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Julie Reyes

Julie Reyes DNP, RN

pediatrics, occupational health
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Julie Reyes has 6 years experience as a DNP, RN and specializes in pediatrics, occupational health.

I have been married for 12 years - 8.5 of those years I have been in school! I recently completed my DNP and I am anxiously awaiting the next chapter in my life book! I was previously known on AN as "itsmeemtp".

Julie Reyes's Latest Activity

  1. Julie Reyes

    Critical Thinking

    Right?! I laughed out loud when I read it! I thought - well, ok, that makes this WAY more entertaining!
  2. Julie Reyes

    Critical Thinking

    I always like it when my patient's turn into a cod. LOL! I wonder how that typo got there?!
  3. Julie Reyes

    Critical Thinking

    I wish someone would have explained exactly what it meant to "think critically" when I first started nursing school - it sure would have saved me a lot of time trying to figure out how to answer my assignment questions and create better care plans! My hope is this article will help you delve deeper into your patient care by looking holistically at your patient - from the cause of injury/illness to the pathophysiology to the interventions and WHY you are using the interventions you chose. Let's start with you as a student nurse tech in an emergency room. Level 1 You are a new student nurse and you have just learned how to take a blood pressure. Your job is to take vitals on patients who come into the Emergency Room and record them. This is the first level of the pyramid. Level 2 You understand the numbers - diastolic and systolic - and what a normal range is. Level 3 You understand that you need to report the "abnormal" range numbers to someone because something is not right with the patient. Level 4 You are now a nurse working in the Emergency Room. You understand your patient, who just came in the ER because of an auto accident and has no external bleeding, has a lower than normal BP that could be due to some sort of internal bleeding that you cannot see. You call for help (Rapid Response/Code, depending on the situation) because this patient may turn into a code. You draw labs and a type & cross for blood matching, radiology in to do x-rays, and respiratory in for oxygen support. Level 5 You understand that your patient (in the ER) needs you to provide fluids through an IV so that he/she will not "bottom out" and die. You remember your ER has a protocol for this situation and you begin to follow that protocol: You take steps to help the patient, including starting an IV, elevating the feet, keeping the head flat. You set the monitor to record BP every 5 minutes (or 2, depending on your situation). You understand you will need to monitor the urine output for this patient so a foley is needed. Level 6 You begin to classify your patient's hemorrhage level from a class I - class IV Level 7 You understand that a low BP due to hypovolemia (low fluids in the body) can cause the heart rate and respiration rate to increase and perfusion failure/tissue hypoxia. You know you need to begin to administer IV fluids - but you know that you cannot use ISOTONIC fluids, instead, you will need a crystalloid. You anticipate the need for blood and (you can then discern if your patient needs whole blood versus packed red blood cells). You also know the amount of fluids you can give in a certain time frame so that you don't turn the patient's remaining blood into "kool-aid" with a fluid overload and thinning it out too much. Level 8 You understand if your patient continues down the present road, the next step will be organ dysfunction and possibly multi-system organ failure and death, so you need to perfuse those organs and prevent shock. Level 9 You understand your patient needs to go to the operating room to find the source of bleeding. You prepare to administer medications to prevent shock - specifically inotropes like dopamine - because you know it has a positive chronotropic and inotropic effect and if a higher dose is used will have a vasoconstrictive effect that can help your patient's perfusion, can help with cardiac output, and can help your patient live! As your knowledge base increases, you will be able to anticipate what is needed for your patient and why. You will be able to intervene before the next problem arises and help fight off the Grim Reaper in some cases. Critical thinking is thinking deeper than the surface level - it means understanding what is happening and why, what will happen to the patient if interventions are not done, and what is needed to make the issue normal - or as normal as possible - again.
  4. Julie Reyes

