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Content That Joe V Likes

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If you made it this far--thanks for visiting. My name is Joe. I'm's Information Architect. I'm the tech behind the scene. I'm in charge of everything that makes tick. Isn't she a beauty! I consider myself to be extremely fortunate, because I love what I do.

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  • May 25

    Hello, my name is Marcy and I live in Virginia. Yes, I would say that I am very HIPPA savvy. In fact, I was told in one of my nursing jobs that if we were caught violating HIPPA, we would be terminated. My job took HIPPA very seriously. I liked your drawing and it did make me feel some humor into a very serious manner. In my book, it is OK to be serious and it is OK to take things into a more lighter humor way. When I look at the picture, I do not feel that the picture violates HIPPA. When I looked at the picture, it made me think of the whole situation in a more light manner. I do not believe that you would be terminated for what was on the picture, but it is hard to tell because I do not know where you work or what your supervisor would say. My best advice to you is to know your HIPPA rules and regulations in your own work place and follow those very closely. I hope this helps. Good luck to you. Marcy

  • May 25

    1. All members can choose to share any posts or articles that pique their interests onto their Facebook walls. Non-members (a.k.a. guests and lurkers) can share posts and articles as well.

    2. A couple of the people who work behind the scenes at share posts and articles onto the Nurses Rock Facebook page that are likely to attract positive traffic onto these forums.

    It is important to remember that any content posted onto these forums becomes public domain. Therefore, if you do not wish for it to be shared on Facebook, think twice about posting the content.

    Be mindful that anyone, even non-members, share our posts onto their Facebook walls. Anyone can and will share, and this is the nature of social media in the 21st century at the present time.

  • May 25

    A usually quiet and reserved student stopped by yesterday just to chat and write me this note:

    You make everyone feel better no matter how bad the case is! Thank you for caring about everyone who walks through the door! THANK YOU!

    He's not much of a talker, comes in for whatever he needs and leaves, so I never would've guessed he felt this way. It melted my heart. And reminded me that what we do DOES make a difference, it's just hard to see it everyday.

    Keep on keepin' on, SNs, summer's almost here!

  • May 25

    I have been an inpatient PEDS Rn for 1 yr. I made a mistake, a lapse in judgement, that caused no harm and was fixed immediately. I was helping a physician with a procedure and I misunderstood what he was asking me to do. I did clarify what he was asking but not sufficiently and I should have known better. I immediately knew I messed up and we fixed it together. It could have been bad but we working together and fixed it immediately. The MD stayed very calm and was very nice about it despite being surprised. I called other nurses in to help just in case and we finished the procedure. No harm was done to the patient and family in the room remained incredibly calm and understanding ( I had already built a great rapport).

    I was was frazzled as all get out and debriefed with my supervisors. One was very supportive and encouraged me to move on from the mistake and not give up and beat myself up for it. The other, who was my immediate supervisor was not necessarily supportive or unsupportive. Although I had a feeling for quite some time that she did not believe in me, which was causing me some anxiety about my position on the unit. I told me self I was just over analyzing and never said anything. She had compared me to other new grads in my 6 mo review and the main reason was time management. I felt very disheartened because I thought I was doing well and making progress, and I thought this was a reasonable weakness as a new grad.

    The resource Rn took my assignment for the rest of the day and I wrote up an incident report on myself and apologized to the mom of my pt. She was so kind and thanked me for my excellent nursing care. I had a day off and then two shifts on. The educator called to ask me if I felt ready to come in to work. I wasn't sure and expressed some feelings of anxiety. She called me back and told me to take the next few shifts off. Then I was suspended pending an investigation.

    I took full responsibility and explained the facts of the situation, knowing it was a big mistake and understanding that accountability is hugely important ( it's one of the facilities core values) despite whatever the consequences may be.

    Ok.. So It was such a whirl wind that I did not probably do a good job of exhaling the brake down of communication when I clarified with the MD. I also did not express how stressed I was that day and how the stress of the day before kept me at work till 9 and up all night( a whole other story that made me feel very unsupported). I did not express how I felt about my manager, and the increasing anxiety I felt by her seeming lack of support ( and she was talking to me right before I went in the room). I did not express how I was struggling with depression that was compounded by my rotating schedule, or other stress in my personal life. I usually do leave my personal life at home however I know that these things/ feelings/ inability for me to cope led to this lapse in judgement.

    I'm unsure of how open I should have been with my state of mind, do you think managers want to know these things? I did not want to sound as if I was making excuses. I just forgot to collect myself, "breathe" and let everything else go when I went into that room. I did tell them this.

