A&P~SKIN

Robot Doctors? (Telemedicine)

In the future, we will see advanced technology. Telemedicine will be taken to a whole new level. Robots will be used to help healthcare providers diagnose and treat patients. Imagine a robot strolling down the hallway of a hospital making rounds as if a healthcare provider would.  How do you feel about this? Will trust be lost with patients? Will it make us less empathetic? It seems a bit impersonal but could decrease cost and give care to patients in rural areas. 

http://www.irobot.com/About-iRobot/Company-Information/Research.aspx

Med Surg~Jaundice

USING A BEDPAN

CARING FOR COGNITIVELY IMPAIRED PATIENTS

HOW TO PUT YOUR PATIENT AT EASE TO SLEEP BETTER?

HEALTH ASSESSMENT~Assessing the Thorax

COOL! VEIN VIEWER~Cool but expensive. Would you rather do IV's the old fashioned way (by feel)?

DO NO HARM~Rules for Patient Safety!

HEALTH ASSESSMENT~Peripheral Vessels and Lymphatics

HEALTH ASSESSMENT~Assessing Acute Arterial Occlusion

MED SURG~Edema

STUDY TIP~Med Surg

Fundamentals~How to Give Culturally Competent Care?

1. Get a professional interpreter if you do not speak the same language. Communication is key. 
2. Think about your own views such as your background, culture, ethnicity, race, and stereotypes.
3. Become objective. Do not take anything personal regarding someone else's cultural practices or views. 
4. Be mindful of gender roles. Who is the head of the household? 
5. Keep in mind time orientation varies by culture. 
6. Body odor does not alway mean the patient has poor hygiene. Natural body odors are normal for the Middle Eastern population. 
7. Food patterns may vary. In some cultures, fasting is practiced on a regularly scheduled basis. Some populations may exclude pork from their diet. 
8. Do you best to accommodate the spiritual needs of your patient. 
9. Health beliefs are different. Ask questions to determine the health beliefs of your patient. Some may practice folk medicine, herbal medicine or other alternative therapies. 
10. What is the socioeconomic level of your patient and how does this affect their health? 

Terms...
Culture: learned, shared and transmitted knowledge of values, beliefs and ways of life of a particular groups that are transmitted from one generation to the other. Culture is learned and is not genetic.

Ethnicity: persons identification with or membership in a particular racial, national or cultural group and observation of the groups customs, beliefs and language.

Race: socially constructed concept that tends to group people by common descent, heredity or physical characteristics.

MED. SURG~ peripheral arterial(PAD) disease Vs. venous disease

MED. SURG~Gastritis

A&P~Layers of the Heart Wall (Pericardium)

Electrocardiogram

A&P~Cardiac Cycle

HOW TO TAKE A PATIENT HISTORY?

NURSING SCOPE OF PRACTICE~ANA

MEDICATION ADMINISTRATION~The 6 Rights

HEALTH ASSESSMENT~Abdomen Sounds

Abdominal Sounds: 5-30 per minute listen for 1 full minute per quadrant. If there are hypoactive bowel sounds listen for 5 minutes per quadrant. 

HEALTH ASSESSMENT~Lung Sounds

10 in the front 

18-20  in the back 

Reference: Health Assessment in Nursing fifth edition Janet R Weber & Jan H. Kelly 

HEALTH ASSESSMENT~Heart Sounds

A Good Mnemonic to remember the heart sounds is APETA.  

APEX

PULMONIC 

ERBS 

TRICUSPID 

AORTA 

STUDY TIP~NCLEX Questions

If your answer choice has the words...None, Never, Only, Always, Must or Cannot it is safe to say that you can eliminate this answer choice. With the human body things change and can change quickly therefore there will not be a definitive answer for a certain question. 

STUDY TIP~Be Open to Learn from anyone

You should be open and receptive to learn from anyone in any discipline. Even housekeeping could give you some tips on proper cleaning and sanitation. During clinicals ask if you could follow the medical students, LVN's and UAP's. Most often this will stimulate your curiosity to learn more. It will also stimulate you to critically think. 

