Third semester Nursing Students
NCLEX-RN Nursing Review w/Sally Lagerquist, R.N., M.S.
Author of Davis’ RN-NCLEX Success
http://nclex.reviewfornurses.com/NCLEX/NCLEX_Review_Packages/Live_NCLEX_
Four Day Seminar at San Francisco State University
January 8, 9, 10 & 11, 2008
Register as part of our 3rd semester group and go for $200. This will also enable you to return in early June for a refresher or the entire course for only $75 right before our own NCLEX-RN.
Group Registration Deadline is November 2, 2007 to go for $200, after this date it goes up by $25. All Registration closes on 12/3. Please Contact: Kelly Widger @ 482-1463 or k9nurse86@comcast.net to add your name to our growing list of attendees. I will be carrying registration forms with me on campus. Do Not mail into Nursing Review or you will not get the discounted group rate. Please return completed registration form and Money to Kelly Widger the sooner the better, I would like to have everything no later than Oct.26th. At least email me so I can put you on the attendee list. I am on campus every Tue/Wed and can make arrangements to meet to turn in paperwork. If you do not have the full $200 at the time of registration you can pay the $75 registration fee to save your spot and pay the balance by Nov.1
Forms of payment are Money Order, Checks, Visa or Mastercard all made payable to Nursing Review.
2 Hotels offering discounted rates are:
Days Inn 415-665-9000 (1.8 mi) 2600 Sloat Blvd. San Francisco, Ca. 94116 (Complimentary continental breakfast) 1 King non-smoking……$70/ngt. 2 Queen non-smoking…..$80/ngt.
They do have smoking rooms call for rates.They only have 33 rooms total so book early
Hampton Inn—Daly City 650-755-7500 (2.3 mi)2700 Junipero Serra Blvd.San Francisco, Ca. 94051(Complimentary hot breakfast or continental)2 Queens non-smoking…………..$139/ngt
Sunday, August 26, 2007
BP and Cap Dynamics Questions
Factors that Affect Blood Pressure
1. What are the three main factors affecting peripheral resistance?2. What effect does vessel diameter have on peripheral resistance and blood pressure?3. What effect does sympathetic nerves have on the vessels smooth muscle layer?4. State three vasoconstrictors.5. How does viscosity affect the peripheral resistance?6. What effect does viscosity have on peripheral resistance and blood pressure?7. How does blood vessel length affect blood pressure?8. How does blood vessel elasticity affect blood pressure?9. How does blood volume affect blood pressure?10. State two behaviors that can affect blood pressure and explain how?11. Describe how changes in cardiac output affect blood pressure.12. What are the effects of autonomic stimulation on blood pressure?13. What affect does changes in stroke volume have upon blood pressure?
Blood Pressure Regulation
1. How is rising blood pressure detected by the body?2. Describe how the brain lowers blood pressure in response to signals that it is increasing?3. Describe the short term regulation of falling blood pressure.4. What are the effects of epinephrine and norepinephrine on the cardiovascular system?5. How do juxtaglomerular cells of the kidneys contribute to the long term regulation of blood pressure?6. Describe the steps of the renin-angiotensin mechanism.7. What is the secondary effect of angiotensin that causes it to raise the blood pressure?8. What is the effect of aldosterone on the kidneys?9. What is the long term effect of an increase in osmolarity?10. What is the effect of antidiuretic hormone?11. What is the short term effect of an increase in osmolarity?
Autoregulation and Capillary Dynamics
1. Explain how blood flow is controlled at the capillary bed.2. What is the effect of different concentrations of oxygen and carbon dioxide on the capillary bed?3. What is the effect of pH on the precapillary sphincters of the capillary bed?4. Name some other factors that influence blood flow through the capillary bed.5. State structural features of capillaries that aid in the transport of nutrients across the capillary wall.6. By what process does oxygen and carbon dioxide move across the capillary wall?7. What type of molecules are transported across the capillary wall by exocytosis?8. Explain why bulk fluid flows are important at capillary beds.9. What is hydrostatic pressure?10. What is the hydrostatic pressure in the capillaries?11. How does the hydrostatic pressure in the arteriole end of capillaries compare with that in the venule end.12. Why is the hydrostatic pressure in the fluid spaces normally low?13. What is the net hydrostatic pressure and how does it affect the net movement of fluid across the capillaries?14. What is osmotic pressure?15. Why does the capillary bed have a high osmotic pressure?16. Why is the osmotic pressure in the interstitial fluid low?17. Where does the fluid flow in a capillary bed because of the net osmotic pressure across the capillary walls?
1. What are the three main factors affecting peripheral resistance?2. What effect does vessel diameter have on peripheral resistance and blood pressure?3. What effect does sympathetic nerves have on the vessels smooth muscle layer?4. State three vasoconstrictors.5. How does viscosity affect the peripheral resistance?6. What effect does viscosity have on peripheral resistance and blood pressure?7. How does blood vessel length affect blood pressure?8. How does blood vessel elasticity affect blood pressure?9. How does blood volume affect blood pressure?10. State two behaviors that can affect blood pressure and explain how?11. Describe how changes in cardiac output affect blood pressure.12. What are the effects of autonomic stimulation on blood pressure?13. What affect does changes in stroke volume have upon blood pressure?
Blood Pressure Regulation
1. How is rising blood pressure detected by the body?2. Describe how the brain lowers blood pressure in response to signals that it is increasing?3. Describe the short term regulation of falling blood pressure.4. What are the effects of epinephrine and norepinephrine on the cardiovascular system?5. How do juxtaglomerular cells of the kidneys contribute to the long term regulation of blood pressure?6. Describe the steps of the renin-angiotensin mechanism.7. What is the secondary effect of angiotensin that causes it to raise the blood pressure?8. What is the effect of aldosterone on the kidneys?9. What is the long term effect of an increase in osmolarity?10. What is the effect of antidiuretic hormone?11. What is the short term effect of an increase in osmolarity?
Autoregulation and Capillary Dynamics
1. Explain how blood flow is controlled at the capillary bed.2. What is the effect of different concentrations of oxygen and carbon dioxide on the capillary bed?3. What is the effect of pH on the precapillary sphincters of the capillary bed?4. Name some other factors that influence blood flow through the capillary bed.5. State structural features of capillaries that aid in the transport of nutrients across the capillary wall.6. By what process does oxygen and carbon dioxide move across the capillary wall?7. What type of molecules are transported across the capillary wall by exocytosis?8. Explain why bulk fluid flows are important at capillary beds.9. What is hydrostatic pressure?10. What is the hydrostatic pressure in the capillaries?11. How does the hydrostatic pressure in the arteriole end of capillaries compare with that in the venule end.12. Why is the hydrostatic pressure in the fluid spaces normally low?13. What is the net hydrostatic pressure and how does it affect the net movement of fluid across the capillaries?14. What is osmotic pressure?15. Why does the capillary bed have a high osmotic pressure?16. Why is the osmotic pressure in the interstitial fluid low?17. Where does the fluid flow in a capillary bed because of the net osmotic pressure across the capillary walls?
Saturday, August 25, 2007
SNA PDA Party - Sept. 17th!!
Your Student Nursing Association will be presenting a PDA party Sept. 17th 1-3pm in Locke 314.
Bonnie Boss has agreed to come give her PDA presentation. We invite other SJDC students to be on hand to give a PDA "show and tell". Come make some suggestions for future meetings that will provide you with the info you really need to know!
All are welcome to attend, if you still have not registered for the SNA, we will be happy to register you at the door.
SNA items will be raffled and Snacks will be served!!
Your Fall 2007 SNA officers are:
Danielle Mathias-Lamb, President
Barbara Buonauro, V. President
Amanda Aguirre, Secretary
Aime Edwards, Treasurer
Mrs. Batson, SNA Faculty Advisor
Bonnie Boss has agreed to come give her PDA presentation. We invite other SJDC students to be on hand to give a PDA "show and tell". Come make some suggestions for future meetings that will provide you with the info you really need to know!
All are welcome to attend, if you still have not registered for the SNA, we will be happy to register you at the door.
SNA items will be raffled and Snacks will be served!!
Your Fall 2007 SNA officers are:
Danielle Mathias-Lamb, President
Barbara Buonauro, V. President
Amanda Aguirre, Secretary
Aime Edwards, Treasurer
Mrs. Batson, SNA Faculty Advisor
Thursday, August 23, 2007
Great resource........
Hi everyone,
I just wanted to let you all know that the website for evolve http://evolve.elsevier.com for our Thelans Critical Care Nursing Book is a GREAT resource!! There are video clips showing all kinds of physiology and it is just full of relevant info. for those of us in nursing 7.
I just wanted to let you all know that the website for evolve http://evolve.elsevier.com for our Thelans Critical Care Nursing Book is a GREAT resource!! There are video clips showing all kinds of physiology and it is just full of relevant info. for those of us in nursing 7.
Thanks Nurse Nicky and Kat!
Just wanted to say thanks for the question you ladies made! I am so glad to have you two in my class.....
Practice Unit I NS07
1.)Morphine is good for cardiac pts because...
a.) It makes them feel really good
b.) It increases GFR which increases urine production which helps avoid 3rd spacing, and augments gas exchange at the cellular level.
c.) It helps with pain.
d.) both b and c
2.) When involving capillary pressures, which statement is true?
a.) Both negative and positive pressure pull.
b.) Negative pressure pushes while positive pressure pulls.
c.) Positive pressure pushes while negative pressure pulls.
3.) When figuring out the calculations for IV meds, you would use.
a.) dry weight
b.) my weight and your weight.
c.) All weight including 3rd spacing volume.
4.) What 2 meds call for lab work of potassium before administration?
a.) vicodin and viagra
b.) lopressor and metformin
c.) lasix and digoxin
5.) What increases the force or tension of the heart?
a.) cardiac output
b.) volume
c.) heart rate.
6.) What is Epinephrine?
a.) 30% alpha vasoconstriction and 70% beta increase heart rate.
b.) 60% beta increase heart rate and 40% alpha vasoconstriction.
c.) Its all alpha vasoconstriction
7.) What are inotropic agents?
a.) influence the force of muscular contractility
b.) influenc heart rate
c.) both a and b
8.) How much oxygen does the brain utilize?
a.) 20%
b.) 50%
c.) 100%
9.) What are the 2 phases of cellular damage?
a.) Ischemia and hypovolemia
b.) decrease cell production and leakage
c.) Ischemia and Necrosis.
10.) In anaerobic metabolism, we don't produce c02 like we do in the kreb cycle, but we produce what?
a.) Chocolate
b.) lactic acid
c.) urea
11.) What are scrubbers, and what do they do?
a.) o2 radicals are scrubbers that scrub the membranes so thin they tear.
b.) students nurses that give bedbaths
c.) antioxidants that counteract the o2 radicals.
1.)d 2.)c 3.)a 4.)c 5.)c 6.)b 7.)a 8.)a 9.)c 10.)b 11.)a
a.) It makes them feel really good
b.) It increases GFR which increases urine production which helps avoid 3rd spacing, and augments gas exchange at the cellular level.
c.) It helps with pain.
d.) both b and c
2.) When involving capillary pressures, which statement is true?
a.) Both negative and positive pressure pull.
b.) Negative pressure pushes while positive pressure pulls.
c.) Positive pressure pushes while negative pressure pulls.
3.) When figuring out the calculations for IV meds, you would use.
a.) dry weight
b.) my weight and your weight.
c.) All weight including 3rd spacing volume.
4.) What 2 meds call for lab work of potassium before administration?
a.) vicodin and viagra
b.) lopressor and metformin
c.) lasix and digoxin
5.) What increases the force or tension of the heart?
a.) cardiac output
b.) volume
c.) heart rate.
6.) What is Epinephrine?
a.) 30% alpha vasoconstriction and 70% beta increase heart rate.
b.) 60% beta increase heart rate and 40% alpha vasoconstriction.
c.) Its all alpha vasoconstriction
7.) What are inotropic agents?
a.) influence the force of muscular contractility
b.) influenc heart rate
c.) both a and b
8.) How much oxygen does the brain utilize?
a.) 20%
b.) 50%
c.) 100%
9.) What are the 2 phases of cellular damage?
a.) Ischemia and hypovolemia
b.) decrease cell production and leakage
c.) Ischemia and Necrosis.
10.) In anaerobic metabolism, we don't produce c02 like we do in the kreb cycle, but we produce what?
a.) Chocolate
b.) lactic acid
c.) urea
11.) What are scrubbers, and what do they do?
a.) o2 radicals are scrubbers that scrub the membranes so thin they tear.
b.) students nurses that give bedbaths
c.) antioxidants that counteract the o2 radicals.
1.)d 2.)c 3.)a 4.)c 5.)c 6.)b 7.)a 8.)a 9.)c 10.)b 11.)a
Wednesday, August 22, 2007
Practice Test
I was going over my audio, text and notes from todays lecture and I put together a little test you can practice with. Please feel free to reference my answers to your own material and pose any questions. It would be cool if someone else can post another "Self Created" test with about 10 or 15 questions on different material. It would help us all!!! See ya, next week :)
Practice Test for N7
Unit #1
1. Nasal Cannula delivers what type of gas:
A. Moist gas
B. Warm gas
C. Dry gas
2. Pavoulon a Muscle Paralyzing Agent:
A. Decrease demand and Increase supply
B. Decrease demand and Decrease supply
C. Increase demand and Increase supply
3. TPN can infuse through a peripheral line: T or F
{If answer is false give reasoning to make answer true}
Peripheral line is too small to infuse TPN. TPN contains protein and fats that are to big to transfuse through peripheral line. Also TPN is an irritant to peripheral veins.