    I was left eligible for rehire w/I the hospital and even eventually down the line they encouraged me to reapply to my unit. I have a hard time understanding that if they think I can learn from this, why not on my unit?

    I feel so outcast. They told me over and over that "you will make mistakes," as if they would support me through expected new grad mistakes. I did not do it on purpose, took accountability and identified several things that could help me prevent this in the future. I'm not sure how to recover, I don't think I'm handling this well. I have hardly talked to anyone, and it's been a few months. I feel like my career is over and no one will understand or give me the benefit of the doubt. My director said that I can use her as a reference but that she would have to tell them what happened. I know this put her in an awful position. I just don't understand how I will ever get another job if she tells everyone what I did and fired me.

    I'm unsure of everything at this point and I've contemplated leaving this stressful profession entirely. Any advice is greatly appreciated, I really need to hear other perspectives.

  • May 24

    There’s no shortage of studies, statistics and research on the essential roles nurses play today in primary care. A rapidly growing patient population and expanded access to health insurance have combined to cause a surge in demand for health care that physicians alone simply cannot provide.

    Nurses have answered that calling and they’ve done so in a big way. Over 205,000 licensed nurse practitioners are treating and managing care for patients, supplementing physicians and contributing to a better quality of care.

    The advanced practice role has been widely accepted in primary care for several decades. It’s why nearly 90 percent of NPs are trained in primary care.

    But there’s yet another impending health care shift on the horizon. Our nation’s health care needs are changing and that change corresponds to an aging, elderly population. According the US Census Bureau, by 2030, people age 65 and older in the United States will more than double from 35 million to 71.5 million, with the oldest of the population -- people over age 85 -- as the fastest growing segment. The American Journal of Nursing (AJN) recognizes that nurses will care for more adults over 65 than any other patient population. The aging Baby Boomer population is both educated and articulate about their health, yet they will have more complex, acute care needs than previous generations.

    As nurses, we rely on our education, training and experience to prepare us and make us qualified to treat patients. So when asked to fill acute care roles with primary care skills and credentials, it’s our duty to respond and be the best possible advocate for the patient. The NP role is no longer emerging in acute care – it’s here. And it’s growing in a big way.

    How do NPs best prepare to assume roles in acute care? Two ways:

    Get the proper education for your role.

    In-classroom, supervised, clinical training is the ideal way to build credibility for your role. On-the-job training may provide practical, focused experience, but it’s not a replacement for building specialized knowledge and skills. There are many accredited Adult-Gerontology Acute Care Nurse Practitioner programs that can be completed in 12 months, without the need to earn a second master’s degree. If you’re an NP in Denver, Regis University has such a program.

    Get certified for your role.
    Nearly all NPs are certified but acute care credentials are very new. Building your education is the first step to earning a national acute care certification that’ll help take your career further. Plus, credentials make you marketable for roles where your peers may not yet hold the proper designation.

    As health care professionals, we’re confronted with ethical dilemmas on a daily basis. We’re asked to respond to challenging situations and seek out ways to provide service to those in need. Keeping an eye on the future and preparing for impending shifts in health care is a way to not only advance your nursing career, but to advance the entire field of nursing.

    Are you an NP trained in primary care that’s practicing in an acute care setting? Or are you looking to move into acute care? Share your experiences and how you’ve shifted – or plan to shift – from primary to acute care.

  • May 24

    "New age" describes a recent trend in the United States toward alternative solutions to those provided by science and modern medicine. This new sense of spiritualism embraces some old solutions like the mind-body connection, massage therapy, natural methods and medicines, homeopathy, yoga, candle therapy, acupuncture, and other things excluded from a typical visit to a physician's office.

    This new trend in the U.S. is not so new to immigrants from Latin America. What we call "traditional" or "folk" medicine has been practiced in their home countries for a long time. These practices have coexisted with modern medicine. Practitioners of traditional remedies do not consider the traditional and modern solutions to be distinct, but rather complementary.

    So we should not be surprised that some Hispanic patients may have sought natural solutions before visiting a physician's office for healing. Some patients believe strongly in curanderos or spiritual healers. Some have brought with them a system of cures passed down from generation to generation for self treatment. Supplements and special diets are popular in Latin America. Often a visit to the homeopathy shop, or even a farmer's market, provides natural medicines for certain ailments. More surprising for many U.S. healthcare providers is the belief in a direct relationship between wellness and magic. Consider the following examples of folk maladies recognizable to many Latin Americans.