    A note about Healing after Harvey

    I knew it was coming, but I didn't ever dream it would be this bad. I have been in hurricanes before. Where I live, the wind always is strong, so tropical storm winds are equal to Spring time weather. At work in our hospital, we focused on getting information out to Team A and Team B. Who was expected to show up when, what they needed to bring - including bedrolls, family members, pets, snacks, etc. We initially planned for a 3 day stint, and then Harvey was upgraded to a level 1 then possibly a 3 or 4, and as the expected rainfall turned from inches to feet, the plans were extended to Team A possibly staying 5 days to care for patients. When our area in Corpus Christi was spared the full impact of Harvey, our sights turned from our own homes to our neighbors just north of us. Many of our employees, family, and friends live in these areas and their homes were in ruins. Some of them we have not even been able to contact yet. So we packed up our gear - stethoscopes, scrubs, pillows, sleeping bags - from the hospital and went home. We repacked new gear - work boots, gloves, shovels, rakes, flashlights, food, water - and headed north. On Monday, post-Harvey, we arrived at one of our own nurses home in Aransas Pass. Her roof was badly damaged and her home flooded, no electricity or water. We went to help restore her home, but she pointed us to her neighbor who was also in need. And she went over with us to put a tarp over her neighbor's missing roof, help with clean up, and offer support even though her own home was in great need of repair. We watched as a small 4-year old boy, who lived in that home, wearing a pair of Winter Spiderman gloves picked up single small tree branches and threw them in the brush pile. Even the youngest of us was willing to help and not afraid of hard work - and my heart broke. We drove up and down roads handing out flashlights, food, water, gas cans filled with gasoline for generators, work gloves, tarps, rope, baby wipes for "baths" since there is no water, and hugs. Lots and lots of hugs. At one badly damaged home, a few adults and about 8 children were in the front yard sitting down on what was left of the porch steps. They looked like they came from a third world country and still looked like they were in shock. They gratefully accepted canned spaghettios, flashlights, water, snacks. They literally had nothing. They were hungry, thirsty, and exhausted. Word got out that a small group of nurses and doctors were heading out every day after work. My office became the donation station with supplies offered from big-hearted folks. We have been creating care packages from the supplies and handing them out. Every day we have been able to go out and cut down trees off of roofs, haul brush, insulation, soaked mattresses, ruined items, roofing materials, etc., to huge piles for pickup. We have helped folks look for anything salvageable to keep, and we have been truly humbled. We have been humbled at the resiliency, the graciousness, the gratitude. Truly, no one has been asking for a handout, but pointing us to others who may be in greater need. The victims are trying to care for the volunteers by offering us water to drink when WE are thirsty or tired from the work. The outpouring of love from other cities, counties, and states is astounding. There has been so much animosity and anger in our nation in the past few years that it has taken a catastrophic event of astronomical proportions to wash away the hate and breathe new life into us - bringing hope, help, and healing. As we trudge forward every day to clear the piles of debris, may this newfound life Spring forth, may we not only rebuild our homes and neighborhoods, but our country as well. May we quit pointing fingers in anger, but instead offer open hands to help our neighbors. May we crush the spirit of division and become united. This is the reaction I have seen this past week from my community. Let's keep moving forward. After all, we are healthcare professionals. Hope and Healing is our middle name.
  5. Julie Reyes

    Merry Christmas, Little Angel

    Our hospital is a not for profit organization, and no one is refused. All care was donated.
  6. Julie Reyes

