DSM-5

For fellow classmates. You know how we have our charts for giving numbers to a condition to see if it fits or what heading it falls under? Such as the APGAR, Braden Scale, Glasgow coma scale. There is a recent drafting of a proposed classification for diagnostic and statistical manual of mental disorders called the DSM-5. Maybe it is really like taking our 8×5 Orem cards and coming up with the focus for our nursing diagnosis. Personally I always wondered about the classification of bipolar and schizophrenia as they are both so close together.

Anyways, the American Psychiatric Association just recently came out with this new global draft on Feb 10th 2010 to place the listed disorders in their classifications. After complete review and revision, (2 years) it will be the new taxonomy. The last published edition was six years ago in 1994. The original publication – DSM-1 was in 1952. If you want to read more go to http://www.dsm5.org/Pages/Default.aspx. You know NANDA-I just recently is going through the process of submission of new diagnosis and revisions of old ones too.

Since we are going into Psych one of these days, and this is a pretty big thing going on right now, I wanted to post it. The following links go to the APA site with the proposed classification criteria for each disorder.

As stated on their site, “Anyone can submit their suggestions and ideas to the members of the work groups through the DSM-5 Web site, by clicking the “Participate” button on the upper right hand side of this screen and registering. The proposed draft revisions to DSM-5 are posted on the Web site, and anyone can provide feedback to the work groups on these during periods of public comment.”  To put this in perspective – the final publication of the DSM-5 will be released May 2013.

 

Structural, Cross-Cutting, and General Classification Issues for DSM-5

Adjustment Disorders

Anxiety Disorders
Delirium, Dementia, Amnestic, and Other Cognitive Disorders
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Dissociative Disorders
Eating Disorders
Factitious Disorders
Impulse-Control Disorders Not Elsewhere Classified
Mental Disorders Due to a General Medical Condition Not Elsewhere Classified
Mood Disorders
Other Clinical Conditions That May Be a Focus of Clinical Attention
Personality and Personality Disorders

Schizophrenia and Other Psychotic Disorders
Sexual and Gender Identity Disorders
Sleep Disorders
Somatoform Disorders
Substance-Related Disorders

 

American Psychiatric Association

Why iso to hypo on the D5W?

Glad you asked! It is my understanding:

When the body consumes the Dextrose 5% in water – it is isotonic or “same as” our tonic. But our body gets hungry and insulin pulls that sugar from the solution. Not quickly, but if we kept consuming quantities of this we would pretty soon have an abundance of just free water in our system waiting to be absorbed. You know people like the sound of a “sugar” pill much more than a “water” pill – right.

So what happens is you have the lumen carrying the water because the sugar left. In fact some of that sugar probably went to the cell who has a good number of osmolarity already. Kind of like a little dinner party. Sure there is over 300 people already there, but when the sugar runs over there, it is even more like a party.

Now who doesn’t like a party? The water is going to go and crash that party. Yep, from the lower concentration to the higher concentration in the cell, it will through osmosis, but it is going to get there. After all, there is so much going on!

All that water moving into the cell is a bit too much! Like your party being crashed! Before you know it, your house gets labeled as “Edema – with Infiltration”, who likes the sound of that, and the nursing police have to fix this situation.

Intervention will be by stopping the flow of water, putting a lock on the door, a fake police car in the yard, anything. Maybe we will only allow crashers bearing gifts. NS and LR.

So my question to you is: When you drink a lot of high caloric drinks with nothing much more than water and sugar, what happens to your body? Does it go to your tissues and make you hypervolemic? And if so, do you now crave salty snacks to balance the osmolarity? But if so, does the new salt make your body retain that water? Does this sound healthy?

Guess that is more than one question….

IV Solutions

I have been working on IV information and was wondering of the osmolarity of the solutions. Especially with the D5W turning hypotonic in the body as the body pulls the dextrose leaving only free water behind with 0 osmolarity. So I made this chart. Here is  a good site for calculating osmolarity of fluids with additives http://www.globalrph.com/ 

if you want to print a copy, click here    IV Solutions       .pdf

Health Science’s T-Shirt

 

as requested

My Med Sheet  Updated 022110

Pizza Sales

Today we are selling Pizza in the Library Plaza to raise money for our Nursing Class. Please stop by and buy some of Rigatony’s Pizza by Michelle Fallato. It’s AWESOME!

Extra large slice with your choice of drink $3.00 (pepperoni or cheese – your choice)

PIZZA

SNAC Spring Logos – Sweatshirts/Tshirts

Wow. No posts for 3 days.

Okay, things got a little busy, a little sneezy, and a little messy – but I’m ready to go again.

3 days of lecture, one check off, one math quiz down. Next week we go to the maternity ward. I like my clinical instructor, I think she will guide us through what we need to learn. So – here it goes again!

Day One

`Okay – Day One. Wish us Luck!

Student Nurse Flo

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 Catheter 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.html
Initiating & managing an intravenous infusion	http://www.medtrng.com/blackboard/initiate_iv.htm
Intravenous 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 Intravenous Fluids into an Existing IV site	http://www.mccfl.edu/Academics/NursingHealthProfessions/HealthProfessionsLab/Level1Skills/InitiatingIntravenousTherapy.asp