Advice for New Nursing Students, part 1

Yes, it has been a really long time since I last remembered to post. I have been extremely busy with school. Each semester, I have even more to do. It's all very interesting and I'm enjoying it, but it's a lot of work.

Currently, I'm on break between 1st and 2nd year. It's hard to believe, but I graduate nursing school next May! Just 9 months away! I can barely believe nursing school is almost halfway done.

It had been so long since I'd had a break with nothing to do, that my first week of break I had no idea what to do. I'm used to always having to be studying so suddenly not having to study and getting to decide what *I* want to do was extremely hard. I had no idea what to do.

Anyway, I decided to write a post to encourage students starting nursing school this fall. If you're like I was, you're excited and nervous and have no idea what to expect. If your program is anything like mine, then hopefully my recommendations and tips will be helpful!

Warning: your first day of school will be overwhelming! There is so much the teachers will cover that first day. I know I was stressed out within 20 minutes of class starting because we started with the syllabus. If your teachers are anything like mine, they will like to scare you. My teachers started with the "don'ts" and the "this will get you kicked out of nursing school." By the end of the day, I was convinced I'd be kicked out by the end of the week.

Don't worry! You can do this!

When you get your syllabus, take the time to go through and read everything, write every single due date down on every single calendar you own, highlight the important stuff (yes, everything's "important," but highlight the "drop dead" dates), and post it in places you'll see it. My teachers made us calendars with the class schedules so I taped the calendars to my desk so I'd see it every day. I also wrote every possible due date onto that calendar. It was my most important calendar. And to keep me motivated, I crossed off every day that passed with a pretty highlighter. (If you haven't noticed, I'm right brained and I LOVE color! The more colors I see, the more I get excited. Needless to say, I highlight everything - my notes, my calendars, my textbooks, etc.)

For clinicals, make sure to print off everything you need for clinicals at least the night before. Don't wait until the morning of clinicals to try and print everything because Murphy's Law will take effect and your printer will die. Also, lay out everything you need the night before. I always put my uniform together on one hanger and stick all my pens and penlights and stethoscope and paperwork in my pockets and stick the hanger in the bathroom so all I have to do at 4:30am is roll out of bed and get straight into the shower. Then, everything I need is right there.

Make friends with your classmates! They are your biggest support group. You will spend more time with your classmates than with your family. There will be classmates you love, classmates you like, classmates, you don't like or dislike, and classmates you don't particularly like. But please make friends with your seat mates! The girl I sit next to has quickly become one of my best friends. We'll spend the night at each others' houses, study together, go out to lunch, practice skills together, text each other about everything, cry together, laugh together, roll our eyes at each other, etc. A buddy in class is invaluable!

Also, it's ok to take an afternoon off and not think about nursing school occasionally. Not frequently, but only occasionally. I'd do it about once a month, whenever I'd hit a wall and think "that's it! I'm going to quit!" It's ok to just take an afternoon off, go to a movie, go shopping, whatever you need to do to relax!

One thing I have found extremely helpful is to do practice NCLEX questions. I've found free online NCLEX questions and there's also apps with practice NCLEX questions. The more questions you do, the better you'll do.

Lastly, don't forget to relax and have fun! Nursing school is extremely stressful and hard but it is worth it! You will get to see and do so much and you will feel so overwhelmed and tired and confused. There is nothing like it. I love it but I can't wait to graduate in May!

Hopefully next week I'll get to post "Advice for New Nursing Students, part 2" and talk about clinicals.

You will feel like this after every single test

Nursing humor is its own breed

This is hilarious!

The only stories that gross me out are ones with oozing dead fluids...or maggots in your skin...

This is what your textbooks will look like

You will eventually cry at clinicals or work

You will save a life

And this will be your life! (And I have gotten fat in nursing school)

The Truth About Nursing School...

Note: Before reading my post, please know that I really do enjoy nursing school and really enjoy learning how to become a nurse. I just need to enlighten people of the truth of what school is like...

As anyone who's been reading my blog has quickly figured out over the last few weeks, I've been insanely busy. And it's not been because I haven't had anything to write about. It's because I have been SO busy!

We finished Maternal Child nursing last week and started Medical-Surgical nursing Monday. We're six days into the semester and I'm already overwhelmed and feel like I'm drowning. Our first test is Monday and it only covers two subjects. So what do I do? Write a blog post instead of study! After all, if I just ignore the mountains of work I have to do, it'll just go away, right?

Don't worry - I'll study after I finish writing this!

But I just wanted to write this blog post for anyone planning on going into nursing school or who is curious why their friend in nursing school never has social time...