STUDY TIP~Independent Nursing Action Questions

You may be asked a question to test your knowledge on the difference between independent nursing action and dependent nursing action. When answering questions about independent nursing action it is helpful to ask yourself if this action requires an order.

Nursing actions that do not require an order are repositioning a patient, giving a massage and providing emotional support. 

Nursing actions that do require and order are dependent nursing actions such as administering medications, administering oxygen, wound care, getting an EKG reading or monitoring telemetry. 

STUDY TIP~Practicing Questions

When practicing questions write notes next to each answer choice as to why you chose that answer or why you did not choose the answer choice. Then read the rationale for the question. If the rational matched your thought process then you are on the right track if it did not then assess why you chose to answer the question as you did. This will help you to figure out where you may be going wrong when answering questions and help you to figure out what you need to study more. 

STUDY TIP~Health Assessment

When studying HA you must know how to properly perform the assessment, understand abnormal situations and diseases, recall anatomy and physiology, understand elderly abnormals and cultural implications.

A good way to critically think about HA is to ask yourself questions.

1. What am I observing? 
2. What are the normal findings? 
3. What position should the patient be in? 
4. What could I see abnormally? 
5. How would I know if it is an abnormal finding? 
6. What would I do if there was an abnormal finding? 
7. What would I do in an emergency situation?

For example: When testing for symmetry of the chest using the chest expansion test you would give your partner instructions, "I observed my thumbs moving apart symmetrically."

What position should the patient be in? At least 30 degrees at all times with lung problems 

If this did not happen then ask why not? If your thumbs did not move apart symmetrically this could indicate atelectasis, rib fracture, pneumonia,  pleural effusion or collapsed lung. 

How would you know if it is a rib fracture vs. collapsed lung?  Understand the signs and symptoms of the possible causes. 

Is this an emergency situation? A fractured rib and a collapsed lung are both emergency situations but the pneumothorax would need to be addressed first (always think critically because not every situation is alike). With a collapsed lung or pneumothorax you will see signs of shortness of breath, tachycardia, tracheal deviation to the opposite side  (one of the main signs) and cyanosis. 

What would the nurse do? The nurse would give oxygen if ordered, put the pt. in a high fowlers position, monitor the chest tube, monitor for subcutaneous emphysema. 

When practicing your head to toe assessment it could be helpful to speak out loud to your partner giving instructions and saying normal and abnormal findings. 

MED SURG~Peripheral Arterial Disease PAD

PAD 

What is it: Artery wall thicken 

Pathophysiology: The walls of the arteries narrow. 

What Normally Happens in the Body: Thickening happens with cholesterol deposits in the vessel walls. 

What makes it worse: Tobacco, diabetes, hyperlipidemia, family history, increased age, hyperuricemia, obesity, sedentary lifestyle and stress. 

Signs and Symptoms: intermittent claudications, paresthesia, skin is shiny and taut  pallor, decreased or absent femoral pulse 

Possible Causes: atherosclerosis 

Labs and Diagnostics: Doppler ultrasound, segmental BP, angiography and ABI

Meds: Antiplatelets 

Nursing Interventions: femoral pulse absent or decreased, pallor present, have the pt walk, nutrition therapy, Pre-op and Post-op care

What is it Like to be a Nursing Student?

Being  a Nursing Student is Stressful but Fun

Nursing school is rigorous and demanding. It is strict because they uphold student nurses to the same standards as the BON (Board of Nursing). They consider you to be a professional when you enter the program. It'll be a good idea to look at your BON and see what is required of nurses. You may be required to not smoke or drink in uniform or not curse in uniform. Punctuality is important too. You can't miss any more than 2 days per class. A lot is required of you as a student. 

You will be required to study 30 plus hours per week, participate in clinical, sometimes class lasts as long as 8 hours per day and you must put in lab time. Plus exams require critical thinking skills, making below a 75 on exams is unacceptable, you have to score well on HESI exams, you must make a 90 on dosage calculations, and perform exceptionally well on nursing skills exams, perform well at clinical and write care plans that could take many hours. A lot is required and time management skills are a must.You must have time management skills because you could quickly get behind. 

A lot is required but nursing school is also fun. You have simulation lab where there is an actual scenario where your patient's health may be failing and you have to save your patient. These simulation dummies actually breathe, have heartbeats,  pulses, move, talk and vomit. You also develop bonds with your classmates. You all at some point have to come together and help one another because it is challenging. You will participate in community events like blood drives and other charitable things and these could give you a chance to network and gain more experience. During clinical, you have the opportunity to work with actual patients and practice what you have learned in class. 

Nursing school can be difficult but it is also rewarding if you care about people, love science and genuinely want to become a nurse. 

Dosage Calculation~Gtt/min

FUNDAMENTALS~Stress Management

Stress Management 

http://piic1.blogspot.com/2012/10/best-relaxing-moments.html

Everyone could benefit from stress management and not just patients. We all have some stress at some point in our lives and must learn how to manage it effectively. Stress could have some physical effects on the body causing a decrease in the ability to fight off organisms that could make us sick or even increase the blood pressure. Here are some ways to effectively reduce stress levels...

Journaling: expressing yourself on paper but be careful not to use negative words

Exercise and release endorphins

Art Therapy could help with emotional expression

Social support: Talk to friends or self-help groups 

Humor brightens up anyone's day 

Breathing exercises 

Meditation will take you away from the stressors of the day 

Using imagery imagine being at the best most serene place in the world uses all of the senses 

Playing relaxing music 

Getting a massage 

MED SURG~Hyperthyroidism

Hyperthyroidism 

What is it: Hyperactive thyroid gland. It is an excessive amount of thyroid hormones circulating.

Pathophysiology: Graves disease causes excessive thyroid hormone production. The body develops antibodies to the TSH receptor. They attach to the receptors and cause an excessive release of T3 and T4. 

What makes it worse: Smoking and iodine 

What Normally Happens in the body: The thyroid gland secretes T3 and T4 hormones. Iodine synthesises these hormones. The release of thyroid hormones generation and release is triggered by TSH by the anterior pituitary gland. 

Possible Causes: Graves Disease

Signs and Symptoms: Increased hr, bounding pulse, palpations, angina, increased respirations, dyspnea on exertion, increased appetite and thirst, diarrhea, increased bowel sounds, thin nails, hair loss, clubbing, fine hair, premature gray in men, diaphoretic, vitiligo, hyperthermia, restless, delirium, coma, shock, and seizures. 

Lab and Diagnostics: Increased T3 and T4 levels and RAIU test 

Medications: Antithyroid drugs and Beta Adrenergic blockers

Nursing Interventions: Auscultate the thyroid gland for bruits, palpate for a goiter, abnormal eye appearance/exophthalmos, dry corneas present, is there any diplopia, look for thyrotoxicity, get rest, eye care related to dryness, pre-op and post-op care for thyroidectomy. 

HEALTH ASSESSMENT (Abdomen)~Findings in an Elder Adult

What are considerations when assessing an elder adults abdomen?  

1. Reduced stomach acid (HCL acid secretion is reduced). This acid protects against ingested organisms. 

2. Reduced saliva production (Xerostomia) which could cause some swallowing problems (dysphagia). 

3. Gastric motility is reduced. 

4. Peristalsis is reduced that could be related to inactivity. 

5. Problems with chewing because of changes in dentition such as periodontal disease leading to loss of teeth. 

6. Decreased appetite leading to weight loss. Also, consider economic status and transportation issues. 

7. Liver decreases in size. 

8. Liver function declines and this makes it hard for them to metabolize medications. 

9. Renal function is diminished and they can't eliminate medications as well. 

10. No sensation of thirst and this could lead to dehydration, UTI and even constipation. Causes of constipation are inactivity, decreased fiber intake, medications, laxative abuse, and decreased fluid intake. 

A&P~Heart Circulation

https://youtu.be/SvAVu-7E2gA

Easy way to remember blood flow in the heart 

A&P~Breathing/Inspiration and Expiration

https://youtu.be/uAlKNVw-Wwo

A nurse must understand how the anatomy and physiology of breathing. 

A&P~Thermoregulation/Body temperature regulation

https://www.youtube.com/watch?v=e7kmmj_qRss

A nurse should understand thermoregulation and how it relates to body temperature. 

FUNDAMENTALS~Vitals Signs

Vital Signs 

Used to monitor vital body systems

They include...

1. Temperature: Sites~oral, axillary, rectal, tympanic or temporal. Conditions~Hyperthermia, hypothermia, hypotension, frostbite, fever/pyrexia, febrile, heatstroke, heat exhaustion. 
2. Pulse: Sites~Temporal, Carotid, Apical, Brachial, Radial, Femoral, Popliteal, Posterior tibial and Dorsal Pedis. Rhythm~arrhythmia or dysrhythmia. Volume~ weak, thready, strong, bounding 
3. Respirations: Conditions~tachycardia, bradycardia, hypoxemia, hypercapnia, eupnea, tachypnea, bradypnea, hypoventilation, hyperventilation, apnea, dyspnea, orthopnea, pulse deficit 
4. Blood Pressure: Systolic and Diastolic. Conditions~ hypotension, hypertension, orthostatic hypotension, 
5. Pain: Pain scale 0-10 
6. Pulse Oximetry: Conditions~cyanosis

http://www.emt-national-training.com/vitals.php

Not only must a nurse know the normals and abnormals but also have the ability to critically think about these values. A nurse must read the lab values, vital signs and assess the patient appropriately.

1. Establish a Baseline.
2. Measure every 4-8 hrs. with a stable patient.
3. When there is a change in patient condition monitor more often and double check the vital signs. 
4. If there is a change in patient condition the RN must monitor the vital signs and not delegate them to the UAP or the LVN.  

Keep Yourself Motivated

Motivation

It's important to keep yourself motivated. One way to keep yourself motivated is to create a dream board and put it somewhere you can see it when you wake up and go to sleep. Your dream board will have your future goals on it. 

SaveSave

Patient Education~DON'T LEAVE YOUR PATIENT BUMFUZZELED!

KNOW HOW TO EDUCATE YOUR PATIENT

A nurses role is to educate. Your patient must know understand how to self-administer  medications, how to perform treatments at home and what their illness consists of for self-care. Not only does a nurse educate the patient, but  must educate the family, significant others, spouses, friends or whom else might aid in caring for the patient.

As has been mentioned, consider the caregiver of the patient.  Assess the caregiver of the patient. You will want to know if they are suffering from caregiver role strain if they have the proper resources, how they are coping with any family role changes, any family conflict, and any financial problems. While educating, it is best to use the nursing process.

Diagnose

1. Does the patient have a knowledge deficit? 
2. Do they have a readiness to learn? 
3. Are they at risk for injury at home? 

Plan

1. Set your goals. Ensure your goals are measurable and have a reasonable time-frame.
2. What kinds of educational materials will you use? Will you use pamphlets, magazines, audio, or  videos. Don't forget to include items the patient may already be familiar with such as setting an alarm clock to take medication or demonstrating how to use dress themselves without causing strain on a surgical site. 

Implement

1. Actively listen to your patient. They will give cues or verbalize understanding or confusion. 
2. Sit at eye level when speaking with the patient. 
3. Use positive reinforcements as a reward such as, "you are doing great!" 
4. Involve the caregivers, family and friends of the patient. 
5. Use verbal and nonverbal communication skills. 

Evaluate

1. Does the patient understand what you have taught them? Use the "teach back" or "show back" method. 
2. Was the goal met? If the goal was not met then reassess the patient. Usually, this happens when a nurse makes an assumption that the patient already has knowledge on their disease process.

