Gravida

     

Day One

`Okay – Day One. Wish us Luck!

Math Review

If you had the math questions from the workshop on Jan 28th, but need the answers – go to Resources/Semester 2 and you will find them!

Adjustments to Questions/Answers

#2 – If you use the conversion of 1 g = gr 15  or the conversion of 60 mg = gr 1, your answer can come out differently.

#27 – My answer is 40.9 mL/hr as we have learned to go to the tenths. But with pumps we may be rounding. I suggest for our test, go to the tenths place.

#30 – The answer I came up with is 47 gtt/min.

#31c – I used 20% lipids.

Questions of the Fetal Heart Monitor

Sticking with the OB theme here, I saw the article in the American Journal of Nursing questioning the use of fetal heart monitors or fetal oxygen monitors relating to reduction of cesarean and improved perinatal care.

Yesterday’s article at Off the Charts, brought me to this 2007 article. Personal experience with this situation does bias my position, but I am slow to disregard the importance of these measures. Isn’t it through evidence-based practice that this standard protocol has allowed health care personnel to understand interventions such as the effects of maternal positioning to enhance uteroplacental blood flow?

Quite often the seed of knowledge remains underground developing its resources until it is the right time to sprout. – my two cents.

Needle Gauges

I was wondering about the relationship of needles and gauge sizes. This is what I found out:

The first hollow needed used for injection of was made of silver measuring 3cm long and 5mm in diameter  and had a screw used as the plunger. It was made in 1844 by Établissements Charrière and invented by Francis Rynd.

The inverse of gauge sizes to diameter is from the original use of drawing metal through a wire-drawing plate. The original size is One. After passing though the different sizes on the plate, you could make sixteen16-gauge wires from the original one. Or ten 10-gauge wires from the original one. Or two 2-gauge wires from the original one – see where this is going? 

http://books.google.com/books?id=YSgDAAAAMBAJ&pg=PA95&lpg=PA95&dq=Wire+gauges +come+from+the+drawing+plates&source=bl&ots=Zntoq0KXKe&sig= 45DCzIZmgTBiJNJHIyiChqSNTIo&hl=en&ei=VJpoS_ugJYOSsgPth7GbBQ&sa =X&oi=book_result&ct=result&resnum=7&ved=0CCMQ6AEwBg#v=onepage&q=&f=false

IV sites

IV Therapy	http://www.childbirths.com/cypress/ivtherapy.htm
Emergency Nursing World	http://www.enw.org/IVStarts.htm
University of Pittsburgh Peripheral IV Cathetier Insertion video	http://mediasite.cidde.pitt.edu/mediasite/Viewer/?peid=bee0c8e0d3ab434b892474357ec4da24
Dalhousie University Video	http://currency.medicine.dal.ca/videos/qt_play.cfm?sourceurl=http://videtis.ucis.dal.ca:8080/dal/video/mcms/20040416/Peripheral_Venous_Access.mov&sourcename=Peripheral_Venous_Access
IV Pump Simulations	http://classes.kumc.edu/general/IVPump/IVSimulation.html
National Guideline Clearinghouse	http://www.guideline.gov/summary/summary.aspx?doc_id=8338&nbr=004666&string=central +AND+venous+AND+access+AND+devices
How to start an IV	http://www.mrprotocols.com/sset/iv.htm l
Initiating & managing an intravenous infusion	http://www.medtrng.com/blackboard/initiate_iv.htm
Intrvenous Therapy	http://www.answers.com/topic/intravenous-therapy?cat=health
ABCs of IVs	http://employees.csbsju.edu/mbyrne/IVSite/CTPart1.htm#Part1
Newborn Services Clinical Guideline	http://www.adhb.govt.nz/newborn/Guidelines/VascularCatheters/IVCannulationPreparation.htm
Net Wellness	http://www.netwellness.org/healthtopics/anesthesiology/ivcomplications.cfm
Nursing Legal Issues	http://www.medi-smart.com/pitfalls.htm
Initiating Intrvenous Fluids into an Existing IV site	http://www.mccfl.edu/Academics/NursingHealthProfessions/HealthProfessionsLab/Level1Skills/InitiatingIntravenousTherapy.asp

American Cancer Society’s Daffodil Days Campaign

 http://www.main.acsevents.org/goto/AVCollege

“I am sending this to you, Laura, as the class president, and Diane because of our discussion on Thursday.  If you think this would be of interest to your classmates, please pass it on.  Also, if anyone would be interested in helping distribute the daffodils on March 22, they may contact me.   Thank you!    Mrs. Dickinson
I am the college representative for the American Cancer Society’s Daffodil Days campaign.”