    Merry Christmas, Little Angel

    Born with a cardiac anomaly, the family immediately noticed something was "wrong" with their child, but they did not know what. Thus began their journey to another country - our country - our state and our hospital - desperately seeking help. During the course of the stay in the PICU, this baby boy coded 9 times, and each time we were relieved (if not surprised) to bring him back. Each time, the parents stood at the bedside as the crash cart was rushed to the room yet again, as chest compressions were initiated, as drugs were pushed into his IV. The parents were on the rollercoaster ride of their life. Watching the color on his face as much as the numbers on the monitor, each minute of their precious baby's life hanging in the balance. One minute he was being held in the arms of his mother and the next we were pumping on his chest to bring him back. Over and over again. He endured cardiac surgeries, g-tube placement, interventions for intussusception, and eventually a trach placed when we were unable to extubate successfully. Every day, nurses would work with the parents to educate them on the care the child needed. They learned how to do G tube feedings, suction the trach, clean and change the trach and holders, how to work a ventilator, learned CPR, and learned how to care for a child with special needs. The baby was delayed in physical and mental growth, yet we were still surprised at how well he was able to interact with his parents and the staff. At nine months of age, this baby had never had the opportunity to try to sit up. The nurses pooled their money together and purchased a walker for the baby. The move from the crib to a walker involved a nurse, a respiratory therapist, and at least one of the parents. We padded the baby in the seat so he would not fall over. The expression on his face was priceless - and the parents had tears of joy. It may not seem like much to many people, but this was an achieved "milestone" no one ever dared thought would happen. We took many pictures for the parents that day and surprised them with the photos framed as a gifted memory. As days grew into months, this baby was ready to be discharged (if we could get extensive home health services). However, there was no place to discharge this baby to. In this particular case, the family came from an area in another country where there is no electricity or running water, much less home health services. Additionally, since this family was not from America, they did not have Medicaid, or insurance, or money. They had no family to call on for help. They did not have citizenship. This case seemed as if we would send the child home to die should they go back to where they came from. We would not do that. This child needed a ventilator and a feeding pump. This child needed access to medical care at the drop of a hat. Case managers, social workers, clergy, surgeons, cardiologists, pulmonologists, GI docs, therapists, and nurses were all working together to ensure the life, health, and safety of this child and family. Letters were written, federal agencies contacted, court appearances were made. Someone donated a small home, a surgeon brought them an AC/heater unit, the father was granted work privileges. Doctors and pediatricians donated follow up appointments for free for the child's checkups. A home health service offered a month of free care. The mother and father were trained and "specialists" in all aspects of the baby's care. ...and we sent them 'home', not sure if the baby would survive the month. On Thanksgiving Day, the parents came to the hospital, to the PICU. To visit. To say thank you. In their stroller, they toted this beautiful baby boy and his vent. He started crying when he saw us. And we all laughed. He knew where he did NOT want to be! I knew at that moment that this baby boy had a chance. A chance at life. December came around and we were talking about him in the breakroom at lunch. We knew this family did not have money for Christmas and would not be able to be with their family who they sorely missed. The situation seemed so sad to us, and we wanted to make Baby's First Christmas as special as possible. Our unit decided to "adopt" the family. We took up a collection, someone had an artificial Christmas tree to donate, others had extra decorations. People brought gifts - not only for the baby - but for the parents. We asked the social worker to contact the parents to inform them we had some items for them, and set up a time for delivery. We went to their tiny home (cozy home), and with much laughter and festivities, we set up the Christmas tree while Baby Boy sat in his walker chewing on a teething ring. As the clergyman who went with us said a blessing over the parents, the baby, and the food we brought to eat, the joy and gratitude shone in the eyes of the humble parents. And as for the baby who played happily in the walker - Merry Christmas Little Angel, Merry Christmas!
  7. Julie Reyes

    Nurses that eat their young

    Maybe - it is a good reminder!
  8. I tend to agree with you too. I was always moving my study place - but that could have been because I got bored easily and needed new things to look at when I would stare off into space! I am not even sure this is a realistic list either - I mean, what student nurse has the luxary of sleeping that much?! haha!
  9. Smartharvardadmissions.com (2015) cites three must-have skills in order to succeed in school. The first is to know and embrace your learning style. For example, some people need absolute quiet while others prefer studying in a loud area. Secondly, and almost unanimously agreed upon in every top ten is the need to take notes. Then review them immediately after class, and that night, and before class the next time you go. Finally, the last skill stated is to know how to make a schedule. Make a plan that is realistic. You might be surprised on the consensus I found in my research. Some places had tips that are valuable, but did not make the tally for the best of the best tips. I will start from the least mentioned study tip that was agreed upon. There is actually a tie for BOTH ninth and tenth place. That being said, lets dive in, shall we? What are the Best of the Best suggestions for study tips? Survey says ... The number 10 study tip suggestion(s) is/are: Use Flash Cards Use Mnemonics Reward Yourself for Hard Work Set Realistic Goals Study Every Day The ties for number 9 are: Attend All Classes (Oddly Enough...) Complete Practice Exams/ Quizzes Take Regular Breaks Use Technology (Apps, Youtube, Etc). Number 8 Eat healthy (brain food) Number 7 Take notes Review notes after class, that night, before next class, and weekly Number 6 Ask questions in class Visit with your professor Talk with classmates Number 5 Sleep between 6-8 hours at least every night Number 4 Study at the same place / same time every day if possible Number 3 Make your study area a place where you learn Quiet? Library Loud? Use music, etc. Number 2 Study groups Study with classmates that are serious and have the same goals of passing that you do! And, the Number 1 Agreed Upon Study Tip Across the Board (Nearly): Create a Schedule Create a Calendar Organize Your Semester! Find what works for you. The more organized you are, the more you plan, the more you study, the more you will succeed. I hope that helps!!! Best of luck future nurses!!! YOU CAN DO THIS! Related Articles My guide to making the grade during nursing school and maintaining your sanity. Online Nursing Study Tips: What Has Worked For Me Tips for surviving the 1st Semester of Nursing School Keys to Studying better using your Visual, Auditory or Kinesthetic talents I am an RN!!! NCLEX Tips and Tricks Just For You!!
  10. Julie Reyes

