Student Nurse Laura

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

Archive for the ‘Concepts’ Category

Crackles to Tamponade

Posted by Laura on March 7, 2011

Posted in Acute Cardiovascular Disease, Concepts, Physiologically, Renal, Resources | Comments Off on Crackles to Tamponade

Creatine, Creatinine, Creatine Kinase, Phosphocreatine!

Posted by Laura on January 19, 2011

 

So I am trying to pull it all together, what is Creatine, is Creatinine a misspelling?

Why is there this Kinase and why is it important to understanding the working of the Renal System?

All info is pulled directly from our Tabers, Thanks Tabers!!

 

 

 

 

 

Posted in Concepts, Day-to-Day, NS 241 - Med/Surg II, Physiologically, Renal, Resources | Comments Off on Creatine, Creatinine, Creatine Kinase, Phosphocreatine!

RN, LVN or UAP – What can you do in CA?

Posted by Laura on December 23, 2010

I spent the day looking at the BRN web site for CA focusing on our Nurse Practice Act and what can be delegated to LVNs or UAPs.

There is no easy official list to go by located there, though I did get a reply back from Miyo Minato. Read the rest of this entry »

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Difference between Postural and Orthostatic Hypotension

Posted by Laura on September 27, 2010

My understanding is when a patient has orthostatic hypotension they have a fall in blood pressure occurring when they stand up quickly after lying or sitting down. This is due to a temporary shortage of blood to the brain. The decrease in required blood, causes dizziness. 

When you have postural hypotension, it has a similar end effect on the brain – loss of blood and dizziness, but the cause is a little different. The cause is usally from blood pooling in dilated blood vessels, such as in an athlete after a good work out. Because the blood is pooling into these dilated/warm blood vessels as a person is just standing there, there is little blood returning to the heart. If they sit, it helps the blood perfusion back to the heart and therefore to the brain.

Orthostatic Hypotension is a side effect from Psychotropic drugs such as anitpsychotics: Phenothizaines

According to Tabers a way to determine orthostatic hypotension is by taking the BP:

“The measurement of blood pressure and pulse rate first in the supine, then in the sitting, and finally in the standing position. A significant change in both of these vital signs signifies hypovolemia or dehydration. A positive test result occurs if the patient becomes dizzy or loses consciousness; or if the pulse increases by 20 or more beats per minute and the systolic blood pressure drops by 20 mm Hg within 3 min of arising from supine to sitting position or from sitting to standing position.”

♥ ↑ 20+, or ↓ Sys BP 20+ w/in 3 min

Posted in Concepts, Day-to-Day, NS 232 - Psych, Ger, CH, Semester III | 1 Comment »

Osmolality

Posted by Laura on December 10, 2009

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Metabolic by Electrolytes

Posted by Laura on December 10, 2009

You can tell if a person has Metabolic Acidosis by using the Anion Gap.

The Anion Gap is a difference between the cations and anions. The anion gap indicator # you look at is > 20 mEq for Metabolic Acidosis. Cations are the positive ions in the serum. Anions will are the negatives. Na and K (sodium, potassium) are positive (cations). Cl and HCO3 (chloride and bicarbonate) are negatives (anions).

So here’s the math:

Now the Question is –

Is metabolic acidosis present (anion gap > 20 mEq/L) ?

Answer – Yes, metabolic acidosis is present with an anion gap of 24.

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Respiratory or Metabolic Acidosis or Alkalosis?

Posted by Laura on December 8, 2009

 This is the way I see it.

pH  norm = 7.4  +/-  0.05

PaCO2 norm = 40  +/-  5

HCO3 norm = 24  +/-  2

 

  • If your pH is low and your PaCO2 is high (inverse) you have RESPIRATORYacidosis.  
  • If your pH is high and your PaCO2 is low (inverse) you have RESPIRATORY alkalosis
  • If your pH is low and your HCO3 is low, (and your PaCO2 is normal or low) you have Metabolic acidosis
  • If your pH is high and your HCO3 is high, (and your PaCO2 is normal or high) you have Metabolic alkalosis

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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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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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Insulin Chart

Posted by Laura on November 24, 2009

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

Posted in Concepts, NS111 - Fundamentals, Physiologically | Tagged: | 1 Comment »

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

Posted in Concepts, Day-to-Day, Resources | Tagged: , , , | 3 Comments »

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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Erickson’s Psychosocial Developmental Stages

Posted by Laura on November 8, 2009

I saw this video and thought it was a nice way to understand Erickson’s Stages.

This video is by Fieldman, Robert S. (2007). Child Development. New Jersey: Pearson Education, Inc. and is available for free viewing at YouTube.

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Enteral and Parenteral Feeding Notes

Posted by Laura on November 1, 2009

A Good site for more information on enteral /medication administration is: (they even talk about Phenytoin -Dilantin)

http://www.ascp.com/publications/tcp/1999/jan/tubes.shtml

Enteral Parenteral Nutrition Notes 

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Pain – Acute/Chronic

Posted by Laura on October 27, 2009

Difference between Acute and Chronic Pain

Type Acute Pain Chronic Pain  
Definition Generally rapid in onset, varies in intensity from mild to severeProtective in nature Pain that may be limited, intermittent, or persistent but lasts beyond the normal healing period
Length < 6 months > 3-6 months or longer +++
Intensity Usually Sharp, may radiate Poorly localized, dull, aching
Intensity Mild to severeSubsides as healing takes place Mild to severe
ANS response? present may be absent
Patient expectations Relief of pain Reduce pain, but expects continuation
Subdivided no Malignant / Nonmalignant

Posted in Concepts, NS111 - Fundamentals, Physiologically | Tagged: , , , , | 1 Comment »

The Eyes Have it

Posted by Laura on October 27, 2009

anisocoria OD-5mm OS-6+mm

Sally Joan's Eyes

The Eyes Have It

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