4. ART lines need to be counteracted with how much pressure:
A. 150 mmHg of counter pressure
B. 300mmHg of counter pressure
C. 425mmHg of counter pressure
5. Nitro is a potent coronary artery dilator and a vasodilator. What is the priotity after administraiotion of Nitro:
A. Monitor B/P for low blood pressure
B. Monitor every 15 minutes for pt’s report of headache
C. Monitoring pt’s appetite
6. What is a intervention for Nipride:
A. Observe pt for paralyses, due to Nipride high incidence of paralyzes 1 hour after administration of medication.
B. Store med in a plastic bag, due to photosensitivity
C. Never Administer with Dopamine
7. What is the first indicator a patient is suffering from hypoxia:
A. Patients’ respiratory rate increases
B. Patients’ has a change in LOC
C. A marked decrease in urine output
8. When patient is suffering a nitrogen imbalance:
A. Serum Albumin increases
B. Serum Albumin remains unchanged
C. Serum Albumin decreases
9. Dilantin must not be pushed greater than:
A. 25 mg/min
B. 40mg/min
C. 250mg/min
10. Your patient states “I have this ringing in my ear and it’s never happened to me before this morning after I took all of my morning meds”. From your knowledge of meds, you know that of the meds listed one cause a feeling of “ringing in the ear”:
A. Regular Insulin
B. Heparin
C. Lasix
11. You notice MD ordered a insulin drip containing Lantus, you:
A. Question the order, knowing that only Regular insulin is to be used as a IV drip
B. Give the med as ordered
C. Refuse to give the medication
12. Morphine Sulfate should never be pushed faster than:
A. 1.0 mg/min
B. 2.0 mg/min
C. 3.0 mg/min
13. Your preceptor states, “His central line has been in for two weeks and that’s good, we won’t have to worry about it, because central lines are good for a month”. You:
A. Agree, because central lines are intended to be in place for 30 days
B. Disagree, knowing that central lines are only good for 72 hours
C. Disagree, knowing that central lines are intended to be in place for 7-10 days
14. You Instructor gives you a verbal warning when she sees you:
A. Check the K+, of your patient prior to administering a loop diuretic
B. Push 25mg/min of Dilantin
C. Give pt a med via his central line without flushing line with heparin
15. Mrs. Antran knows you know your stuff when you:
A. Raise you hand to say, “K+ must be diluted in 100ml of NS for 20 meq or less
B. Digoxin is to be given 1.25 mg within one hour
C. Dilantin increases heart rate
Answers: 1c, 2a, 3F, 4b,5a, 6b, 7a,8c,9a,10c,11a,12b,13c,14c,15a
Practice Test for N7
Unit #1
1. Nasal Cannula delivers what type of gas:
A. Moist gas
B. Warm gas
C. Dry gas
2. Pavoulon a Muscle Paralyzing Agent:
A. Decrease demand and Increase supply
B. Decrease demand and Decrease supply
C. Increase demand and Increase supply
3. TPN can infuse through a peripheral line: T or F
{If answer is false give reasoning to make answer true}
Peripheral line is too small to infuse TPN. TPN contains protein and fats that are to big to transfuse through peripheral line. Also TPN is an irritant to peripheral veins.
4. ART lines need to be counteracted with how much pressure:
A. 150 mmHg of counter pressure
B. 300mmHg of counter pressure
C. 425mmHg of counter pressure
5. Nitro is a potent coronary artery dilator and a vasodilator. What is the priotity after administraiotion of Nitro:
A. Monitor B/P for low blood pressure
B. Monitor every 15 minutes for pt’s report of headache
C. Monitoring pt’s appetite
6. What is a intervention for Nipride:
A. Observe pt for paralyses, due to Nipride high incidence of paralyzes 1 hour after administration of medication.
B. Store med in a plastic bag, due to photosensitivity
C. Never Administer with Dopamine
7. What is the first indicator a patient is suffering from hypoxia:
A. Patients’ respiratory rate increases
B. Patients’ has a change in LOC
C. A marked decrease in urine output
8. When patient is suffering a nitrogen imbalance:
A. Serum Albumin increases
B. Serum Albumin remains unchanged
C. Serum Albumin decreases
9. Dilantin must not be pushed greater than:
A. 25 mg/min
B. 40mg/min
C. 250mg/min
10. Your patient states “I have this ringing in my ear and it’s never happened to me before this morning after I took all of my morning meds”. From your knowledge of meds, you know that of the meds listed one cause a feeling of “ringing in the ear”:
A. Regular Insulin
B. Heparin
C. Lasix
11. You notice MD ordered a insulin drip containing Lantus, you:
A. Question the order, knowing that only Regular insulin is to be used as a IV drip
B. Give the med as ordered
C. Refuse to give the medication
12. Morphine Sulfate should never be pushed faster than:
A. 1.0 mg/min
B. 2.0 mg/min
C. 3.0 mg/min
13. Your preceptor states, “His central line has been in for two weeks and that’s good, we won’t have to worry about it, because central lines are good for a month”. You:
A. Agree, because central lines are intended to be in place for 30 days
B. Disagree, knowing that central lines are only good for 72 hours
C. Disagree, knowing that central lines are intended to be in place for 7-10 days
14. You Instructor gives you a verbal warning when she sees you:
A. Check the K+, of your patient prior to administering a loop diuretic
B. Push 25mg/min of Dilantin
C. Give pt a med via his central line without flushing line with heparin
15. Mrs. Antran knows you know your stuff when you:
A. Raise you hand to say, “K+ must be diluted in 100ml of NS for 20 meq or less
B. Digoxin is to be given 1.25 mg within one hour
C. Dilantin increases heart rate
Answers: 1c, 2a, 3F, 4b,5a, 6b, 7a,8c,9a,10c,11a,12b,13c,14c,15a
Tuesday, August 21, 2007
Helpful information for N 7
Hi All,
Here is some helpful information I found on the blog of our upper- classmen that helped them with Nursing 7.
Sunday, August 20, 2006
Some Helps for N7 Ok you N7 SNs. I also recommend that you check out this site!Critical Care TutorialsThese tutorials are short and sweet and break all of the difficult concepts of N7 into easy to understand packets.I read the respiratory section the night before our test and scored really high. (hint, hint)Do yourself a favor and check it out!
Posted by Bonnie Boss
Here are the Shock Key Points from the Critical Care Tutorials
1. Blood Pressure is Cardiac Output multiplied by Peripheral Resistance.
2. Cardiac Output is Heart Rate times Stroke Volume.
3. Hypotension is caused by either inadequate Cardiac Output or inadequate Peripheral
Resistance
4. Heart Rate, Stroke Volume and Total Peripheral Resistance exist in dynamic equilibrium: these interactions maintain blood pressure. If one of the three becomes abnormal, the other two compensate. This represents the cardiovascular physiologic reserve.
5. Hypotension is an indication of 1) an abnormality of Heart Rate, Stroke Volume or Peripheral Resistance, & 2) failure of the others to compensate.
6. Shock is acute circulatory failure leading to inadequate tissue perfusion and end organ injury: it classified as being due to malfunction of 1) the Pump (cardiogenic), 2 ) the Tubing (distributive), or 3) the Fluid (hypovolemic).
7. The heart rate is a fundamental element of hypotension both in terms of cause (tachyarrhythmias / bradyarrhythmias) and compensation – hypotension should be accompanied by a tachycardia.
8. Low Stroke volume is caused by a problem with reception or a problem with ejection.
9. Problems with reception are: inadequate venous return or cardiac inflow obstruction.
10. Fluid loss is caused by either absolute hypovolemia (e.g. blood loss) or relative hypovolemia ("third spacing").
11. Cardiac inflow obstruction is caused by a pericardial (tamponade) or intrathoracic process (PEEP), or a lesion within the heart itself (mitral stenosis).
12. Problems with ejection include pump failure (ischemia, overload, contusion, inflammation) and outflow obstruction (embolism, aortic stenosis, aortic crossclamps).
13. Shock caused by low peripheral vascular resistance is caused by loss of tonic vasoconstriction (vasoplegia), due to sympathectomy, anaphylaxis or sepsis, leading to relative hypovolemia.
14. Vasodilation associated with septic shock occurs due to increased synthesis of nitric oxide, activation of ATP-sensitive potassium channels in vascular smooth muscle, and deficiency of vasopressin.
Here is some helpful information I found on the blog of our upper- classmen that helped them with Nursing 7.
Sunday, August 20, 2006
Some Helps for N7 Ok you N7 SNs. I also recommend that you check out this site!Critical Care TutorialsThese tutorials are short and sweet and break all of the difficult concepts of N7 into easy to understand packets.I read the respiratory section the night before our test and scored really high. (hint, hint)Do yourself a favor and check it out!
Posted by Bonnie Boss
Here are the Shock Key Points from the Critical Care Tutorials
1. Blood Pressure is Cardiac Output multiplied by Peripheral Resistance.
2. Cardiac Output is Heart Rate times Stroke Volume.
3. Hypotension is caused by either inadequate Cardiac Output or inadequate Peripheral
Resistance
4. Heart Rate, Stroke Volume and Total Peripheral Resistance exist in dynamic equilibrium: these interactions maintain blood pressure. If one of the three becomes abnormal, the other two compensate. This represents the cardiovascular physiologic reserve.
5. Hypotension is an indication of 1) an abnormality of Heart Rate, Stroke Volume or Peripheral Resistance, & 2) failure of the others to compensate.
6. Shock is acute circulatory failure leading to inadequate tissue perfusion and end organ injury: it classified as being due to malfunction of 1) the Pump (cardiogenic), 2 ) the Tubing (distributive), or 3) the Fluid (hypovolemic).
7. The heart rate is a fundamental element of hypotension both in terms of cause (tachyarrhythmias / bradyarrhythmias) and compensation – hypotension should be accompanied by a tachycardia.
8. Low Stroke volume is caused by a problem with reception or a problem with ejection.
9. Problems with reception are: inadequate venous return or cardiac inflow obstruction.
10. Fluid loss is caused by either absolute hypovolemia (e.g. blood loss) or relative hypovolemia ("third spacing").
11. Cardiac inflow obstruction is caused by a pericardial (tamponade) or intrathoracic process (PEEP), or a lesion within the heart itself (mitral stenosis).
12. Problems with ejection include pump failure (ischemia, overload, contusion, inflammation) and outflow obstruction (embolism, aortic stenosis, aortic crossclamps).
13. Shock caused by low peripheral vascular resistance is caused by loss of tonic vasoconstriction (vasoplegia), due to sympathectomy, anaphylaxis or sepsis, leading to relative hypovolemia.
14. Vasodilation associated with septic shock occurs due to increased synthesis of nitric oxide, activation of ATP-sensitive potassium channels in vascular smooth muscle, and deficiency of vasopressin.
Monday, August 20, 2007
From Afghanistan...
As we start our final year....I wanted to share a story that was just emailed over from my best friend, whose sister is serving in the Airforce in Afghanistan as an ER Nurse. Wow, truly amazing. Good luck and happy studying to all in our final semesters!
From Afghanistan...
The last few days have been very exciting here. Not only b/c we are allgetting ready for the end of August, but our patient tempo has picked upalso.We've been busy since I have been here. I have touched a lot of lives, butI have to tell you about one story in particular that literally made my deployment worth it this week!!
Friday (17th) we were pretty busy in the ER. We had normal ER patients,but we also got a few traumas in. One patient we were waiting on was an American who was severely injured when a sniper hit him with a bullet. The story is this soldier was wearing all his protective equipment, but the sniper picked the one spot that wasn't covered by his kevlar vest. Thebullet pierced the R side of his chest and played pin ball with his insides until it exited out his back. We were expecting him for many hours. We had to extend our time b/c we were told that at the place he was at, he began to crash (b/c of internal bleeding) and they had to take him back into the OR to save him. We weren't even sure he was going to make it here alive.
A few hours later, we got the call that he was coming and he was extremely critical. He had already received 32 blood products down range, he had 4 chest tubes, already lost a kidney and he was bleeding from his liver.
As soon as the medevac landed, we rushed him into the trauma bay. The directions were, "get blood and get him to the OR!" I was working at thebedside and he looked awful. He was intubated, had blood all over him andhad so many tubes coming out of him. He was in and out of our department in 10 minutes and onto the OR. I held 15 bags of fluids/blood etc andraced to the OR with him and the OR staff. At the doors of the OR, the labtech came to me and said, "do you think he is going to need more blood?" Isaid "definately!" He told me that we only had 8 more units of O+ blood in the hospital and he would need to make a call for blood donors. I told himto start making the calls.
Once I got back to the ER, I looked down at my scrub top and I had some ofhis blood on it. I was praying he would make it through the surgery, but Iwas worried b/c he was pretty bad!
A few hours went by and I finished up my shift. Chris (that's his name)was still in the OR. I had already been called to donate blood, but I wasstill working so I told them I would be down once I got off shift. So, Igot off work, went over to the blood donation area expecting only a few folks to be there. There were at least 20 people in line to donate blood.My eyes began to swell with tears. I stood in line and started filling out my paperwork just as a soldier came in to the hospital. He said he was amedic and would like to help. The blood donation folks were overwhelmed with patients, so they had him take vital signs.