    Brian Short News

    Wow. I am deeply saddened by this tragedy. Prayers for the family and those who knew and loved Brian and his family.
  11. First, let me just go over some of the symptoms of the flu, and then we will get down to business on the controversy surrounding the push to create mandatory flu vaccines for healthcare workers: Sudden onset fever Headache Chills Myalgia Dry cough Sore throat Stuffy nose Loss of appetite Limb or joint pain Difficulty sleeping Diarrhea or upset stomach I can't think of anyone who wants any of these symptoms, or to come down with the flu, can you? Influenza vaccination research has clearly documented the benefits of receiving the flu vaccine (google it - you will find a plethora of information...however, I will list some links at the end of this article for your information). However, even though there is sufficient evidence to prove the benefits of receiving the flu vaccine, vaccination rates among healthcare workers are pitifully low. In 2013, only 55% of nurses in the frontlines were vaccinated. Organizations such as The Joint Commission, the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, American College of Physicians, Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the Centers for Medicare & Medicaid Services, the Centers for Disease Control, Healthy People 2020, etc., etc., have stated their position on recommending the flu vaccine for healthcare workers in order to decrease the risk of exposure and reduce deaths. Due to this recommendation, many healthcare facilities are now creating mandatory flu vaccine policies as a condition of employment. Employers who create mandatory policies will have exemptions, of course. Exemptions are made for medical and religious exceptions. For places that do not have a mandatory flu vaccine, they may "strongly recommend" the vaccination and may have a declination form for employees to submit if they refuse the vaccine. Additionally, some employers will enforce refusers to wear a mask during flu season while they are at work in order to protect the patients and the employee. What is the purpose behind the push toward flu vaccines? Evidence has shown that there are more than 36,000 deaths in the US each year related to influenza, and more than 200,000 hospitalizations. Influenza is the 6th leading cause of death. Healthcare workers are the leading cause of influenza outbreaks in the healthcare system. up to 50% of people who are infected by the flu virus do not fill ill for several days and can spread the virus to people at risk of complications and death from the flu. Additionally, evidence shows vaccination decreases mortality by 40%, decreases the spread of nosocomial infections by 43%, and decreases absenteeism by 20-30%. Additionally, there is the ethics to consider. As healthcare workers, we have all taken an oath to "do no harm". As a nurse caring for patients who are not in their most physically healthy state, do we take the vaccination in order to prevent spreading the flu to our vulnerable patients, in order to "do no harm"? We must consider this when we make our decision to take or refuse the vaccination. What hospitals have created a mandatory flu vaccine policy? I have the names of a few hospitals, and this is by no means a comprehensive list. This is based on a ListServe survey of hospitals and these are the responses received: Children's Hospital of Philadelphia (Philadelphia, PA) - since 2009 Children's Mercy Hospitals and Clinics (Kansas City, MO) Children's Colorado (Aurora, CO) Children's Hospital of the King's Daughters (Norfolk, VA) Children's Medical Center Dallas (Dallas, TX) - since 2012 Riley Children's (Indianapolis, IN) - since 2012 East Tennessee Children's (Knoxville, TX) - since 2013 Boston Children's (Boston, MA) Sharp Mary Birch Hospital for Women and Newborns (San Diego, CA) - since 2013 Roger Williams Medical Center (Providence, RI) Brookwood Medical Center (Birmingham, AL) Johns Hopkins (all hospitals/clinics) (Baltimore, MD) Driscoll Children's Hospital (Corpus Christi, TX) Spohn Health System (Corpus Christi / San Antonio, TX) All Connecticut Hospitals What are some reasons that people refuse the flu vaccine? Refusal may be largely due to misconceptions related to the vaccine. Fears that the immune system will cause them to get the flu, beliefs that hygiene and better nutrition are more helpful than the vaccine, fear of needles, beliefs that the vaccine does not work, and fear of side effects. Others believe that they have a constitutional right to refuse the vaccine and that mandatory policies are violating these rights. Common concerns and myths about the flu vaccination (taken from the Los Angeles County Department of Public Health outline of flu vaccine talking points for managers) The flu shot will give me the flu The flu shot does not give people the flu. It uses inactivated ("dead") virus. People may still catch a cold or other virus that the vaccine is not designed match. I don't believe the flu vaccine actually works Studies have shown that flu vaccination prevents flu in 70% to 90% of healthy adults younger than 65 years old. I had the vaccination last year You need a new vaccine every year - the virus changes over time. What about possible adverse reactions Serious adverse reactions are very rare. They are explained on the CDC's Vaccine Information Statement, which is distributed when the vaccine is administered. Local short-term reactions - such soreness at the vaccination site, slight fever, achy feeling - may occur