The Nurse’s Secret Weapon for Study

Posted by nurse on May 24, 2011 under Study Cribs, Study Helps | Be the First to Comment

Fifty years ago every household had a First Aid manual. casual reading or even quick cribs in case of an emergency were commonplace. Today even the Internet can’t provide information and education fast enough to assist patients. But an First Aid manual is one of the best preparatory education guides a future nurse can access. Online First Aid training and methods for response to emergency medical needs start the basic building blocks to the lifetime career of nursing.

Nurses are trained in chemical sciences, human biology, pharmaceutical methods, pathology of disease, and more, but the basic preventative and acute care habits are all listed in the pages of a First Aid manual. The primary elements of the respiratory system, treatment for shock, skin wounds, and more begin with the simple “case” described in a first aid manual. Dressing wounds and analysis of patient symptoms begin with very generalized but completely common physical symptoms.

The Socratic method of teaching uses cause and effect to build the long raveling core of knowledge nurses use in healthcare administration. Understanding basic anatomy, wound care absent modern technology, and being able to recall emergency field First Aid makes a First Aid manual an extremely valuable learning tool. Examining the physiological rationale behind the applied treatment and the advised steps to wound healing and shock prevention improves the relationship to information developed later on in advanced nursing courses.

The First Aid manual of the modern era includes advanced and recent medical disorders, such as traumatic stress disorder, self-aid, and armed forces medical wound care. The digestion of the treatment  information in a First Aid manual and the recognition of basic acronyms and chemical symbols can begin the long string of ever-more-devolved institutional training and knowledge culminating in a Nursing license and and Associates, bachelor’s, masters’ degree or Doctorate of Science in Nursing.

Urinary Incontinence

Posted by nurse on January 25, 2011 under Critical Care, Study Cribs | Be the First to Comment

Incontinence is a symptom of physical dysfunction of the bladder and urinary tract. In men and in women, seniors and children, the causes can be varied. Urinary incontinence can be a problem for people to deal with and confront. The people who experience incontinence may not know how to deal with it and make it worse. Incontinence can occur to anyone pregnant, sneezing, under stress and/or with prostrate issues. Nurses should encourage patients who are suspected victims of urinary incontinence to raise the issue with the physician.
Aging does not automatically confer urinary incontinence, but there is a constant covariable. Men who are suffering from stages of progressive prostate cancer. Women who are pregnant report incidental urinary incontinence. But stress and other behavioral disorders that cause urinary continence can require new programming and staged behavioral alterations. Avoiding drinking water within two hours of bedtime and forced bathroom visits during the day three hours apart can be part of this regimen.

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The diagnosis of urinary incontinence should stand apart from any other current condition, must depend on the candor of the patient with the doctor and results of a physical exam. Leakage, loss of bladder control, and fecal incontinence must be shared with doctors for improvement of standard of living and general health. Urinary incontinence may exist on its own, but patients may not bring it up for fear it signals something worse is wrong.
Nursing staff might post urinary incontinence brochures or notices in exam rooms, for example. Nurses might also discuss “other patients’, using anecdotal (fictional) examples to illustrate how urinary incontinence can be treated. Patients may counteract urinary incontinence by traveling with extra pairs of underwear, making excuses for unexplained absences and delays, and avoiding car driving, train trips, and airplane travel. They may make their condition worse by avoiding drinking water and liquids.
Bladder control issues in urinary incontinence occur because the patient is physically unable to get to a bathroom, they are tied up doing other things, or because they cannot walk or get to a proper bathroom due to physical illness or bedridden status. Patients may reschedule vacations, miss work, or avoid certain situations out of familiarity with an incident of urinary incontinence they feel sure will follow. Some patients may not realize it may be treated and simply plan ahead or avoid situations where they must stave off visiting a restroom.
Female patients with urinary incontinence may start wearing pants instead of skirts all the tie, men may skip wearing expensive clothing like suits, and/or children may start wearing bathing suits as underwear because they can stand up to urinary incontinence better and may be washed more frequently. Urinary incontinence should be addressed as soon as possible.

Nurses should be observant if patients are visiting the restroom constantly during one visit and feel this is normal. Getting up in the middle of the night, wearing excessive sanitary pads, or avoiding sports and public events might have hidden reasons due to the patient feeling anxious about urinary incontinence in public.
Urinary incontinence is uncomfortable and unhygienic, and specifically unsafe as it relates to uric acid in contact with skin. Buildup of bacteria due to urinary incontinence, infection prone matter in the bowel and urinary tract, and uric acid ported to the skin can be a harmful as well. Circulatory problems and blood pressure can rise if urinary incontinence is not addressed.

Best Mnemonic Nursing Exam Study Aids

Posted by nurse on August 24, 2010 under Study Cribs | Be the First to Comment

How Do I Measure PCWP?