The daffodil is a symbol of hope and renewal. To the American Cancer Society, daffodils represent the hope we all share for a world with less cancer and more birthdays – one where cancer never steals another year from anyone’s life.   During my career as a registered nurse I have have personally seen the progress in treatments and survival rates for patients with cancer.

 By making a Daffodil Days donation, you will be doing more than giving or receiving beautiful flowers; you will be sharing hope for a future free of cancer by raising funds and awareness to beat the disease.

Use the link at the bottom of this page to make a donation.  Cut and paste it into your browser.

You can donate on this Web site until Friday, February 26, 2010 at 5 PM. Actual daffodil delivery will be available during the week of March 22, 2010.

Please make your donation using the Place an Order button on the AVCollege page.

Thank you for supporting Daffodil Days and for helping save lives from cancer.

Debra Dickinson, RN, MN,         Health Sciences Division

http://www.main.acsevents.org/goto/AVCollege

This is absolutely a wonderful way to support the cancer research. The page link above gives the place to donate. Let’s try to make Debra Dickinson’s goal! If you are interested in helping with delivery, please send her an email at ddickinson@avc.edu

 

Clip Art

EKG P Wave Chart

I made a chart to help me remember my class work. This chart is only in reference to the P wave. Using the P wave to answer some questions and fitting some rules to identify the arrhythmia.

 P Waves  .pdf  full chart

Student Nurse Flo

It’s those new beginings Vicki was emailing about…

FAFSA

http://www.fafsa.ed.gov/

Free Application for Federal Student Aid (FAFSA)

Yes, you have to apply! So you may make too much money. You don’t make money.  They may only give you loans, no grants. It is like getting the bowl out to make salad. Unless you prepare with a foundation (the bowl), the opportunity to fill it up with lots of greens won’t happen (the money!)

Filling out the FAFSA isn’t that hard. First you have to apply for a pin number. After you complete this part and have a pin you can fill out a temporary FAFSA form that will be good until later in the year.

Just get a rough idea of what your W2s may say and fill in the form. After you have filed your taxes in April, you can then finalize your FAFSA.

The thing is, you don’t really know what your school is going to do unless you fill this form out. I personally like salads, lots of greens, and other colors of vegetables with fruits thrown in. My husband makes a great salad! Some years it has paid off. It really pays off if you fill out the preliminary one before FEBRUARY 10th.

Do the work. Maybe one hour of your time. Think of it this way, is your 1 hour of time worth a few thousand? Do you need your vegetables? Yes, and the more the better right?

IV Math

1. The doctor’s order is for an intravenous infusion of one liter of 5% Dextrose with Lactated Ringers (D5LR) to infuse at 125 ml/hr. How many hours will it take for the IV bag to infuse?

Since we are talking about infusion I would automatically start thinking what I am looking for is Hrs.

Hrs |

So I know my first conversion factor must have hrs as the numerator, and I like to start usually with what the doctor wants or what is on hand.

Answer

2. The physician’s new order is to infuse 1000 ml 5% Dextrose and 0.45 Normal Saline (D5 1/2 NS) with 40 mEq KCL, over 10 hours.  (a) what will the rate be using an infusion pump?  (b) How many milliliters will the patient receive in one day?

Here I think “rate” is always ml/hr. I’m also thinking infusion which is again Hrs. So I would start with Hrs or look for the mL/hr.  Remember from the answer above, infusions are total volume divided by mL/hr.

answer

3. You are to infuse an antibiotic via IVPB. The order is for Cefazolin one-gram q 8 hrs. The medication book recommends the the infusion time of 30 minutes. The drug is supplied in 50 ml of NS. The tubing drip factor is 15 gtt/mL. (a) what will the drip rate be for the infusion?  (b) What will the rate be using an infusion pump?