but usually do not last long. Over the counter medicines are helpful. Even short-term reactions are much less bothersome than catching the flu and feeling very sick for days. I'm not in a high-risk group Your patients are at-risk, and possibly some friends and family members. You can be infected with the flu virus but not feel ill - and can still transmit flu to at-risk patients. The flu vaccine made every year does not match the circulating flu strain Inactivated influenza vaccine is effective in preventing transmission and reducing complications of the flu. In years when there is a close match between the vaccine and circulating virus strains, the vaccine prevents illness among approximately 70%--90% of healthy adults under 65 years of age. Vaccinating healthy adults also has been proven to lead to decreased work absenteeism and use of health-care resources, including use of antibiotics. Strong protection is also expected when the vaccine is not a close match with circulating strains, with 50%--77% effectiveness in these instances. In addition, effectiveness against influenza-related hospitalization for healthy adults from inactivated vaccine is estimated at 90%. Knowledge is Power All healthcare facilities will be facing the choice of creating a mandatory influenza vaccination in the near future, if they have not already. In order to make an informed decision on the topic, we must have information. Knowledge is power. Before you make a blanket statement on pros or cons, have the information you need, know the research, and make an educated decision. Please respond to this article by answering the following questions: Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)? Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? What concerns do you have about the flu vaccine? Do you know if anyone who has been released from their job because they did not get the flu vaccine? References American Association of Family Practitioners. (2011). AAFP supports mandatory flu vaccinations for healthcare personnel. Retrieved from: AAFP Supports Mandatory Flu Vaccinations for Health Care Personnel ATrain. (2014). To accept or refuse the flu vaccine. Retrieved from: ZZZ_133_Influenza: Module 7 CDC. (2014). Vaccination: Who should do it, who should not and who should take precautions. Retrieved from: Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions | Seasonal Influenza (Flu) | CDC Influenza Action Coalition. (2015). Influenza vaccination honor roll. Retrieved from: Honor Roll: Mandatory Influenza Vaccination Policies for Healthcare Personnel Los Angeles County Department of Public Health. (2014). Talking points for managers. Retrieved from: http://tinyurl.com/p6nbg2u National adult and influenza immunization summit. (2015). Vaccinating healthcare personnel. Retrieved from: Vaccinating Healthcare Personnel - National Adult and Influenza Immunization Summit NursingTimes. (2014). Why do health workers decline flu vaccination? Retrieved from: http://www.nursingtimes.net/Journals/2014/11/28/y/k/x/031214-Why-do-health-workers-decline-flu-vaccination.pdf TJC. (2012). R3 Report: Requirement, rationale, reference. Retrieved from: http://www.jointcommission.org/assets/1/18/R3_Report_Issue_3_5_18_12_final.pdf
  12. wow. While some people have responded in a less than tactful way (more like a punch in the face), I slightly understand some of their responses. Slightly. I don't think it really matters what calls a person into nursing. Be it a life changing experience to following in their parent's footsteps to wanting to do it to prove they can and shove it in their ex husband's face that you smarter than he is (me). I can't think of a degree where people have NOT got some reason or another for pursing a particular field. I can't fathom why it should matter WHY any one pursues whatever degree they are going for. If someone thinks they want to give it a go, then go for it 100%. Give it all you got. There are hundreds of different fields within nursing, and if one isn't your cup of tea (wiping butts), then go into a different field (informatics, administration, teaching, etc, etc, etc). Besides, the difference between wiping adult butts versus baby butts may be all the change in fields one needs to find sanctification and happiness in a career...) There are hundreds of avenues within nursing. If anyone is miserable in nursing, all they have to do is go down a different path. You will have the degree already - and that will put you ahead of the game and will give you options.
  13. Julie Reyes

    Taboo: 10 Things Nurses Should NEVER Say!

    Haha! You guys are so funny! Love it!! :) I just love you guys!!
  14. Julie Reyes

    Ebola Update: Highly Effective Ebola Vaccine Developed

    now if only one of these companies could keep their promise to deliver the flu vaccine on time! Excellent article! Thanks!
  15. Julie Reyes

    Disgusting Icky Stickies: Nurse Protect Yourself

    Why are the readers on this awesome site always telling the authors how to write? Maybe the authors should start every article with a disclaimer or a warning? something like, "You may not want to read this article if you are Debbie Downer". This article rocked. There is VERY IMPORTANT LIFE SAVING INFORMATION in it, mixed in with humor to make the medicine go down a little easier. Good job, Jacqueline!
  16. Julie Reyes

    Taboo: 10 Things Nurses Should NEVER Say!

    LOL! As I am sitting in my office eating lunch to be here for phone duty!!!
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