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sirI, MSN, APRN, NP Admin 95,367 Views

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  • Jun 26

    It may seem unfair that you would need to watch a series of videos understand your large pharmacology textbook or teacher. I understand. But, if pharmacology is a second language, that is absolutely the best approach. In this 7 video series, I take two hours of content from my bestselling audiobook Memorizing Pharmacology and put it on the whiteboard. This should help you visualize the language of pharmacology especially if you have only had a little bit of chemistry (or remember a little bit of chemistry.)

    The most important analogy I can start with is that if you were going to sit down in a foreign language class, it’s better for you to travel to the country where they speak that language the week before. Instead of looking at pharmacology as something to survive, let’s take a quick vacation week to get to know the pharmacology language that can help you in the classroom and clinical.

    Instead of hoping a nursing professor doesn't call on you, wouldn't it be nice to have the confidence to be able to pronounce and articulate what you do know about the medication? Saying you don't know something in a specific way shows competence and asking questions shows genuine curiosity - both qualities instructors love hearing from students.

    I recommend you ask questions in this way. "I understand that _____, but I'm not clear on _____" For example, I understand bismuth subsalicylate, Pepto Bismol, helps with stomach upset, but I'm not clear why bismuth subsalicylate is unsafe for children." The salicylate is like aspirin and can cause Reye's syndrome is the answer. But, can you see how this two step approach shows your competence, but allows you to ask a question in a way that isn't embarrassing? To get that initial competence, however, you need to do a little, not a lot of preparation for pharmacology class with these videos.

    The seven videos are in a specific memorizable (not memorable, but memorizable) system-by-system order of gastrointestinal, musculoskeletal, respiratory, immune, neuro/mental health, cardiovascular, and endocrine. This order isn’t an accident. It’s in order from easiest to hardest based on research articles I’ve read. Remember them with the mnemonic Grand Mothers RINCE kids hair, GMRINCE with the French spelling of rinse, r-i-n-c-e. Intuitively, it should make sense that you’ve used over-the-counter medicine for a stomachache, muscle pain, runny nose, or topical infection so these would be more familiar. Prescription mental health, cardiovascular, and endocrine medications are less familiar and there are many more drugs to know. In your pharmacology class, however, I’m betting most of you will get hit with neuro first and that’s one reason you need to make it through this seven video series.

    This gastrointestinal pharmacology video provides some lessons that are foundational to the system.

    1) Each drug class has a specific order, for example antacids work faster than H2 blockers, which work faster than Proton Pump Inhibitors (PPIs), so it goes antacid, H2 blocker, PPI, in that order. Within each class they are alphabetized for easier recall.

    2) Anytime a drug has a prefix, infix, or suffix, I underline it to help you learn other drugs related to this one.

    3) The temptation is to start making paper or electronic notecards. Notecards work for smaller numbers of drugs, a quiz of 20 for example. However, if you are trying to remember 200 drugs, then 5,000 questions for your boards, you want to employ the serial (in order) techniques I teach in this video as memory anchors. Just as you know in your closet that t-shirts hang in one place, pants in another, when you gain a new t-shirt or new knowledge, you know exactly where to hang it in your mind.

    For now, let’s work with this quick 13 minute video to start your journey to thriving in pharmacology class by learning this important foreign language.

  • Jun 26

    With the recent passing of National Cancer Survivors Day on June 4th, his incredible journey seemed like the perfect one to explore. Read on and get to know Brett and how he turned being dealt a bad hand into a helping hand for others.

    Although our meeting started with several technical difficulties on Skype, we both had a good laugh about it and eventually conducted our interview. Brett is not only lighthearted but also incredibly passionate about the work he does and the patients he serves. He was so happy about a recent win for his foundation, we hardly got through introductions before he wanted to tell me all about it. It’s this kind of attitude, bursting with excitement and energy, that I’m sure draws many to him as a public speaker and comforting patient navigator. His compassion for serving others is evident. Having walked in their shoes, he is the perfect person for the job.

