Wednesday, February 29, 2012

Respiratory Review Packet

I was cleaning out my Nursing School folder on my hard drive and came across these packets. Basically they were passed on from "generation" to generation of Block Four (last semester) students. They contain study material that is broken down by system and contain a ton of information about the diseases, medications and interventions that you need to know. Each generation of students have added on to it, making it a great resource. 

Since I no longer am in need of these I am happy to pass them along to any of you nursing students. Please follow the tradition and pass them along and edit or add any relevant information.  As always this packet comes with the caveat that I make no guarantees that information contained in the packet is up to date or correct, so please do not take it for gospel and do not come back screaming at me if you find any inaccuracies.

Aren't We All On The Same Side?

  After working four nights in a row I was treated this week to my first episode of "Nurses Eating Their Own". I won't bore anyone with details, but I made a small mistake and one of the nurses took the chart, not to the charge or even the head of our department, she took it straight to the house supervisor. She even went so far as to make copies of the chart and show the Doc, who got all steamed too. 

  Now I admit I made a mistake, no harm came to the patient. In fact it was a silly thing and I have learned my lesson to read protocols a little more carefully. But really? Aren't we all on the same side here? Isn't our job to provide care to our patients, not hunt out silly mistakes made by another nurse and blow it up into a huge mess? I was so demoralized that morning on my way home, I really do believe that healthcare only works when you have a team. I know this is reality but is it really best for the patients that we care for when Doctors and Nurses are at odds with each other? What ever happened to the Sisterhood of Nurses? Back in the day we hung together, now all we do is try to tear each other down, for what gain?  If anyone can tell me what we actually achieve by backstabbing one another I would love to hear it.

  Oh yes in case you were wondering, the Director called me into the office in the AM and told me not to take anything personally. Things like this happen she said, no one is mad at me and did I learn my lesson? 

  Yup I sure did, TRUST NO ONE. 

  Damn I feel like I working in the spy business may be less stressful!

Thursday, February 23, 2012

Nursing Dx: Disturbed Body Image is Not Just for Women

  It occurred to me after reading the article Being Ken is as Hard as Being Barbie: Why Body Image is a Male Problem, Too (warning this will take you to a website with adult only content, please lock the kiddies up before viewing) that while the modern media is always talking about all the issues women have with "body image" we very rarely talk about how men feel. For the last decade we have very much ignored the male point of view when it comes to body image issues. 

  Do men not face the same pressures that women to conform to a particular and highly unrealistic image of what is attractive? I find that very hard to believe since every page I turn in a magazine features some well muscled, smooth skinned guy sans his shirt trying to convince you to buy whatever it is he is hocking. 

  As nurses I believe it is very important for us to understand the issues that face those who will walk through our doors in whatever setting that we work, but even more important is to continue to look at all sides of the issues that are presented to us.  I would highly suggest reading the above mentioned article as it is written very honestly from the male point of view, I found it very enlightening.

Wednesday, February 22, 2012

SOAP Notes in Pysch

  I have heard from a few friends that are finishing up school that the psych rotation is the most frustrating.  The biggest complaint that I have heard is that a lot of psych facilities (at leas in our state) still use a SOAP style of documentation which is rarely seen in the acute care setting anymore. 

  So lets review SOAP stands for subjective, objective, assessment and plan. In a Psych setting the subjective is what the patient tells you he or she is feeling. Objective data is what you see, is the patient clean or disheveled, what kind of affect are they displaying? Remember in this portion that you must not record any opinions, this is only what you have observed. The assessment portion is where you now take your objective data and use what you have seen to form an assessment of the patient. The planning phase is where you now lay out a plan of care to work with.