    Digestive Distress

    Empacho is a type of indigestion identified with symptoms such as stomach pain, swelling, fever, vomiting, acid reflux, diarrhea, and lack of appetite. These are symptoms associated with ulcers. The condition is often described as a ball of undigested food stuck to the stomach wall. Some believe it's caused by an excess consumption of certain rich or greasy foods. Others say it results from forcing someone to eat something against their will.

    Psychic Distress

    Susto (or "fright") is an emotional illness affecting anyone at any age. Symptoms include depression, nausea, anorexia or weight loss, insomnia, hyperventilation, and nervous breakdowns. It is traced to supernatural causes. Each person has a body and a soul. If a person suffers a traumatic event, his or her soul may flee the body. The soul must be returned to the body, through magical means, or the patient's life is at risk. This condition could mask a general infestation or meningitis. Caregivers working with pediatric patients should be especially aware of this phenomenon.

    Mal aire ("bad air") is a psychic form of possession resulting in respiratory problems, muscle aches, and nervous or digestive problems. It is believed that people can be taken over by deities borne by the wind or by the spirits of victims of a violent death. Since the cause is spiritual, so is the cure—rituals performed by a healer—, sometimes in combination with healing herbs like the common rue plant (ruda), sage (salvia) or rosemary (romero).


    Fallen fontanelle (mollera caída) affects new born babies. Babies are born with delicate craniums which do not firm up until 7 to 19 months of age. When a baby suffers from dehydration from excessive crying, diarrhea or fever from a bacterial infection, the upper front of the cranium may sink in. In these cases, a healer might push up on the upper palate of the baby, or hang the infant upside down.

    Infants are the most common victims of "evil eye" (mal de ojo) and other types of mal puesto, or hexes. This type of magic spell is performed after securing a personal object belonging to the victim such as a lock of hair or saliva. All that's required is a simple look from a powerful individual, often motivated by envy. The solution is also magical, of course. It is the caregiver's role to find a medical solution to the excessive crying, fever and other symptoms presented by infants, or time spent seeking a magical cure may allow an undiagnosed illness compromise a baby's health.

    A Better Cure: Culturally Competent Interviews

    Healthcare providers managing care for Latino immigrant patients need to be aware of the prevalence of alternative practices common in Latin America. Often these practices are not even on the radar screen of U.S. physicians and care givers. But imagine the health risks related to negative interactions between natural and pharmaceutical remedies. Natural remedies and supplements could interact with prescribed medications. And also consider the fact that patients may self treat or rely on the advice of a spiritual healer and thus delay a trip to a clinic or physician’s office when haste is essential to effect a treatment or cure.

    The solution is not to contradict or ridicule a practitioner of alternative therapies, but to work within the cultural framework of the patient. The first task is to find out if a patient is following a form of traditional or folk medicine. Review the following culturally-sensitive questions inspired by the work of Dr. Arthur Kleinman of Harvard. (Refer also to the writings of Dr Nancy Neff of the Baylor College of Medicine, and Berlin and Fowkes' LEARN method.) Underneath each question set is an explanation for the purpose behind the questions.

    • What do you think is the cause of your condition? What do you call this illness? How do you believe the problem started?

    How often does a healthcare provider ask the patient what the patient thinks is wrong with them? Surely some chatty patients will share their own theories with their doctors and nurses, but doesn't the modern provider filter out this "noise" when assessing a patient's condition? Asking these questions may identify what the patient believes is the source of the problem. With this knowledge, the provider can assess the situation and work to separate the affective or emotional side from the physical ailments. Don't discount the patient's beliefs but rather dig deeper to isolate physical symptoms.
    • What remedies are you taking to cure the problem? Have you consulted anyone? Whom? A doctor? A spiritual healer? What did he or she advise? Did someone at home treat you? What did they give you? Are you taking any supplements?

    These questions are intended to reveal to the healthcare provider whether the patient is following any alternative practices or taking any natural remedies or supplements. Home remedies could be dangerous when combined with pharmaceutical drugs, or they may be benign. If the remedies have no effect on a health outcome, we advise against discouraging the patients from taking them. Respect their familiar practices and beliefs. Since spiritual healers can include Catholic priests, we advise using this term instead of curandero in order not to insult a "modern-thinking" Hispanic patient.
    • What are you afraid will happen to you from this illness? What treatment do you believe you should follow? What results are you seeking?

    The answers to these questions will help the healthcare provider assess whether there will be any interference between modern and traditional cures. It also provides an opportunity to anticipate what will happen to patients as they follow recommended treatments, and to discuss realistic expectations for a cure. Including any harmless practices the patient is engaged in—like drinking an herbal tea or wearing a protective amulet—is a good idea for two reasons: it shows you respect their beliefs and it may result in a positive placebo effect. Saying there is 'nothing to fear' or that 'the best thing to do for now is nothing' is not enough. Be aware that Latin American patients who leave a physician's office without a plan of action that includes medicine or supplements may not return!

