring blood to the area while the veins take blood away from the area so having dilated arteries brings more blood to the scene of the crime. However, the veins are smaller so it is harder for the blood to leave. This causes the redness you see in inflammation.

The 5 Pillars of Inflammation

Since all the blood is staying in the area, the area begins to grow and swell causing edema. Since the area is growing, this puts pressure on the nerves in the area which causes the pain involved in inflammation. Also, the edema and pain causes the person to not move the area as much so the last sign of inflammation is loss of function.

So there you have inflammation in a nutshell! :-D

Another very important topic we talked about was antibiotic resistance. Antibiotic resistance has become a huge problem lately because bacteria are smart and can easily figure out how to change so that the antibiotic is no longer effective on them. This can be caused by people taking antibiotics when they don't need to or by taking antibiotics for a little bit and stopping before the bacteria is fully killed. Either way causes bacteria to build up resistance to the antibiotics which makes it really hard to kill the bacteria. One famous example of an antibiotic resistant bacteria is MRSA - Methicillin-resistant Staphylococcus aureus. MRSA starts looking like a harmless spider bite but then it progresses and becomes really bad, eventually killing the person if it's not treated and stopped in time.

Harmless spider bite? Maybe not!

Anyway, almost all antibiotics have bacteria that are resistant to them. So the moral of the story, folks, is be careful with your antibiotics! If your doctor prescribes antibiotics for you, take them until they're completely gone! Don't just stop taking them because you "feel better!" You aren't just harming yourself, you're also harming everyone else around you who might get your newly antibiotic-resistant bacteria!

...Until next week!

Week 9: Quality Informatics

This week, we had fall break for a few days but still had to go to school Wednesday. We learned about quality improvement and different ways health care errors happen. Did you know that health care errors are the 8th leading cause of death in the United States?! I hadn't realized they happened that frequently. These last few weeks, I've noticed that hospitals are not near as safe as I once thought they were! The chances of you acquiring another infection or experiencing an error are extremely high! In fact, we learned that 1 in 20 inpatients will experience a hospital acquired infection. That is an extremely high number!

Healthcare Acquired Infections by the percentages.

I had absolutely no idea what to write for week 9 (because, if you haven't noticed, I'm writing it a week late) but got my inspiration during clinicals. During clinicals on Thursday, I saw a few quality improvement mistakes. I'll tell you about the first one.

My patient had a precautions sign on her door which warned anyone entering to put on PPE (gown, gloves, and mask). She had C. diff (a horrible diarrhea infection) which is highly contagious. I put on full PPE and cared for her.

Then the nurse informed me that she just checked my patient's chart and my patient was negative for C. diff. The precautions sign was taken down and PPE was no longer required. No one interacting with the patient had to wear PPE anymore (except for gloves during certain interactions).

At the end of the shift, the nurse came back up to me and said, "I'm sorry, I just looked at looked at her chart again and realized that I read her results wrong - your patient does have C. diff!"

?!

You mean to tell me that I've cared for this patient for the last several hours with no gown or mask and sometimes no gloves and she was positive for this horrible, contagious bacteria the whole time?!

I was not happy.

Thankfully, I never got the bacteria (it has a 7 day incubation period and today's day 8) but if I did, I would have been SOOO upset at that nurse.

Anyway, it was just a perfect example for quality improvement.

So, anyway, always always always wear your PPE!!!! It protects not only you, but your other patients and anyone you might bring the bacteria/virus home to!

Remember, safety first!

...Until next week!

Week 8: Evidence Based Practice

This past week, we studied two subjects that I am very passionate about - evidence based practice and patient education. Evidence based practice dictates what we do and how we do it. The first application of evidence based practice was in the 1800s when a physician noticed that women who delivered at home had much less rates of childbed fever (a septic infection that killed the moms a few days after they gave birth). The doctor started washing his hands before working with his patients (postpartum women). He quickly noticed that he too had much lower rates of childbed fever than other doctors in the area. Other doctors would go straight from an autopsy to the delivery room without washing their hands (yes, I know - DISGUSTING!). He told the other doctors to start washing their hands to protect their patients. However, the sad and scary thing is that the other doctors didn't like having to take the extra few seconds to wash their hands and so refused and even kicked the hand-washing doctor out of the country! Not surprisingly, the rates of childbed fever shot up again.

This week, we're having to write a paper about some form of evidence based practice and I (unsurprisingly) chose a childbirth related topic. In the year 2000, the Term Breech Trial released a report that significantly more babies born in the breech position died from being born vaginally than from Cesarean sections. Midwives were suddenly banned from attending breech deliveries and doctors stopped allowing vaginal breech births (except for the accidental ones where the mom walks into the hospital with her baby's butt hanging out...you get the picture).