Here is a really basic SOAP note that I found on my computer from school:

S: Pt is requesting discharge and states “I’m done with this place” “I’m much better now and have gotten what I need from here” “My mania is much better now that they started me on that other med”

O: Alert and oriented x4 with a bright affect. Pt is well groomed, with a neat appearance in clothing, clean shaven and reports that he showered this morning.  Speech is clear with a normal rate, pt tends to ramble and is hyper-vocal. Thought is tangential at times but logically sequenced. Delusions are present, pt often refers to the “mission from God” that he is on. Appropriate eye contact, social with staff and some peers. Spent part of the morning walking around the unit pushing a peer in his wheelchair. Attended group activity but declined to participate. Denies any suicidal or homicidal ideations and is able to contract for safety. Good appetite, ate all of breakfast and lunch tray. Verbalizes a belief that medications do not work and the self medication is more effective. Vitals WNL

A: Pt remains delusional with no suicidal thoughts and mania is subsiding but not yet fully controlled as evidenced by the tendency to be hyper-vocal. Pt is avoiding working on issues and has expressed that he feels above his peers. Pt may be at risk for non-compliance of medication

P: Encourage Pt to participate in groups daily. Begin medication education with pt 1:1 and have doctor reinforce education. Continue with treatment plan

  This was not highly detailed as this was the first SOAP note done on the patient, but hopefully it will give any of you having a hard time with organizing your information a hand.  Remember SOAP notes don't need to be long, they are designed to pass on pertinent information about the patient to whoever else is reading the chart, keep it clean and concise.

Cultural Sensitivity Gone Wrong

This week a writer for ESPN was fired for writing this headline

"Chink In the Armor"

  This was in reference to the New York Knicks newest sensation Jeremy Lin and the Knicks loss that evening in the wake of an incredible run that began with Asian American Lin's amazing off the bench performance that saw the team enjoy a winning streak the team had not seen before in years.  The headline ran on ESPN's website article that detailed the Knicks loss and Lin's less than spectacular performance that night until outraged readers complained believing that the word "chink" was being used as a pun and racial slur. One writer lost his job for this oversight and the reporter has been suspended for 30 days.

  I won't fill this post with links to all the articles that have be written about this headline because I couldn't fit them all in one post. Much heated debate has taken place about this headline, many people are offended.  Miriam Webster defines "chink" as "a weak spot that may leave one vulnerable"  not immediately as racial slur and might I be so radical as to say that perhaps that is how this headline should have been read. 

  But this brings me to my point. All through nursing school we have had cultural sensitivity crammed down our throats and now in the work world we are being constantly being harried by someone in management about being culturally sensitive. But are we now just fostering a need to be hyper-vigilant to anything that could possibly be translated as a racial injustice? I notice nurses around me being worried about how to take care of a patient who's culture is foriegn to them lest they make a mistake and get hauled into HR for being insensitive. Being Asian myself I have found that on more than one occasion people were offended on my behalf whereas I didn't even notice the alleged slight. Case in point is this little interaction I had seen with a nurse and patient while in school.

Patient: Nurse have you seen that nice student nurse who has been helping me today?

Nurse: Well Sir we have about ten student nurses here today, which one were you looking for?

Patient: That nice Oriental girl

Nurse: Sir! That is horrible language!

Patient: What is? I didn't say anything mean.

Nurse: Sir Oriental is a derogatory term and very offensive, the correct word is Asian.

Patient: Since when was Oriental a bad word? 

Nurse: Sir! Oriental is a RUG not a Person!

  The nurse obviously meant well in trying to be sensitive to my culture, but seriously did she need to berate an 80 year old man? And she never once asked if I was offended by being referred to as "Oriental", which I was not.  My belief is that the intent behind what is said is much more important than a persons choice of words. I also believe that while a respect for a persons culture is important in our ever globalizing world that this trend to hyper sensitivity is not helping anyone. My belief is that as nurses we should strive to treat everyone as with dignity and respect, and in doing this we can transcend cultural difference because we acknowledge each other as human beings. 