    Brett was diagnosed with ALL (acute lymphocytic leukemia) in 1974 and NHL (non hodgkin's lymphoma) in 1982. There are little words to use when having to imagine surviving such an experience not once but twice. I asked Brett if news of the second diagnosis ever changed his outlook. What kept him positive? “I was devastated,” he said “without my mother I wouldn’t be where I am today. I remember her telling me ‘We’ll do this together’”. And so they did. Many years into survivorship, his mother is still by his side (I even heard her come in for a brief moment during our meeting together). Having a support system is invaluable especially when interwoven with loved ones.

    Brett went through a combined total of 8 years on treatment including cranial, neck & chest radiation and the CHOP protocol (a chemotherapy regimen including cyclophosphamide, doxorubicin, vincristine and prednisolone). While survivorship is certainly something to celebrate, it can also come with many lasting long term side effects. Since entering into survivorship Brett has had two pacemakers, an aortic valve replacement, his gallbladder removed, and continues to persevere despite unilateral loss of eyesight and neurocognitive issues. When asked what being a cancer survivor means to him, he states, “I’ve overcome odds that no one expected [me to]. I’m a faith based person. I can relate to people on a level [others] can’t because I have walked in their shoes”.

    When asked what prompted him to start the Walking Miracles foundation, Brett stated, “We had no resources in our community to help us once we came home from the hospital. I started studying the new standard set by the College of American Surgeons for cancer care and survivorship. I wondered why that didn’t roll down into pediatrics. Survivorship just wasn’t considered a need at that time”. Walking Miracles currently assists families by providing financial assistance to help offset the travel costs to and from the hospital. The foundation is also available to help families navigate the healthcare system during and after treatment - making sure they stay connected to a support network and have proper medical surveillance during survivorship.

    I asked Brett to describe his healthcare experience overall...in one word. Not an easy task. “Trying. Having to figure everything out on your own. Finding information and resources on your own” he says. When discussing nursing care while in treatment he states, “My mother and I know all the nurses from back then, all five were our absolute support system. Without the nurses we would have never made it through”. His willingness to help families navigate through the rough seas of healthcare as someone who has charted the course previously is nothing short of admirable. Brett’s endurance and positive outlook is one we can all learn from, provider or patient. In closing he told me, “[I’ve] overcome adversity through support and determination. You decide who’s going to make your destiny. When you go through what [I have] there is no quit. I am not defined by this. It can make me stronger”.
    ls-jpg

    Links:
    Walking Miracles - Childhood Cancer Services in West Virginia
    LinkedIn Brett Wilson

  • Jun 24

    I froze by room 650 as I wheeled the med cart.

    The scent hit me.

    The overpowering scent of flowers candles and incense. The smell, I associated with death. This was a very familiar smell to me. I had lost both parents as a teenager and this was the smell in the viewing room that was filled with flowers, wreaths, candles and incense. I hated it with all my heart.

    Two decades later, the smell was hitting me right outside Ms. Watson and Ms. Grey's hospital room. I parked my locked cart and went in to investigate. The smell was not around Ms. Grey's bed but around Ms. Watson's bed. Ms. Watson lay sleeping peacefully, the early morning sun gently glowing on her face like a mother's caress. The scent was overpowering and I slowly backed out of the room. I went to the nurse's station and sat down, my mind whirling. What should I do?

    This was not the first time; I had smelt death on this telemetry unit. The first time was a few months ago when I was taking care of a very sick septic patient John Perkins. I smelt it around his bed and was puzzled. I did not connect the dots and thought I was being overly sensitive. I thought I imagined the smell and ignored it. He was a full code and coded two hours later. He did not make it.