I waited for 2 hours until I could donate my blood. I was #125. Once Iwas finished donating, I checked on Chris. He was still in the OR andstill alive. I passed one of the OR nurses on the way out and asked how he was doing. She told me that he was still holding his own, but had more damage than what the surgeons expected. That one bullet did so muchdamage! i asked her how much blood product they had gone through and she told me they were up to 40+!
I left the hospital and as I was walking home, I heard over the "loud voice" 'all available blood donors to the hospital.' I wondered how many people would come. I found out the next day that there was a line out thehospital driveway and down to the street. The blood donation folkscollected over 60 units of whole blood! All for one soldier...amazing!
I woke up on Saturday praying that Chris had made it through surgery. Iwalked into the ICU for my shift and saw him in bed 1. Whew...I thought.Now, I just have to keep him alive until we can get him to Germany. Iasked if I could take him since I saw him in the ER. The charge nurse wasa bit leary b/c ...well, lets face it, I'm an ER nurse working in an ICU.BUT I told her that I could handle it, but would let someone know if Ineeded help. He was the most critical patient in the ICU.
As the day progressed, we did well together. I found out that the surgeons stopped all the internal bleeding after they found major damage. I gavehim 6 units of more blood product and found out that the OR ended up giving him 54 blood products during his surgery. that was in addition to the 32 he received down at the FOB (forward op base). As I was looking through his chart, I found multiple blood transfusion sheets and then I found blooddonor #125. I smiled b/c I realized that he had received my blood.
He went back into the OR that day to make sure that everything looked good and the bleeding was stopped. The good news was yes, everything looked fine...he was flight ready for Germany. the bad news was that the bullet demolished his T12-L1 spine...chances were slim that he would ever walkagain. Chris is 21 yo; he is married with a baby on the way.
As shitty as that is, at least he is alive; at least he will be able tohold his baby when he/she is born and at least he'll be home.
At change of shift, I reported off to the night nurse. Everyone commented how much better he looked. yes, he was still intubated and still had an open belly wound and chest tubes...but he made it...he was alive!! On my way home, I replayed the last 24 hours in my head. I reflected onthe blood he shed on my scrub top and the blood I shed to help save him. It was the most rewarding 24 hours I have ever experienced. I reallyhelped save a life!!
Until next time....
From Afghanistan...
The last few days have been very exciting here. Not only b/c we are allgetting ready for the end of August, but our patient tempo has picked upalso.We've been busy since I have been here. I have touched a lot of lives, butI have to tell you about one story in particular that literally made my deployment worth it this week!!
Friday (17th) we were pretty busy in the ER. We had normal ER patients,but we also got a few traumas in. One patient we were waiting on was an American who was severely injured when a sniper hit him with a bullet. The story is this soldier was wearing all his protective equipment, but the sniper picked the one spot that wasn't covered by his kevlar vest. Thebullet pierced the R side of his chest and played pin ball with his insides until it exited out his back. We were expecting him for many hours. We had to extend our time b/c we were told that at the place he was at, he began to crash (b/c of internal bleeding) and they had to take him back into the OR to save him. We weren't even sure he was going to make it here alive.
A few hours later, we got the call that he was coming and he was extremely critical. He had already received 32 blood products down range, he had 4 chest tubes, already lost a kidney and he was bleeding from his liver.
As soon as the medevac landed, we rushed him into the trauma bay. The directions were, "get blood and get him to the OR!" I was working at thebedside and he looked awful. He was intubated, had blood all over him andhad so many tubes coming out of him. He was in and out of our department in 10 minutes and onto the OR. I held 15 bags of fluids/blood etc andraced to the OR with him and the OR staff. At the doors of the OR, the labtech came to me and said, "do you think he is going to need more blood?" Isaid "definately!" He told me that we only had 8 more units of O+ blood in the hospital and he would need to make a call for blood donors. I told himto start making the calls.
Once I got back to the ER, I looked down at my scrub top and I had some ofhis blood on it. I was praying he would make it through the surgery, but Iwas worried b/c he was pretty bad!
A few hours went by and I finished up my shift. Chris (that's his name)was still in the OR. I had already been called to donate blood, but I wasstill working so I told them I would be down once I got off shift. So, Igot off work, went over to the blood donation area expecting only a few folks to be there. There were at least 20 people in line to donate blood.My eyes began to swell with tears. I stood in line and started filling out my paperwork just as a soldier came in to the hospital. He said he was amedic and would like to help. The blood donation folks were overwhelmed with patients, so they had him take vital signs.
I waited for 2 hours until I could donate my blood. I was #125. Once Iwas finished donating, I checked on Chris. He was still in the OR andstill alive. I passed one of the OR nurses on the way out and asked how he was doing. She told me that he was still holding his own, but had more damage than what the surgeons expected. That one bullet did so muchdamage! i asked her how much blood product they had gone through and she told me they were up to 40+!
I left the hospital and as I was walking home, I heard over the "loud voice" 'all available blood donors to the hospital.' I wondered how many people would come. I found out the next day that there was a line out thehospital driveway and down to the street. The blood donation folkscollected over 60 units of whole blood! All for one soldier...amazing!
I woke up on Saturday praying that Chris had made it through surgery. Iwalked into the ICU for my shift and saw him in bed 1. Whew...I thought.Now, I just have to keep him alive until we can get him to Germany. Iasked if I could take him since I saw him in the ER. The charge nurse wasa bit leary b/c ...well, lets face it, I'm an ER nurse working in an ICU.BUT I told her that I could handle it, but would let someone know if Ineeded help. He was the most critical patient in the ICU.
As the day progressed, we did well together. I found out that the surgeons stopped all the internal bleeding after they found major damage. I gavehim 6 units of more blood product and found out that the OR ended up giving him 54 blood products during his surgery. that was in addition to the 32 he received down at the FOB (forward op base). As I was looking through his chart, I found multiple blood transfusion sheets and then I found blooddonor #125. I smiled b/c I realized that he had received my blood.
He went back into the OR that day to make sure that everything looked good and the bleeding was stopped. The good news was yes, everything looked fine...he was flight ready for Germany. the bad news was that the bullet demolished his T12-L1 spine...chances were slim that he would ever walkagain. Chris is 21 yo; he is married with a baby on the way.
As shitty as that is, at least he is alive; at least he will be able tohold his baby when he/she is born and at least he'll be home.
At change of shift, I reported off to the night nurse. Everyone commented how much better he looked. yes, he was still intubated and still had an open belly wound and chest tubes...but he made it...he was alive!! On my way home, I replayed the last 24 hours in my head. I reflected onthe blood he shed on my scrub top and the blood I shed to help save him. It was the most rewarding 24 hours I have ever experienced. I reallyhelped save a life!!
Until next time....
Wednesday, August 15, 2007
NCLEX REVIEW......follow up
Hi Everyone,
It is GREAT to see all of your interest in the NCLEX review session coming up in January!!
I just received the packet of materials we will need to get everyone signed up that is interested.
All registration paper work and fees will go through me, but will be payable to Davis' NCLEX review by check, money order or credit card. If you have N 7 first rotation then I am in your lecture class and will be making an announcement one morning in class. If you are N 6 first then I am going to email your instructor to see if I can get a quick minute to come by your lecture when it is okay with her for me to talk to all of you as well. This way everyone should know what is going on and we will all have the same opportunity to sign up at the discounted price. With the interest being shown so far, it looks like our price will be $200 per student. Davis' is putting together a hotel list for us of near by hotels offering us a student/corporate discounted rate. I will get all of this info. out as soon as I get it. Our deadline for group registration will be early November.
See You Next Week!!!
It is GREAT to see all of your interest in the NCLEX review session coming up in January!!
I just received the packet of materials we will need to get everyone signed up that is interested.
All registration paper work and fees will go through me, but will be payable to Davis' NCLEX review by check, money order or credit card. If you have N 7 first rotation then I am in your lecture class and will be making an announcement one morning in class. If you are N 6 first then I am going to email your instructor to see if I can get a quick minute to come by your lecture when it is okay with her for me to talk to all of you as well. This way everyone should know what is going on and we will all have the same opportunity to sign up at the discounted price. With the interest being shown so far, it looks like our price will be $200 per student. Davis' is putting together a hotel list for us of near by hotels offering us a student/corporate discounted rate. I will get all of this info. out as soon as I get it. Our deadline for group registration will be early November.
See You Next Week!!!
Thursday, August 09, 2007
Welcome the incoming class
Hey folk,
I hope all had a wonderful summer and enjoyed the weddings, vacations, online classes and work experiences they were gifted with!
The incoming class Welcoming Tea will be held Monday 8/13 from 12 noon - 2 pm. If you have a moment, please pop over to their new blog site and welcome them. Just click on the 1st semester link and it will take you there.
I can't wait to see you all!
I hope all had a wonderful summer and enjoyed the weddings, vacations, online classes and work experiences they were gifted with!
The incoming class Welcoming Tea will be held Monday 8/13 from 12 noon - 2 pm. If you have a moment, please pop over to their new blog site and welcome them. Just click on the 1st semester link and it will take you there.
I can't wait to see you all!
Wednesday, August 08, 2007
Desperately Seeking Nurse Nickey
Please contact me ASAP.... thank ya very much!
PS I emailed you my phone #.
PS I emailed you my phone #.
Monday, August 06, 2007
Thursday, July 26, 2007
Mistake on NCLEX website
Hi,
There is a mistake with the dates on the NCLEX review website previously posted. The corrected dates of the review are Tues thru Fri. Jan 8 - 11. Thank You Shawna !
Kelly
There is a mistake with the dates on the NCLEX review website previously posted. The corrected dates of the review are Tues thru Fri. Jan 8 - 11. Thank You Shawna !
Kelly
Monday, July 23, 2007
THINK NCLEX !!!!!!!
Hi All,
I hope you all are having a great summer and getting ready to hit the books again. (for those of us that are not already) It is not too early to be thinking about the NCLEX and a NCLEX review class. I am coordinating a group from our semester for the upcoming DAVIS' LIVE NCLEX REVIEW in January at San Francisco State the dates are Jan.8 thru Jan 11. Prices will vary from $200-$275 for all four days not including hotel accomodations, but discounted info. on accomodations I will post soon. I have had some really good feedback on this review session from other students and nurses that have taken it in the past. Please email me if you are interested so I know if I should continue with this or not.......If you attend in January, you can again attend in June for $75 a great refresher right before our NCLEX!! I have included the link below so you can check out some of the other benefits of attending this review.
Let me know what all of you are thinking about this.
Kelly
http://nclex.reviewfornurses.com/NCLEX/NCLEX_Review_Packages/Live_NCLEX_Review/
I hope you all are having a great summer and getting ready to hit the books again. (for those of us that are not already) It is not too early to be thinking about the NCLEX and a NCLEX review class. I am coordinating a group from our semester for the upcoming DAVIS' LIVE NCLEX REVIEW in January at San Francisco State the dates are Jan.8 thru Jan 11. Prices will vary from $200-$275 for all four days not including hotel accomodations, but discounted info. on accomodations I will post soon. I have had some really good feedback on this review session from other students and nurses that have taken it in the past. Please email me if you are interested so I know if I should continue with this or not.......If you attend in January, you can again attend in June for $75 a great refresher right before our NCLEX!! I have included the link below so you can check out some of the other benefits of attending this review.
Let me know what all of you are thinking about this.
Kelly
http://nclex.reviewfornurses.com/NCLEX/NCLEX_Review_Packages/Live_NCLEX_Review/
Saturday, July 14, 2007
Trade In Your Scrubs!
FYI!
July 14 through the 22nd you can trade in any scrubs you
no longer use for a 20% discount off any reg. priced scrub top, jacket or pants
at Life Uniform in the Lincoln Center on Pacific Ave. Your used scrubs will go
to a local charity.
Hope everyone is having a great summer!
Mary-Jane
July 14 through the 22nd you can trade in any scrubs you
no longer use for a 20% discount off any reg. priced scrub top, jacket or pants
at Life Uniform in the Lincoln Center on Pacific Ave. Your used scrubs will go
to a local charity.
Hope everyone is having a great summer!
Mary-Jane
Wednesday, July 11, 2007
desperate!!
Hey everyone I hope everyone is enjoying their summer. Congrats to all of the newly-weds and those to be. Well Im posting this on behave of Adriana she has a bit of a dilemma, do to child care issues she would like to know if anyone is willing to trade N7 PM for the AM shift? She is taking it a St. Joe's. If anyone is interested please let her know by e-mail/blog :montys2047@sbcglobal.net
Thanks everyone
Ale
Thanks everyone
Ale
Welcoming tea date/time
Monday, August 13, 2007 at 12:00 noon - 2:00pm, upper danner hall.
Blog admins, please be on notice... your help may be needed and I will be out of town that week.
Blog admins, please be on notice... your help may be needed and I will be out of town that week.
Thursday, July 05, 2007
Stacy's Wedding
Sorry for posting these so late, but I just got the chance to upload them. I hope everyone's summer is awesome, I know I'm enjoying being a bum at home. BTW, does anyone know the reading for N7 yet???
Tuesday, July 03, 2007
Monday, July 02, 2007
Updated links
I have updated the links on this blog to reflect overall changes in semesters. Once we have a new 1st semester blog up and running I'll add it as well.
I hope everyone is having a fantastic summer break!
I hope everyone is having a fantastic summer break!
Saturday, June 30, 2007
Wednesday, June 27, 2007
Jessica is getting married!
Girls nigh out!!! Celebrating Jessica's last 'outtie' as an unmarried woman! Congrats!
p.s. Hope everyone is enjoying their Summer!
Tuesday, June 26, 2007
Does anyone want to take N7 first???
I'm taking N7 the first nine weeks at county and I was signed up for N6 for the second half at county, but was changed to Dameron. If anyone is taking N6 for the first half and wants to switch please let me know.
THANKS
THANKS
Monday, June 04, 2007
Need a job?
Just wanted to inform you all that San Joaquin General Hospital just opened up the position for Student Nursing Assistant. If you're interested call 468-6000 for more info.
Saturday, June 02, 2007
Wednesday, May 23, 2007
Pics from the last day...
Congratulations to all. Our first year is over and done with. It has been a pleasure to meet so many wonderful people. I'm glad we are all sharing the experience together. May you all have a wonderful and relaxing summer, enjoy it because I'm sure it's a well needed break. Till Fall 2007.... ~much love Drea ~
FANTASTIC FOUR!!!
Lunch @ Chilis with friends from N4 and N5
FANTASTIC FOUR!!!
Lunch @ Chilis with friends from N4 and N5
Monday, May 21, 2007
Sunday, May 20, 2007
Saturday, May 19, 2007
Thursday, May 17, 2007
switch?
hey everyone,
i am posting for Shawna... she is at st. joes with peterson for 7, the first half of the semester. she was wondering if anyone who is at dameron with Antaran for 7, the first half would like to switch with her...if so email her at: sbrunmeier477@students.deltacollege.edu or talk to her on monday
i am posting for Shawna... she is at st. joes with peterson for 7, the first half of the semester. she was wondering if anyone who is at dameron with Antaran for 7, the first half would like to switch with her...if so email her at: sbrunmeier477@students.deltacollege.edu or talk to her on monday
Wednesday, May 16, 2007
Sunday, May 13, 2007
It will take just 37 seconds to read this and change your thinking.
>> Two men, both seriously ill, occupied the same hospital room.
>> One man was allowed to sit up in his bed for an hour each afternoon to
> help drain the fluid from his lungs.
> His bed was next to the room's only window.
>> The other man had to spend all his time flat on his back.
>> The men talked for hours on end.
> They spoke of their wives and families, their homes, their jobs, their
> involvement in the military service, where they had been on vacation.
>>> Every afternoon, when the man in the bed by the window could sit up, he
> would pass the time by describing to his roommate all the things he could
> see outside the window.
>> The man in the other bed began to live for those one hour periods where
> his world would be broadened and enlivened by all the activity and color
> of the world outside.
>>> The window overlooked a park with a lovely lake.
> Ducks and swans played on the water while children sailed their model
> boats. Young lovers walked arm in arm amidst flowers of every color and a
> fine view of the city skyline could be seen in the distance.
>>> As the man by the window described all this in exquisite details, the man
> on the other side of the room would close his eyes and imagine this
> picturesque scene.
>> One warm afternoon, the man by the window described a parade passing by.
>>> Although the other man could not hear the band - he could see it in his
> mind's eye as the gentleman by the window portrayed it with descriptive
> words.
>>> Days, weeks and months passed.
>> One morning, the day nurse arrived to bring water for their baths only to
> find the lifeless body of the man by the window, who had died peacefully
> in his sleep.
> She was saddened and called the hospital attendants to take the body away.
>> As soon as it seemed appropriate, the other man asked if he could be moved
> next to the window. The nurse was happy to make the switch, and after
> making sure he was comfortable, she left him alone.
>>> Slowly, painfully, he propped himself up on one elbow to take his first
> look at the real world outside.
> He strained to slowly turn to look out the window besides the bed.
>> It faced a blank wall.
>> The man asked the nurse what could have compelled his deceased roommate
> who had described such wonderful things outside this window.
>>> The nurse responded that the man was blind and could not even see the
> wall.
>> She said, "Perhaps he just wanted to encourage you."
>>> Epilogue:
>> There is tremendous happiness in making others happy, despite our own
> situations.
>> Shared grief is half the sorrow, but happiness when shared, is doubled.
>>> If you want to feel rich, just count all the things you have that money
> can't buy.
>>> "Today is a gift, that is why it is called The Present."
>> Two men, both seriously ill, occupied the same hospital room.
>> One man was allowed to sit up in his bed for an hour each afternoon to
> help drain the fluid from his lungs.
> His bed was next to the room's only window.
>> The other man had to spend all his time flat on his back.
>> The men talked for hours on end.
> They spoke of their wives and families, their homes, their jobs, their
> involvement in the military service, where they had been on vacation.
>>> Every afternoon, when the man in the bed by the window could sit up, he
> would pass the time by describing to his roommate all the things he could
> see outside the window.
>> The man in the other bed began to live for those one hour periods where
> his world would be broadened and enlivened by all the activity and color
> of the world outside.
>>> The window overlooked a park with a lovely lake.
> Ducks and swans played on the water while children sailed their model
> boats. Young lovers walked arm in arm amidst flowers of every color and a
> fine view of the city skyline could be seen in the distance.
>>> As the man by the window described all this in exquisite details, the man
> on the other side of the room would close his eyes and imagine this
> picturesque scene.
>> One warm afternoon, the man by the window described a parade passing by.
>>> Although the other man could not hear the band - he could see it in his
> mind's eye as the gentleman by the window portrayed it with descriptive
> words.
>>> Days, weeks and months passed.
>> One morning, the day nurse arrived to bring water for their baths only to
> find the lifeless body of the man by the window, who had died peacefully
> in his sleep.
> She was saddened and called the hospital attendants to take the body away.
>> As soon as it seemed appropriate, the other man asked if he could be moved
> next to the window. The nurse was happy to make the switch, and after
> making sure he was comfortable, she left him alone.
>>> Slowly, painfully, he propped himself up on one elbow to take his first
> look at the real world outside.
> He strained to slowly turn to look out the window besides the bed.
>> It faced a blank wall.
>> The man asked the nurse what could have compelled his deceased roommate
> who had described such wonderful things outside this window.
>>> The nurse responded that the man was blind and could not even see the
> wall.
>> She said, "Perhaps he just wanted to encourage you."
>>> Epilogue:
>> There is tremendous happiness in making others happy, despite our own
> situations.
>> Shared grief is half the sorrow, but happiness when shared, is doubled.
>>> If you want to feel rich, just count all the things you have that money
> can't buy.
>>> "Today is a gift, that is why it is called The Present."
Thursday, May 10, 2007
Come join us for Rootbeer Floats at the SNA meeting!!
Did you ask when and where???
Monday, May 14, 2007 @ 1:00pm in Locke 314
(It's the last meeting of the semester)
There will be lots of info from our Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Hope to see you there!! Spread the word.
Monday, May 14, 2007 @ 1:00pm in Locke 314
(It's the last meeting of the semester)
There will be lots of info from our Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Hope to see you there!! Spread the word.
Tuesday, May 08, 2007
Use of Seclusion and Restraint?
This is only part of the article....
Alternatives to Restraint and Seclusion in Mental Health Settings: Questions and Answers From Psychiatric Nurse Experts
Posted 05/03/2007
Laura Stokowski, RN, MS
from Medscape Website http://www.medscape.com/viewarticle/555686?src=mp
What Alternative Approaches Can Nurses Use to Avoid the Use of Seclusion and Restraint?
A reader asks, "What do you do when a 220-pound violent patient is throwing furniture or has already assaulted a staff member?" The first thing you should do is clear the area of others, and then remain quietly available at a safe distance until the peak of the crisis has passed. The risk of injury to both patients and staff is high when a direct verbal or physical intervention is attempted at the peak of a crisis. If a staff member has been assaulted, the staff member should be removed from the area and other staff must take the lead in intervening. A patient should not automatically be secluded or restrained following a staff assault, a response often born of fear or the conviction that the person needs "consequences." Seclusion or restraint should never be used to introduce consequences; instead, other approaches to supporting behavior change may be instituted once the crisis has passed.
Early identification of the problem and appropriate assessment of the situation are essential because different situations must be dealt with differently. Anger, fear, and frustration can all lead to violent behavior, and each calls for a specific approach. "Meet the patient where the patient is at" is a phrase commonly used to convey the need to match the approach to the patient's emotional state and to what has triggered that state.
An often overlooked but very simple crisis communication technique is to ask the patient "What would help you right now, at this moment?" It is surprising that this is a question we don't think of asking, yet it often yields a very specific and helpful response. A patient might just need clarification of a misunderstanding, some personal space, or might need to walk. Engaging the patient in the decision of how best to intervene can help them get through the situation without resorting to seclusion or restraint.
Chabora and colleagues[4] developed the Four S Model as a way of reducing the use of seclusion and restraint. The 4 S's are safety, support, structure, and symptom management. In brief:
Safety means assuring the individual's physical and emotional well-being via interventions such as modifying the environment to reduce stimuli and induce a calming ambiance.
Support involves listening and talking in a supportive way, offering comfort measures or whatever is needed according to the individual, and using verbal de-escalation.
Structure techniques, like limit setting, convey behavioral expectations and aid in constructive problem solving.
Symptom management is aimed at specific symptoms including stress and relaxation measures, diversionary activities, or medication.
The scenario described above (the 220-pound patient throwing furniture) is already an out-of-control situation. The question must be asked, what happened before this patient started throwing furniture or assaulted the staff member? At that point, engaging this patient might have led to a different outcome. When the patient is at the point of throwing furniture, the only option may be to clear the area and have everyone get out of the way until the patient winds down. This can be difficult and scary for staff to do, but it is likely to result in less injury than trying to physically contain the patient and apply restraints. When the patient is calmer, staff can proceed with crisis communication techniques that involve the patient, and the use of seclusion or restraints has been avoided.
Prevention is always easier and more effective than reacting to episodes of violent behavior. Careful patient assessments can identify risk factors for violence including triggers, previous restraint and seclusion history, and trauma and abuse history. At the same time, effective coping strategies previously used by the individual to safely manage behavior, as well as specific directions for what staff can do to help, should be elicited and documented in the treatment plan. Patients can be involved in developing their own de-escalation or safety and support plans (including psychiatric advance directives). Gathering this information at the point of admission provides a foundation for effective partnership when circumstances present that could give rise to a behavioral emergency. "I remember you saying...." is an opening statement that sets the stage for working together.
Alternatives to Restraint and Seclusion in Mental Health Settings: Questions and Answers From Psychiatric Nurse Experts
Posted 05/03/2007
Laura Stokowski, RN, MS
from Medscape Website http://www.medscape.com/viewarticle/555686?src=mp
What Alternative Approaches Can Nurses Use to Avoid the Use of Seclusion and Restraint?
A reader asks, "What do you do when a 220-pound violent patient is throwing furniture or has already assaulted a staff member?" The first thing you should do is clear the area of others, and then remain quietly available at a safe distance until the peak of the crisis has passed. The risk of injury to both patients and staff is high when a direct verbal or physical intervention is attempted at the peak of a crisis. If a staff member has been assaulted, the staff member should be removed from the area and other staff must take the lead in intervening. A patient should not automatically be secluded or restrained following a staff assault, a response often born of fear or the conviction that the person needs "consequences." Seclusion or restraint should never be used to introduce consequences; instead, other approaches to supporting behavior change may be instituted once the crisis has passed.
Early identification of the problem and appropriate assessment of the situation are essential because different situations must be dealt with differently. Anger, fear, and frustration can all lead to violent behavior, and each calls for a specific approach. "Meet the patient where the patient is at" is a phrase commonly used to convey the need to match the approach to the patient's emotional state and to what has triggered that state.
An often overlooked but very simple crisis communication technique is to ask the patient "What would help you right now, at this moment?" It is surprising that this is a question we don't think of asking, yet it often yields a very specific and helpful response. A patient might just need clarification of a misunderstanding, some personal space, or might need to walk. Engaging the patient in the decision of how best to intervene can help them get through the situation without resorting to seclusion or restraint.
Chabora and colleagues[4] developed the Four S Model as a way of reducing the use of seclusion and restraint. The 4 S's are safety, support, structure, and symptom management. In brief:
Safety means assuring the individual's physical and emotional well-being via interventions such as modifying the environment to reduce stimuli and induce a calming ambiance.
Support involves listening and talking in a supportive way, offering comfort measures or whatever is needed according to the individual, and using verbal de-escalation.
Structure techniques, like limit setting, convey behavioral expectations and aid in constructive problem solving.
Symptom management is aimed at specific symptoms including stress and relaxation measures, diversionary activities, or medication.
The scenario described above (the 220-pound patient throwing furniture) is already an out-of-control situation. The question must be asked, what happened before this patient started throwing furniture or assaulted the staff member? At that point, engaging this patient might have led to a different outcome. When the patient is at the point of throwing furniture, the only option may be to clear the area and have everyone get out of the way until the patient winds down. This can be difficult and scary for staff to do, but it is likely to result in less injury than trying to physically contain the patient and apply restraints. When the patient is calmer, staff can proceed with crisis communication techniques that involve the patient, and the use of seclusion or restraints has been avoided.
Prevention is always easier and more effective than reacting to episodes of violent behavior. Careful patient assessments can identify risk factors for violence including triggers, previous restraint and seclusion history, and trauma and abuse history. At the same time, effective coping strategies previously used by the individual to safely manage behavior, as well as specific directions for what staff can do to help, should be elicited and documented in the treatment plan. Patients can be involved in developing their own de-escalation or safety and support plans (including psychiatric advance directives). Gathering this information at the point of admission provides a foundation for effective partnership when circumstances present that could give rise to a behavioral emergency. "I remember you saying...." is an opening statement that sets the stage for working together.
