Do You Know Where Your Urethra Is?

I found this video trolling on Facebook today, it is both hilarious and profound.

I think every nurse both new and old should watch this and take a trip down memory lane.

Ever Wonder.....

Ever been through a chart and see these funny diagrams 

the Doc writes in his progress note?

It took me awhile to ask what the heck these were,

and I finally have an answer.

Now you know too!

Bones: A Visual Study Guide

Just found this on Pintrest.

What an awesome way to study 

the skeletal system.

Source: themetapicture.com via Chanda on Pinterest

IV Insertion Tips

  A couple of days ago a reader asked me for some tips on IV insertion, unfortunately I was in the middle of a three day stretch and I wasn't able to get a post up in time. It got me thinking though and I began going over all the things that I have learned in the last few months that have made putting in an IV much easier for me. 

  So here is what I could think of, I hope it helps.

Feel, don't look.  

  I know every instructor has said this and it makes about zero sense, but trust me, this is one time in nursing that your eyes can lie to you. It makes sense that every new nurse (and even some seasoned ones) will go for an easily visible vein, but often these veins are very close to the surface and will blow easily, deeper veins are often stronger, less fragile veins.  

  Palpate veins with your fingers tips and feel around for a springy feeling vein. It will feel vaguely like  pressing down on an under inflated balloon, it will "bounce" a little under your fingers. Avoid "mushy" or soft feeling veins, these can be more delicate and blow easier. Select the largest vein you can find, they are way harder to miss, you can use a nice large catheter and they are less likely to "go bad". No point in putting in an IV that only lasts a few hours. 

  Once you have a found a nice big, bouncy vein follow it up about an inch or two and make sure it feels pretty much the same all the way up. A hardened area can indicate a valve or sclerotic area that will not allow the catheter to advance. If you find one of these area's be patient and follow the vein further up or down until you find a nice stretch of clean vein.

Hold on!

  Now that you found that vein, anchor that sucker!  You went through all the time to find it now make sure it doesn't run away when you try to poke it. I hear a lot of people say that a patient has veins that roll, all veins do roll to a certain extent so hold em down!

 Everyone does it a little differently

For really roll-y veins try stabilizing

between two fingers.

Spread your fingers wide and hold the skin 

very taut.

OR

Anchor the base of the vein close to your puncture site.

Apply pressure and pull your thumb towards yourself

pulling the skin taut

  The key to anchoring a vein is to apply pressure,  so don't be shy about pushing down on your patient and to pull their skin nice and tight. Apologize and let them know the discomfort will only be for a few seconds, it's a way better option than having to poke them a second time. 

Don't go deep!

  It's tempting to puncture the vein at a 30 to 45 degree angle, especially if you have drawn blood a lot, then drop your angle and attempt to advance the catheter, don't do it!  Going in on a steeper angle than 15 or 20 degrees increases your chance of going straight through the vein, and I find that when I drop my angle after a flash I flub the insertion almost 50% of the time.

  An IV nurse I work with gave me these tips, go in at an angle that is only slightly steeper than parallel with the vein and then check for your flash. If you don't have one advance slightly at a slightly steeper angle.  As she put it veins aren't that deep and your aren't drilling for oil.

Don't be shy

  OK so you got a great flash, but as you advanced the catheter you lose it. Sound familiar? It happened to me over an over again until my friend the IV Nurse commented that I am "bashful" in threading the catheter.

  What she meant is that when I was advancing the catheter I would do so slowly because I was worried about losing my IV. Problem was that my caution was what was causing me to lose my IV sticks. She reminded me that advancing a catheter quickly would not cause any damage.

  What I learned to do it insert the IV and check for a flash, 

then wait and see how well the flash chamber is filling. 

When I see that the chamber is nearly full, 

 I am sure the IV is in the vein.

Now in one smooth quick motion I advance the catheter.

  I know it sounds way too simple but honestly it has worked like a charm every time. Oh yes and don't worry, if there is a valve or sclerotic area that you did not find prior to inserting the catheter won't advance, promise.

And remember....

If you don't get it the first, second or even third time

it's OK.

Don't beat yourself up about it, 

stop and think about what you learned from the experience.

Then let it go.

Remember,

 none of us were born with these skills.

We all have had to learn them

and

YOU WILL TOO!

Neurological Review Packet

Neurological Review Packet

 I just inherited my hubby's computer which is a huge upgrade to my old one. In transferring files I found another review packet. This review packet I found in my Nursing Folder is on all things Neurological. 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.

DOWNLOAD NEUROLOGICAL REVIEW PACKET HERE

Enjoy!

Offended?

  Earlier today I found this article from Scrubs Magazine on Facebook.

Do "New Nurses" Scare You Too?