    The percentage of Latin American folk medicine practitioners is relatively low when compared to the huge number Hispanic patients managed by the U.S. healthcare system. But these precautions can help assimilate the recent immigrant and their families into good health and improve wellness outcomes for all patients.

  • May 23

    Not nursing but we have teleneurology at our hospital because we no longer have in-house neuro group. It works great for us and allows us to still provide neuro consults when stroke patients come in. (We are a small rural hospital) I think telenursing is a very interesting concept!

  • May 23

    Telenursing: Is It in My Future?

    How would you like to receive medical care, education, and support without ever leaving your living room? Through telehealth services medical assistance and support can now be provided to you in the comfort of your home. Through telenursing, a registered nurse is able to provide nursing services through remote telecommunications. While aiding the patient and family with virtual learning, the telenurse provides the best practice to achieve optimal outcomes for the patient. “Telehealth nursing practice is now considered to be a subspecialty of nursing.” (Hebda & Czar, 2013, p. 523). Telenursing has both advantages and disadvantages. Patients benefit from decreased hospital readmission, prevention of complications related to the disease process, and lower healthcare costs. “Hospitals increasingly are turning to telehealth as a tool to increase patient access to care, manage care better and lower healthcare costs.” (Aston, 2015, p. 24). Barriers to telenursing include communication failure; disadvantages related to resources in the home environment and confidentiality concerns.

    According to the Online Journal of Issues in Nursing, “patient responses to date have been extremely positive regarding telehealth nursing.” (Hutcherson, 2001, para. 24). A survey conducted by American Well states, “64 percent of Americans would be willing to see a doctor via video, and 7 percent of Americans (17 million) say they would change primary care doctors for the availability of telehealth visits.” (Aston, 2015, p. 24).

    Benefits of Telenursing

    Today’s healthcare industry is changing rapidly. Technology has allowed healthcare professionals to remotely access, monitor and manage patient medical needs. Telenurses are able to case manage patients with chronic illnesses, provide counseling, and coordinate care among healthcare providers. Allowing the telenurse to collect and transmit data for clinicians to interpret so medical interventions maybe applied. “Telehealth services include health promotions, disease prevention, diagnosis, consultation, education, and therapy.” (Hebda & Czar, 2013, p. 505).

    The advantages to telenursing include: personal individualized attention, closer monitoring of a patient after hospital discharge, early detection of complications, increased patient satisfaction, and prevention of re-hospitalization. “Telenursing currently addresses aging populations and chronic disease problems, community and home-based care needs, geographic health services, access problems, and nursing shortage issues.” (Hebda & Czar, 2013, p. 522). The main focus of the telenurse is to ensure safe, quality, low cost healthcare services.

    Patients are benefiting from telenursing services as a cost effective, convenient, healthcare is being provided to patients in the home care setting. Patients are able to receive web consults, telephone based education and counseling. Patients may also benefit from being assessed and managed through remote access to home devices. A few examples of home devices include blood pressure monitoring, glucose monitoring, and EKG/cardiac monitoring. (Westra, 2012). Eliminating the need to travel for follow up appointments and therapies allow patients to save travel time and expense. Patients that reside in rural areas that have limited access to healthcare and can now benefit from remote healthcare services.

    Disadvantages of Telenursing

    According to Ernesater, Winbald, Engstrom, & Holmstrom (2012), there have been documented malpractice cases filed against telenurses due to poor patient outcomes. In this article, the authors discuss malpractice cases, relating the problems of communication failure. In their opinion, the telenurses were guilty of asking insufficient questions. These factors lead to patients not seeking medical attention resulting in fatal patient outcomes. As a telenurse, communication can be the key to patient safety. Communicating directly with the patient, while using open-ended questions can enhance patient safety. Ensuring patient understanding by asking a patient to repeat instructions can eliminate miscommunication and misinterpretation.

    Disadvantages telenurses may experience include increased stress due to inexperience, understaffed, or insufficient support. A competent telenurse is required to have clinical expertise and experience in order to make quick decisions. Patients rely on telenurses to give adequate and up-to-date information and teaching related to their disease process and medication regime.

    From a patient’s perspective, one may experience disadvantages owning to the inability to acquire Internet access. Reliable telephone service would also be a key factor to provide a successful connection with the telehealth services. Lack of technological expertise along with the possibility of equipment failure may result in a patient’s negative experience with virtual nursing care.