Breech babies frequently keep their legs in this position for several days after birth.

Recently, childbirth professionals started looking more closely at the Term Breech Trial and discovered that their results aren't as obvious and dramatic as originally claimed. In fact, the trial tried to add mortality results from 3rd world countries (which already have high maternal and neonatal mortality rates regardless of how normal the birth is) with 1st world countries! Also, quite a few of the vaginal births used in the study violated the terms of the study. For instance, the study said the baby must be a non-footling breech (either frank or complete breech),  there must only be one baby (no twins!), the baby must be alive at the start of labor (you would think this one would be a "duh!" but read on...), the baby must not have any congenital defects (no heart or brain or chromosomal conditions), and the birth must be attended by an experienced birth attendant (again, another aspect you'd expect to be a "duh!").

Different types of breech positions - note the baby's feet

However, the study included several footling breeches, several sets of twins, several babies who were "probably" dead before their moms joined the study, at least one baby who had a congenital problem, and many of the births were NOT attended by experienced clinicians. Yet all the results - and resulting deaths -  were added to the study under the vaginal breech birth category. Also, the study "forgot" to mention that more moms died from a routine Cesarean section than from a vaginal birth.

Healthy mommy, healthy baby! :-D (And yes, in case you were wondering, I took this image)

For several years, a Cesarean became the only way to give birth to a breech baby. However, some European countries examined the study and conducted their own evaluations and discovered the Term Breech Trial results were wrong. When all results and extenuating circumstances are equal (healthy mom and baby, experienced birth attendant, resuscitation equipment ready, etc), the mortality rates were for babies were practically the same. However, the maternal mortality rates were significantly lower for moms having vaginal deliveries instead of Cesarean deliveries. Thankfully, some clinicians are starting to change their policies and "allow" vaginal breech births!

Once again, another picture I took :-D

If anyone wants to read the articles I'm using for my paper to validate what I wrote, the articles can be found here:
http://onlinelibrary.wiley.com/doi/10.1111/j.1523-536X.2011.00507.x/pdf
http://connection.ebscohost.com/c/articles/95894341/re-engaging-vaginal-breech-birth-philosophical-discussion
http://openaccess.city.ac.uk/3680/

...Until next week!

Week 7: Assess, Assess, Assess!!!!

One concept our nursing instructor has been drilling in us over and over and over (and over and over and over!) again is that we need to ASSESS! We need to assess our patients before we can care for them. To know what someone needs, we need to assess them. The very first step of the nursing process is assess. If you think assessments are important, you're 100% right!

This week we learned about the nursing process and diagnoses. The acronym for remember the order of what we need to do is ADPIE:

1. Assess
2. Diagnose
3. Plan
4. Interventions
5. Evaluate

When we assess our patients, we perform a physical assessment (which I posted about a few weeks ago), gather information from the patient about their health history, look at information from the chart, and use our five senses to learn everything we can about the patient and his/her problems. This is the foundation for our nursing diagnosis.

Once we've assessed the patient, we need to come up with a nursing diagnosis. There is a big difference between a nursing diagnosis and a medical diagnosis. A medical diagnosis would be "congestive heart failure" while a nursing diagnosis would be "decreased cardiac output." Obviously, there's a lot more to both types of  diagnoses but that's the basics: nurses can't diagnose a medical problem. We can describe the problem in our diagnosis, however. 

There are a list of about 80 nursing diagnoses that can be used. They are regulated and approved by NANDA-I (North American Nursing Diagnosis Association International) and are all compiled in a wonderful book called the "Nursing Diagnosis Handbook." We've been warned that this book will become like the Bible to us.

Already, I've been amazed by what we can do with this book. In one section, we can look up our patient's problem and it will give us a list of possible diagnoses. Then, we look up the diagnoses and they give us the characteristics of the diagnosis so we can determine whether it's the right diagnosis for our patient. 

Once our diagnosis is written, we move to the plan - what should we do about it? If our patient is at a risk for falls, our plan could be something as simple as, "My patient will not fall during my shift." The plan is just a goal. 

After we determine our plan, we plan out our interventions - what steps do we need to do to accomplish the goal? The Nursing Diagnosis Handbook is very helpful for this - telling us good interventions for each diagnosis. In other words, what do I actually need to do to help my patient?

Last, but not least, is evaluation. Throughout the day, we need to be evaluating our patients, reassessing, and determining whether our goals are good. Sometimes, we can write "goal met!" Other times, we have to write, "Goal not met." It's not bad if the goal is not met, it just means the goal was not met. There is (usually) not judgement involved. For instance, if a woman is in active labor, the goal might be "patient will give birth during my shift." However, if the lady has a long labor, the nurse might have to write, "Goal not met. Patient is still in labor."

