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Our system has failed us. For most of us, following the American or Canadian food guide will cause us to gain weight. Look up what Peter Attia, a surgeon now working in the field of nutrition, has to say on his TED talk: If you want more science to back this up, see his website: Start Here - The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D.Another good resource is found at diet doctor.com For most of us, the conversion of simple carbs (including too many natural sugars) will cause a spike in insulin, which causes our bodies to stop using fat as fuel, and instead to start storing it. Add to that the fact the we work night shifts, which disrupts our circadian rhythm, causing our bodies to produce cortisol instead of melatonin at night when we should be sleeping. Our serum glucose levels become elevated from the cortisol, and our body produces insulin. Nurses struggle against the odds to stay slim. My solution has been to eat low carb, use coconut oil (it is metabolized differently from other fats, is burned for energy immediately, and does not cause dyslipidemia), and engage in moderate activity. I won't give the references to the studies that support the use of coconut oil, as they are readily available on pubmed, ebsco, ovid, etc. Part of our problem is that we believe what we have been taught since the 70s, that fat is bad, and sugar is necessary in our diets. We convert all the sugar we need from a wholesome diet. Sugar, corn and wheat growers want us to eat what they produce, and ensure that almost all packaged foods contain some of their products. So another part of my solution has been to eat almost zero packaged food. Yes, this does mean extra work, but I prioritize, and despite having a family that depends on me, working full time (nights and days) as well as occasional overtime shifts, I manage to put healthy food on the table. I have been challenged to maintain my weight since I was a plump child, have dealt with gestational diabetes for each of my three pregnancies, but so far have maintained a healthy weight. It is not easy to resist the packaged foods, the high carb snacks brought to work by my colleagues, the tempting array of foods available to us at every turn. I am in my forties now, and I know I will be challenged to maintain my weight until the day I die. It has been worth it though, as I have more energy than most of my colleagues, even those who are a decade or two younger than I am, and I am mentally as sharp as I have ever been. I am not skinny, but I am strong and average weight, at 140 pounds (I am 5'3"). I haven't suffered from carb induced food comas since I started low carb about three years ago. I have gained about 12 pounds since my late thirties, possibly as a result of a lower metabolism as I age, more likely because I moved to the city in that time, and spend more time commuting, less time walking/running/cycling. Also, I try to keep food in perspective. Food is meant to nourish my body, and mealtimes are family times, not time in front of the TV or computer. Many of us are addicted to food, and need to make lifestyle changes to focus on things other than food. Since I've started low carb I do not crave sugar anymore, and only crave junk food when I am sleep deprived. One cup of bullet proof coffee (or a variation thereof e.g. decaf, green tea, herbal tea) cures that and refuels me for 4-6 hrs, which gets me through the worst part of a night shift. You have to be prepared in advance though, unless you have access to a blender at work. Here is the recipe I use: 1 cup coffee (or other hot drink) 1 Tbsp coconut oil (or 2 if you like) 1 tbsp heavy cream (can substitute 1 tbsp grass fed butter) 1 few drops of vanilla extract (opt) Blend at high speed. It makes a lovely, frothy, cappuccino-like coffee. If you want it sweet, add a little bit or xylitol, erythritol or stevia (I don't use any sweeteners because I don't really trust them). But sugar is worse. Here is an amusing article that explains another way that coconut oil can be used The Insane Coconut Oil Weight Loss Hack (explained) | Sunfood Articles and Recipes In a nutshell: 1.Carbs cause blood glucose elevation.... 2.Blood glucose elevation causes insulin production... 3.Insulin causes fat storage.

Sometimes patients will refuse blood transfusions for any number of reasons (sometimes religious, or other, but they have that right). Sometimes patients have very low hemoglobin levels, or are bleeding, and the amount of blood work drawn will actually affect the patient's ability to recover from whatever it is they are ill with, because their hemoglobin truly drops even further. Sometimes patients are on medications, or are so ill, that frequent monitoring of things like coagulation, hemoglobin, lactate, etc are required. So...this question is not entirely off the mark. What we do for these patients in our department (ICU) is use paediatric blood tubes, which take less volume of blood. Also, the doctors know that these patients are at risk, and they will order blood work to be drawn as infrequently as possible while still measuring the values we need to monitor. Last but not least, the nurse yelling, especially in front of family members, for whatever reason, was not being professional. Whether her concerns were legitimate or not, emotional outbursts are not going to be helpful. People need to be level headed, think clearly, be supportive, and take their concerns to the people who can do something about them (E.g.the physician), and not instill fear in people who do not understand what is happening. Just my humble opinion.

Interesting comments. And what a relief. I used to pride myself on remembering people's names - and did quite well using baylor's trick - to use the name a few times. Alas, for me, this ability is limited to names I am familiar with. I have recently moved, and the new hospital I work at serves a different demographic - an ethnic group (and names) I have had little or no exposure to in the past. I am lucky if I remember a patient's name after 2 or 3 days with them, if they are not discharged before this time. Once the name sticks, I usually remember it for several weeks at least, but often I will just remember the face, the faces of family members, the diagnosis... but no name. sigh. I had a patient once, when I was a student, and she was admitted to my ward again several years later. She remembered ME very clearly, and was delighted to see me... I was humbled and blessed. I had only a vague recollection myself. I think as nurses sometimes we are so busy with our very sick patients, that the less needy ones remain in our peripheral perception, both during our time with them and in our memories. This is a poor defense, but the only reason I can fathom. In any case, it is not that we care about them less.