Here's a little secret: Nursing school thinks they own you. While you're in school, your nursing schedule comes above your family schedule, work schedule, or any other schedule you could imagine.

This is the truth!

If there's a change in your nursing schedule, they'll give you about a week's notice and expect you to be there, no matter what you had scheduled that day. And if you're not there, you're counted absent. In our semesters, we can only be counted absent from class twice and absent from clinicals once so we try not to miss anything! With rescheduling snow days, it has made everyone's lives interesting...

To give you an example, I volunteer for the local EMS agency 5 times per month. I'm supposed to send in my work dates a few weeks before the month starts. Since March was already crazy for me, I was only able to find 4 dates that worked for me. I got all scheduled and everything was rolling smoothly. But then school got rescheduled and I had to cancel two of those EMS dates and pick up a different date to work. And then I got scheduled for something else that new EMS day... All in all, I've had to change my EMS schedule 3 times and was only able to work three times this month!

Also, we had our spring break taken away so anyone who had plans for spring break suddenly had to cancel them. And we were only given a one week warning about that.

If you tell your instructors you're working on a day they just turned into a school day, they tell you, "sorry, but you're in nursing school. You need to be here or be canceled absent." No ifs, ands, or buts.

So if you're looking to start nursing school, kiss your life and schedule good bye! All your spare time will be spent studying and any plans you make will most likely be canceled due to school being rescheduled.

Ok, I'm done ranting for today and am off to study chest tubes and anxiety and all sorts of good stuff... :-D

Week 6: The Dangers of the HPV vaccine

The vaccine debate! Oh boy... (Warning: please don't read this article looking for a fight. I am neither overly for or against vaccines but just want to share some information about a certain vaccine...)

Yes, this is what we were supposed to have a class about in school but our class was cancelled so we just had to do the readings for it. There are two sides to the vaccine debate and both have very valid points. But I just want to quickly clarify some things:

1) If your child is vaccinated, you do not need to worry about them being infected by unvaccinated kids. If your child had his/her vaccines, he/she theoretically can't catch the diseases he/she's been vaccinated against. So you don't have to worry. According to the CDC, your kid is fine.

2) People who choose not to vaccinate their child are not stupid or selfish. Most of them have educated themselves and are choosing this option because they believe it is the best option. They're not just "thinking of themselves" and ignoring everyone else around them. A lot of these parents are choosing not to vaccinate because they believe vaccines are harmful and so they believe that by not vaccinating their child, they are benefiting their child and society.

Ok, now that we've clarified that a vaccinated child shouldn't catch diseases from the unvaccinated child and that anti-vaxxers aren't selfish and stupid, let's continue...

The vaccine I'm going to write about tonight is the HPV vaccine. It has been hugely promoted recently by the CDC and vaccine companies yet there has been a LOT of controversy over it.

According to the CDC, the HPV vaccines, Gardasil and Cervarix, "Can prevent most cases of cervical cancer in females, if it is given before exposure to the virus. In addition, it can prevent vaginal and vulvar cancer in females, and genital warts and anal cancer in both males and females." (http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html) Sounds great, right? 

When you look at the side effects that the CDC reports, They write: 

"This HPV vaccine has been used in the U.S. and around the world for about six years and has been very safe.

However, any medicine could possibly cause a serious problem, such as a severe allergic reaction. The risk of any vaccine causing a serious injury, or death, is extremely small.

Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.

Several mild to moderate problems are known to occur with this HPV vaccine. These do not last long and go away on their own.

• Reactions in the arm where the shot was given:
  • Pain (about 8 people in 10)
  • Redness or swelling (about 1 person in 4)
• Fever:
  • Mild (100° F) (about 1 person in 10)
  • Moderate (102° F) (about 1 person in 65)
• Other problems:
  • Headache (about 1 person in 3)
• Fainting: Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your doctor if the patient feels dizzy or light-headed, or has vision changes or ringing in the ears.
  Like all vaccines, HPV vaccines will continue to be monitored for unusual or severe problems."

(http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html#risks) 

It's been declared "very safe" worldwide? Then why has Japan banned it because it has hurt so many young girls in their country? Why has it happened that "France banned HPV vaccine ads due to the false claims. Japan has banned the use of the HPV vaccine, Spain has recalled it and Israel is now considering a ban. India banned the HPV vaccine clinical trials in their country." Isn't it a very safe vaccine?! 

It's not.