Saturday, May 05, 2007
Honey could save diabetics from amputation
MADISON, United States (AFP) - Spreading honey on a diabetic ulcer could prevent the need to amputate an infected foot, researchers say.
A doctor at the University of Wisconsin who helped about half a dozen of her diabetic patients avoid amputation has launched a controlled trial to promote the widespread use of honey therapy.
The therapy involves squeezing a thick layer of honey onto the wound after dead skin and bacteria have been removed.
The honey kills bacteria because it is acidic and avoids the complication of bacterial resistance found with standard antibiotics, Jennifer Eddy, a professor at the University's School of Medicine and Public Health, told AFP.
"This is a tremendously important issue for world health," Eddy said.
Diabetics typically have poor circulation and decreased ability to fight infection and ulcers can be hard to treat. An amputation is performed every 30 seconds somewhere in the world, Eddy said.
"If we can prove that honey promotes healing in diabetic ulcers, we can offer new hopes for many patients, not to mention the cost benefit, and the issue of bacterial resistance. The possibilities are tremendous."
Honey therapy is already used to treat bed sores in New Zealand and as an alternative form of medicine in Europe, but has largely been relegated to history books in the United States.
Eddy first heard of it in medical school when a professor commented that of all the ancient remedies, honey actually seemed to work when he tried it out in the laboratory.
She tried honey therapy as a last resort six years ago with a 79-year-old diabetic patient who had developed foot wounds resistant to standard treatments.
"I tried it only after everything else had failed and... we had essentially sent him home to die," she said. "All antibiotics were stopped when we started honey, and his wounds rapidly healed."
Eddy hopes to have the trial completed and the results published by 2008 or 2009.
http://news.yahoo.com/s/afp/20070504/hl_afp/healthscience_070504213618
A doctor at the University of Wisconsin who helped about half a dozen of her diabetic patients avoid amputation has launched a controlled trial to promote the widespread use of honey therapy.
The therapy involves squeezing a thick layer of honey onto the wound after dead skin and bacteria have been removed.
The honey kills bacteria because it is acidic and avoids the complication of bacterial resistance found with standard antibiotics, Jennifer Eddy, a professor at the University's School of Medicine and Public Health, told AFP.
"This is a tremendously important issue for world health," Eddy said.
Diabetics typically have poor circulation and decreased ability to fight infection and ulcers can be hard to treat. An amputation is performed every 30 seconds somewhere in the world, Eddy said.
"If we can prove that honey promotes healing in diabetic ulcers, we can offer new hopes for many patients, not to mention the cost benefit, and the issue of bacterial resistance. The possibilities are tremendous."
Honey therapy is already used to treat bed sores in New Zealand and as an alternative form of medicine in Europe, but has largely been relegated to history books in the United States.
Eddy first heard of it in medical school when a professor commented that of all the ancient remedies, honey actually seemed to work when he tried it out in the laboratory.
She tried honey therapy as a last resort six years ago with a 79-year-old diabetic patient who had developed foot wounds resistant to standard treatments.
"I tried it only after everything else had failed and... we had essentially sent him home to die," she said. "All antibiotics were stopped when we started honey, and his wounds rapidly healed."
Eddy hopes to have the trial completed and the results published by 2008 or 2009.
http://news.yahoo.com/s/afp/20070504/hl_afp/healthscience_070504213618
Wednesday, May 02, 2007
Hey, there's a party.............and you all are invited!
Please come to the May 24th 2007 graduation of your upper classmen, from the RN program! Soon, you will be here at this point...and believe me, it comes on so quickly, you are there before you know it!
May 24th, 2007 at 7 pm, Atherton Auditorium, Delta College
No tickets required.
A little bit of advice for you all:
Take lots of pictures! Get your slide show person nominated now, so that he/she can begin collecting pictures....we got bombarded in the end...it is easier to do it as you go along, and sadly we missed alot of our "firsts" skills labs, IV day etc...dont forget the camera everyone.
Second...we made our own yearbook. I contacted the graphic art department and asked the instructor if one of her students would like to make us a cover...and he did, his name is Voltaire and he did an incredible job...THANK YOU DELTA GRAPHICS ART PROGRAM!
Third, and not lastly...guys, truly enjoy every second. There were so many times, I wanted to run away, cry, oh and did I cry. I look back, and see how far I have come, how far we all have come, and it is truly amazing, how much you grow into your own within this program. Take care of eachother, help eachother. Smile, laugh....become a solid team all 100 of you, can help eachother. Lift up your fellow student on their bad day...give them some advice, a little time...a little kindness will go a very long way guys. Love the moments you are in, while you are in them, they only come once in a lifetime. Make every bit of the time you have with your patients, a special time...some of your patients have no other support in their illness, except for the staff...remember that in report, you will hear things about the behavior of one of your patients, you will think, " can't I have another patient?" truly....these are the patients that need you the most...a little bit of listening, patience, kindness, empathy, compassion...can change someones' life...this is the truest gift one can give...of their time, of their ability to be "in the moment", and it will change you as well.
I, and our class, wish you all the very best that nursing has to offer you all. You will all become such close friends, confidants, nurses....together. Love nursing for all it is, all it can be, all that you make it to be. Discover yourself, you will be surprised to find all the gifts that you have inside your heart to share with others. Bless the world with your peace. That stethescope, that student nurse being that you are, symbolizes hundreds of years, as the most compassionate, selfless job in the world. Honor tradition, and be proud.
May you all be blessed with good health, 72 percents, and let the pathomapping God's be with you all.
Your fellow RN 2 B
Christine Moles
Graduating class May 2007
Please come to the May 24th 2007 graduation of your upper classmen, from the RN program! Soon, you will be here at this point...and believe me, it comes on so quickly, you are there before you know it!
May 24th, 2007 at 7 pm, Atherton Auditorium, Delta College
No tickets required.
A little bit of advice for you all:
Take lots of pictures! Get your slide show person nominated now, so that he/she can begin collecting pictures....we got bombarded in the end...it is easier to do it as you go along, and sadly we missed alot of our "firsts" skills labs, IV day etc...dont forget the camera everyone.
Second...we made our own yearbook. I contacted the graphic art department and asked the instructor if one of her students would like to make us a cover...and he did, his name is Voltaire and he did an incredible job...THANK YOU DELTA GRAPHICS ART PROGRAM!
Third, and not lastly...guys, truly enjoy every second. There were so many times, I wanted to run away, cry, oh and did I cry. I look back, and see how far I have come, how far we all have come, and it is truly amazing, how much you grow into your own within this program. Take care of eachother, help eachother. Smile, laugh....become a solid team all 100 of you, can help eachother. Lift up your fellow student on their bad day...give them some advice, a little time...a little kindness will go a very long way guys. Love the moments you are in, while you are in them, they only come once in a lifetime. Make every bit of the time you have with your patients, a special time...some of your patients have no other support in their illness, except for the staff...remember that in report, you will hear things about the behavior of one of your patients, you will think, " can't I have another patient?" truly....these are the patients that need you the most...a little bit of listening, patience, kindness, empathy, compassion...can change someones' life...this is the truest gift one can give...of their time, of their ability to be "in the moment", and it will change you as well.
I, and our class, wish you all the very best that nursing has to offer you all. You will all become such close friends, confidants, nurses....together. Love nursing for all it is, all it can be, all that you make it to be. Discover yourself, you will be surprised to find all the gifts that you have inside your heart to share with others. Bless the world with your peace. That stethescope, that student nurse being that you are, symbolizes hundreds of years, as the most compassionate, selfless job in the world. Honor tradition, and be proud.
May you all be blessed with good health, 72 percents, and let the pathomapping God's be with you all.
Your fellow RN 2 B
Christine Moles
Graduating class May 2007
Tuesday, May 01, 2007
Interesting Article
To Treat the Dead
The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.
May 7, 2007 issue - Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.
But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.
Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.
© 2007 Newsweek, Inc.
By Jerry Adler
Newsweek
http://www.msnbc.msn.com/id/18368186/site/newsweek?GT1=9951
The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.
May 7, 2007 issue - Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.
But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.
Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.
© 2007 Newsweek, Inc.
By Jerry Adler
Newsweek
http://www.msnbc.msn.com/id/18368186/site/newsweek?GT1=9951
Sunday, April 29, 2007
Save the date - Info filled SNA mtg!!
SNA Meeting May 14th @ 1:00-2:00pm Locke 314
Last meeting of Spring 2007.
Rootbeer Floats and Much Needed Info!
Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Anyone interested in getting units for working while in school or gearing towards furthering your education should not miss this meeting – see you there!
Last meeting of Spring 2007.
Rootbeer Floats and Much Needed Info!
Special Guest Speakers:
Rocky La Jeunesse, Guidance and Counseling
Topic: Requirements for Transfer (LVN/PT to RN, RN to BSN)
Shelba Durston, Kymn Trujillo and Dean Alin Ciochina
Topic: Work Experience/Internship/Apprenticeship Program
Anyone interested in getting units for working while in school or gearing towards furthering your education should not miss this meeting – see you there!
Friday, April 27, 2007
Tuesday, April 24, 2007
this is cute...even if it's not Christmas time
Carols for the not so mentally healthy
stolen from Futurenurses2007 and from 3rd semester
Schizophrenia --- Do You Hear What I Hear?
Multiple Personality Disorder --- We Three Queens Disoriented Are
Dementia --- I Think I'll be Home for Christmas
Narcissistic --- Hark the Herald Angles Sing About Me
Manic --- Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Busses and Trucks and trees and Fire Hydrants and......
Paranoid --- Santa Claus is Coming to Get me
Borderline Personality Disorder --- Thoughts of Roasting on an Open Fire
Personality Disorder --- You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll tell You Why
Obsessive Compulsive Disorder ---Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells
stolen from Futurenurses2007 and from 3rd semester
Schizophrenia --- Do You Hear What I Hear?
Multiple Personality Disorder --- We Three Queens Disoriented Are
Dementia --- I Think I'll be Home for Christmas
Narcissistic --- Hark the Herald Angles Sing About Me
Manic --- Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Busses and Trucks and trees and Fire Hydrants and......
Paranoid --- Santa Claus is Coming to Get me
Borderline Personality Disorder --- Thoughts of Roasting on an Open Fire
Personality Disorder --- You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll tell You Why
Obsessive Compulsive Disorder ---Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells
Wednesday, April 18, 2007
N5 study guide #2
1. What communication techniques work best for clients rendered immobile by anxiety?
Clients with panic anxiety are out of control so they need to know that they are safe from their own impulses. Firm, short, and simple statements are useful. Use a low pitched voice, speak slowly and with repetition. Reinforce reality if distortions occur, listen for themes in communication (Varcarolis pg 216).
• Maintain a calm manner, and remain with the patient who is experiencing the severe to panic anxiety attack
• Minimize environmental stimuli (move to a quieter setting)
• Use clear simple statements and repetition in a low-pitched voice while speaking slowly
• Reinforce reality if distortions occur while listening for themes in communication
• Attend to physical and safety needs when necessary (warmth, fluids, pain, etc.)
• Safety is an overall goal, a “show of force” or use of physical limits may need to be implemented
• Provide opportunities of exercise to help dissipate tension
• Offer high caloric drinks to someone who is constantly moving and pacing
• Assess need for meds or seclusion after other interventions have failed
• If hypercapnia occurs, instruct client to take slow, deep breaths. Breathe with the patient to obtain cooperation.
• Keep expectations minimal and simpleSee also table 14-2 page 233, and table 14-5 page 237
2. What techniques are used by a crisis nurse that might not be used in a traditional therapeutic setting?
The nurse must be willing to take an active, even directive role in intervention; this is in direct contrast to what occurs in conventional therapeutic interventions, which stress a more passive and nondirective role for the practitioner (Varcarolis pg 459).
• The following are important assumptions when working with a client in crisis: The person is in charge of their life; the person is able to make decisions; the crisis counseling relationship is one between partners.
• See Table 22-4 page 465, and Box 22-1 #8 page 459
3. Differentiate between primary and secondary crisis interventions.
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. The nurse will work with the client to recognized potential problems, teach specific coping skills and evaluate life changes to decrease the negative effects of stress.
Secondary care establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the client. Then the nurse will assess the clients problem, support systems, and coping styles to lessen the time a person is mentally disabled during a crisis (Varcarolis pg 465).
4. Describe characteristics of clients manifesting escalation of aggressive behavior.
Hyperactivity: most important predictor of imminent violenceIncreasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self,Verbal abuse, profanity and argumentativeness.Loud voice: change in pitch, or very soft voice forcing others to strain to hearintense eye contact or avoidance of eye contact (Varcarolis pg 493).
• Recent acts of violence, including property violence
• Stone silence
• Alcohol or drug intoxication
• Possession of a weapon or object that may be used as a weapon
• Milieu characteristics conducive to violence: overcrowding; staff inexperience; provocative or controlling staff; poor limit setting; Arbitrary revocation of privileges
5. Discuss techniques used when staff needs to administer IM medication to an aggressive client.
A team with about five staff members is gathered and organized before approaching the client. They are equipped with medication and the right size restraint. Each member knows which limb to secure or task to perform. The team leader explains to the client in a matter of fact manner exactly what the team is about to do and why. Often the client will cooperate at this point, if not the team remains calm and acts as quickly as possible to restrain the client. Once restrained the nurse administers the IM injection (benzodiazepine, major tranquilizer, or antihistamine). The nurse provides an explanation to the client of the medication. Throughout the whole process the team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency and control (Varcarolis pg 496).