This article was written by a Nurse Practitioner who obviously feels less than thrilled 

"new nurses" lately.

Personally I was seriously offended by the entire tone of the article

but I would like you, dear readers, to take a look and decide for yourselves.

Should I be offended?

Should you be offended?

Are you?

What would you like to say to this fellow in response to his article?

Braaains!

  As a student I always giggled when a nurse exclaimed "Oh crap I've lost my brain again". It always sounded so strange, calling that ratty, dog eared scrap of paper your brain. I never fully appreciated how such a small piece of paper could assist a nurse with keeping all pertinent information straight.


 That was until now. Now I totally understand how devastating losing my "brains" is. I have also learned that no nurses keeps hers exactly like another nurse. From organization to  pertinent information, every nurse has their own unique way scribbling it down to fit on one sheet of paper, making it very apt that we call these papers "brains". Not to mention every department requires a slightly different brain sheet, you'll notice a Tele nurses brain looks nothing like an ICU nurses brain.


  When I was first getting started it was one of the things that required a lot of trial and error for me to get "just right". In the development process I looked at how the other nurses around me scribbled down their information, paying close attention to how they organized it and what info they kept and what they did not. Now I have a system that works for me pretty well, and I figured I'd share. 

  So let's start with a brains for Telemetry.

 Obviously this is a HIPPA-ized version of my report sheet, but it IS a real one from my last trip to Telemetry.


 It was made on a single sheet of paper that was folded in four so that it can be folded and fit easily into my pocket for quick reference.


  My belief behind my brain is that is should contain only relevant information but at the same time I should be able to know everything about the patient in just a glance to my brains.
  
So let's go over a few of my organizational tricks really fast before I go in depth into my brain.


  


  The first thing I do is color code my brains, notice the red and black pen. Basically the black pen is your basic information, major systems information, vascular access, labs etc. The red pen is important information that you want your eyes to fall on like drug allergies, medical history and diagnosis, and things to do like blood glucose checks and meds to give.


  Second thing to do is decide what information is relevant to me and my treatment of the patient. On a Telemetry ward it's handy to know what telemonitor the patient is assigned. Generally I take down information by exception, meaning I only write down what is abnormal with my patients rather than everything that is going on. I always right down what lines the patient has, where they are and what is running through them this way I know who is going to have IV's to hang. Also if the patient has any procedures going on like dialysis it's important to note what days they generally have it done on in case the Doc wants to know.


  Third thing I do is review what is on the To Do List for the the shift and jot it down (in red) so I know what has to be done with each patient. More importantly this gives you a picture of what your night is going to look like as a whole and gives you the ability to prioritize. By doing this I can now look at all the meds that I have to give on this shift and know that Patient #4 doesn't have any meds due until 2300 so I can leave them to last for med admin and get to the other folks who have earlier meds due.

  To help sum up everything I've said 

here is what my brains for just one patient looks like.

  I hope this helps and makes it easier for you to summarize the whack loads of information that we get as nurses down into a small concise picture of what is going on with your patient.

 If you are looking for some more templates for brains 

Scrubs Magazine 

has a great set of brain sheets with a number of different layouts for different specialties 

here. 

Do you have any tips that you would like to share?

Happy Nurses Week 2012!

Say it loud and say it proud my fellow nurses!

Happy Nurses Week!

  All kidding aside I wanted to say thank you. To all you wonderful people who give up your days and nights to take care of total strangers, you all rock! I also wanted to put in print a shout out to all my instructors, preceptors, friends and most importantly the patients who helped this every day gal become a nurse. Without your help, guidance and encouragement I would never have gotten to where I am.

  To all you student nurses out there, take time to celebrate this week. You are on the most incredible, life changing journey. This week take a moment to look back to the day before you started nursing school and then look at yourself now. I bet you will be shocked to see how far you have come already. Good luck to all of you, but as my dad says you won't need it because you all have brains!

   Oh yes and head on over to this super cute blog 

The Days When I'm Not a Nurse

Anna is giving away a lovely package of great stuff

in celebration of Nurses Week.

Happy Nurses Week everyone!

ABG Tic Tac Toe

  I remember the first time I was presented with ABG's, I nearly cried. I could figure out the pH part, acid vs alkaline was pretty simple I had been testing the acidity of pool water for a long time by them. But the metabolic vs respiratory boggled my mind and hurt my head, and forget compensation. No way!


  Obviously I figured it out, I wouldn't have graduated if I hadn't. And now I specialize in ventilators, so it's kind of second nature. But I realize how intimidating it is, and after a little digging I found this work sheet that an instructor handed out in class. 

download ABG Tic Tac Toe Worksheet here

 I hope it helps!