The HPV vaccine is very dangerous with thousands of normal, healthy girls reporting damaging side effects including constant fatigue, constant pain, frequent seizures, paralysis, and more. These girls were perfectly healthy. Most of them had never had health problems! Then, within 1 month of receiving the Gardasil shots, they started experiencing health problem after health problem. And the health problems have not stopped. They now have chronic fatigue, pain, seizures, paralysis, headaches, etc. And the only thing that could have possibly caused these problems is the HPV vaccine.

I'm all for following the evidence and I'm not against vaccines. But I strongly oppose the HPV vaccine. It has ruined thousands of lives.

Here's some more information about HPV vaccine, compiled by: http://www.ashotoftruth.org/vaccines/hpv-vaccine

1. HPV is not only a sexually transmitted disease. HPV can be transmitted in many different ways: From person to person, mother to child, autoinoculation, and indirect transmission. 
2. If you have HPV and then become vaccinated with the HPV vaccine, according to FDA documents your chances of cervical cancer increases by 44%.
3. Pap smears, not the HPV vaccine, prevent cervical cancer. There is no scientific evidence the HPV vaccine prevents cervical cancer.
4. Your chances of dying from cervical cancer are very low. The American Cancer Society's estimates 4,030 women will die from cervical cancer in 2013.
5. Since August 2013, the CDC is reporting the HPV vaccine has over 30,000 vaccine reaction reports (VAERS) including 140 deaths. Of all the vaccines, HPV vaccine has the most vaccine reactions being reported.
6. According to the American Cancer Society (ACS) there are 150 strains of human papilloma virus (HPV) and 12 of those strains are considered "high risk" for causing cancer.  The ACS indicates 2 other strains are considered "low risk" for causing cancer. Both Merck's Gardasil(tm) and GlaxoSmithKline's Cervarix(tm) have protection from 2 of the 12 "high risk" strains (HPV-16 and HPV-18). Merck's Gardasil(tm) further covers 2 other strains which the ACS classifies as "low risk" for causing cancer.
7. A myth reported consistently by the media is the HPV vaccine is a "cancer prevention vaccine."  There has never been any scientific data to qualify this statement as the vaccine was never studied long enough to show it indeed prevents cancer.  

 I recommend going to the link above and reading their article about the HPV vaccine. It's basically a comprehensive compilation of articles and information about the dangers of the vaccine.

So, folks, please research this vaccine very VERY carefully before allowing your son or daughter to receive the HPV vaccine!

Week 5: Placenta Previa

I'm going to try and make this post short and to-the-point because I have a LOT of school to do...

Last week in class, we learned about placenta previa. It has the potential of being fatal to mom and/or baby and occurs in 1 in 200 term pregnancies.

Placenta previa is classified by painless vaginal bleeding. It is when the placenta covers all or part of the cervix. When the cervix starts to dilate and thin, it breaks the blood vessels in the placenta which causes a hemorrhage. The hemorrhage can sometimes be small and controllable and the pregnancy can be continued under close supervision. However, it can also cause massive hemorrhaging, lack of oxygen to the baby, and death for both mom and/or baby. Usually, it is somewhere in the middle, but if a pregnant woman ever experiences a lot of painless vaginal bleeding (more than just the normal spotting that occurs with labor), she should call her midwife/doctor immediately and be evaluated.

Normally, the placenta is near the top of the uterus. Sometimes, it will implant close to the cervix (called a low-lying placenta) but as the uterus grows throughout pregnancy, the placenta will "migrate" up the side of the uterus.

Placenta previa can either be classified as a low-lying placenta, marginal placenta previa, or complete placenta previa.

Low-lying placenta is exactly as its name implies. It's a placenta that is really low in the uterus and might be partially touching the cervix. It can cause some vaginal bleeding as the cervix stretches and thins, but is usually harmless.

Marginal placenta previa is sometimes manageable too but the edge of the placenta is covering part of the cervix. This usually requires a Cesarean delivery since the baby can't exactly be born when half his exit route is covered...

Complete placenta previa is where the placenta completely covers the cervix. This requires a Cesarean section birth since there is absolutely no way the baby can be born when his exit route is completely covered. Also, the Cesarean is usually planned in advanced and before the mom goes into labor since when the cervix dilates, it breaks the blood vessels to the placenta causing massive hemorrhage and lack of blood going to the baby. Yah, it has the potential to be very bad.

When placenta previa is present, the baby has a fairly high chance of being breech because the placenta blocks his usual head spot. This is illustrated in this picture:

So anyway, that's the down and dirty on placenta previa. :-D

Weeks 2, 3, and 4: Enjoyable but Amazingly Busy...

Yes, yes, I know. I haven't even thought about this blog for the last several weeks. I have had so much readings and assignments to accomplish that by the time I finish them, I just want to fall asleep. And that's what I usually do. lol.