Educating a patient is essential, therefore documentation is necessary. Document while educating the patient. If you do not document your actions and the patients progress it is as if the education never took place.


Wilkins, L. W. (2014). Taylor fundamentals of nursing, north american edition, 7th ed. taylor prepu for taylor's .. Place of publication not identified: Wolters Kluwer Health.

Critical Thinking~Case study: Delegation

CLIENT A: The client is a 25 y/o home vented patient with severe Multiple Sclerosis, bedbound, unable to direct his own care but a parent is available 24/7 either in home or telephonically and never more than 30 minutes from home; the parent is very willing to participate in care decisions. The unlicensed assistive person (UAP) has been with this client for 2 years and is very mature/reliable in carrying out activities of daily living (ADLs) and health maintenance activities (HMAs), as well as certain delegated nursing tasks (including trach care and suctioning). All ADL/HMA tasks have previously been exempted from delegation by the RN. Up until now, the Home Health RN has been making routine visits every 90 days, and as needed to reassess if there are any changes in the client’s condition.

This client developed an obstruction of his G-tube, which required an overnight hospital stay for placement of a new G-tube. At home again, his vital signs are stable, and the RN assesses his condition to be stable and non-fluctuating (ie: no change from his previous condition).

Based on RN assessment, it is acceptable to continue exemption of ADLs and HMAs. The client’s condition is stable and the UAP is capable of safely completing tasks related to the client’s change in condition. The RN elects to make skilled RN visits every two weeks for the first month to assess the status of the new G-tube and client’s status in general to be sure the client’s status remains non-fluctuating. 

Certain Titles. (n.d.). Retrieved September 1, 2016, fromvRule 225: RN Delegation & Tasks Not Requiring RN Delegation in Independent Living Environments with Stable & Predictable Client Condition. (n.d.). Retrieved September 1, 2016, from Rule 225: RN Delegation & Tasks Not Requiring RN Delegation in Independent Living Environments with Stable & Predictable Client Condition

DOSAGE CALCULATION

You review your MAR and see that Mrs. Hobbit has been ordered Ranitidine 150 mg b.i.d by NG tube. It is 0800 and time for her first dose. You then read the medication label that you have available. How much of the medication would you administer to Mrs. Hobbit via NG tube? 

https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=20640

150mg/15mg X 1mL = 10mL 

Nursing Student Study Tip~HOW THE HECK DO I STUDY HEALTH ASSESSMENT?

How to Study Health Assessment

With Health Assessment it is helpful to study it while practicing the head to toe assessment at the same time. But first, you must recall your A&P. If it has been a while since you took A&P then take a while to remember the structures there function.

For example: 
Let's start with Inspection: Let's say you are studying how to assess the heart. The first thing you do when assessing any system you begin with inspection so you would speak out loud while you are doing your inspection. Such as, "I don't see cyanosis of the lips, the nails are normal, and there is no pursed lips or nasal flaring. Then you would ask yourself what if I saw these things? What does this mean? Nasal flaring could indicate hypoxia if your patient is having difficulty breathing. Then what intervention would I do? I would assess respirations, pulse oximetry and give O2 by nasal cannula. Do I need to call the physician and in what case would I call the physician and when I call him or her how do I use SBAR?  

Next: The Thorax (Anterior and Posterior) 

Ask yourself questions...

What position does the patient need to be in? What can I physically see? What is normal? What is abnormal? If I see abnormals what is it? What can I do about it? When to call the physician? What can and can not be delegated? What is common in older adults? What are some cultural considerations? When to palpate and how? When to auscultate and how? When to percuss and how? Why are you performing these? What are some special considerations? 

Last: Review the common disease processes related to the system you are studying. It is helpful to come up with mnemonics or songs to help you remember these disease processes. 

https://www.pinterest.com/explore/nursing-assessment/

Note: Your focus should be on the proper way to assess the body and abnormal situations. Asking yourself as many questions as you can gets you in the habit of critically thinking about what you are studying.