Nurses (and other healthcare and housekeeping personnel) on the wards are most frequently exposed to chemical cleaning and disinfecting agents.

http://www.drspock.com/article/0,1510,5050,00.html by Lewis Hsu, M.D., Ph.D. and William Muller, Ph.D reviewed by Laura Jana, M.D., F.A.A.P. Diet and Nutrition in Sickle Cell Disease: "Extra calories are required. The calories contained in our food are converted by our bodies into energy that is used to help us grow, ward off infection, and engage in our daily activities....Recent research shows that children with sickle cell need about 20 percent more calories than other children to fuel their production of red blood cells to replace the damaged, sickled ones. Not getting enough calories may lead to delays in growth and maturation. Try to ensure that your child usually snacks on healthy foods, such as fruits, vegetables, and grains, not just junk food. You can work in some additional calories (and protein) by putting peanut butter on celery or carrots; adding cheese, nuts, or wheat germ to appropriate foods; making milkshakes or yogurt smoothies; and serving pudding or instant-breakfast drinks."

I was answering NurseJen's question about why litmus paper, and what other aspirates a person might find. I agree, absolutely, that it is best practice to X-ray for placement, and every place I've worked has required this prior to starting a feed. Why do both? - anybody's guess - if we're going to do an x-ray anyways... it's kind of redundant. I did do it on a doctor's request once, when the tube had to be advanced by 10cm, and I was to check the pH, then call the results back to the Doc before starting the feed.

Reply to NurseJen: Gastric acid is highly acidic - somewhere between pH 1.0 - 2.0 The gastric content of the stomach usually ranges from 4 - 5, may sometimes be as high as 6.0 (still acidic), whereas the contents of the lungs are neutral - that is, close to 7.0 Per the AACN, the following conditions must be met to measure the pH of gastric content accurately: - No feedings or medications given orally for one hour prior to test - No antacids within last hour - Flush tube with 30-mL air before aspirating contents for pH testing Why litmus paper? It is sensitive to the pH of solutions - it will indicate the acidity of your aspirate by the colour it changes to. Easy to use and effective. pH meters and probes are expensive. The only other (heaven forbid) aspirate you might find would be in, say, a trauma patient with skull base fractures - then you might push the tube into the brain...

To answer Celebrate5's question (Dec28/07), YES, absolutely, a feeding tube can cause a pneumothorax - witnessed it once - the patient had emphysema, lung tissue so fragile when the feed tube went down - incorrectly - the fragile lung tissue was disrupted and torn by the tube and a pneumothorax ensued. Because the lung tissue was so fragile, the tube met no resistance going down, and the patient was too sick to respond. The patient might have died had the nurse not immediately noticed the patient's immediate respiratory distress and called the doc for a chest tube. Very scary!

It is clear we are told to use the filtered needles in some hospitals (and given varied reasons for doing so) and in others, nurses (and other HC workers) haven't even heard of them. The question isn't whether or not we've been told to use them, or their reasons for doing so. The question is, what reputable evidence is out there, that shows that drawing up meds from glass ampules without filtered needles has resulted in any of the damages feared to be caused by this practice. When I phoned the ICU for a filtered needle, they didn't have them either. I finally had them send me a few from PAR... If it was really so dangerous, wouldn't we have discovered this by now? Then again, a few people died before we found out about handwashing, didn't we??? Who'd 'a' guessed? Anyone find any more studies out there? I am going to explore this on the university's database when I get a chance, rather than just on the www.

Hello Everyone - I am glad this topic has generated so much debate - makes me feel less lonely in my quest for discovering what best practice constitutes with regards to use of THE FILTERED NEEDLE... I started working in a hospital that supplies filtered needles, and we were taught to use them if drawing up meds from glass ampules. Then I moved, and the hospital I worked at didn't supply them, even though we were told in our orientation that we were expected to use them... First I asked how to get them ordered - I asked the Charge Nurse, the clinical educator, the clinician, the unit clerk (who I was told did the actual ordering), the supply room stock-person, the manager... I also looked up whether or not using the filtered needles was best practice, or just theory-based practice. I found the site with the article that suggests that glass particulate may cause pulmonary thrombi and microemboli, etc (http://findarticles.com/p/articles/mi_m0FSS/is_5_15/ai_n17215448/ quoted on one of the earlier posts). I also found this study suggesting that there is no difference: http://handle.dtic.mil/100.2/ADA284401 http://en.scientificcommons.org/19889561 (this site links to the pdf file above, in case it is not available via the posted link here) Look it up, see what you think. I hope to find more on this. Am busy taking my critical care training right now, so not much time for my own research, but will continue to follow this thread. Take care! :[anb]: