Tuesday, July 30, 2013

Nursing Student Jitters During Clincials

I'm an old nurse, I remember those first days of clinicals very well.  As though it happened yesterday in fact.  Not a good feeling.  Trust me, every nurse you meet has been there and felt the same way.  You are not alone in your thinking. 

Do your homework, know the material you are expected to know prior to any clinical day.  You will have a chance to research your patient ahead of time---do it!  Know their meds and side effects, someone will ask, most likely your clinical instructor.  Be prepared.  Know what labs they had done, the abnormals and why they are abnormal.  What tests is the patient scheduled for?  You can glean a lot of information about your patient by taking the time to read their chart, even their social history, likes and dislikes.  Allergies????  Do they have them?  Very important to know on ALL patients.  You never want to get caught giving a medication someone may be allergic to.  If the chart says NKA (no known allergies), ask the patient yourself again if they have any.
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Be professional at all times, friendly but not overly so.  The nurses you will encounter will be busy most of the time, under stress and possibly will have a difficult caseload.  They may come across as unfriendly, unwilling to be helpful.  Do not take this personally, they are only trying to manage their patients first and foremost.  Offer to help in some way, maybe to get supplies or assist with bathing or turning a patient.  It's a good way to gain trust and stand out in the unit as a student nurse.  Most nurses appreciate help, even in small ways. 

Don't stand around idle.  I don't care if you're not busy at the moment, just don't do it.  Look busy.  Read a chart, look up labs, make notes.  Just don't stand or sit in a chair staring blankly. 

Be confident around your patients even if you're not quite feeling it yet.  Act as though you've done a procedure a 100 times.  If you're unsure of performing a procedure always, always ask someone to guide you.  Never do a new procedure blindly even if you feel 'stupid' for asking.  Causing harm to a patient is far worse that feeling stupid. 

Relax, take some deep breaths.  You will be just fine.  It's why they call it the "Practice of Nursing", it all takes practice and every single day you are a nurse you will learn something new, even after doing it for 30+ years. 

Nursing is a rewarding career on so many levels.  You're going to do just great!
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Buying Your First Stethoscope

Stethoscopes come in a variety of price ranges and brand names.  You first need to decide what you're going to be listening to, cardiac or lung sounds?  Or both.  If your're a nurse or nursing student, you're going to listen to both...a lot!!  If you're short on cash as a nursing student, purchasing a less expensive model will get you through school just fine.  However, if you can, purchase a good stethoscope as you will use this same one for many years in your career.  In my 35+ years of nursing, I had a total of 3 stethscopes in all.  The important thing is don't lose it.  Don't ever leave it at the nurses station or in a patient's room, I guarantee you, it will walk away in someone's hand.  Some medical student will invariably borrow it and leave the unit...without realizing it's around his/her neck and never remember where it came from.  Gone.  Get in the habit as a student nurse to always wear it around your neck.  Always.  Even to the cafeteria.  You will always know where it is and soon it will become a part of you during your entire shift.  Here is a great video on choosing a stethoscope:


Points to remember: 

Stethscope should have soft, comfortable ear tips
Avoid plastic bells, these are disposable and you can't hear well with them. 


Saturday, July 27, 2013

Hospice, How to Know When It's Time To Call

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As a former hospice nurse, it was common for patients and their families to wait too long before using hospice services because they simply didn't know when to contact hospice.

If you or your loved one wishes to have palliative or comfort care only and no longer wish to have extensive tests, hospital stays or have CPR performed if the heart stops and there is a marked decline in overall health, it may be time to contact hospice.  Anyone can ask for a referral to a hospice service.  Your doctor or the hospital can make a referral for you if hospice is what you desire to assist with comfort care during the end stages of life.

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I have encountered instances where a patients own physician has refused to allow their patient to go onto hospice services for various reasons.  Some physician's simply do not believe in hospice and still have the mindset of "we can fix this" or "it's not time yet", when the patient and family know their loved one has little chance of recovery or improvement.  In this case, a patient and or family can by-pass their own physician and contact any hospice on their own and request and evaluation to see if they meet the criteria for hospice services.  After the evaluation, the hospice nurse will contact your own physician for an order of referral.  If the physician denies the request, you have the option to utilize the hospice medical director as your physician, he or she can accept you onto the hospice service.  The main criteria is having 6 months or less to live, providing the disease follows the natural course. 

Who pays for hospice services?  Medicare pays 100% of hospice if you are over 65 as well as many private insurance carriers.  If you are not on Medicare and do not have private health insurance the hospice you choose will assist you in obtaining Medicaid or help to ensure you receive hospice care.

Patients sometimes improve or stabilize while on hospice care and stop showing signs of decline, in this case, your doctor or the hospice physician will discharge you from hospice care.  If your condition declines or worsens again at a later date, you will again be reevaluated for hospice services if you so desire.

Hospice does not provide 24 hour care in the home.  A nurse will visit at least once a week or as often as necessary if needed.  A nurse is always on-call and can generally be at your home quickly should you need assistance.  Nursing assistants are usually assigned to assist with bathing, dressing and feeding based on your needs.  In addition, a hospice chaplain and social worker as well as volunteer services will be assigned and readily available to you or your family.

Some hospice services have their own in-patient facilities, some do not.  If you or your loved one can not be cared for at home, hospice DOES NOT COVER long term care room and board if you are on Medicare, but Medicaid does.   Or perhaps you have private insurance for nursing home/long term care coverage.   This is something you need to consider.  Caring for a loved one at home is rewarding but also can be tiring and wearing on just one caregiver.  Many families try to line up several family members to assist in the care to give the primary caregiver a much needed break, even  if it's just for a few hours to go to church, an appointment or grocery store.  If you ever find yourself as a caregiver in a situation where something comes up such as an appointment for yourself, you can ask hospice if someone is available to come sit with your loved one for a few hours, most are happy to accommodate you.

Again, if you unsure if you are ready for hospice because of your current illness or eligibility for hospice services, give any hospice a call, they will be more than happy to answer your questions.  After all, it's what they are there for. 

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Are You a Type II Diabetic?

More and more Americans are being diagnosed each year with Type II diabetes.  In fact,  the number of people diagnosed with Type II diabetes has risen by approximately 50% in 42 states and 100% in 18 states.  These are significant numbers!!  Our high fat diets, fast food and sedentary lifestyles are all factors contributing to this rapidly growing problem.

Risk factors for type 2 diabetes include:
  • Age (greater than age 45)
  • Overweight
  • Physical inactivity
  • Family background that is American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander
  • Parent or sibling with diabetes
  • High blood pressure
  • Abnormal cholesterol levels
  • Having had a baby that weighed more than 9 pounds or having had gestational diabetes
  • Pre-diabetes
  • History of polycystic ovary disease (PCOS) 
Symptoms you may have if diabetic:

  • Increased thirst
  • Increased hunger
  • Having to urinate more often – especially at night
  • Feeling very tired
  • Weight loss
  • Blurry vision
  • Sores that do not heal
  • Tingling/numbness in the hands and feet

  • If you don't have health insurance and are overweight, I suggest purchasing a glucometer device and testing yourself at home.  These devices are fairly inexpensive, cost is around $20 and comes with 10 test strips.  A normal fasting blood sugar should be around 70-99 mg/dl.  A pre-diabetic range is 100-125mg/dl.  If your reading is 126mg/dl on more than on occasion, you most likely are diabetic. 

    You should have any abnormal readings reported to your doctor so he can prescribe a diabetic diet for you to follow and he/she may want to start you on an anti-diabetic medication as well as an exercise program. 

    By following a prescribed diet and exercising everyday you can significantly reduce your chances of
    diabetes worsening and preventing more severe problems such as nerve damage in your feet, kidney failure which can lead to dialysis as well as increasing your chances for a stroke or heart attack. 

    Friday, July 26, 2013

    Grieving For Gluten

    I want a piece of cake with thick, buttercream frosting, any kind of cake will do.  Or, how about one of those French cream horns, flakey pastry filled with luscious cream?  Perhaps just some macaroni and cheese? 


    Nope, can't have it!  I'm nearly 60 years old, all my life I've been able to eat cakes, pastries, cookies, ice cream, pasta, any kind of cereal...but not anymore.  First started the lactose intolerance about 6 years ago.  Every single time I ate cheese or had any kind of dairy product, I spent minimally 3 hours in the bathroom.  It took me almost a year to put two and two together...and many near accidents before I realized, IT'S THE DAIRY!! So, no more dairy.  No more shrimp fettuccine.

    All seemed well for about a year, until the bathroom episodes resumed with the vengeance of a tsunami.  It's lucky I live alone, the moaning and groaning of the painful cramps sounded as though I were dying.  At times, I wished I had.  It was that bad.  As a nurse, I was stumped as to the cause, certain I'd eaten nothing with dairy, I went searching the internet.  Voila---Gluten Intolerance kept
    popping up.  Admittedly, even as a nurse of 35+ years, I had never once encountered anyone with a gluten intolerance problem.  Even more sad, I really wasn't sure what "gluten" really was. 

