Student Nurse Laura

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

Archive for February, 2010

Blue Spots

Posted by Laura on February 28, 2010

After being with some patients, I go home wondering if I did enough, or if I took the right steps. I know things are okay with the nurse on the floor, but I’m still fighting battles in my mind as I learn the ropes. This was the most recent thought process: 

The infants in my limited experience all had what is clinically known as Congenital Dermal Melanocytosis, or Mongolian Spots.

According to Merk’s Manual “Mongolian spots are bluish gray, flat areas that usually occur over the lower back or buttocks. At first glance, they appear to be bruises but are not and should not be mistaken for signs of abuse. They usually occur in black or Asian newborns, tend to appear less noticeable with age, and are of no consequence.”


I feel funny saying mongolian spots. I have since seen it posted elsewhere as ‘blue spots’ or even ‘CDM’. I’ve decided to use these names instead, along with the definition of them being genetic and will most likely disappear as the child gets older. Concern of mothers may be that it was the triple dye leaving a mark on her baby’s skin, or the baby was hurt after birth. A concern of others in the future may be that they are bruises. This makes it important to be sure it is marked in the the baby’s records. (for an image.)

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Posted by Laura on February 28, 2010

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Saga 3 – Marcelo now has Bryan

Posted by Laura on February 27, 2010

Marcelo Marroquin, Bryan Ethridge and Debra Dickinson (instructor at AVC)

Look how happy everyone is here!

before the game begins….

Applying the ChloraPrep

Selecting the vein

Excellent shot on Marcello entering Bryan’s vein

Not so much fun now.

Moving into the vein

Retracting the needle, a perfect insert!

DC ing the IV!



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Saga 2 – Bryan Ethridge & Marcelo Marroquin

Posted by Laura on February 27, 2010

Debra Dickinson (Instructor at AVC), Bryan  and Marcelo during their IV check offs

Getting the tourniquet – Marcelo’s jaw set.

Which vein is the best?

No Stress here!

The teaching process

Okay, maybe a little stress.

In the vein

Moving the cannula up

All done!

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Saga 1 – Laura & Vicki’s IV Check Off

Posted by Laura on February 27, 2010

Debra Dickinson (Instructor at AVC) is checking off the IV technique. Here are some of the step-by-step pictures taken by Lisa Gallardo yesterday.

Applying the gloves.

Getting those supplies ready. My jaw is already set though I trust her completely.

Cleaning with ChloraPrep.

Selecting the vein and lining up.

Trying to enter…..

Still trying to get that vein

Where did that vein go?

Wishing she would find it soon 🙂

Really – not there. But Vicki’s technique was good. We both passed! I stuck her and her vein’s produced right away. People are so different. Good to know.

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Lab Images at AVC

Posted by Laura on February 26, 2010


Vicki eating Lisa’s birthday cake made by Diane! Yummy!!!


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IV Therapy

Posted by Laura on February 26, 2010

Starting an IV line. Just a little nervous…

So I check my orders properly, gather my supplies and bring to my patient. Check his id, wash my hands and explain the procedure. Next I will prepare all my supplies.

I have gathered my supplies based on the order. I have the bio-bag, chux, gloves, tourniquet, alcohol, chlorhexidine or providone-iodine depending on allergies. I have my needle dependent upon type of therapy and duration, prn adaptor, saline flush in syringe (supplies to fill syringe if needed with alcohol wipe), transparent dressing, tape, pen/label. Preparing my supplies prime y-port/prn adaptor with saline, leaving syringe attached. Get tape ready, open needle pkg.

Now after selecting the correct location for the IV, place the tourniquet 4-6 above  site, palpate to find good vein. Release tourniquet. Put on gloves and get antiseptic. Put tourniquet on again, clean area for IV – allow to dry. While using traction on skin to stabilize vein, insert needle – bevel side up at a 15-30 degree angle. Then decrease angle and enter vein. When flash-back is visible, release traction, release tourniquet, advance needle 1/2 cm, advance cannula off needle into vein. Occlude vein proximal to site, remove needle and push needle’s protective pull-back mechanism. Attach prepared prn adaptor and flush. Apply tape and dressing to site. Mark dressing with date, my initials and catheter size. Document records.

Wish my patient/friend luck!

 – almost forgot, I need to have guaze and bandaid for D/C!

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Breastfeeding and Breast Milk

Posted by Laura on February 23, 2010

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Posted by Laura on February 21, 2010

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Math – Hemorrhage

Posted by Laura on February 20, 2010

A.) If 2 grams of blood is loss from a NSVD what is your nursing consideration?