Friday, February 17, 2012

Nursing Care Minus the Care Part

  The last two night were undeniably frustrating. The lady in the corner room spent all of my first night screaming that she needed to get out of bed and her nurse was in and out of her room trying to keep her comfortable by alternating morphine and ativan. And the fellow in the opposite corner kept hollering "Nurse" at the top of his lungs for no reason that we could discern. My fellow is being weaned off his vent so his sedation level is pretty low and while I have never been intubated I have been told it's holiday. No biggie I parked outside of his room and every time he reached for the tube I just reminded him the tube was keeping him breathing, so lets not pull on it. He was a good boy and I learned over the night that all he wanted to do as itch his nose once in awhile, so I let him.
  As the sun rose so did my blood pressure, my relief came in and instantly demanded to know why I didn't tie down my fellow. I explained that my guy was just scratching his nose and we had a couple of conversations over the night about his ET tube and he agreed to leave it alone and had held up to his end of the bargain evidenced by the fact that it was still there. I may as well been talking to a brick wall, a brick wall who was busily getting the restraints out and telling me that I must be new to believe that he wouldn't go for that tube in a heart beat. She also said the one thing that made my blood boil.

  "I don't have time to baby sit him all day and make sure he doesn't yank it out"

  Don't have time? What was she going to do all day with only one patient? Go out and get a pedicure? It's not like I didn't have other things to deal with like the admit I got at 2am that needed multiple units of blood hung, but I made it work. We deliver nursing care to out patients, they are not in the hospital for our convenience, they need care
  Yes I am new and I do believe that our job is to care for our patients not to "fix" them or "patch" them up. Maybe the real world hasn't ground me down enough yet or maybe I am totally out of touch but I take pride in the care I provide for them. 
  Take care out of Nursing Care and what do you get, just a Nurse. Which seems apt in this case because none of what she was doing was about the patient it was all about the nurse.

Tuesday, February 14, 2012


Toast /E/R by Shay Carmon
Clear! Get me some butter STAT!

I think I need this!
Saddly there is not one to be found for sale.

It's Not Just The Patients

One of the respiratory therapists came to me last night and asked me this

RT: Is a blood pressure of 179/109 bad?

Me: Uhhh, it's not good. What are you doing that it's so high? Are you on any medication?

RT: Nope, nothing.

Me: Are you sure?

RT: Yeah, all I've had tonight was 3 Monster energy drinks and some Sudafed for my cold.

Me: Well there's your answer.

RT: Really? Wow the things you don't know that are bad for you. By the way could smoking and drinking do that too cause I just had a smoke and was drinking ALOT last night.

 And I thought my patients were bad! 

Monday, February 6, 2012

RN = Patient Advocate, But MD Disagrees And Nurses License is Threatened

  If you have not hear of the case of 
please take a moment to read this short post. 
Ms. Trujillo is an RN who was fired for doing what 
we as nurses consider to be our most sacred duty, 
to be an advocate for our patients. 

  To read the entire story via an email that Amanda wrote herself please see this link you can read the entire story from her point of view on the Nerdy Nurse

  This case has even hit the airwaves now, to see the news story on it please see this link to CBS-5 KPHO

 Outraged? Want to help? Here's how you can...

Sign the petition 


  • Make a donation to help cover legal fees HERE
Don't stay silent over this! Blog and Tweet about this, get your fellow nurses talking! If you have blogged or will blog about this add your article to the growing list on The Nerdy Nurse

Tweet about it and use  #NurseUp 

Contact Amanda and let her know you are on her side 

You Know It's Going to Be a Bad Night When.....

........your charge hands you your assignment and says " Don't bother staying for the huddle, they need you at beside NOW!" walk into your patients room and find out they have been trying to intubate for the the last hour with no success.

.......the family members of a patient demand to know why their sweet grandma is restrained and you have to try and tell them that she punched a nurse in the face last night. look up and notice that one of your neighbors patients is standing next to the bed quietly removing the IV's for their arm, when they should be sedated and restrained.

..... the patient who is sundowning gets out of bed and poops on the floor thinking it's the toilet. give a patient 5mg of Haldol and they still are trying to knock you out. call the Dr. to tell him the 5mg of Haldol didn't work and he says that he's out of ideas.

.....everyone is asking if it's a full moon tonight, and you find out that it's not.

All this from one night in the ICU.