Drip rate? Well, we know that means gtts/min right?

answer

4. The order is for Erythromycin 750 mg in 250 mL of 5% D5W to infuse over 1.5 hours. The tubing drop factor is 15.  (a. ) what will the drip rate be for the infusion?  (b) What will the rate be using an infusion pump?

This one gets tricky. Drip rate again means gtts/min we are looking for, but you think where is the gtt conversion?  When it says factor, know it means per min or hr. If we are talking drops it will be per min, so use the 15gtts/min.

answer

5. The physician’s order is to infuse a continuous IV of 1 liter or 1000 mL of NS with 20 mEq of KCL at 75 mL/Hr. (a) How many mL will the patient receive per day?  (b) If the infusion was started at 1:30 pm, at what exact time will the bag be totally infused?

This one is fun. I think the question (a) is a little off. You figure it will get infused before a full 24 hrs is complete. So then figure out how many hours it will take. For (b) I changed my hours to military or 2400 hrs, and added the total time. Make sure you have changed the part of an hour into minutes by multiplying the .33 of an hour by 60 to get you true minutes.

answer

New 1st Semester Students of the ADN at AVC

There is an orientation of the new (can I say “probies” ? - too much NCIS!) students entering the nursing program at AVC. Some of us, second semester students, will be going to say hi and let them know we support them, along with what they can do to support themselves through the first few weeks.

Of course I’m going to promote the new chapter of the National Student Nurses’s Association, see flyer I made here.

And I will give them a copy of some of the learning center’s workshop courses available on this preliminary schedule they did up for us.  see here

My dear friends will also talk about support study groups, tutoring (Lisa, Kendra) and even Diane is bringing cupcakes! We will all wear our uniforms, so they can see what they look like on. Should be fun. I think there are many students who I went through pre-reqs with in this class.

So here’s to -

 CLASS of FALL 2011!!!!!

Reading Cards for OB & Professional

8×5’s

012710 reading cards   .pdf

012710 reading cards .doc 

See any errors, please let me know

Be careful using Tylenol, it could save your life

At this time, many products by McNeil are recalled. According to their site it is due to only an “unusual moldy, musty, or mildew-like odor that, in a small number of cases, was associated with temporary and non-serious gastrointestinal events. These include nausea, stomach pain, vomiting, or diarrhea.”

Products include: Tylenol, Motrin, Benadryl, Rolaids, Simply Sleep, and St Josephs

But as with the past September 09 recall (http://www.examiner.com/x-14041-Charlotte-Health-and-Happiness-Examiner~y2009m9d24-Bacteria-prompts-Tylenol-recall-2009), the recall was due to a bacteria found in the product. Gram-negative bacteria Burkholderia cepacia (B. cepacia) can kill. 

Many people have not heard of these recalls, so I am posting this info to warn my friends to use caution. Check your medications against the McNeil list  using the link below. Throw away the old, check those expiration dates, and make sure you are only using new products. Heck, it’s probably time to go through you medication closet anyways and clean out the old!

Be safe.

For all current recalls, check out the McNeil page. Images and product numbers can be seen at http://www.mcneilproductrecall.com/ 

Image found at (http://iai.asm.org/cgi/reprint/68/1/24.pdf)

EKG or ECG

I know it is originally the “elctrokardiogram” or EKG by Einthoven. As a new student in this health field, my physiology teacher taught us it is now called the ECG (Electrocardiogram).

I have browsed through a neon orange book called, Rapid Interpretation of EKG’s by Dale Dubin, MD. I say browsed because the first 4 chapters out of 10 where easy, relatively speaking. Then I got half-way through the 5th chapter. It has me bogging down.

According to Mr. Dubin, EKG stands up for tradition and uses this acronym in his book.