    Due to telehealth members managing and storing confidential medical information and records, patients may be concerned about identity breaching or the exposure of personal information. According to Telehealth Resource Centers, “the transmission of information over communication lines lends itself to hackers and other potential exposure. Protocols must be scrupulously followed to ensure that patients are informed about all participants in a telemedicine consultation and that the privacy and confidentiality of the patient are maintained, as well as ensuring the integrity of any data/images transmitted.” (Telehealth Resource Center, 2010, para. 4.


    Healthcare is changing, are you ready to be part of the future in healthcare? As stated by The National Council of State Board of Nursing, “Telecommunications is advancing at such a rapid rate that its application to healthcare delivery and nursing practice will continue to emerge and evolve.” (The National Council of State Board of Nursing, 2014, para. 5). “The rapid uptake of telehealth modalities and dynamic evolution of technologies has outpaced the generation of empirical knowledge to support nursing practice in this emerging field specifically in relation to how nurses come to know the person and engage in holistic care in a virtual environment.” (Nagel, Pomerleau, & Penner, 2003, para. 2).
    The position of a telelnurse is an important aspect of nursing. Telenursing provides a beneficial and supportive service to patients in a comfortable home setting. One must stay abreast of patient communication and awareness of privacy rights and ethical principals. Branching out into the teleheatlh field requires continual education while remaining aware of rules and regulations regarding HIPPA laws.


    Aston, G. (2015). Telehealth Reshaping Your World and Your Patients’. Retrieved from Hospitals & Health Networks - Hospital and Health Care Executives

    Ernesater, A., Winblad, U., Engstrom, M., & Holmstrom, I. K. (2012). Malpractice claims regarding calls to Swedish telephone advise nursing: what went wrong and why? Journal of Telemedicine and Telecare, 18(), 379-383. Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?

    Hebda, T., & Czar, P. (2013). Telehealth. In (Ed.), Handbook of informatics for nurses & healthcare professionals (5th ed., p. 522). Upper Saddle River, New Jersey: Pearson.
    Hutcherson, C. M. (2001, September). Legal Considerations for Nurses Practicing in a Telehealth Setting. The Online Journal of Issues in Nursing, 6. Retrieved from American Nurses Association

    Nagel, D., Pomerleau, S., & Penner, J. (2013, June). Knowing, Caring, and telehealth technology: “going the distance” in nursing practice. . J Holist Nursing, 31(2). Retrieved from National Center for Biotechnology Information.

    Privacy, Confidentiality, and Security. (2011). Retrieved from Telehealth Resource Center
    The National Council of State Board of Nursing (NCSBN) position paper on Telehealth Nursing Practice. (2014). Retrieved from

    Westra, B. (2012). Telenursing & Remote Access Telehealth. Retrieved from

  • May 23

    What Are We Looking At?

    There are four classes of drugs typically implicated in the rave culture. Stimulants and dissociatives are the two most commonly used agents.

    Amphetamines and stimulants:

    Methamphetamine (beanies, blue devils, chalk, CR, crank, crystal, crystal meth, fast, granulated orange, ice, meth, Mexican crack, pink, rock, speckled birds, speed, tina, yellow powder)

    3-4, methylene-dioxymethamphetamine (Adam, bean, blue kisses, clarity, club drug, disco biscuits, E, ecstasy, hug drug, love drug, lover’s speed, Mercedes, Molly, New Yorkers, peace, roll, white dove, X, XTC)

    Cocaine (blow, C, candy, coke, do a line, freeze, girl, happy dust, Mama coca, mojo, monster, nose, pimp, shot, smoking gun, snow, sugar, sweet stuff, white powder)

    Crack cocaine (base, beat, blast, casper, chalk, devil drug, gravel, hardball, hell, kryptonite, love, moonrocks, rock, scrabble, stones, tornado)

    ADHD drugs (Ritalin ©, Adderal ©, Dexedrine ©, Vyvance ©, Concerta ©: crackers, one and ones, pharming, poor man’s heroin, R-ball, ritz and t’s, set, skippy, speedball, t’s and ritz, t’s and r’s, vitamin R, west coast)



    Dissociatives and anaesthetics

    Ketamine (bump, cat killer, cat valium, fort dodge, green, honey oil, jet, K, ket, kit kat, psychedelic heroin, purple, special “K”, special LA coke, super acid, super C, vitamin K)