B. ) What if the patient had a decrease in Hct of 3pts with 500mL blood loss?

answer to A & B

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Fetal Blood Circulation

Posted by Laura on February 20, 2010

My understanding of Fetal Blood Circulation. The umbilicus vein from the placenta is bringing oxygen rich blood to the fetu’ss liver where deogenated blood from the lower portion of the fetus is mixed (through the Ductus Venosus) and directed to the heart. The blood now 1/2 & 1/2 or decreased O2 runs through the fetus’s heart mixing more with deoxgenated blood running through the lungs and heart (through the Foramen Ovale), and deoxgenated blood from the upper part of the baby (through the Ductus Arteriosus.) Now this decreased blood  is brought back to the placenta.

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Math – APGAR

Posted by Laura on February 20, 2010

APGAR = Appearance, Pulse, Grimace, Activity, Respiration – for my spanish speaking friends (Apariencia, Pulso, Gesticulación, Actividad, Respiración) – or as figured by my friend Kendra CHaRRM (color, heart rate, respiratory rate, reflex irritability, muscle tone).

The apgar score was created by a Doctor Virginia Apgar, an anesthesiologist, to assess the health of the newborns immediately after being born.  Using the APGAR Score sheet (mine here), figure the score of this newborn.

A newborn was assessment was noted: Acrocyanosis, good cry but only grimacing when applying stimulation to infant. Some muscle tone is noted with an apical heart rate of 101. What is the score?


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GPTAL – Math

Posted by Laura on February 20, 2010

We know GPTAL means:

  • G – gravida or # of pregnancies
  • T – term or # of deliveries after 37 weeks
  • P – preterm or # of deliveries after 20 weeks but before 38 weeks
  • A – abortion or # of deliveries before 20 weeks, either spontaneous or induced
  • L – living or # of living children

A prenatal woman states having 3 young children at home. She says her daughter was born right on time, but her sons were both a month early. Sadly, she lost a baby in her second month. What is her GTPAL?


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Saturday Math

Posted by Laura on February 20, 2010

So can you come up with the EDC for:

                        4 February 2010     answer

                        30 April 2010           answer

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Posted by Laura on February 20, 2010

These are all abbreviations denoting delivery date.

Estimated Date of Confinement  –  EDC

Estimated Date of Delivery  –  EDD

Estimated Date of Birth –  EDB

EDC is an older term meaning the women is confined to the hospital for the birth of her child. As records are noted, the phrase  such as “on the third day of confinement patient…” would be used. This term is used quite a bit today.

EDC is figured by using Naegel’s Rule:

 This method for estimating the expected date of delivery is named after Franz Karl Naegele who was a director and professor in Heidelberg, Germany in the early 1800s. A picture of his forceps along with pictures of an old birthing room in Germany can be found here

His rule takes the last menstrual period (LMP) adds a year, subtracts three months and adds seven days to that date. LMP = 2 May 2007

+1 year = 2 May 2008
-3 months = 2 February 2008
+7 days = 9 February 2008

or +9 months and +7 days only, or according to our book:

Nägele’s (different spelling) rule is “subtract 3 months, add 7 days”. These all come up with a similar estimated date.

Calculator for EDC

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First General Meeting!!

Posted by Laura on February 18, 2010

We are going to have our first meeting of the new Antelope Valley College California Nursing Students’ Association under the NSNA on  Friday, February 19th, at 8:00am. In the APL rm 101.

A flyer with the  meeting’s date and location is outside Professor Stewart’s door.  

Please come and learn what this chapter will be all about and how it can help you. 

We can go over what this chapter of the National Student Nurses’ Association will be doing, what benefits there are in belonging to this chapter, select officers, sign our ICC papers to be official, and entertain any questions.

Upcoming Events:
 There is a CNSA for chapter representatives to attend in Mission
> Viejo,California at the Saddleback College on Feb 20th 9am – 3pm for anyone who wants to go.

Thanks! See you there.
Laura Barron

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American Cancer Society’s Daffodil Days Campaign

Posted by Laura on February 17, 2010

“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 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

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 – Laura


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Newborn Assessment Terms

Posted by Laura on February 17, 2010

Reading the various items we are to observe, measure or palpate when doing a newborn assessment, I realized I needed to add a few more words to my vocabulary and understand what they mean. Here is a list of these words. Most of the definitions came from MedicinePlus

caput succedaneum –It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. A caput succedaneum is swelling that occurs in the scalp of a newborn. This means that bruising occurs in the thin layer of tissue between the hair and the skull itself. This typically appears as a puffy spot on the baby’s head, but it can even be so large as to cover the whole top portion of the skull, making the newborn’s head look misshapen. A caput can also cause molding of the head.