Well, today I am taking a “ECG” class. Basic ECG Course for Healthcare Providers. I’m hoping this will put me though my reading material, and I’ll try not to show my age by saying EKG

1/27/10

 - Dang, the instructor called it EKG also!  The class was good. By halfway through the second day of worksheets, my mind was tired. I think most of the class felt that way, as the volume of unrelated chatter increased every time he stepped out the door. It was a positive learning experience. I do have a better knowledge base of trying to read EKGs. I understand where the P wave comes from, and if it doesn’t – why. The shape of the P wave is one of the biggest clues, and helps you categorize the arrhythmia. Then using our rules, I should be able to make a good judgement. I really look forward to using some of this knowledge in my upcoming classes.

This looks like a good on-line site to reference http://www.nottingham.ac.uk/nursing/practice/resources/cardiology/function/sinus_arrhythmia.php

Classification of Hypertensive States of Pregnancy

 .doc

Hypertension is defined as a systolic BP greater than 140mm Hg or a diastolic BP greater than 90 mm Hg. There must be 2 measurements at least 4-6 hours apart for diagnosis.

Proteinuria is a concentration of >30 mg/dl in a random urine specimen, or >300 mg/24 hours (preferred method).

Pathologic edema + generalized accumulation of fluid of the face, hands, or abdomen not responsive to 12 hours of bed rest -  or rapid weight gain of more than 2kg in 1 week. (this is no longer considered a diagnostic of preeclampsia alone)

Preeclampsia progresses from mild to severe preeclampsia, to HELLP syndrome or eclampsia.

Severe preeclampsia

• systolic 160 or diastolic 110
• proteinuria > 2g in 24 hr
• oliguria < 500 ml / 24 hrs
• ALOC
• hepatic involvement
• thrombocytopenia w/platelet  < 100,00/mm3
• pulmonary edema or cyanosis

• fetal growth restriction

HELLP syndrome

• H – hepatic dysfunction characterized by hemolysis
• EL - elevated liver enzymes
• LP – low platelets < 100,000/mm3

Lab Tests: Blood

• CBC (including a platelet count)
• clotting studies (bleeding time, PT, PTT, fibrinogen)
• Liver enzymes (lactate dehydrogenase LDH, AST, ALT
• Chemistry panel (BUN, creatine, glucose, uric acid
• Type and screen

    Urine

• volume of at least 30 ml/hr, or 120 ml/4 hr
• Proteinuria

New Temporary Reading Cards

I put together the new reading cards for OB 1st half, leaving some room for Professional. Will update with Professional once we have the Syllabus. These pages reflect the new set-up and any red is new pages, any grey is repeat reading. This way I could see what is different and what I need to cover.

8×5’s

012210 reading cards .pdf

012210 reading cards .doc

If anyone doesn’t know what a basement cat is – check this out: http://icanhascheezburger.com/tag/basement-cat/

Student Nurse Flo

Let’s hope those rainy days have gone!

Looks like just under 4″ of rain has fallen. Our average per year is less than 8″.

Starting a Chapter of CNSA at AVC

https://nsnamembership.org/

I am working to start a chapter of the National Student Nursing Association at Antelope Valley College. I think it offers AVC’s nursing program, both students and teachers alike, an opportunity to network amongs the four semesters, encourage professional development and leadership opportunities. Our school deserves to be on the NSNA map and part of CNSA.

Please let me know if you want to be involved. We have many students and teachers already who are excited to get it going. 

I’m also applying for a grant through NSNA to get $1000 towards creating this chapter. Check out the Grant Statement so far. (still working it, any advice is good )

And for all you 1st semester students, by being a member you can apply for this scholarship:

The Foundation of the
National Student Nurses’ Association
In Memory of Frances Tompkins

ATTENTION ALL UNDERGRADUATE STUDENTS

 The deadline to submit an application for the 2011 – 2012 academic year will be in May 2010. Updates regarding the application process will be made on the website in spring 2010. An application will also be made available for download at that time.

Download the FNSNA Scholarship Fact sheet, if you would like more information regarding the scholarships that we offer or contact the FNSNA at (718) 210 – 0705.

The Foundation of the National Student Nurses’ Association
Attention: Undergraduate Scholarship Program
45 Main Street Suite 606
Brooklyn , NY 11201

Maternity Common Abbreviations

Go to flashcardexchange.com to find cards for AVC or studentnurselaura. Or click on the flashcard link to the right.

Here you will find OB abbreviation cards. Takes 24 hrs to show on their site sometimes.