Since I was a midwifery student and doula for five years, I'm very familiar with all that we're learning. Occasionally I learn something new. It's nice to actually know what we're learning, but there's still so many assignments that it's hard to stay on top of.

Clinicals have been the best part. I had my labor and delivery clinicals two weeks ago and got to see a Cesarean section (yay!) which is something I've been desperately wanting to see. I was amazed at how long it takes to get the baby out (since it was a non-emergent Cesarean) and how much tugging, pulling, and force was put into it. A Cesarean section is MAJOR abdominal surgery! And then for the next six weeks, you're not allowed to lift anything heavier than your baby! So the moral of the story is, unless it is a medical necessity, try to avoid a Cesarean at all costs! (Disclaimer: Obviously, there are times where a Cesarean is necessary and needed and it saves lives but it is major surgery). 

Anyway, I just wanted to quickly go over different fetal heart tone patterns with relation to contractions.

When a mom is in labor at the hospital, two transducers are placed on her stomach - one to monitor the baby's heart rate and the other to record contractions. Then, the nurse evaluates the baby's heart rate in relation to the contractions. There is a quick, easy pneumonic we learned to help us remember different heart rate patterns and what they mean:

VEAL CHOP.

The way the pneumonic works, you place the words vertically and compare the letters, like this:

V    C
E    H
A    O
L    P

So the "V" goes with the "C," the "E" goes with the "H," and so on.

V stands for "variability." We want some variability in the baby's heart rate to show that baby is responsive to contractions, but marked variability (where the heart rate varies suddenly by more than 15 beats per minute) is not a good sign. And that's where the "C" comes in. C stands for "cord compression." So when the baby is experiencing marked variability in the heart rate, it is from the cord being compressed. Just in case you're wondering, this is bad. The first thing that needs to be done is have the mom change positions. This should hopefully fix the problem, but if not, an emergency Cesarean section will probably need to be performed.

E stands for "early decelerations." This is where the baby's heart rate decreases at the beginning of the contraction but then is back to baseline by the end of the contraction. This is caused by the H - "head compression." When the baby is entering the birth canal, its head gets pressed and molded which is a lot of pressure. This pressure causes a vagal response which will decrease the baby's heart rate. Despite how horrific this sounds, it's actually normal and considered benign. In fact, I've always viewed it as a somewhat good sign - something's happening and the baby's descending!

A is "accelerations." Accelerations are abrupt increases in the heart rate by at least 15 beats per minute that last for at least 15 seconds. They can indicate fetal stress, pain, activity, annoyance, and more. The "O" they correspond to in VEAL CHOP just means "okay!" In other words, it's not too terrible to see sudden accelerations. In fact, accelerations means the baby is responsive to labor.

The last one is L - late decelerations. Late decelerations can be pretty bad since they mean the placenta isn't oxygenating the baby well. It corresponds to the P, meaning placental insufficiency. However, it can be caused by the mom being in the wrong position (like on her back), having hypotension (which decreases perfusion to the placenta), having strong uterine contractions (which makes the uterus slightly ischemic), etc. When late decelerations are seen, the first action is to change the mom's position in case it's just a positional problem. Then, decrease pitocin (if it's being given) and give oxygen. This will usually fix the problem.

One pattern midwives, doctors, and nurses really don't like to see is this one:

It's a prolonged deceleration. Not only did the baby's heart rate decrease with the contraction, it stayed low for four minutes. A normal baby's heart rate is 110-160 and this baby was happily plugging along at 160 when the contraction came and his heart rate plummeted to the 80s. Not good! The heart rate recovered but then jumped to the 180s for two minutes which is not good either. I took one look at this fetal heart recording and squirmed. This baby is not doing well...

There are many more fetal heart rate variations which make birth health care providers nervous but these are some of the main ones.

....Until next week (if I remember and don't fall asleep...)

(And because I had a very stressful day, I'm going to post funny birth pictures so I can laugh and de-stress)

Semester 2, Week 1: I'm Back!

Miss me?

Second semester started on Monday and I'm back in the groove. This semester, we're studying pregnancy, birth, newborn, and pediatrics. This is "my" semester! This week we studied the newborn. Newborns are fascinating and adorable and helpless and cute and fussy and difficult and sweet and smell good. To a parent, they will change your life forever.