    Phencyclidine (Angel dust, belladonna, black whack, CJ, cliffhanger, crystal joint, Detroit pink, elephant tranquilizer, hog, magic, PCP, Peter Pan, sheets, soma, TAC, trank, white horizon, zoom): may be mixed with marijuana or tobacco then smoked, or with other drugs in the rave drug family, such as MDMA, ketamine, LSD, mescaline or methamphetamine
    Lysergic acid diethylamide (A, Acid, black star, blotter, boomers, cubes, Elvis, golden dragon, L, LSD, microdot, paper acid, pink robots, superman, twenty-five, yellow sunshine, ying yang)

    Mescaline (beans, buttons, cactus, cactus buttons, cactus head, chief, love trip, mesc, mescal, mezc, moon, peyote, topi)

    Psylocibin (boomers, god’s flesh, little smoke, magic mushroom, Mexican mushrooms, mushrooms, musk, sherm, shrooms, silly putty, simple simon)

    Plant materials such as Datura stamonium (Hell’s bells, Jimson weed, locoweed) and Salvia divinorum may also be ingested via smoking, chewing, vaping or drinking as tea. The hallucinogenic effect depends on method of ingestion as well as purity of the product used.

    Users tend not to appear in ERs unless they engage in behaviour leading to accidental self-harm. The psychological effect of particularly vivid or frightening hallucinations may be severe.


    Gamma-hydroxybutyric acid (caps, cherry meth, ever clear, easy lay, fantasy, G, GHB, G-riffic, gamma hydrate, Georgia Home Boy, Grievous Bodily Harm, liquid ecstasy, liquid X, soap, sodium oxybate)

    Flunitrazepam (circles, forget-me pill, la rocha, lunch money drug, Mexican valium, pingus, R2, Reynolds, roche, Rohypnol, roofies, rope, ruffles and wolfies)


    Synthetic Opioids

    Fentanyl (Apache, China girl, China town, dance fever, friend, goodfellas, great bear, he-man, jackpot, king ivory, murder 8, poison, tango and cash, TNT)


    1-(4-Nitrophenylethyl)piperidylidene-2-(4-chlorophenyl)sulfonamide (aka W-18) was originally developed as a potential analgesic by chemists at the University of Alberta in 1981. It was abandoned only to be resurrected by labs in China. 100 times as potent as fentanyl, it has been found in tablets sold as oxycodone; its lethality means even a microscopic dose could be fatal. It is not known if naloxone is effective to reverse the effects. 4 kg of it was seized in Edmonton in December 2015, and 1.3 kg were seized in Florida last August.

    What’s the Attraction? Enhancing the RAVE experience

    Stimulants produce euphoria, heightened sensations, altered sense of time, increased stamina, hypersexuality & psychedelic hallucinations; they may also produce tachycardia, hyperthermia, dry mouth, blurred vision, bruxism and dehydration. Onset of action is 30-45 minutes for oral ingestion, and duration is approximately 3-6 hours. Because of the slow onset of action, subsequent doses may be taken, which then produce a dramatic collapse.

    Dissociatives produce euphoria, analgesia, amnesia, hallucinations, derealisation & depersonalization; more noxious effects may include hypertension, nausea & vomiting – aspiration is highly possible – & psychotic emergence reactions. Onset of action depends on route; snorting or injecting produces rapid onset (seconds) while oral ingestion takes 2-5 minutes. Duration of the high is about an hour for ketamine; hallucinations may continue for several hours. Continued use may cause renal failure.

    Depressantsmay produce euphoria, hypersexuality, tranquility & a sense of well-being; hypotension, sweating, nausea, hallucinations, amnesia, somnolence, loss of consciousness (reported by 69% of GHB users) & coma are less welcomed effects and are potentiated by alcohol. Onset is rapid, 10-20 minutes following oral ingestion; duration may be as long as several hours and is dose-dependent.

    Synthetic opioids create relaxation, euphoria, analgesia & hallucinations; they also cause respiratory depression, nausea, vomiting, arrhythmia, seizure and coma. Onset of effect is seconds when injected or inhaled and 15-30 minutes when taken orally. Duration is relatively brief, 1-2 hours when ingested.

    The Ugly Side of Ecstasy

    Stimulant effect > dehydration, hypertension, cardiac and renal failure

    High doses > malignant hyperthermia, rhabdomyolysis, low cardiac output syndrome +/- cardiac arrest, cerebrovascular accident, seizure

    Chronic abuse > confusion, depression, sleep disturbances, drug craving, severe anxiety and paranoia, psychotic episodes, muscle tension, involuntary teeth clenching, nausea, blurred vision, nystagmus, faintness, liver damage, chills/fever or sweating, hypertension and tachycardia may occur even WEEKS AFTER LAST DOSE

    Long-term neurological damage > serotonin receptor destruction > impaired regulation of aggression, mood, sexual activity, sleep patterns, sensitivity to pain

    Comparing Ecstasy to Cannabis

    Recreational Ecstasy users are unimpaired in simple tests of alertness when under the influence while marijuana users are somewhat impaired.