• The nurse’s role is to provide an explanation to the client for the medication and to make sure the client is properly restrained so that the medication can be safely administered.
• The team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency, and control.
• Prior to medication administration, the client needs to be restrained and in doing so each team member needs to have proper training
• The approach needs to be organized with each team member knowing what their role is
• Also make sure to appropriate sized equipment is ready
• The team leader explains to the client in a matter-of-fact manner exactly what the team is about to do and why; this may provoke the client to cooperate or move into a seclusion room
• Refer to Box 24-3 page 497 for some other guidelines to restraint.
6. Describe aspects of a unit milieu that decreases likelihood of violent behavior.
The following are to be avoided to decrease likelihood of violence:Overcrowding.Staff inexperience.Provocative or controlling staff.Poor limit setting.Arbitrary revocation of privileges (Varcarolis pg 493).
• You want to make sure that the environment provides enough space for clients to prevent overcrowding.
• There also needs to be a balance between structure and quiet time
• Staff should be provided education in verbal de-escalation techniques
• Counseling of staff regarding the use of punitive and arbitrary approaches to clients
• The need to look for escalating events and how to provide immediate intervention to prevent overt violence (deescalating techniques, restraints/seclusion, and/or medication)
• Provide the client with the tools via psychotherapeutic approaches to the client new skills for handling anger.
• See box 24-2 page 496 for deescalating techniques, and refer to questions 5 and 6
7. Discuss reasons for seclusion and restraint as well as priority actions by a nurse caring for a client who has been restrained and secluded.
Seclusion or restraint is used in the following circumstances:
Ø Alternative interventions have been tried (documented) and failed. These include; verbal intervention, behavioral care plan, medication, decrease in sensory stimulation, removal of problematic stimulus, presence of significant other, frequent observation, and one-on-one observation of client.
Ø The client presents clear and present danger to self or
Ø The client presents a clear and present danger to others or
Ø The client has been legally detained for involuntary treatment and is thought to pose an escape risk or
Ø The client requests to be secluded or restrained.Priority actions by the nurse caring for a restrained or secluded client include:
Ø Be sure to receive or maintain an updated Physician’s Order for the restraint.
Ø Have nurse in constant attendance.
Ø Complete written record every 15 minutes.
Ø Release limb from restraint every 2 hours.
Ø Stretch limb through range of movement.
Ø Monitory vital signs, observe blood flow.
Ø Observe that restraint is not rubbing.
Ø Provide for nutrition, hydration, and elimination.
Ø Closely monitor client to determine the client’s ability to reintegrate into the unit activities (Varcarolis pg 497).
8. Differentiate between child abuse and neglect.
Child abuse is a broad category, which includes battering, neglect, physical endangerment, and sexual abuse.
Child neglect is either physical (failure to provide medical, dental, or psychiatric care needed to prevent or treat physical or emotional illnesses), developmental (failure to provide emotional nurturing or the physical or cognitive stimulation needed to ensure freedom from developmental deficits), or educational (failure to provide education in accordance with state law) (Varcarolis pg 511,786).
• Physical violence: is the infliction of physical pain or bodily harm
• Sexual violence: is any form of sexual contact or exposure without consent, or in circumstances in which the victim is incapable of giving consent (childhood sexual abuse destroys an individual’s positive self-concept and can interfere with the learning of self care skills)
• Emotional violence: is the infliction of mental anguish and take the form in the following; terrorizing through verbal threats; demeaning an individuals self worth; directing blatant or subtle hostility and hatred; persistently ignoring an individuals needs; consistently belittling and criticizing an individual; with holding warmth and affections; threatening an individual with abandonment or institutionalization.
• Neglect: can be physical, developmental, or educational.
• Physical neglect: failure to provide the medical, dental, or psychiatric care needed to prevent or treat physical or emotional illness
• Developmental neglect: failure to provide emotional nurturing and the physical and cognitive stimulation needed to ensure freedom from development deficits
• Educational neglect: when a child’s caretakers deprive the child of the education available in accordance with the state’s education laws.
9. Describe the cycle of violence and assessment priorities for a nurse caring for a victim of physical abuse.
Periods of intense violence alternate with periods of safety, hope, and trust during three phases known as the cycle of violence.
Ø Tension building stage is characterized by minor incidents such as pushing, shoving, and verbal abuse.
Ø Acute battering stage involves a serious battering incident where the perpetrator releases the build-up tension by brutal and uncontrollable beatings.
Ø Honeymoon Stage is characterized with kindness and loving behaviors. The perpetrator feels remorseful, is apologetic, brings gifts and makes promises to change
(Varcarolis pg 511).
Assessment priorities for a victim of physical abuse include
Ø A series of minor complaints such as headaches, back trouble, dizziness, accidents or falls.
Ø Bruising, scars, burns, and wounds around head face, chest, arms, abdomen, back, buttocks and genitalia.
Ø Be wary if the explanation does mot match the injury or if the client minimizes the seriousness of the injury, a high index of suspicion is key.
Ø Bruises on an infant younger than 6 months is suspicious, shaken baby syndrome is frequently overlooked and manifest as an abnormal pulmonary examination, or head circumference greater then 90th percentile.
Ø Nonverbal responses are also important such as hesitation or lack of eye contact (Varcarolis pg 514).
o Escalating-deescalating: conditions of anger and fear escalate until an incident of violence takes place, after which there is a defusing of tension and a brief feeling of safety; victims over time believe that the beatings are deserved and accept blame.
• Important interviewing guidelines are listed in box 25-4 page 512
• Priorities that should take place are initially started with safety and addressing any signs/ symptoms of the traumatic injuries that were inflicted during the incident. Should utilize the “Abuse Assessment Screen” found on page 517, figure 25-2
• Assess for potential problems in vulnerable families
• Physical, sexual, and/or emotional abuse and neglect, and economic maltreatment in family should be assessed
• Observe what family coping patterns are present
• Assess the client’s support system
• Assess for drug/ alcohol abuse
• Are there any suicidal or homicidal ideation
• Is post traumatic stress disorder present?
• Appropriate agencies need to be contacted to handle the matter.
10. Know the priority nursing diagnoses for clients with Alzheimer’s disease who may be suffering from abuse.
Risk for injury related to helplessness as evidenced by signs of violence
Page 510, table 25-3 on page 518.
• Elderly adults may become vulnerable because they are in poor mental and/pr physical health, or are disruptive (i.e. an Alzheimer client)
• There is a dependency need upon caretakers which places the client at risk for abuse.
• Refer to questions 8 and 9 for addition information
• View page 518, under Nursing diagnosis for potential Dx in the Elderly
• Some might include: Risk for injury; Anxiety; Fear; Disabled family coping; Interrupted family process; pain related to physical injuries.
• See also box 25-3 page 518 for potential nursing Dx in family violence
11. Differentiate between mild, moderate, severe, and panic levels of anxiety in victims of abuse.
Mild anxiety occurs in the normal experience of everyday living, the person’s ability to perceive reality is brought into sharp focus. A person may display physical symptoms such as slight discomfort, restlessness, irritability, or mild tension relieving behaviors.
Moderate anxiety causes perceptual field to narrow and some details are excluded from observation. The person will see, hear, and grasp less information than normal. Physical symptoms include tension, pounding hearth, increased pulse and respiration rate along with mild somatic symptoms.
Severe anxiety causes the perceptual field to be greatly reduced. The person may focus on one particular detail or many scattered details. Behavior is autonomic and the person may complain of increased severity of somatic symptoms along with trembling, pounding heart and hyperventilation.
Panic Level anxiety is the most extreme form and results in markedly disturbed behavior. The person is not able to process what is going on in the environment and may lose touch with reality (ie screaming or hallucinations) (Varcarolis pg 213-215).
12. Discuss priority assessments and discharge instructions for rape victims in emergency departments.
Assessment guidelines include
Ø Assess psychological trauma. Write down verbatim statements of the client.
Ø Assess level of anxiety
Ø Assess physical trauma. Use a body map and ask permission to take photos
Ø Assess available support system. Often partners or family members do not understand the trauma of rape and may not be the best supports to draw on.
Ø Identify community supports (attorneys, support groups, therapists) ect
Ø Encourage the client to tell his or her experience. Do not press the client to tell (Varcarolis pg 536).
Because the ramifications of rape are experienced for an extended time after the acute phase discharge instructions must include information for follow-up care. In addition information on likely physical concerns, emotional reactions, legal matters, victim compensation, and ways that the family and friends can help should be provided. Everything must be in writing since the amount of verbal information the client can retain may be limited due to anxiety. (Varcarolis pg 537-538).
13. Describe key features of the following disorders:
Anxiety disorders: Anxiety becomes a problem when it interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level. The client with an anxiety disorder will use rigid, repetitive, and ineffective behaviors to try and control anxiety. The anxiety is so high that it interferes with personal, occupational, or social functioning (Varcarolis pg 228).
Ø Agoraphobia: Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred. Feared places are normally avoided. This avoidance behavior can be debilitating and life constricting. (Varcarolis pg 234).
Ø Obsessive-compulsive disorder: Obsessions or compulsions cause marked distress to the individual, rituals are performed to relieve anxiety. The rituals are time consuming and interfere with normal routine, social activities, and relationships with others. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed in the mind (think of a song stuck in your head). Compulsions are ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety (this decreases the anxiety temporarily until the compulsive act needs to be repeated). Table 14-4 page 235 shows common traits. These clients are humiliated by their acts but they cannot control it. (Varcarolis pg 234).
Ø Post-traumatic stress disorder: Repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others. Symptoms often begin within 3 months after the trauma but a delay of years is not uncommon. Post-traumatic stress disorder: characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others with intense fear, helplessness, and horror. Usually 3 months after the event occurred and has a couple of key features: Persistent re-experiencing (flashbacks); persistent avoidance of stimuli associated with the trauma; experience persistent numbing of general responsiveness (detached from others, feeling empty inside); also a persistent increased arousal (difficulty sleeping, difficulty concentrating, hypervigilance, or startled responses). There are issues of trust, and also chemical abuse involved. (Varcarolis pg 236).
Ø Social phobias: (Social anxiety disorder) is a severe anxiety or fear provoked by exposure to a social situation or a performance situation. Fear of public speaking is the most common social phobia (Varcarolis pg 234).
Ø Panic attacks: Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom. The feelings of terror present are so severe that normal function is suspended. People experiencing panic attacks believe they are losing their minds or having a heart attack. Usually come out of the blue. (Varcarolis pg 232).
Somatoform disorder: Physical symptoms suggest a physical disorder for which there is no demonstrable base. There is a strong presumption that the symptoms are linked to psychobiological factors (Varcarolis pg 253).
Ø Conversion disorder: Development of one or more symptoms or deficits suggesting a neurological disorder (blindness, deafness, loss of touch) but which is NOT due to a general medical condition, a malingering or factitious disorder and is not culturally sanctioned. Symptoms are associated with psychological factors and are initiated or exacerbated by psychological stressors. They are not caused by a substance. Significant impairment is present (Varcarolis pg 255).
Ø Hypochondriasis: For at least 6 months preoccupation with fears of having a serious disease, these persist despite appropriate medical tests and reassurances. Other disorders are ruled out (somatic delusional disorders) and significant impairment in social or occupational functioning or marked distress is present (Varcarolis pg 255).
Ø Somatoform pain disorder: Pain in one or more anatomical sites which causes significant impairment in occupational or social functioning or marked distress. The pain is associated with psychological factors and is not intentionally produced or feigned (Varcarolis pg 255)
.Ø Body dysmorphic disorder (BDD): Preoccupation with some imagined defect in appearance, or excessive concern over a minor defect that is present. Preoccupation causes significant impairment and is not better accounted for by another mental disorder (Varcarolis pg 255).
Personality disorders: An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (Varcarolis 275-276).
Ø Paranoid: Distrust and suspiciousness towards others, based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. They are hyper-vigilant, anticipate hostility and may provoke hostile responses. They are difficult to interview and, underneath the surface, are quite anxious about being harmed (Varcarolis 280).
Ø Schizoid: Is emotionally detached and does not seek out or enjoy close relationships (Varcarolis 280)
Ø Schizotypal: Odd beliefs lead to interpersonal difficulties. The client has an eccentric appearance and shows evidence of magical thinking or perceptual distortions. The client cannot understand the usual interpersonal cues in social situations and thus relates to others inappropriately. The person is more likely to seek psychiatric help then those with Schizoid PD because of the intense anxiety felt in social relationships (Varcarolis 280).
Ø Borderline: Instability in affect, identity, and relationships. Individuals desperately seek relationships to avoid feeling abandoned however often drive others away because of their excessive demands. Multiple dramatic suicidal gestures may be present and risk of suicide is increased (Varcarolis 282).
Ø Narcissistic: Arrogance with a grandiose view of self-importance. The person has a need for constant admiration along with a lack of empathy for others. Underneath the surface of arrogance they feel intense shame and fear that if they are bad they will be abandoned and are afraid of their mistakes (Varcarolis 284).
Ø Histrionic: Emotional attention-seeking behavior, in which the person needs to be the center of attention. The person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight (Varcarolis 282).
Ø Dependent: Extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends. The person has difficulty making independent decisions and are constantly seeking reassurance. Their submissiveness makes them vulnerable to abusive relationships. (Varcarolis 284).
Ø Obsessive-compulsive: Perfectionism with a focus on orderlineness and control. The person becomes so preoccupied with details and rules that they may not be able to accomplish a given task. They do not have full blown obsessions or compulsions but do not have insight about their own difficult behavior (Varcarolis 286).