    I read on and learned "gluten" is in almost everything we eat these days.  Even worse, it's hidden under different names, here is a short list, yes, there's more:  Abyssinian Hard (Wheat triticum durum)
    Alcohol (Spirits - Specific Types)
    Amp-Isostearoyl Hydrolyzed Wheat Protein
    Atta Flour
    Barley Grass (can contain seeds)
    Barley Hordeum vulgare
    Barley Malt
    Beer (most contain barley or wheat)
    Bleached Flour
    Bread Flour
    Brewer's Yeast
    Brown Flour
    Bulgur (Bulgar Wheat/Nuts)
    Bulgur Wheat
    Cereal Binding
    Club Wheat (Triticum aestivum subspecies compactum)
    Common Wheat (Triticum aestivum)
    Cookie Crumbs
    Cookie Dough
    Cookie Dough Pieces
    Criped Rice
    Dinkle (Spelt)
    Disodium Wheatgermamido Peg-2 Sulfosuccinate
    Durum wheat (Triticum durum)
    Edible Coatings
     Edible Starch
    Einkorn (Triticum monococcum)
    Emmer (Triticum dicoccon)
    Enriched Bleached Flour
    Enriched Bleached Wheat Flour
    Enriched Flour
    Farina Graham
    Flour (normally this is wheat)
    Fu (dried wheat gluten)
    Graham Flour
    Granary Flour
     Hordeum Vulgare Extract
    Hydrolyzed Wheat Gluten
    Hydrolyzed Wheat Protein
    Hydrolyzed Wheat Protein Pg-Propyl Silanetriol
    Hydrolyzed Wheat Starch
    Hydroxypropyltrimonium Hydrolyzed Wheat Protein
    Kamut (Pasta wheat)
    Kecap Manis (Soy Sauce)
    Ketjap Manis (Soy Sauce)
     Maida (Indian wheat flour)
    Malted Barley Flour
    Malted Milk
    Malt Extract
    Malt Syrup
    Malt Flavoring
    Malt Vinegar
    Macha Wheat (Triticum aestivum)
    Matzo Semolina
     Oriental Wheat (Triticum turanicum)
    Orzo Pasta

    Suddenly, the bells went off in my head as I recalled what I had eaten in the past week.  Bread, pasta, fake crab in my salad, Chinese food with mushroom gravy and all had made me very sick.  For the next week, I eliminated ALL GLUTEN from my diet and felt great, no cramps or diarrhea and lost a few pounds.  I couldn't wrap my head around it, wasn't quite convinced and while out to dinner with friends, I ate a few dinner rolls.  Big mistake!  I almost didn't make it home. 

    I read the book by Dr. William Davis, Wheat Belly, Lose the Wheat, Lose the Weight.  A wonderful book and I highly recommend it.  It provided so much insight as to the whys and reasons to avoid wheat even if you're not intolerant---yet.  Links to Dr. Davis's book are located on this blog page.

    After reading his book, I immediately cleaned out my cupboards and pantry of ALL GLUTEN and gluten related (hidden) products.  It was nearly bare when I got done.  After that, I headed to a health food store and purchased gluten free pasta, bread, sauces etc.  It was pricey, but I had no choice. 

    I have found that most gluten free breads taste just like cardboard and really wasn't worth eating.  I essentially gave up bread but will occasionally bake some gluten free corn bread, which at least has a substance and tastes like the real thing. 

    I feel better, no more cramping, no diarrhea.  After 2 weeks, another amazing thing happened, my blood pressure decreased to about 100/60....consistently.  I am hypertensive and take a number of anti-hypertension meds, I had to cut them in half and within another week even eliminated 2 of them. 
    I had also been experiencing neuropathy in both feet, on and off for several years and I'm not diabetic.  Once I cut out the gluten, the neuropathy resolved.  Amazing, because the neuropathy could get pretty bad at times.  Even now, if I accidentally eat something that contains a 'hidden' gluten, the neuropathy is back and lasts for almost 10 days.  I did some further research on this and yes, there is such a thing as Gluten Neuropathy, it's the 2nd most common symptom of gluten intolerance. 

    However, in the meantime, I still miss all the things I used to love that is made from white flour and gluten.  Foods I grew up eating, those luscious cakes, brownies, pasta smothered in cream sauce.  Sometimes just to torture myself, I will walk down a bread aisle at the grocery store....just to inhale the aroma of bread.  Yes, I'm grieving gluten.
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