The newborn period lasts from birth through day 28. At birth, the newborn experiences multiple changes and adjustments, especially as they take their first breath. Every time the mother's uterus contracts, the baby goes into a slight state of hypoxia and hypercarbia (low oxygen and high carbon dioxide). This triggers the medulla in the brain that the person needs to breathe. Because the baby's in the womb still, he/she is unable to take a breath just yet so needs to hang tight for a few more minutes (or hours or days). If the baby is born vaginally, his/her lungs get compressed and the amniotic fluid gets squeezed out of the lungs. This negative pressure should cause the lungs to fill with air once the baby is born. Also, during the last few weeks of pregnancy, the baby creates surfactant, which is a lot like dish detergent, which keeps the lungs from collapsing. (Preemies don't usually have surfactant which is one of the reasons they have so many respiratory problems...Imagine your lungs collapsing every time you take a breath...)

Also, immediately after birth, the umbilical cord senses the cooler air (normally the delivery room is cooler than inside the mom) and a substance called Warton's jelly starts compressing and closing off the two arteries and one vein in the cord. Until this happens (or the placenta detaches from the mother), the umbilical cord keeps pulsing. In the old days, doctors automatically cut the cord immediately after birth for no apparent reason. However, research is starting to show that it's beneficial to the baby to let the umbilical cord finish pulsing before cutting the cord. This can be anywhere from a few seconds to a few minutes.

This is a very striking photo taken a few months ago of twins born a few minutes apart. Baby on the left was born first and had his cord cut immediately. Baby on the right was born next and got to have his cord finish pulsing before being cut. Do you see the difference?

By delaying the cord cutting, the baby receives its full blood volume (otherwise, baby practically goes into hypovolemic shock because it's missing so much of its blood). This gives the baby good hemoglobin levels for the next six months as well as other positive benefits. Otherwise, the baby is anemic, which is not the way one want to start out their life. Frequently in hospitals, the cord is automatically clamped and cut immediately due to doctor's preference and habit.

It absolutely drives me nuts when a doctor says, "Oh, but there's no evidence that delaying cord clamping benefits the baby at all." Excuse me?! 

This article explains the benefits really well: 

http://debrapascalibonaro.com/infant-rights-birth-ibu-robin-lim/

Ok, I'm done with that rant. Just remember, for a normal birth, let the baby's cord finish pulsing before cutting it!

I also wanted to quickly go over the APGAR score. When a baby's born, at one and five minutes after birth, the midwife or doctor assigns the baby a number between 0-10. Zero means the baby is probably dead. Ten means the baby is perfectly healthy and responding well to extrauterine life. Any score less than seven means the baby is in distress and neonatal resuscitation usually needs to be started.

When I worked in the Philippines, most babies received a one minute score of 8 or 9 (take a point off for color and possibly grimace) and by five minutes they were all at 9 or 10 (possibly take one off for color again).

An easy way I was taught to quickly remember the APGAR score is by turning the word APGAR into an acronym. A stands for Appearance (color), P stands for pulse (heartbeat), G stands for grimace, A stands for Activity, and R stands for respirations.

For Appearance, is the baby completely pink? If so, give him two points. Are his extremities still a little white/blue? If so, give him one point. Is he completely white/blue? Give him zero points.

This baby has a pink body but blue hands and feet so he'd only get one point.

The next assessment is pulse. If the heart is beating more than 100 bpm (beats per minute), the baby gets a 2. If the heart is beating less than 100 bpm, baby gets a 1. No heart beat gets a 0. If the baby is crying and responding well to birth, their heart rate is normally perfectly fine and baby scores a 2.

Next is grimace. If you suctioned the baby or messed with him, did he cry and pitch a fit when you suctioned him or did he just grimace or did he remain limp? Crying and gagging and fighting scores a 2. Just grimacing scores a 1 and no response scores a 0.

Next up is activity. To score a 2, the baby has good muscle tone and keeps his/her extremities flexed and close to his/her body and moves actively. A score of 1 means the baby only partly flexes its extremities and isn't really moving. A score of 0 means the baby is completely limp. I've seen a baby with an activity score of 0 and it's pretty scary. The baby is completely limp. The midwife almost dropped him because he was hard to hold. However, he perked up and ended up being just fine.

The last one is respirations. Is baby breathing fine (i.e. screaming with no problem)? That's a 2. Is baby gasping and having problems screaming? That's a 1. Is baby making no breathing attempts at all? That's a 0.

this picture has nothing to do with any of what we just talked about, but it made me laugh so that's why I posted it. :-D

Anyway, the midwife (or doctor) quickly assesses the baby and determines the score at 1 and 5 minutes. If the baby needs resuscitation, that's started almost immediately. And that's all for today, folks! Next week is pregnancy care. (And I'm ridiculously happy about that)

...Until next week!