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Julie Reyes

Julie Reyes DNP, RN

pediatrics, occupational health
Member Member Columnist Expert Nurse
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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


    February 22 is National Red X Day. This is called the "End It" movement; it is an effort to help victims of human trafficking escape. The US State Department estimates there are approximately 20-30 MILLION slaves in the world TODAY, and the US has approximately (grossly underestimated) 600,000 - 800,000 trafficked across the borders every year, with the average age 12-14 years old in sex trafficking. Did you know a life expectancy of a child who is sex trafficked is only 7 years from the first sexual assault? The reason sex trafficking is such a huge trade is because the children are... Reusable. This is a simple business math equation. If you sell drugs, you can only sell them once and you don't have any more to sell. A person can be sold over. And over. And over. Some children are sold 10-20 times in one day. Yes, one day. The National Human Trafficking Hotline (1-888-373-7888 or text HELP or INFO) is the number to call if you suspect trafficking. Did you know that they receive more calls from Texas than any other state? The highest trafficking area in the nation is Los Angeles, San Francisco, and San Diego, California? The business profit is greater than $32 billion every year internationally? Traffickers target children in particular. Children who are at the mall, school functions (e.g, sporting events, etc), schools, bus or train stations, group homes. Classmates can be recruiters, family members can be predators, siblings can traffic siblings, and so on. What are the signs and symptoms you should know? Red Flags in Physical Appearance of Sex Trafficking Victims (This is not a complete inclusive list - these are JUST SOME of the signs and symptoms you may see😞 Signs of physical abuse (bruises, broken bones, burns, scars) Traumatic brain injury (TBI), memory loss, dizziness, headaches, numbness Skin or respiratory problems caused by exposure to chemicals Infectious diseases or reproductive health issues (TB, hepatitis, pelvic inflammatory disease or other sexually transmitted diseases, urinary tract infections, miscarriage(s), forced abortions) Drug and/or alcohol addiction Psychological & Behavioral Clues Helplessness, shame, guilt, low self-esteem, self-blame, humiliation Shock & denial, PTSD, phobias, panic attacks, anxiety, anger Withdrawn behavior, depression, fear Emotional numbness, detachment, dissociation Sleep problems or eating disorders Drug/alcohol abuse or addiction Stockholm Syndrome - a victim feels an attachment to the abuser. This makes it difficult for law enforcement to break the bond of control a trafficker holds over the victim. Avoiding eye contact, memory gaps, resisting being touched Sex Trafficking Signs Stockholm Syndrome An older "boyfriend" or "girlfriend" Unexplained absences or a sharp drop in grades Frequently running away from home Social isolation from friends and family Drug addiction / may show as bad behavior References to frequent travel to other cities Signs of physical abuse Health issues (see red flags) Lack of control over schedule and/or documents Hunger or clothing not suited to the place/weather Coached or rehearsed responses to questions Sudden change in behavior, relationships, or material possessions (e.g., expensive clothes or accessories) More than one mobile phone Hotel keys and many fast-food restaurant receipts Uncharacteristic promiscuity or references to sex that are inappropriate for the age Highly sexual clothing or online profile Poor personal hygiene Tattoos or burns (branding) displaying the name or moniker of the trafficker (e.g., "Daddy's Girl") If you ever suspect a person is in danger of trafficking, please report it! Resources : National Human Trafficking Hotline Chicago Alliance Against Sexual Exploitation - End Slavery Now Coalition Against Trafficking in Women (CATW)
  2. Julie Reyes

    Critical Thinking

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

    Critical Thinking

    I always like it when my patient's turn into a cod. LOL! I wonder how that typo got there?!
  4. 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.
  5. Julie Reyes

    February 2018 Caption Contest - Win $100!

    When you walk into work and diagnose the C-diff patient before you ever get report.
  6. 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.
  7. Julie Reyes

    Merry Christmas, Little Angel

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

    The Leap to Crusty Status

    HAHAHA! visual....
  9. Julie Reyes

    COHN-S Study Materials

    So, did you all pass the certification exam?
  10. Julie Reyes

    I Should Be in Jail

    Woah! I totally disagree with you, but this article isn't about that.
  11. Julie Reyes

    Magnet Designation: What's the Attraction?

    Hey Elizabeth - great and interesting article! I don't know much about magnet status, or unions for that matter. This was really interesting! Sorry so many people felt the need to get so defensive over an article that was meant for information. Keep on keeping on!
  12. Julie Reyes

    The Leap to Crusty Status

    :) Crusty ol bat is a nurse with a lot of experience under their belt - and is full of wisdom. I would say that being a crusty old bat is something to be extremely proud of!
  13. Julie Reyes

    That's So Fetch! (Pink Wednesdays)

    I saw someone said they only had red or maroon - just wash it with your whites, then you will have a LOT of pink.
  14. Julie Reyes

    That's So Fetch! (Pink Wednesdays)

    This is funny! We do EOC rounds at work, and we always wear pink on wednesdays!
  15. Julie Reyes

    The Leap to Crusty Status

  16. Julie Reyes

    Even the Stoic Have a Breaking Point

    This sounds like one of the stories you will remember forever, and I am so sorry that you had to go through it. I struggle with PTS from some of my paramedic calls and I had a frequent ghost visitor (maybe in my head, I don't know) that haunted me for years asking why I didn't save her. Worst call of my life and I still get tears in my eyes when I think about it. I didn't have any counselling, and I still think, 17 years later, that I sure could use it. Hugs to you.