Common Lab Value Interpretations

  A friend of mine is starting into the RN half of nursing school and was saying that she needed to brush up on labs. That got me sifting through my files and I came upon this handout a teacher put together for us. She made a list of common labs and what a high or low result could mean. There are no lab values for norms but that should be relatively simple for you guys to find yourselves. Remember the best way to learn is by doing.

Common Lab and Diagnostic Tests

  As always I take zero responsibility for the content contained within the pages being correct. If something doesn't seem right please check it out for yourself. Also when sharing please give credit to Cheryl Cipriano RN, MSN for all her hard work

Days vs Nights

  The eternal question when looking at jobs in nursing, days or nights? That's the wonderful thing about the healthcare industry, we are 24/7. This can lead to amazing flexibility in when and how often you work. In very few jobs can you say you work full time and only work 3 days in a week.  Yes I know it can be frustrating because we do not always have the option to have major holidays off to be with our families, but in truth nursing offers some of the most flexible scheduling options. 

  Think about this. Some hospitals will hire nurses only for weekends due to a lack of staff interested in working these days. If you work the ER there are a number of different shifts up for grabs, your traditional 7-7, 12-12 even 10-10. If you think you would like a regular 9-5 five days a week kind of job then you may love working in a doctors office or outpatient surgery. The options are really endless. The first real question that you need to ask yourself is days or nights?

  The majority of society works during the daylight hours, so it is pretty normal to know how things are going to work out. For many people nights is a very alluring possibility, the shift differential, the lack of round physicians, and less need for child care. These are all good reasons to think about trying night shift, but many people wonder can they survive? 

  That is a very hard question to answer. Personally I was born for the night shift, literally. My parents tell stories about me as a baby being up all night and sleeping all day. To this day I am a night owl and would rather be up prowling around at 2am then waking up at 6am to face a new day. A friend of mine asked me the other day how you know if you are just NOT cut out for nights as she was thinking about switching because she could really use the extra money. So I sat down and thought about all the people I have seen try to switch to night and what made them fail or succeed. Here's what I cam up with.

  Do you have a circadian rhythm? Are you one of those people that starts yawning the minute the sun goes down and jumps out of bed at sunrise? If you are the night shift may not be for you. It's very hard to break that natural rhythm. One fellow who started working at the same time I did was that type and within 2 months was desperately looking for a spot on days. He just could not break his body of that rhythm. It was so bad that when the sun began coming up earlier, he could not sleep when he got home.  

  How do you sleep? Are you very particular, do you need silence, the room to be dark, for it to be cold? These are things that very few people take into account and begin to notice as they try to adjust. People forget that during the day there is so much more activity taking place that you may find the general everyday noise to hinder your sleeping. Me, I sleep a coma, dead to the world, no word of a lie but I slept through an earthquake once. The noise doesn't bother me, but if you are used to sleeping at night when most of the world is in bed you may find the amount of noise to be earth shattering.

 Can you sleep with the lights on? Personally I think there is nothing better than curling up in bed with a sunbeam on my face, me and the cat often fight over napping spots. But a lot of people find that little spot light obnoxious. Think it over carefully, blackout curtains only work so well. My suggestion is think about if you nap well during the day, and if you do nap where and for how long you do. Ask yourself do you sleep deeply or just drowse? Remember the quality of sleep you get will be a huge factor in how you feel deep into your 12 hours.

  What kind of a nurse are you? Are you very task oriented, do you prefer to have everyone leave you alone? I hear it over and over, the differences in nurse on days versus nights is well like day and night. This is very true, don't listen to the lies that one is easier than the other, because they are not, but they are hugely different. Knowing yourself is key to finding a good fit. Having worked both shifts I will say this...

  Day shift tends to be very task oriented. Take your patient to CT scan, then PT, then speak with the rounding physicians and participate with Case Management etc.  If you like a lot of structure to your shift, days is an excellent place for you. On days everyone is around, doctors are constantly in and out along with all the other departments, if you like to influence and take a very active role in your patients care, you will do great on days.

  Nights is a whole different kettle of fish. Doctors rarely round on nights, in fact you rarely see anyone in the evening, meaning it's just you and your compadres. If anything goes down, it's up to you to figure out how to deal with it. If you work nights you will need to be comfortable knowing that you call the shots. You need to be able to work independently and have a high level of critical thinking, it's up to you to decide when to call the Doc for orders, or ask the Hospitalist to come and actually look at the patient because they are heading south. You will need to be ok with getting yelled at when you wake up a Doc in the middle of the night and they do not agree with your assessment of the situation, and you will need be strong enough to stand up to the Doc who doesn't want to leave the sleeping room to come see your patient, but you know they need to.

  In the end sometimes all you need to do it try it. There have been many people who have though they had no business being on one shift or the other and found their niche. And in the end if you really can't take it you can always transfer when an opening arises!