    I began getting the smell more and more frequently before patients coded. Some made it, some didn't. I cursed this "gift" of sensing the angel of death. I tried very hard to ignore it. I dared not speak up about it as I did not want to have a Salem witch hunt or my coworkers look strangely at me. I wanted to be part of the crowd and blend in and not create waves.
    My conscience started pricking me. Maybe, if I had told someone else, we could have been better prepared. Maybe, I could have setup the suction machine on the wall, ready to go; maybe I could have asked the telemetry monitor room to observe that pt's rhythm more closely. I beat myself up every which way without relief. One night I sat pondering about this wondering aloud about why I, who was so uncomfortable with death and dead bodies, was given this gift. I argued loudly with God as my kids were sleeping soundly and my husband was at work. I got tired eventually and went to sleep. The next day, I resolved to do things differently. I decided to be proactive. I went in to work with a plan but of course did not smell anything for almost a week! God had his own plan--!

    On a Friday, I smelt death outside a single room. The smell was overpowering in the room. There was not a single flower in sight, so I was sure of what I smelled. I quietly checked the suction (which was not set up in readiness---my pet peeve) and set it up ready for any emergency. I then went to the nurses’ station and rolled the emergency cart to outside that room. The patient crashed within the hour. We successfully resuscitated her and transferred her to the CICU. She was forty five years old and the mother of three. Later, when the patient's primary nurse asked me how I knew to get the equipment in readiness, I told her that I had a" feeling". She believed me as us nurses are famous for our feelings and intuition.

    The team noticed me doing this before unexpected codes and started joking during report at shift change. They would finish report and then ask "Annie, any feelings?" and snicker! I took it in stride .There was an older wise nurse from the "Islands" who suspected that there was more stuff going on that I was letting on and once gently asked me. I told her not to label me a witch and told her.

    She told me simply, “Annie, don't fight it. It's a gift not a curse. Use it to help others".
    I still was not sure as patients still died, so what was the point of the gift. I did not realize why I got this gift until Ms. Watson room took on the now familiar smell of death.

    Ms. Watson was a walkie talkie with three daughters that she always talked about. I had met one of them Beth, who came every day after work. I enjoyed watching the mother daughter interaction as they teased each other and joked about the hospital food and planned for the upcoming summer. Ms. Watson was a renal patient waiting on her shunt to mature and had come in with hyperkalemia with tented T waves on her EKG and chest pain. Her pain had subsided and she was waiting for a cardiac catheterization as her Echo had shown some possible issues in her heart. She was chest pain free but there was a possibility that her Potassium would go up again, hence the wait and monitoring. Her other daughters lived out of state but called every day in the evening without fail.

    Beth was walking out of the room and saw me park the emergency cart outside her mother's room. Ms.Grey had been discharged and was waiting for her son to pick her up. Puzzled Beth asked me, "Who is that for Nurse Annie?" I attempted to give her a vague answer but I could never lie convincingly! She saw something in my face and persisted with her questions. I told her that I was being extra cautious. She bought it for the time being. Later she asked me seriously, “Annie there is something you are not telling me. Please, tell me."
    I did not want to freak her out so I kept it simple.

    "You know Beth how nurses are very intuitive. I just feel we should be extra careful with your mother and monitor her more closely."
    She read between the lines, looked me straight in the eye and asked me, "What should I do?"

    "Get your sisters to come and stay with mum for the next few days."

    She nodded her eyes filling. The next day she called me from work.

    "Annie, I took a couple of days off to stay with mum. My sisters are flying in. The three musketeers will be there in the evening! Don't tell mum".

    That evening I spoke to the nursing supervisor and got permission for the family to stay in the visitors lounge at night past visiting time for the next few days. Thankfully telemetry was slow and her roommate bed remained empty which was surprising as those beds filled like hotcakes. I told Beth about getting them permission to stay. She was very grateful and introduced me to her sisters. I left for my weekend off with their laughter ringing in my ears as they surrounded their mom who was ecstatic that they girls had surprised her!

    I came back on Tuesday to find an empty bed. I was surprised as she was supposed to have her cardiac catheterization that day. I asked around but no one knew as the weekend crew was off. I took the admission discharge log and checked it. My heart leaped to my throat when I saw the Monday 3 am entry. Ms. Watson had died. I was in shock.

    I pulled Beth's number from the paper chart that was still there. Drawing a deep breath as she picked up, I carefully said, "Beth, this is Nurse Annie from the hospital. Can you talk?"
    I heard her crying and then she told me what had happened. Ms. Watson was fine all weekend and insisted that the girls go home but they all refused. So they kept watch at the bedside, talking softly in between with mom when she woke up. At around 2.00 am, Ms. Watson had a massive heart attack and arrested. She was coded for almost an hour and declared dead at 3 am.

    Beth told me, "Nurse Annie! I do not know how to thank you. Mom's last three days on earth were her best and she never looked happier. The memories in this last three days with our mother will comfort us. We have these memories thanks to you. Bless you for giving us that chance to be with mum. I think she is at peace and so are we."

    I was too choked up to speak. A month later, I received a bouquet of flowers with a thank you card that said, "Mum thanks you from heaven! We thank you too!-Beth, Pam and Sara". I treasure that card more than a paycheck! Once I moved from acute care, I did not get that scent again. I hope I don't either!

    Since Ms. Watson's death, I realized that my gift was to be used to help the patient, family or staff to get prepared. I never knew what the outcome would be but I knew now that every patient got a fighting chance to live or die in peace. As a nursing supervisor covering that same unit, I still see some of the nurses I worked with, who remind me that before we had a rapid response team or a cardiac arrest team we had Annie's ESP!

  • Jun 23

    Update (Jun 19)

    Top 8 Captions Poll is now available!

    Vote for your favorite.

  • Jun 20

    It is interesting to see the demographics of nursing changing, including average age, gender, ethnicity etc., and there are several reasons for that. In looking at some of the results from the allnurses 2017 Interactive Salary Survey, we can see a change, but do the results leave us with more questions than answers???

    The 2017 allnurses Salary Survey asked questions about nurse’s age, years as a nurse, and years of experience. It is interesting to compare the current data provided by more than 18,000 respondents to data from the past. Looking back in time, we are able to see from a study conducted in 1980 that 25% of registered nurses were over 50 years old. By 2000 33% were over age 50, and in 2007 the numbers rose to 41% of RNs were over 50 years of age. In the allnurses 2017 interactive study, results show that 30% of nurse respondents are over 50 years old. Why the drop? Are aging Baby Boomers leaving the workforce? Are nurses retiring early? Are they leaving the nursing workforce for other careers? Leaving to care for aging parents?

    Now, let's look at the opposite end of the spectrum. In 1980 25% of nurses were under age 25, but by 2007 that number drastically dropped to only 8% under 30 years old. Our 2017 survey shows that approximately 16% or our respondents were under the age of 30 with 4% under the age of 25. This presents an interesting question? In 2007 there are the least number of nurses under 30 and the greatest number over 50. The largest percentage, 54%, of respondents in the 2017 allnurses survey fall in the 30 - 50 age range. Does the shift have to do with age entering into nursing as a career? In other words, were there more nurses choosing nursing as a second career or career change? What factors may be playing into the drop in nurses entering nursing under the age of 30?






    Part of the equation seems to be the age of nurses when they graduate nursing school as their INITIAL education. We have some statistics showing that in 1985 the average age of the registered nursing school graduate was 24 years old. By 2004 that number jumps to 31 years old.

    Additionally, many students obtaining an RN license have initially earned a different academic degree before deciding to enter the nursing field. During the years from 2000 to 2008, the percentage of RN candidates having earned previous degrees rose from 13.3 percent to 21.7 percent. The increase in the number of second-career students entering the nursing profession would help account for the increase in age of nurses with fewer years' experience.

    When we compare the years of experience as a nurse from our allnurses 2015 study to the 2017 study we see age does not seem to correlate directly to number of years of experience. In the 2015 results, 62% of nurses had less than 10 years of experience as compared to the 2017 results showing the number has dropped to 56% having less than 10 years experience. As one would expect the numbers have increased in years of experience between 11-20 years (a 3 point increase), 21-35 (2 point increase), and 35+(up 1 point) since the 2015 survey.