Usually, a patient has more than one diagnosis at a time so the diagnoses need to be listed in order of priority and implementation. 

Until next week!

Week 6 Revisited

So anyone who read my last blog post for week 6 will know I was terribly boring and the chances of learning anything from the post was incredibly small because I myself didn't know the information.

My second test was Monday. Sunday night, right before I put my books away, I was trying to come up with some trick to remember the different fluid and electrolyte imbalances. While I was staring at the page, I suddenly got an idea to turn the information into a story.

How on earth did I turn fluid and electrolyte imbalances into a story? Read on!

First, I want to introduce you to a group of "friends." Their names are Kay, Cal, Mag, and Po.

Kay is a surfer dude (he got his name from always saying, "OK" to whatever his friends said). He spends all his time out surfing. All his friends think he's cool and he thinks he's a hot bod. He's always surrounded by 3-5 friends (yes, the numbers are important in the story too!)

I picture Kay as one of the dudes from "Dude and Dude," one of my favorite comics

Cal is a small cow, only about 10 hands high. However, he's extremely buff and highly excitable. He always seems slightly nervous.

Cal, the muscular cow

The next friend, Mag, is a magpie. He's controls train junction, called Neuromuscular Junction. However, he drinks a lot of alcohol and frequently falls asleep at work, causing many problems. His Blood Alcohol Content will frequently go to 0.2. (Just remember the "2" from this number, not the 0.)

Mag the magpie (yes, I know this bird isn't a magpie, but it was the only image that worked for "drunk bird.")

Last, but certainly not least, is little Po, only about 4 feet tall. He's a little Chinese man who works very hard and diligently. He has a lot of energy and a very good metabolism. His work ethic is amazing! However, he and Cal don't really get along so they try and avoid each other.

Little, energetic Po

Now that I've introduced you to all the friends, let me first go into detail about Kay, the surfer dude. Remember how he likes to have 3-5 friends with him? That's the perfect number for him. If he has less than 3 friends, he gets low. When Kay gets low, he doesn't exercise anymore on his surf board and just sits and sulks. Because he's not exercising anymore, his muscles get weak and he gets fat (abdominal distension). Also, he becomes constipated from not exercising and his heart starts having problems. He gets all out of wack. 

taken from http://www.gocomics.com/dudedude/2013/07/30

However, when Kay has more than 5 friends around him, he gets really hyper. He goes out on the waves and exercises until his muscles are weak from exhaustion, his belly hurts, and he has shooting diarrhea (yah, I know, lovely mental image). If he gets too hyper, he'll go into cardiac arrest. So for Kay, he needs 3-5 friends to keep him normal.

taken from http://www.gocomics.com/dudedude/2014/08/01

I'll now explain who Kay is, if you haven't already guessed. Kay is Potassium (whose periodic sign is K+). Potassium levels in the blood have to stay between 3-5. If the levels get low, they cause muscle weakness, abdominal distension. constipation, and cardiac arrhythmias. If the levels get high, they cause muscle weakness, abdominal cramps, diarrhea, and cardiac arrest. 

If Cal shrinks below 9 hands, he gets really twitchy. Every muscle in his body starts contracting and he becomes jumpy. Sometimes, he even has seizures when he shrinks.

Here, he got so jumpy, he jumped right over the moon!

However, when Cal grows over 10 hands, he gets all out of shape. He's nauseous, tired, lethargic, and confused. Everyone tries to make sure he stays between 9-10 hands tall to keep him from being twitchy or tired.

Poor Cal is sick

If you haven't guessed it yet, Cal is Calcium. It's supposed to stay between 9-10 in the blood. Hypocalcemia causes muscles to start contracting and twitching. Hypercalcemia causes the person to become lethargic.

Mags, the magpie, has problems similar to Cal. When he's got a low blood alcohol content, he's very twitchy and anxious from alcohol withdrawal.

However, when he's high with a BAC over 0.2%, he's very weak and lethargic.

Time for the big reveal: Mag is Magnesium. Magnesium is lowered by alcohol intake and has similar symptoms to Calcium problems. Magnesium levels should stay around 2.

The only really interesting information to give about Po is that he and Cal don't like each other. Po only comes out and works fast and hard when Cal is low (short). However, if Cal is tall that day (apparently Cal is the magically growing cow!), Po tends to lay low.

Po is phosphorous. It has an inverted relationship with Calcium in that it when calcium levels are high, phosphorous levels are low and vise-versa.

So that's how I remember the different fluid and electrolyte levels and responses! And here's a little fluid and electrolyte joke to tide you over until I post about week 7!