Posted by nurse on August 22, 2010 under Study Cribs | Read the First Comment

PCWP is measured by the nursing professional when insertion of a balloon-tipped, multi-lumen catheter (Swan-Ganz catheter) occurs. The balloon is placed into a peripheral vein, then the catheter is advanced into the right atrium, right ventricle, pulmonary artery, and then into a branch of the pulmonary artery. Nurses should practice in labs or on clinical models.

Just behind the tip of the catheter is a small balloon that can be inflated with air (~1 cc). Sterilization techniques should be observed by the nursing staff and attendants. The catheter has one opening (port) at the tip (distal to the balloon) and a second port several centimeters proximal to the balloon.

These ports are connected to pressure transducers. Nursing staff should be well aware of these controls before actual clinical patient testing. When properly positioned in a branch of the pulmonary artery, the distal port measures pulmonary artery pressure (~ 25/10 mmHg) and the proximal port measures right atrial pressure (~ 0-3 mmHg).

The balloon is then inflated, which occludes the branch of the pulmonary artery. Nursing staff should attend proper pacing and pressure application. Pulmonary artery occlusion signals the next phase in balloon administration.

When this occurs, the pressure in the distal port rapidly falls, and after several seconds, nursing staff will record pressure stabilizing to a lower value that is very similar to left atrial pressure (LAP, normally about 8-10 mmHg). The balloon is then deflated. The same catheter can be used to measure cardiac output by the thermodilution technique.

The pressure recorded during balloon inflation is similar to LAP because the occluded vessel, along with its distal branches that eventually form the pulmonary veins, acts as a long catheter that measures the blood pressures within the pulmonary veins and left atrium. Nursing staff should be familiar with ranges of pressure for acceptable balloon pump pressure changes and ongoing stable results.

Intra Aortic Balloon Pump Indications

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The Intra-aortic balloon pump (IABP) is a mechanical device that is used by nursing staff and physicians to decrease myocardial oxygen demand while at the same time increasing cardiac output. By increasing cardiac output it also increases coronary blood flow and therefore myocardial oxygen delivery.

Nurses should be familiar with the IABP device. It consists of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 cm from the left subclavian artery and counterpulsates. This is referred to as the “balloon” or heart balloon method informally among nursing students. It is recommended this administration and the pressure ranges be constantly reviewed by nursing students for tests and clinical consultation.

The IABP actively deflates in systole increasing forward (heart) blood flow by reducing afterload (pressure) thus, and actively inflates in diastole increasing blood flow to the coronary arteries. These actions have the combined result of decreasing myocardial oxygen demand and increasing myocardial oxygen supply. This process is in great demand by nursing staff during certain incidences of MI complications and shock treatment.

The IABP process should be mastered by nursing students hoping for independent patient administration. The balloon is inflated during diastole by a computer controlled mechanism, usually linked to either an ECG (EKG) or a pressure transducer at the distal tip of the catheter. Some IABPs, such as the Datascope System 98XT, allow for asynchronous counterpulsation at a set rate, though this setting is rarely used.

Nursing professionals are required to administer the IABP in clinical and emergency care situations. The computer controls the flow of helium from a cylinder into and out of the balloon. Helium is used because low viscosity allows it to travel quickly through the long IABP connecting tubes, and this has a lower risk of causing a harmful embolism should the balloon rupture while in use.

EKG Study Notes

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Auscultation for heart beats can complement EKG strips for identification of cardiopulmonary distress. The SA Node, the Av Node the HIS bundle and the Purkinje fibers are involved in this process. Leads should not have too much lotion or this will obscure the signal/voltage. The Electrical Conduction system of the heart must be thoroughly grasped to master EKG rhythm strip identification. Graphical representations of the electronic activity of the heart must be learned for LVN, RN or EKG tech nursing.

The Sino-Atrial node is the primary pacemaker of the heart, beating 60-100 beats per minute.
The Atrial Ventricular node allows for a delay while ventricles fill, about 40-60 beats per minute.
The HIS has its own ability to stimulate electrical activity and beats at 40-60 bpm.
The Purkinje Fibers are conductive tissue that relays electronic signal through the heart. (20-40) bpm.

The isoelectric line of the EKG measures signal from the leads (wires) from sternum and chest points on the body. Nursing students in clinicals will be trained to administer these leads. Artifacts in the EKG graph occur when a flat line is presented. The p wave fires off, (about ten milliseconds) the QRS wave records the .12 millisecond of the complex interaction between the atria and the ventricles, (The T wave is the recovery interval).

But whereas in asystole the line flattens the P wave, QRS and T interval ,and the effect nulls out when no signal from the body is present, a truly flat line can mean artifact occurs from lack of grounding in the wire circuit, mechanical trouble, patient movement, or lose or defective electrodes.