    There are so many variables to factor into these statistics, and it will be interesting to see if the entire 2017 allnurses survey answers or leaves more questions. As we can see, the average age of registered nurses is increasing yet the number of years as a nurse or years of experience does not reflect the age increase. When a younger friend of mine graduated nursing school with her BSN in 1993 their graduating class had a greater number of second career, or mothers that raised children prior to attending nursing school, than those of us coming straight out of high school into college.





    What have you newer grads been seeing? This year’s survey did not ask how many of you entered nursing as a second career or how old you were when you graduated, but we would love to get your input on that, and any other variables you think contribute to the statistics.

    The results of the 2017 allnurses Salary Survey will be posted soon.

    Resources:

    2015 National Nursing Workforce Study NCSBN.org
    2015 allnurses Salary Survey Results
    NLN Biennial Survey of Schools of Nursing, 2014
    Nursing: Tradition Gives Way to Non-Traditional
    Non-Traditional Nursing Students Take Non-Traditional Pathways

  • Jun 20

    Any of you who have read my articles know that I choose to write about things I know from first hand experience or something of particular interest to me. Irritable bowel syndrome (IBS) is a subject matter that I wish I did not have experience with. IBS is a super pain in the butt...literally! It gets in the way of everything from the fantastic food I love to eat, to work, to shopping adventures and vacations, weddings etc. It makes you a 24/7 hot mess (as we say in the south)! Since this is a syndrome that affects so many people, I decided to write about it and divulge my own “dirty secret”.

    What is IBS?

    By definition Irritable bowel syndrome is “a common disorder that affects the large intestine (colon). Irritable bowel syndrome commonly causes cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long term.” One in every 5 Americans is said to have some degree of IBS. but less that 1% actually seek treatment due to the severity of their discomfort or symptoms. The symptoms and severity vary from person to person but the primary issues include:

    • Abdominal pain or cramping
    • Feeling bloated
    • Gas
    • Diarrhea or constipation- sometimes varying between both
    • Mucus in stool

    While these symptoms resemble other diseases like Crohn's disease and ulcerative colitis, irritable bowel syndrome does not cause changes in bowel tissue or increase risk of colorectal cancer.

    Various factors play a role with irritable bowel syndrome. With “normal bowel function”, muscles in the intestines contract and relax in a coordinated rhythm to move food along from the stomach through to the rectum. With Irritable bowel syndrome one of two problems can occur.

    1. IBS-D (Irritable bowel syndrome-Diarrhea) occurs when contractions are stronger and last longer than normal causing gas, bloating and diarrhea.
    2. IBS-C (Irritable bowel syndrome-Constipation) occurs when the muscle contractions of the intestines are weak, slowing the passage of food through the gastrointestinal tract leading to dry hard stools.

    Another key factor that research has been focusing on is the gastro-nervous system and the connection between the brain and intestinal tract. When the gastro nervous system is not functioning properly, it causes increased discomfort (above the norm) when the abdomen stretches from gas or stool. Poorly controlled signals between the intestines and the brain cause the body to overreact, creating diarrhea and pain.

    Risk Factors

    There are a few risk factors associated with Irritable Bowel Syndrome.

    • Family history plays a role in development of IBS. If you have family members with this disorder, you are more likely to have it yourself.
    • Youth is another known risk. IBS is usually diagnosed in persons under 45 years old
    • Females are twice as likely to develop Irritable Bowel Syndrome. Researchers believe that there is some connection between IBS and hormones.
    • Mental Health disorders such as depression, anxiety, and personality disorders have been linked to IBS.

    Triggers

    Research has made links between common triggers for symptoms of irritable bowel syndrome.