14. Describe complications of re-feeding syndrome in clients with anorexia nervosa.
A potentially catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiovascular collapse (Varcarolis 308).
15. Discuss binge-purge syndrome and likely triggering factors.
This typically has a binge eating behavior (eating till they are literally stuffed) followed by self induced vomiting (laxatives and diuretics can also be used). There are depressive signs and symptoms and have problems with: Interpersonal relationships; problems with self concept; and problems with impulsive behavior. There is increased level of anxiety and compulsivity, possible chemical dependence, and compulsive stealing. They can be found to have 5-8 episodes per night of the binge eating followed by the purging.
• Refer to table 17-1 for phenomena surrounding bulimia on page 303, also refer to box 17-1 on page 304 for some medical complications
16. Name some physical assessment findings in the client with severe anorexia nervosa.
Low weight, amenorrhea, yellow skin, lanugo, cold extremities, peripheral edema, muscle weakening, constipation, hypotension, bradycardia, heart failure, kapokalemia, anemic pancytopenia, and decreased bone density (Varcarolis 302).
17. Describe the defense mechanism of splitting and circumstances that provoke its use.
Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of self or others tend to alternate between opposite poles either all good or all bad. This defense mechanism is prevalent in personality disorders, especially the borderline ones (Varcarolis pg 282).
• Splitting usually takes place when a client tries to be manipulative to get there way and will use flattery, seductiveness, even instilling guilt to get there way. The second the nurse does not provide what the client desires then splitting takes place. Staff splitting can occur because of the clients which is why it is important to have supervision over the staff to monitor for splitting and have debriefing once a week to prevent it.
• Read Case study and plan of care 16-1 on page 290 to get a better picture of a borderline client
18. List pertinent client education for those who are prescribed alprazolam (Xanax) for acute anxiety disorders.
The medication reduces the ability to handle mechanical equipment, do not drink alcohol or take other anti-anxiety drugs because depressant effects can be potentiated and avoid caffeine. Avoid becoming pregnant because the drug increases the risk for congenital anomalies, do not breast feed because the drug can be excreted in the milk. Cessation may cause withdrawal symptoms, take with food or shortly after to reduce gastrointestinal discomfort. Antacids delay absorption, cimetidine interferes with metabolism, alcohol and barbituarates can cause increased sedation (Varcarolis pg 246).
19. Name a drug that might be prescribed for the social phobia – fear of public speaking.
Antidepressant Selective serotonin reuptake inhibitors are the first line treatment for anxiety disorders because they have a more rapid onset of action and fewer problematic side effects then alternatives. Keltner mentions Paroxetine (Paxil) and Sertraline (Zoloft) specifically. Fluoxetine (Prozac) is our prototype drug in that class (Keltner pg 251).
20. Discuss the drug buspirone (Buspar) and contrast it with the drug diazepam (Valium) for those clients with anxiety.
Buspirone (Buspar) is a nonbezodiazepine anxiolytic used to treat anxiety disorders. It does not cause dependence and so can be used by clients with known substance abuse problems. It does however take 2-4 weeks for full effects; it may be used for long-term treatment and must be taken regularly. In contrast diazepam (Valium), an anxiolytic benzodiazepine has a rapid onset of action but has the potential for dependence. It can cause sedation, impair performance, and is associated with falls in elderly. It is ideal for short periods until other medication or treatments reduces symptoms (Keltner pg 237).
• Buspar is a drug that reduces anxiety without having strong sedative-hypnotic properties
• It is much better tolerated than benzodiazepines because it does not induce sleepiness.
• Since it is not a CNS depressant, it will not have adverse affects with other depressants
• It seems to act as an antagonist to presynaptic serotonin receptors, thus stopping the negative feedback mechanism which usually stops the secretion of serotonin. By stopping this feedback, there is a greater amount of serotonin in the synaptic cleft. Which presumably accounts for its benefit of decreased anxiety.
• Valium is a benzodiazepine which acts as a depressant and can cause significant adverse affects if mixed with other depressants.
• This drug works by binding to GABA receptors to help increase the infinity of GABA, thus increasing the affects of GABA (only works if GABA is present, unlike Buspar which does not have this stipulation).
Clients with panic anxiety are out of control so they need to know that they are safe from their own impulses. Firm, short, and simple statements are useful. Use a low pitched voice, speak slowly and with repetition. Reinforce reality if distortions occur, listen for themes in communication (Varcarolis pg 216).
• Maintain a calm manner, and remain with the patient who is experiencing the severe to panic anxiety attack
• Minimize environmental stimuli (move to a quieter setting)
• Use clear simple statements and repetition in a low-pitched voice while speaking slowly
• Reinforce reality if distortions occur while listening for themes in communication
• Attend to physical and safety needs when necessary (warmth, fluids, pain, etc.)
• Safety is an overall goal, a “show of force” or use of physical limits may need to be implemented
• Provide opportunities of exercise to help dissipate tension
• Offer high caloric drinks to someone who is constantly moving and pacing
• Assess need for meds or seclusion after other interventions have failed
• If hypercapnia occurs, instruct client to take slow, deep breaths. Breathe with the patient to obtain cooperation.
• Keep expectations minimal and simpleSee also table 14-2 page 233, and table 14-5 page 237
2. What techniques are used by a crisis nurse that might not be used in a traditional therapeutic setting?
The nurse must be willing to take an active, even directive role in intervention; this is in direct contrast to what occurs in conventional therapeutic interventions, which stress a more passive and nondirective role for the practitioner (Varcarolis pg 459).
• The following are important assumptions when working with a client in crisis: The person is in charge of their life; the person is able to make decisions; the crisis counseling relationship is one between partners.
• See Table 22-4 page 465, and Box 22-1 #8 page 459
3. Differentiate between primary and secondary crisis interventions.
Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. The nurse will work with the client to recognized potential problems, teach specific coping skills and evaluate life changes to decrease the negative effects of stress.
Secondary care establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the client. Then the nurse will assess the clients problem, support systems, and coping styles to lessen the time a person is mentally disabled during a crisis (Varcarolis pg 465).
4. Describe characteristics of clients manifesting escalation of aggressive behavior.
Hyperactivity: most important predictor of imminent violenceIncreasing anxiety and tension: clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self,Verbal abuse, profanity and argumentativeness.Loud voice: change in pitch, or very soft voice forcing others to strain to hearintense eye contact or avoidance of eye contact (Varcarolis pg 493).
• Recent acts of violence, including property violence
• Stone silence
• Alcohol or drug intoxication
• Possession of a weapon or object that may be used as a weapon
• Milieu characteristics conducive to violence: overcrowding; staff inexperience; provocative or controlling staff; poor limit setting; Arbitrary revocation of privileges
5. Discuss techniques used when staff needs to administer IM medication to an aggressive client.
A team with about five staff members is gathered and organized before approaching the client. They are equipped with medication and the right size restraint. Each member knows which limb to secure or task to perform. The team leader explains to the client in a matter of fact manner exactly what the team is about to do and why. Often the client will cooperate at this point, if not the team remains calm and acts as quickly as possible to restrain the client. Once restrained the nurse administers the IM injection (benzodiazepine, major tranquilizer, or antihistamine). The nurse provides an explanation to the client of the medication. Throughout the whole process the team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency and control (Varcarolis pg 496).
• The nurse’s role is to provide an explanation to the client for the medication and to make sure the client is properly restrained so that the medication can be safely administered.
• The team leader continues to relate to the client in a calm, steady voice, communicating decisiveness, consistency, and control.
• Prior to medication administration, the client needs to be restrained and in doing so each team member needs to have proper training
• The approach needs to be organized with each team member knowing what their role is
• Also make sure to appropriate sized equipment is ready
• The team leader explains to the client in a matter-of-fact manner exactly what the team is about to do and why; this may provoke the client to cooperate or move into a seclusion room
• Refer to Box 24-3 page 497 for some other guidelines to restraint.
6. Describe aspects of a unit milieu that decreases likelihood of violent behavior.
The following are to be avoided to decrease likelihood of violence:Overcrowding.Staff inexperience.Provocative or controlling staff.Poor limit setting.Arbitrary revocation of privileges (Varcarolis pg 493).
• You want to make sure that the environment provides enough space for clients to prevent overcrowding.
• There also needs to be a balance between structure and quiet time
• Staff should be provided education in verbal de-escalation techniques
• Counseling of staff regarding the use of punitive and arbitrary approaches to clients
• The need to look for escalating events and how to provide immediate intervention to prevent overt violence (deescalating techniques, restraints/seclusion, and/or medication)
• Provide the client with the tools via psychotherapeutic approaches to the client new skills for handling anger.
• See box 24-2 page 496 for deescalating techniques, and refer to questions 5 and 6
7. Discuss reasons for seclusion and restraint as well as priority actions by a nurse caring for a client who has been restrained and secluded.
Seclusion or restraint is used in the following circumstances:
Ø Alternative interventions have been tried (documented) and failed. These include; verbal intervention, behavioral care plan, medication, decrease in sensory stimulation, removal of problematic stimulus, presence of significant other, frequent observation, and one-on-one observation of client.
Ø The client presents clear and present danger to self or
Ø The client presents a clear and present danger to others or
Ø The client has been legally detained for involuntary treatment and is thought to pose an escape risk or
Ø The client requests to be secluded or restrained.Priority actions by the nurse caring for a restrained or secluded client include:
Ø Be sure to receive or maintain an updated Physician’s Order for the restraint.
Ø Have nurse in constant attendance.
Ø Complete written record every 15 minutes.
Ø Release limb from restraint every 2 hours.
Ø Stretch limb through range of movement.
Ø Monitory vital signs, observe blood flow.
Ø Observe that restraint is not rubbing.
Ø Provide for nutrition, hydration, and elimination.
Ø Closely monitor client to determine the client’s ability to reintegrate into the unit activities (Varcarolis pg 497).
8. Differentiate between child abuse and neglect.
Child abuse is a broad category, which includes battering, neglect, physical endangerment, and sexual abuse.
Child neglect is either physical (failure to provide medical, dental, or psychiatric care needed to prevent or treat physical or emotional illnesses), developmental (failure to provide emotional nurturing or the physical or cognitive stimulation needed to ensure freedom from developmental deficits), or educational (failure to provide education in accordance with state law) (Varcarolis pg 511,786).
• Physical violence: is the infliction of physical pain or bodily harm
• Sexual violence: is any form of sexual contact or exposure without consent, or in circumstances in which the victim is incapable of giving consent (childhood sexual abuse destroys an individual’s positive self-concept and can interfere with the learning of self care skills)
• Emotional violence: is the infliction of mental anguish and take the form in the following; terrorizing through verbal threats; demeaning an individuals self worth; directing blatant or subtle hostility and hatred; persistently ignoring an individuals needs; consistently belittling and criticizing an individual; with holding warmth and affections; threatening an individual with abandonment or institutionalization.
• Neglect: can be physical, developmental, or educational.
• Physical neglect: failure to provide the medical, dental, or psychiatric care needed to prevent or treat physical or emotional illness
• Developmental neglect: failure to provide emotional nurturing and the physical and cognitive stimulation needed to ensure freedom from development deficits
• Educational neglect: when a child’s caretakers deprive the child of the education available in accordance with the state’s education laws.
9. Describe the cycle of violence and assessment priorities for a nurse caring for a victim of physical abuse.
Periods of intense violence alternate with periods of safety, hope, and trust during three phases known as the cycle of violence.
Ø Tension building stage is characterized by minor incidents such as pushing, shoving, and verbal abuse.
Ø Acute battering stage involves a serious battering incident where the perpetrator releases the build-up tension by brutal and uncontrollable beatings.
Ø Honeymoon Stage is characterized with kindness and loving behaviors. The perpetrator feels remorseful, is apologetic, brings gifts and makes promises to change
(Varcarolis pg 511).
Assessment priorities for a victim of physical abuse include
Ø A series of minor complaints such as headaches, back trouble, dizziness, accidents or falls.
Ø Bruising, scars, burns, and wounds around head face, chest, arms, abdomen, back, buttocks and genitalia.
Ø Be wary if the explanation does mot match the injury or if the client minimizes the seriousness of the injury, a high index of suspicion is key.
Ø Bruises on an infant younger than 6 months is suspicious, shaken baby syndrome is frequently overlooked and manifest as an abnormal pulmonary examination, or head circumference greater then 90th percentile.
Ø Nonverbal responses are also important such as hesitation or lack of eye contact (Varcarolis pg 514).
o Escalating-deescalating: conditions of anger and fear escalate until an incident of violence takes place, after which there is a defusing of tension and a brief feeling of safety; victims over time believe that the beatings are deserved and accept blame.
• Important interviewing guidelines are listed in box 25-4 page 512
• Priorities that should take place are initially started with safety and addressing any signs/ symptoms of the traumatic injuries that were inflicted during the incident. Should utilize the “Abuse Assessment Screen” found on page 517, figure 25-2
• Assess for potential problems in vulnerable families
• Physical, sexual, and/or emotional abuse and neglect, and economic maltreatment in family should be assessed
• Observe what family coping patterns are present
• Assess the client’s support system
• Assess for drug/ alcohol abuse
• Are there any suicidal or homicidal ideation
• Is post traumatic stress disorder present?
• Appropriate agencies need to be contacted to handle the matter.
10. Know the priority nursing diagnoses for clients with Alzheimer’s disease who may be suffering from abuse.
Risk for injury related to helplessness as evidenced by signs of violence
Page 510, table 25-3 on page 518.
