Student Nurse Laura

Orem – "creative effort of one human being to help another human being."

Archive for November, 2009

Nurses Developing Cultural Competence

Posted by Laura on November 30, 2009

The five components of a nurse’s ability for cultural competence includes the following:

1. The nurse’s knowledge  which is the process of learning of the different cultural backgrounds of her patients.

2. The nurse’s awareness   or looking at self biases and prejudices.

3. The nurse’s desire  or motivation and willingness to learn, respect and accept individual cultures.

4. The nurse’s skill as a framework for assessing cultural ethnic differences.

5. The nurse’s encounter process of interacting with diverse backgrounds thus developing cultural competence.

Skill includes –

Environmental control: how much do we belive we have control over our environment or is it just luck? Traditional western medicine vs. folk medicine

Biological variations: Scientifically any genetic factors in particular ethnic or racial groups that affects their health or high risk in  diseases.

Social organization: Patrilineal or male dominated, Matrilineal or female dominated, Bilineal where male & female are dominate

Communication: assertive vs. more passive, nonverbal verbal, tone of voice, eye contact.

Space: eye contact, touching how close a distance between participants

Time: future-oriented, present oriented or past oriented

 

laura’s thoughts generated by the article of: Flowers, Deborah. “Culturally competent Nursing Care,” Critical Care Nurse, August 2004, Pages 48-52.

 

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Cultural Diversity Match it

Posted by Laura on November 30, 2009

Mod 12 Match it.
match it answers

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Common Occuring Defense Mechanisms

Posted by Laura on November 28, 2009

Added to Flash Cards

http://www.flashcardexchange.com/tag/avc

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Gary’s Student Nursing Tips Blog

Posted by Laura on November 27, 2009

Gary Appel has created a new blog on gaining knowledge from sudent’s experiences in clinical situations. http://srnblog.wordpress.com/

He has also created a medication card he uses. Check it out!

“I print this Excel doc out on 3×5 index cards, punch a hole in the corner, and attach them to one of those cords that retract. I clip the cord thing onto a loop in my uniform pocket so these cards are attached to me, stored in my pocket, and within easy reach.

In the morning when I get my patient meds that I have to administer for the day I write down all the info from the drug guide onto this card, then reference the card when the instructor quizzes me about the drug or as I need to during my shift. I formatted the card so after class you can cut the top portion off at the dotted line and then use the drug card as a future study aid. The back of the card can be used for writing notes as well.”

Gary’s Med Info

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Thanksgiving Mini Care Plan

Posted by Laura on November 27, 2009

Click Image for Thanksgiving Mini Care Plan

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Balance of the Nurses’ Energy

Posted by Laura on November 26, 2009

I made this scale to show the balancing of the nurses’ energy. We have been taught to keep our bodies healthy, our minds nurtured and our spirit awake, but have you really thought how deep this goes? Breaking some of these areas up into mental, intuitional and emotional health lets you see where you may be missing a little tender loving care, and probably more importantly – letting go. So I ask you, is your energy balanced?

The article by D. Sherman on nurses’ stress talked about self-care nurses must do to keep from burning out. It relates the balancing of four fields: the Vital field – physical body, the Emotional field – feelings, the Mental field- thinking, visual images, ideas, and the Intuitional field – creativity, compassion, healing.

When these energies are imbalanced, stress and illness will occur.

 

laura’s thoughts generated by the article in Module 9 – Witt Sherman, Deborah.  “Nurses’ Stress & Burnout,”  AJN, May 2004, Pages 48-57

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Oral Temperature with Thempadot

Posted by Laura on November 26, 2009

  How to Obtain Accurate Readings:

• Wait at least 15 minutes before taking temperature when patient is exposed to cold weather (all assessment methods) or smoking, eating or drinking (oral assessment).

• For oral assessment, place in heat pocket under tongue. Be sure mouth is closed for 60 seconds.

• For axillary assessment, be sure device is against torso, parallel to length of body and completely covered for 3 minutes.

• For rectal assessment, be sure device is completely in sheath and device is inserted into rectum with all dots covered for 3 minutes.

• Allow 10 seconds for the device to ‘lock in’ before reading.

• Read the last blue dot and ignore any skipped dots.

• Retake temperature with new device:

– If left in mouth longer than 2 minutes.

– If left under arm or in rectum longer than 5 minutes.

Download 3M pdf on readings.  tempadotinstructions

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Insulin Chart

Posted by Laura on November 24, 2009

Updated the insulin chart. Updated with Davis Drug Guide, online edition 12, 05/04/2012.