    • Food: high gas producing foods and dairy are major culprits. (we will discuss this in greater depth)
    • Stress: while higher levels of stress do aggravate irritable bowel syndrome, it does not cause the disorder itself.
    • Hormones: as mentioned earlier, females are twice as likely to have IBS. Menses does worsen the symptoms, due to the change in hormones during that time of the month.
    • Other Illness: Acute gastrointestinal illness and high bacterial overgrowth can trigger the symptoms of IBS.

    Treatments:

    There are a number of treatment options for Irritable bowel syndrome. For most people a balance of diet, lifestyle and stress, is all it takes to manage the symptoms of mild to moderate IBS. For the rest of us with severe IBS, multiple treatments are prescribed to balance symptoms from day to day.

    Dietary

    1. Eliminate high gas producing foods that create bloating such as cabbage, broccoli, raw fruits etc
    2. Gluten- some people note improvement by eliminating gluten (wheat, barley, and rye)
    3. FODMAPS- some people are sensitive to certain types of carbohydrates such as fructose, fructans, lactose and others. (FODMAPS= fermentable oligo-, di-, and monosaccharides and polyols). FODMAPS are in certain grains, vegetables, fruits and dairy. Not all FODMAPS foods are a problem for everyone. It is recommended to eliminate all FODMAPS and reintroduce foods groups one at a time to see if you are sensitive to that type.
    4. Eat at regular times
    5. Drink lots of water

    Medications

    1. Fiber supplements help most IBS sufferers- fiber supplements such as Metamucil and Citrucel along with increased fluids help to control constipation. For some it does add an increase in gas production but usually less than fiber itself.
    2. Antidiarrheals for those who have IBS-D- Imodium is one of many over the counter medications that help to control diarrhea.
    3. Anticholinergics/ Antispasmodics-Medications such as Bentyl or Levsin are helpful in preventing or alleviating painful bowel spasms that lead to gas and bloating. Again, an increase in fluid intake is necessary to keep from getting constipated.
    4. Antidepressants- If pain is a problem tricyclic antidepressants or a selective serotonin reuptake inhibitor (SSRI) may be prescribed to inhibit the activity of neurons that control the intestines.
    5. Laxatives are used on occasion for IBS-C. Both laxatives and antidiarrheals are to be used on occasion and with caution and they can cause bowel dependance

    There are medications being marketed specifically for use in IBS (constipation and diarrhea). These medications have not been used long enough to determine how well they work. Your physician may need to be enrolled in a special program to prescribe these medications.

    Exercise: Regular exercise helps to maintain healthy bowel function.

    There is continuous research and developments made in the cause, treatments and aggravating factors in Irritable Bowel Syndrome. While there are multiple lifestyle changes and medications accessible to those of us who suffer with this disorder, nothing is available to completely rid us of the symptoms of IBS. It can be a major intrusion in lifestyle. Symptoms seem to arise at the worst possible time, during weddings, shopping trips, vacations etc. We feel tired, bloated, not hungry, irritable, anxious (as to when symptoms may hit). Someone with IBS is always aware of where the nearest bathrooms are. The symptoms themselves can cause worsening of other symptoms. It is a challenge on a daily basis dealing with the symptoms of Irritable Bowel Syndrome. Until researchers develop or advance technology in the treatment of IBS, we must forge on with a bottle of water always in hand, our travel toilet seat covers, toilet paper, and Poopourri.


    Irritable bowel syndrome - Mayo Clinic

  • Jun 20

    Closed as this has moved into the realm of medical advice.

  • Jun 17

    "What! I'm having a patient emergency and my car is down. I'm just using my critical thinking skills!"

  • Jun 17

    It ain't easy being a Cadillac nurse in a Mazda Miata world.

  • Jun 17

    What makes you think I need a raise?

  • Jun 17

    Does this make me look fat ?

  • Jun 17

    This is not what I had in mind when I mentioned a compact car, Bob.

  • Jun 17

    "I'm trying to reduce my carbon footprint."

  • Jun 17

    You gotta wait your turn 'cause I am trying out this year's Nurses day gift!

  • Jun 17

    "They need me now Bob! I've got to get there somehow."


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