    However, they perform much worse on more complex tests of attention, alertness, memory, learning and tasks reflecting general intelligence, whether they’re high or not. Cannabis effects on frontal attentional networks are generally not as significant as those of MDMA’s hippocampal and frontal cortex effects.

    Neurotoxic effects on cognition and executive function persist more often in MDMA-only users compared to cannabis-only users. Given that MDMA is rarely used alone, impairment in memory and complex thought processes may be additive.

    Signs and Symptoms of MDMA Abuse

    Chronic paranoid psychosis, flashbacks, anxiety, panic, confusion, suicidal depression, insomnia

    Gum-chewing (reduces the distressing effects of jaw muscle fasciculations), weight loss, exhaustion, jaundice, acute hepatotoxicity, hepatitis, irritability, chest pain, tachycardia, hyperkalemia, spontaneous intracranial hemorrhage, retinal hemorrhage, central serous chorioretinopathy, decreased libido, anorexia, amnestic syndrome, severe ataxia, urinary retention likely related to adrenergic effects

    PET shows decreased glucose uptake in caudate & putamen, which is more severe in those users starting before age 18

    Hyponatremia from SIADH and increased H2O intake > cerebral edema & death may be 2o serotonin uptake increase, as is priapism (painful but not fatal)

    γ- Hydroxybutyric Acid (GHB)

    First developed as a general anaesthetic but withdrawn due to unacceptable side effects. Xyrem (Sodium oxybate) approved in 2002 as tx for narcolepsy is a Schedule III drug requiring restricted access and intensive monitoring programs.

    The draw: euphoria, increased libido, sense of tranquility

    When mixed with ETOH it becomes a date-rape drug via amnesia and inability to resist
    Anabolic effects attractive to body builders for increased muscle mass and decreased body fat

    The Downside

    Acts on both GABAB and specific GHB receptors > CNS depression, stimulant and psychomotor effects > 95% hepatic metabolism, t1/2 30-60 minutes with only ~5% renal excretion which makes verification of ingestion very difficult. Urine levels are virtually nil within 24 hours and serum levels in as few as five hours.

    Sweating, LOC, confusion, headache, nausea, auditory and visual hallucination, exhaustion, clumsiness, amnesia > steep dose-response curve with onset noted within 15 minutes. May be implicated in the phenomenon of excited delirium.

    Overdose effects: respiratory depression – apnea or Cheyne-Stokes, acute respiratory acidosis, hypothermia, bundle branch block, bradycardia +/- hypertension, orthostatic hypotension, nystagmus, ataxia, vertigo, tonic-clonic seizure, aggression, impaired judgment, nausea, vomiting, aspiration > especially when combined with ETOH or other sedative-hypnotics

    Addiction - a Bit of a Puzzle

    Historically low levels in 8-12 grade population = 2 % or less

    Withdrawal symptoms are usually severe and require in-patient, medically-supervised treatment for 7-14 days. Amnesia may cause repeated re-addiction - they don’t remember they’ve taken it, or that they’ve been through a horrible withdrawal so they may resume using soon after rehab.

    Benzodiazepines should not be administered to any patient suspected of chronic use; they worsen withdrawal symptoms and increase risk of severe respiratory depression, coma and death. Treatment of intoxication in absence of confirmatory evidence is supportive. Naloxone and other reversal agents do not work. If polypharmacy is suspected, gastric lavage and activated charcoal may be in order.

    Baclofen may have role in tx withdrawal but is not FDA-approved (2014)

    If you're still reading along, here is the personal story I promised in the introduction.

    About 10 years ago on a Saturday morning, I got an alarming phone call from my daughter, who was away at university, The conversation went something like this:

    D: "Mom, I think somebody put something in my drink last night."
    M: <trying not to freak out> "Are you okay? Did anything happen?"
    D: "I started feeling really weird after only a couple of sips and I was scared. So I left and went home. So I'm okay, but I still feel weird."
    M: "Oh. Well. I'm really glad you went home." <practically breaking my arm patting myself on the back for educating her about evil things> "But if you're still feeling weird, you should go to the ED and get checked out."

    She went to the ED, they gave her some IV fluids and sent off blood and urine for drug screens. The serum came back "no illicit substances detected", but the urine tox screen was positive for GHB. She was SOOOO lucky! And I was so thankful that she was safe.

    Talk to your kids!