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Blood Transfusions

Posted by Laura on November 23, 2009

We need to know something about blood transfusions for the HESI. I found this quick quiz to give a little info. Think it might help.

http://www.cetl.org.uk/learning/Blood-transfusion-quiz/quizmaker.html

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PN Math Problems from Lecture

Posted by Laura on November 23, 2009

Calculate Total Calories in One Day 

TPN mixture:

 40% dextrose 500 mL added to 8.25% Aminosyn 500 mL running at 100 mL per hour.

Click for Answer

 PPN mixture:

10% dextrose 500 mL added to 8.25% Aminosyn 500 mL running at 45 mL per hour

Click for Answer

 TPN mixture:

50% dextrose 500 mL added to 8.25% Aminosyn 500 mL running at 85 mL per hour, plus 500 mL of Lipsyn 20% to be run over 20 hours each day

Click for Answer

not sure on this last one – verifying with Harmon 🙂

Harmon says correct. Hmmmm.

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Nutrients

Posted by Laura on November 23, 2009

Nutrients – pdf

12/3/09 Update – What is absorbed in the Large Intestine? Water, Sodium, Potassium, Vitamin K when formed by colonic bacteria.

What is absorbed in the Stomach? Water, alcohol some drugs.

Which nutrient begins digestion in the stomach?  Protein with pepsinogen produced by Chief cells.

  

 

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Another Charcoal/collage – by Nora Barron

Posted by Laura on November 18, 2009

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NANDA-I Article on Patient Safety

Posted by Laura on November 17, 2009

In comprising my article on Patient Safety, I tried my hand at another graph of visual information.

Article titled: Clouded Vision – A Patient Safety Deficit

Clouded Vision 

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Lab Test In ‘General Relativity’

Posted by Laura on November 15, 2009

Using my info from my previous post, I will put abnormal lab values in graphic form for an intereseting perspective. This is my “General Relativity”

gr

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Patient’s Lab Tests

Posted by Laura on November 15, 2009

When looking at my paitents Lab Works, I decided I wanted a little reference/exercise for what each lab test was for.

This is some of what I have come up with.

Test Definition
Auto Diff looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person’s white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils.
BUN The BUN test is primarily used, along with the creatinine test, to evaluate kidney function in a wide range of circumstances, to help diagnose kidney disease, and to monitor patients with acute or chronic kidney dysfunction or failure. It also may be used to evaluate a person’s general health status when ordered as part of a basic metabolic panel (BMP) or comprehensive metabolic panel (CMP).
Calcium involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. Regulated by parathyroid.
Carbon Dioxide The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity.
Chloride, serum Elevated levels are related to acidosis as well as too much water crossing the cell membrane. Decreased levels with decreased serum albumin may indicate water deficiency crossing the cell membrane (edema).
Creatinine The creatinine blood test is used along with a BUN (blood urea nitrogen) test to assess kidney function. Both are frequently ordered as part of a basic or comprehensive metabolic panel (BMP or CMP), groups of tests that are performed to evaluate the function of the body’s major organs. This test is also known as: Creat, Blood creatinine, Serum Creatinine, Urine creatinine 
Glucose The blood glucose test is ordered to measure the amount of glucose in the blood right at the time of sample collection. It is used to detect both hyperglycemia and hypoglycemia, to help diagnose diabetes, and to monitor glucose levels in persons with diabetes
HCT measures the percentage of red blood cells in a given volume of whole blood.
HGB measures the amount of oxygen-carrying protein in the blood.
MCH is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. Macrocytic RBCs are large so tend to have a higher MCH, while microcytic red cells would have a lower value.
MCHC is a calculation of the average concentration of hemoglobin inside a red cell. Decreased MCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anemia and in thalassemia. Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is abnormally concentrated inside the red cells, such as in burn patients and hereditary spherocytosis, a relatively rare congenital disorder.
MCV is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 deficiency. When the MCV is decreased, your RBCs are smaller than normal (microcytic) as is seen in iron deficiency anemia or thalassemias.
MPV is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow.
Platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting.
Potassium is the major intracellular cation. Very low value: Cardiac arrhythmia.
RBC is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.
RDW a calculation of the variation in the size of your RBCs. In some anemias, such as pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW
Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Very Low value: seizure and Neurologic Sx.
WBC count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant.