cephalohematoma – Slightly similar to a caput, a cephalohematoma can result from a forceful delivery. As the baby’s body is forced forwards either during a natural birth or a specialized extraction process, the scalp sticks to the interior of the birth canal. This results in the tearing of blood vessels connecting the periosteum to the scalp and skull. A cephalohematoma is a collection of blood under this material. While a caput succedaneum typically disappears in a few days, a hematoma of the periosteum can last longer.

subconjunctival hemorrhage (eye) – Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is also called red eye. This occurs when blood leaks under the covering of the eyeball due to the trauma of delivery. It’s a harmless condition similar to a skin bruise that goes away after several days, and it generally doesn’t indicate that there has been any damage to the infant’s eyes.

pupil opacity – white spot on the pupil, congenital corneal opacities – cataracts, glaucoma,

epstein’s pearls – Epstein pearls are whitish-yellow cysts that form on the gums and roof of the mouth in a newborn baby. Epstein pearls occur only in the newborn and are very common. They are seen in approximately 80% of newborns. The pearls are protein-filled cysts. The condition is harmless, although it sometimes worries new mothers.

supernumerary nipples – Supernumerary nipples is the presence of extra nipples. Considerations: Supernumerary nipples are fairly common. They are generally unrelated to other conditions or syndromes. The extra nipples usually occur in a line below the normal nipples. They are usually not recognized as extra nipples because they tend to be small and not well formed. Causes: Variation of normal development. Some rare genetic syndromes may be associated with supernumerary nipples. Usually no treatment is needed. The extra nipples do NOT develop into breasts at puberty.

hymenal tag – Sometimes, a small piece of pink tissue may protrude between the labia — this is a hymenal tag and it’s of no significance; it will eventually recede into the labia as the genitals grow

epispadias – Epispadias is a rare congenital (present from birth) defect in the location of the opening of the urethra. Causes: The causes of epispadias are unknown at this time. It is believed to be related to improper development of the pubic bone. In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open the entire length of the penis. In girls, the opening is usually between the clitoris and the labia, but may be in the belly area. Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is exposed, inside out, and sticks through the abdominal wall. However, epispadias can also occur alone or with defects.

hypospadias – is a somewhat common birth (congenital) defect in which the opening of the urethra is on the underside, rather than at the end, of the penis. Causes: Hypospadias affects up to 4 in 1,000 newborn boys. Some cases are passed down through families. In other cases the cause is unknown. Symptoms: The condition varies in severity. In most cases, the opening of the urethra is located near the tip of the penis on the underside. More severe forms of hypospadias occur when the opening is at the midshaft or base of the penis. Occasionally, the opening is located in or behind the scrotum. Males with this condition often have a downward curve (chordee) of the penis during an erection. (Erections are common with infant boys.)

polydactyly – Polydactyly is a condition in which a person has more than five fingers per hand or five toes per foot. Considerations: Having an abnormal number of digits (6 or more) can occur on its own, without any other symptoms or disease. Polydactyly may be passed down (inherited) in families. This trait involves only one gene that can cause several variations. African Americans, more than other ethnic groups, can inherit a 6th finger. In most cases, this is not caused by a genetic disease. Polydactyly can also occur with some genetic diseases. Extra digits may be poorly developed and attached by a small stalk (generally on the little finger side of the hand). Or, they may be well-formed and may even function. Poorly formed digits are usually removed. Simply tying a tight string around the stalk can cause it to fall off in time if there are no bones in the digit. Larger digits may need surgery to be removed. The doctor should ask the parents whether there was polydactyly at birth, because a person may

syndactyly – Syndactyly is the most common congenital malformation of the limbs, with an incidence of 1 in 2000-3000 live births.1,2 Syndactyly can be classified as simple when it involves soft tissues only and classified as complex when it involves the bone or nail of adjacent fingers. It is a shared feature of more than 28 syndromes, including Poland, Apert, and Holt-Oram syndromes. Syndactyly is a failure of differentiation in which the fingers fail to separate into individual appendages. This separation usually occurs during the sixth and eighth weeks of embryologic development. The root words of the term syndactyly are derived from the Greek words syn, meaning together, and dactyly, meaning fingers or digits.

club feet – Clubfoot describes a range of foot abnormalities usually present at birth (congenital) in which your baby’s foot is twisted out of shape or position. The term “clubfoot” refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a common birth defect and is usually an isolated problem for an otherwise healthy newborn. Clubfoot can be mild or severe, affecting one or both feet. Clubfoot won’t hinder your child’s development drastically until it’s time for your child to walk. At that stage, the awkward positioning of the foot may force your child to walk on the outside edge of his or her feet.

simian crease – simian crease is a single line that runs across the palm of the hand. People normally have three creases in their palms. The term “simian crease” is not used much anymore since it tends to have a negative meaning (it refers to monkey or ape). The crease is usually just referred to as a single palmar crease.