    We’ve now gotten some solid information about the effects, both desired and unanticipated, of these drugs. In Act 3 we’ll look at a couple of case studies that will bring the pieces together.

    Watch for Act 3, coming soon.

    Act 1: The Agony of Ecstasy in PICU and Other Tales… a Play in 3 Acts - NTI 2016 Session

  • May 20

    I'm in an RN program and I could use a little advice. Before starting the RN program, I worked in a hospital as a nurse aide in med-surg and hated it. I also work in a primary care clinic (mostly in pediatrics, some in family practice) as a medical scribe and I really enjoy it. It's early at this point and I just finished my rotation at a SNF, but I still dislike everything about bedside care.

    I really like the patient flow and the vibe of the community clinic I work at. Patients come in, they get help, then they leave instead of needing to be tended to and monitored all day and all night. Obviously there are patients who need to be in hospital, and those hospital nurses are great, but I don't feel like that's a good fit for me personally. My clinic job is not easy and most days everyone hustles pretty much all day. We see about three patients per hour depending on complexity, but generally we see them one at a time. My previous job at the hospital was just crazy busy, especially for aides like me with 10 to 12 patients each. I'm never doing that again if I can help it.

    Should I try for a new grad job in public health or primary care without doing time in a hospital first? I could probably do a couple years in hospital if absolutely necessary to gain experience, but I'd rather not. In the hospital setting I felt stretched too thin with too many patients to care for at once, and the nurses were not impressed with my performance (mainly my speed) even after a year. In the community clinic, it took only a few months before everyone respected me and wanted me to be their scribe. I'm very concerned that if my first job is in a hospital, I'll do poorly and get a reputation for mediocrity that might have a lasting negative effect on my nursing career.

    I'm a bit torn by what I hear about the ICU. It's bedside care but only one or two patients at a time, and I've heard you get great experience doing detailed assessments which increases your medical knowledge. However the ICU patients are fragile and very ill, so they have multiple problems to manage and as a new grad maybe i would not have the necessary knowledge to care for them.

    At the clinic where I work they just hired a new grad RN to train as a pediatric triage nurse, so I know at least a few of those jobs are out there. However, they tried this several months ago with another new grad RN and she quit for a hospital job saying she felt like she needed the experience. The veteran pediatric triage nurse does have misgivings about new grads in triage without hospital experience. The RNs in the clinic do mostly triage and case management but also help with catheterization, etc. I actually love talking to patients. My dream job would probably involve wellness checkups, triage and patient education.

    Helpful advice is much appreciated. Telling me I'm lazy for wanting a day shift clinic job or that I simply won't be a real nurse if I don't do bedside care is probably less helpful, but if that's the way you feel go ahead and share. I'm so sorry for this long post I can't stop writing! Thank you for any help!

  • May 20

    I work at a union hospital, I feel that I am paid a fair wage and am happy with my insurance plan and benefits. While I am traditionaly not a pro union person, I do see the need for unions in some situations. My primary gripe with unions is that, in my experience, they promote political issues that I disagree with. One example is the push for an increase in the minimum wage. I don't want to get into a debate about if the minimum wage should or should not be increased, I just want to see if any of you agree or disagree with the opinion I'm about to express.

    For the ease of explaining what I'm thinking I'm going to just use arbitrary numbers here. Lets say minimum wage is $5.00/hr and RN pay is $20.00/hr.

    The various factors in the economy have determined that an RN makes $20/hr, or that the value of the RN is worth $15 more than than that of an unskilled or minimum wage worker.

    I'm thinking that if my union is pushing for the minimum wage to increase to (for example only) $14/hr, then the union should be pushing just as hard for the RN wage to also increase by 50%. If the union does not push for an equal pay increase for the RN's it represents, then isn't it diminishing the value of the RN's education/skills/knowledge. What I'm saying is it seems that to close the gap between an RN's pay and minimum wage, we are effectively earning less or our jobs have been devalued. I'm wondering if this makes sense and if anyone agrees or disagrees and why.

    Unlike past politial threads I've commented in, I promise to keep civil. I'm only interested in discussion and getting some of your input.


  • May 20

    I like being a nurse but the hours make it so hard to meet somebody. I work every other weekend, nights and holidays. It seems as though every nurse I know who is married or in a relationship met their spouses prior to becoming a nurse or on the job (not possible for me). I am not super social and between my ft and prn hospital jobs, I just don't feel like I have time to meet someone especially with night shift.

    I really want to have kids someday too.

    Anyone else have this problem? Any tips?

  • May 19
  • May 18
  • May 18

    Quote from traumaRUs
    An staffer decided to have some fun. Guess who it is?

    I know who this is.