Laboratory – Chemistry

BASIC METABOLIC

  • SODIUM, serum
    • Normal Adult Range: 135-145 mmol/L
      Optimal Adult Reading: 140.5
  • POTASSIUM, serum
    • Normal Range: 3.5 – 5.0 mmol/L
      Optimal Adult Reading: 4.5
  • CHLORIDE, serum
    • Normal Adult Range: 101-111 mmol/L
    • Optimal Adult Reading: 103
  • Carbon Dioxide (CO2)  
    • Normal Adult Range: 20-29 mEq/L 
  • Glucose
    • Normal Adult Range: 70-110 mg/dl
  • BUN (Blood Urea Nitrogen)
    • Normal Adult Range: 6-20 mg/dl
  • Creatinine, serum
    • Normal Adult Range: 0.5-1.2 mg/dl
  • CALCIUM, serum
    • Normal Adult Range: 8.5-10.5 mg/dl
      Optimal Adult Reading: 9.4

Laboratory – Hematology

CBC w/Auto DIFF

CBC

  • WBC Count (White Blood Cell Count)
    • Normal x Range: 4.8 -10.0 x1000/ul
    • Higher ranges are found in children, newborns and infants.
  • RBC Count (Red Blood Cell Count)
    • Normal Adult Female Range: 3.9 – 5.2 mill/mcl
      Optimal Adult Female Reading: 4.55
      Normal Adult Male Range: 4.2 – 5.6 mill/mcl
      Optimal Adult Male Reading: 4.9
      Lower ranges are found in Children, newborns and infants
  • HEMOGLOBIN (HGB)
    • Normal Adult Female Range: 12 – 16 g/dl
      Optimal Adult Female Reading: 14 g/dl
      Normal Adult Male Range: 14 – 18 g/dl
      Optimal Adult Male Reading: 16 g/dl
      Normal Newborn Range: 14 – 20 g/dl
      Optimal Newborn Reading: 17 g/dl
  • HEMATOCRIT (HCT)
    • Normal Adult Female Range: 38 – 46%
      Optimal Adult Female Reading: 42%
      Normal Adult Male Range 42 – 54%
      Optimal Adult Male Reading: 47
      Normal Newborn Range: 50 – 62%
      Optimal Newborn Reading: 56
  • MCV (Mean Corpuscular Volume)
    • Normal Adult Range: 80 – 100 fl
      Optimal Adult Reading: 90
      Higher ranges are found in newborns and infants
  • MCH (Mean Corpuscular Hemoglobin) 
    • Normal Adult Range: 27 – 33 pg
      Optimal Adult Reading: 30
  • MCHC (Mean Corpuscular Hemoglobin Concentration)
    • Normal Adult Range: 32 – 36 %
      Optimal Adult Reading: 34
      Higher ranges are found in newborns and infants
  • RDW (Red Blood Cell Distribution Width)      
    • Normal Adult Range: 11.5-14.5%
  • PLATELET COUNT  
    • Normal Adult Range: 130 – 400 thous/mcl
      Optimal Adult Reading: 265
      Higher ranges are found in children, newborns and infants
  • MPV (Mean Platelet Volume)
    • Normal Adult Range: 7.4-10.4 fl

 

AUTO DIFF

  • NEUTROPHILS and NEUTROPHIL COUNT  – this is the main defender of the body against infection and antigens. High levels may indicate an active infection.
    • Normal Adult Range: 48 – 73 %
      Optimal Adult Reading: 60.5
      Normal Children’s Range: 30 – 60 %
      Optimal Children’s Reading: 45
  • LYMPHOCYTES and LYMPHOCYTE COUNT – Elevated levels may indicate an active viral infections such as measles, rubella, chickenpox, or infectious mononucleosis.
    • Normal Adult Range: 18 – 48 %
      Optimal Adult Reading: 33
      Normal Children’s Range: 25 – 50 %
      Optimal Children’s Reading: 37.5
  • MONOCYTES and MONOCYTE COUNT – Elevated levels are seen in tissue breakdown or chronic infections, carcinomas, leukemia (monocytic) or lymphomas.
    • Normal Adult Range: 0 – 9 %
      Optimal Adult Reading: 4.5
  • EOSINOPHILS and EOSINOPHIL COUNT  – Elevated levels may indicate an allergic reactions or parasites.
    • Normal Adult Range: 0 – 5 %
      Optimal Adult Reading: 2.5
  • BASOPHILS and BASOPHIL COUNT – Basophilic activity is not fully understood but it is known to carry histamine, heparin and serotonin. High levels are found in allergic reactions.
    • Normal Adult Range: 0 – 2 %
      Optimal Adult Reading: 1

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Lab Days Left

Posted by Laura on November 14, 2009

November 18 Wednesday     1 – 6 pm

November 21 Saturday     9 am – 1 pm

December 2 Wednesday 1 pm – 6 pm

December 5 Saturday 9 am – 1 pm

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Week 13 Reading – Rm 114 (Last One!)

Posted by Laura on November 14, 2009

 To print an 8×5 click here for  .doc   .pdf

Week 13 Reading
NS 111 – Mod #14 Cultural Diversity
Book Chapters Pages # pages Min complete
F. of  N.

 

2 30-38 8 Read mod 8
3 41-61 20

 

 

36 1091-1119 30

 

 

McKenry 6 103-117 14

 

 

Articles Culturally competent Nursing Care
  American Nurse Today
Library Reserve Transcultural Nursing and

Cultural Diversity in Health and Illness

             

 

Audio Visuals
Mod

14

Transcultural Perspectives in Nursing: Communication, Part I (#49), Part II (#50), Assessment and Nursing Care (#51)

 

 

Week 13 Quiz/Exam/Other
NS111 Major Care Plan
NS111 Cultural Diversity Presentation (Nov 20th or Dec 4th)
Week 14 Quiz/Exam/Other
NS111 Thanksgiving Break
NS111 Pizza Sales, Community Day, Nov 24th 11-1
Week 15 Quiz/Exam/Other
NS111 Mini Care Plan
NS111 HESI  evaluation
NS111 Exam IV
Week 16 Quiz/Exam/Other
NS111 Final Exam

 

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Did you see the news?

Posted by Laura on November 10, 2009

IMG00015

Clipping from Valley Press 11/13/09

1st page news

pict story

Let me put some names with faces. Student’s in the First Semester ADN program Fall 2009 are:

Top Left, second row, second person is Gary Appel, (Next to Gary, but hidden behind my head is Vicki Halstead).

Front starting at the left is me – Laura Barron, Marcelo Marroquin, Lordes Morgan, DeDee, Kendra Mason and her son.

I would like to names with the other faces – please comment and let me know!

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What is MAO, and how come it keeps coming up in my reading of drugs?

Posted by Laura on November 9, 2009

Since there is great risk for patients on MAO inhibitors, I know I need to understand this area better. Here is what I found out:

MAO stands for monoamine oxidase. Monoamine oxidases are enzymes that catalyze the oxidation of monoamines. In other words, these enzymes oxidize or use oxygen to remove an amine group from a molecule.MAO action

Starting off we have a monamine molecule.  The one above is a base (R) with 2 hydrogen and one ammonia component, plus water and oxygen. We then used MAO (the oxidase) to pull the amino group from the molecule resulting in the amino, 1 hydrogen and 1 oxygen plus the ammonia and water molecules.

Okay, so we know what MAO is. Now a MAO inhibitor would keep this from happening, right? To know why we want it to be inhibited, we need to understand why it normally happens. From what I have read, the normal MAO which happens in our body functions to monitor how many neurotransmitters get to function. If MAOs are increased, then they will be lowering the neurotransmitters activity such as serotonin, norepinephrine, epinephrine and dopamine. Depending if MAO is overworking, or under-working a patient could have depression, schizophrenia, substance abuse, ADD, and migraines.

So now I understand why having our MAOs working correctly is important. If a person is on MAO therapy, then any other drug that may also depress these neurotransmitters – or increase them, will obviously counter act with the MAO drugs and create problems.

Not only other drugs but food also. This example is given in the Tabers (p. 1485) An MAO inhibitor (MAOI) is used to treat depression and Parkinson’s disease. A tyramine-containing food such as cheese can upset this balance.

If you have a MAO excess, then you will have an increased breakdown of catecholamines in your bloodstream. Catecholamines are serotonin, dopamine, metanephrine, norepinephrine, and epinephrine. They are derived from the amino acid tyrosine.

In the Taber’s example, taking an MAO inhibitor will help to not form the tyrosine base by itself. But if you eat certain cheeses (and are using certain MAOI) you just re-establish the high load of tyrosine in your body canceling out the effect of the MAOI.

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Erickson’s Table

Posted by Laura on November 8, 2009

EricksonI re-did our Erickson’s Table to show a positive outcome at each stage vs. a negative outcome. I used the video below, and our F. of N. book  for my chart.

downloadable .pdf

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