Considerations: Strong lines (called palmar flexion creases) appear on the palms of the hands and soles of the feet. The palm normally has three of these creases. But sometimes, the horizontal creases join together to form a single one. Palmar creases develop while the baby is growing in the womb, usually by the 12th week of gestation.

A single palmar crease appears in approximately 1 out of 30 people. Males are twice as likely as females to have this condition. Some palmar creases indicate problems with development and are associated with disorders like Down syndrome.

 desquamation – Shedding of the epidermis. The peeling of skin characteristic of post-mature infants.

 milia – Milia are benign, self-limited lesions that manifest as tiny white bumps on the forehead, nose, upper lip, and cheeks of the newborn. Also seen in the baby’s mouth as Epstein’s pearls. Some dermatologist consider them the continuing formation of secretion glands. Do not remove, let them complete on their own.

erythema toxicum – The main symptom is a rash of small, yellow-to-white colored papules surrounded by red skin. There may be a few or several papules. They usually appear on the face and middle of the body, but may also be seen on the upper arms and thighs. The rash can change rapidly, appearing and disappearing in different areas over hours to days. The large red splotches typically disappear without any treatment or changes in skin care.

hemangiomas – A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs. About 30% of hemangiomas are present at birth. The rest appear in the first several months of life. Most hemangiomas are on the face and neck.

The hemangioma may be:

  • In the top skin layers (capillary hemangioma)
  • Deeper in the skin (cavernous hemangioma)
  • A mixture of both


  • A red to reddish-purple, raised sore (lesion) on the skin
  • A massive, raised tumor with blood vessels

telangiectatic nevi – a common skin condition of neonates, characterized by flat, deep-pink localized areas of capillary dilation that occur predominantly on the back of the neck, lower occiput, upper eyelids, upper lip, and bridge of the nose. The areas disappear permanently by about 2 years of age. Also called capillary flames or stork bite.

mongolian spots – is a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians and named after Mongolians by Erwin Bälz. It is also extremely prevalent among East Africans, Polynesians, and Native Americans. It normally disappears three to five years after birth and almost always by puberty. The most common color is blue, although they can be blue-gray, blue-black or even deep brown. 

Moro’s Reflex – Moro reflex is type of involuntary response that is present at birth. It normally disappears after 3 or 4 months. Considerations: The Moro reflex may be demonstrated by placing the infant face up on a soft, padded surface. The head is gently lifted with enough support to just begin to remove the body weight from the pad. (Note: The infant’s body should not be lifted off the pad, only the weight removed.) The head is then released suddenly, allowed to fall backward momentarily, but quickly supported again (not allowed to bang on the padding). The infant may have a “startled” look, and the arms fling out sideways with the palms up and the thumbs flexed. As the reflex ends, the infant draws its arms back to the body; elbows flexed, and then relax. Causes: This is a normal reflex present in newborn infants. Absence of the Moro reflex in an infant is abnormal. Presence of a Moro reflex in an older infant, child, or adult is also abnormal. Two-sided absence of the Moro reflex suggests damage to the brain or spinal cord. One-sided absence of the Moro reflex suggests the possibility of a broken shoulder bone or injury to the group of nerves that run from the lower neck and upper shoulder area. Conditions associated with such nerve injury include Erb’s palsy and Erb-Duchenne paralysis. Loss of muscle function on one side of the body may also produce an asymmetrical Moro reflex.

Babinski reflex – occurs when the big toe moves toward the top of the foot and the other toes fan out after the sole of the foot has been firmly stroked. This reflex, or sign, is normal in younger children, but abnormal after the age of 2. Considerations: Reflexes are specific, predictable, involuntary responses to a particular type of stimulation. Babinski’s reflex is one of the infantile reflexes. It is normal in children up to 2 years old, but it disappears as the child ages and the nervous system becomes more developed. It may disappear as early as 12 months. The presence of a Babinski’s reflex after age 2 is a sign of damage to the nerve paths connecting the spinal cord and the brain (the corticospinal tract). This tract runs down both sides of the spinal cord, therefore a Babinski’s reflex can occur on one side or on both sides.

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Simian Crease or Single Palmar Crease

Posted by Laura on February 14, 2010


The hand I drew on the left has normal horizontal creases. The right hand has one horizontal crease called the “simian crease”, but more appropriately known as the Single Palmar Crease. When doing our Newborn Examination, we will be checking the extremities for creases. This sign can be normal or associated with:

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Breech Baby #1

Posted by Laura on February 14, 2010

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