• Elderly adults may become vulnerable because they are in poor mental and/pr physical health, or are disruptive (i.e. an Alzheimer client)
• There is a dependency need upon caretakers which places the client at risk for abuse.
• Refer to questions 8 and 9 for addition information
• View page 518, under Nursing diagnosis for potential Dx in the Elderly
• Some might include: Risk for injury; Anxiety; Fear; Disabled family coping; Interrupted family process; pain related to physical injuries.
• See also box 25-3 page 518 for potential nursing Dx in family violence
11. Differentiate between mild, moderate, severe, and panic levels of anxiety in victims of abuse.
Mild anxiety occurs in the normal experience of everyday living, the person’s ability to perceive reality is brought into sharp focus. A person may display physical symptoms such as slight discomfort, restlessness, irritability, or mild tension relieving behaviors.
Moderate anxiety causes perceptual field to narrow and some details are excluded from observation. The person will see, hear, and grasp less information than normal. Physical symptoms include tension, pounding hearth, increased pulse and respiration rate along with mild somatic symptoms.
Severe anxiety causes the perceptual field to be greatly reduced. The person may focus on one particular detail or many scattered details. Behavior is autonomic and the person may complain of increased severity of somatic symptoms along with trembling, pounding heart and hyperventilation.
Panic Level anxiety is the most extreme form and results in markedly disturbed behavior. The person is not able to process what is going on in the environment and may lose touch with reality (ie screaming or hallucinations) (Varcarolis pg 213-215).
12. Discuss priority assessments and discharge instructions for rape victims in emergency departments.
Assessment guidelines include
Ø Assess psychological trauma. Write down verbatim statements of the client.
Ø Assess level of anxiety
Ø Assess physical trauma. Use a body map and ask permission to take photos
Ø Assess available support system. Often partners or family members do not understand the trauma of rape and may not be the best supports to draw on.
Ø Identify community supports (attorneys, support groups, therapists) ect
Ø Encourage the client to tell his or her experience. Do not press the client to tell (Varcarolis pg 536).
Because the ramifications of rape are experienced for an extended time after the acute phase discharge instructions must include information for follow-up care. In addition information on likely physical concerns, emotional reactions, legal matters, victim compensation, and ways that the family and friends can help should be provided. Everything must be in writing since the amount of verbal information the client can retain may be limited due to anxiety. (Varcarolis pg 537-538).
13. Describe key features of the following disorders:
Anxiety disorders: Anxiety becomes a problem when it interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level. The client with an anxiety disorder will use rigid, repetitive, and ineffective behaviors to try and control anxiety. The anxiety is so high that it interferes with personal, occupational, or social functioning (Varcarolis pg 228).
Ø Agoraphobia: Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred. Feared places are normally avoided. This avoidance behavior can be debilitating and life constricting. (Varcarolis pg 234).
Ø Obsessive-compulsive disorder: Obsessions or compulsions cause marked distress to the individual, rituals are performed to relieve anxiety. The rituals are time consuming and interfere with normal routine, social activities, and relationships with others. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed in the mind (think of a song stuck in your head). Compulsions are ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety (this decreases the anxiety temporarily until the compulsive act needs to be repeated). Table 14-4 page 235 shows common traits. These clients are humiliated by their acts but they cannot control it. (Varcarolis pg 234).
Ø Post-traumatic stress disorder: Repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others. Symptoms often begin within 3 months after the trauma but a delay of years is not uncommon. Post-traumatic stress disorder: characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others with intense fear, helplessness, and horror. Usually 3 months after the event occurred and has a couple of key features: Persistent re-experiencing (flashbacks); persistent avoidance of stimuli associated with the trauma; experience persistent numbing of general responsiveness (detached from others, feeling empty inside); also a persistent increased arousal (difficulty sleeping, difficulty concentrating, hypervigilance, or startled responses). There are issues of trust, and also chemical abuse involved. (Varcarolis pg 236).
Ø Social phobias: (Social anxiety disorder) is a severe anxiety or fear provoked by exposure to a social situation or a performance situation. Fear of public speaking is the most common social phobia (Varcarolis pg 234).
Ø Panic attacks: Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom. The feelings of terror present are so severe that normal function is suspended. People experiencing panic attacks believe they are losing their minds or having a heart attack. Usually come out of the blue. (Varcarolis pg 232).
Somatoform disorder: Physical symptoms suggest a physical disorder for which there is no demonstrable base. There is a strong presumption that the symptoms are linked to psychobiological factors (Varcarolis pg 253).
Ø Conversion disorder: Development of one or more symptoms or deficits suggesting a neurological disorder (blindness, deafness, loss of touch) but which is NOT due to a general medical condition, a malingering or factitious disorder and is not culturally sanctioned. Symptoms are associated with psychological factors and are initiated or exacerbated by psychological stressors. They are not caused by a substance. Significant impairment is present (Varcarolis pg 255).
Ø Hypochondriasis: For at least 6 months preoccupation with fears of having a serious disease, these persist despite appropriate medical tests and reassurances. Other disorders are ruled out (somatic delusional disorders) and significant impairment in social or occupational functioning or marked distress is present (Varcarolis pg 255).
Ø Somatoform pain disorder: Pain in one or more anatomical sites which causes significant impairment in occupational or social functioning or marked distress. The pain is associated with psychological factors and is not intentionally produced or feigned (Varcarolis pg 255)
.Ø Body dysmorphic disorder (BDD): Preoccupation with some imagined defect in appearance, or excessive concern over a minor defect that is present. Preoccupation causes significant impairment and is not better accounted for by another mental disorder (Varcarolis pg 255).
Personality disorders: An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (Varcarolis 275-276).
Ø Paranoid: Distrust and suspiciousness towards others, based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. They are hyper-vigilant, anticipate hostility and may provoke hostile responses. They are difficult to interview and, underneath the surface, are quite anxious about being harmed (Varcarolis 280).
Ø Schizoid: Is emotionally detached and does not seek out or enjoy close relationships (Varcarolis 280)
Ø Schizotypal: Odd beliefs lead to interpersonal difficulties. The client has an eccentric appearance and shows evidence of magical thinking or perceptual distortions. The client cannot understand the usual interpersonal cues in social situations and thus relates to others inappropriately. The person is more likely to seek psychiatric help then those with Schizoid PD because of the intense anxiety felt in social relationships (Varcarolis 280).
Ø Borderline: Instability in affect, identity, and relationships. Individuals desperately seek relationships to avoid feeling abandoned however often drive others away because of their excessive demands. Multiple dramatic suicidal gestures may be present and risk of suicide is increased (Varcarolis 282).
Ø Narcissistic: Arrogance with a grandiose view of self-importance. The person has a need for constant admiration along with a lack of empathy for others. Underneath the surface of arrogance they feel intense shame and fear that if they are bad they will be abandoned and are afraid of their mistakes (Varcarolis 284).
Ø Histrionic: Emotional attention-seeking behavior, in which the person needs to be the center of attention. The person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight (Varcarolis 282).
Ø Dependent: Extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends. The person has difficulty making independent decisions and are constantly seeking reassurance. Their submissiveness makes them vulnerable to abusive relationships. (Varcarolis 284).
Ø Obsessive-compulsive: Perfectionism with a focus on orderlineness and control. The person becomes so preoccupied with details and rules that they may not be able to accomplish a given task. They do not have full blown obsessions or compulsions but do not have insight about their own difficult behavior (Varcarolis 286).
14. Describe complications of re-feeding syndrome in clients with anorexia nervosa.
A potentially catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiovascular collapse (Varcarolis 308).
15. Discuss binge-purge syndrome and likely triggering factors.
This typically has a binge eating behavior (eating till they are literally stuffed) followed by self induced vomiting (laxatives and diuretics can also be used). There are depressive signs and symptoms and have problems with: Interpersonal relationships; problems with self concept; and problems with impulsive behavior. There is increased level of anxiety and compulsivity, possible chemical dependence, and compulsive stealing. They can be found to have 5-8 episodes per night of the binge eating followed by the purging.
• Refer to table 17-1 for phenomena surrounding bulimia on page 303, also refer to box 17-1 on page 304 for some medical complications
16. Name some physical assessment findings in the client with severe anorexia nervosa.
Low weight, amenorrhea, yellow skin, lanugo, cold extremities, peripheral edema, muscle weakening, constipation, hypotension, bradycardia, heart failure, kapokalemia, anemic pancytopenia, and decreased bone density (Varcarolis 302).
17. Describe the defense mechanism of splitting and circumstances that provoke its use.
Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of self or others tend to alternate between opposite poles either all good or all bad. This defense mechanism is prevalent in personality disorders, especially the borderline ones (Varcarolis pg 282).
• Splitting usually takes place when a client tries to be manipulative to get there way and will use flattery, seductiveness, even instilling guilt to get there way. The second the nurse does not provide what the client desires then splitting takes place. Staff splitting can occur because of the clients which is why it is important to have supervision over the staff to monitor for splitting and have debriefing once a week to prevent it.
• Read Case study and plan of care 16-1 on page 290 to get a better picture of a borderline client
18. List pertinent client education for those who are prescribed alprazolam (Xanax) for acute anxiety disorders.
The medication reduces the ability to handle mechanical equipment, do not drink alcohol or take other anti-anxiety drugs because depressant effects can be potentiated and avoid caffeine. Avoid becoming pregnant because the drug increases the risk for congenital anomalies, do not breast feed because the drug can be excreted in the milk. Cessation may cause withdrawal symptoms, take with food or shortly after to reduce gastrointestinal discomfort. Antacids delay absorption, cimetidine interferes with metabolism, alcohol and barbituarates can cause increased sedation (Varcarolis pg 246).
19. Name a drug that might be prescribed for the social phobia – fear of public speaking.
Antidepressant Selective serotonin reuptake inhibitors are the first line treatment for anxiety disorders because they have a more rapid onset of action and fewer problematic side effects then alternatives. Keltner mentions Paroxetine (Paxil) and Sertraline (Zoloft) specifically. Fluoxetine (Prozac) is our prototype drug in that class (Keltner pg 251).
20. Discuss the drug buspirone (Buspar) and contrast it with the drug diazepam (Valium) for those clients with anxiety.
Buspirone (Buspar) is a nonbezodiazepine anxiolytic used to treat anxiety disorders. It does not cause dependence and so can be used by clients with known substance abuse problems. It does however take 2-4 weeks for full effects; it may be used for long-term treatment and must be taken regularly. In contrast diazepam (Valium), an anxiolytic benzodiazepine has a rapid onset of action but has the potential for dependence. It can cause sedation, impair performance, and is associated with falls in elderly. It is ideal for short periods until other medication or treatments reduces symptoms (Keltner pg 237).
• Buspar is a drug that reduces anxiety without having strong sedative-hypnotic properties
• It is much better tolerated than benzodiazepines because it does not induce sleepiness.
• Since it is not a CNS depressant, it will not have adverse affects with other depressants
• It seems to act as an antagonist to presynaptic serotonin receptors, thus stopping the negative feedback mechanism which usually stops the secretion of serotonin. By stopping this feedback, there is a greater amount of serotonin in the synaptic cleft. Which presumably accounts for its benefit of decreased anxiety.
• Valium is a benzodiazepine which acts as a depressant and can cause significant adverse affects if mixed with other depressants.
• This drug works by binding to GABA receptors to help increase the infinity of GABA, thus increasing the affects of GABA (only works if GABA is present, unlike Buspar which does not have this stipulation).
Sunday, April 15, 2007
Give blood for your club!
Here's the deal. If a student club can get 20 folk to donate blood then they are eligible to receive $300. SNA could put that $$ to good use helping YOU with information, activities and scholarships. YOU get to help your community by providing lifesaving blood.
Details:Wednesday 4/16..... 9am-230pm in Upper Danner Hall - need photo ID with date of birth on it to donate; to save time call Barbara Barroga @ 209-954-5100 to sign up. Please identify yourself as an SNA member/supporter.
Please respond here if you can attend and donate. Many of us will be in clinicals that day and unable to attend, but pass the word and let's see if we can get a mass o' nursing talent there to support SNA and the Blood Bank!
Details:Wednesday 4/16..... 9am-230pm in Upper Danner Hall - need photo ID with date of birth on it to donate; to save time call Barbara Barroga @ 209-954-5100 to sign up. Please identify yourself as an SNA member/supporter.
Please respond here if you can attend and donate. Many of us will be in clinicals that day and unable to attend, but pass the word and let's see if we can get a mass o' nursing talent there to support SNA and the Blood Bank!
Saturday, April 14, 2007
area AA mtgs and more - for N5'ers
Complete list by city here:
http://www.aadelta.org/meeting_search.htm
Alanon/Alateen by city
http://www.ncwsa.org/meeting.html#anchor50845
Narcotics Anonymous
http://portaltools.na.org/portaltools/MeetingLoc/
Cocaine Anonymous
http://www.norcalca.com/schedules/Stockton.asp
http://www.aadelta.org/meeting_search.htm
Alanon/Alateen by city
http://www.ncwsa.org/meeting.html#anchor50845
Narcotics Anonymous
http://portaltools.na.org/portaltools/MeetingLoc/
Cocaine Anonymous
http://www.norcalca.com/schedules/Stockton.asp
Thursday, April 12, 2007
Job Opportunity
Mrs Batson forwarded this info to me so that I can let y'all know about it:
Part-time jobs are available with the Census Bureau.
Flexible hours $12.25-$14.oo/hour in the San Joaquin area.
Contact: Jennie Rillamas cell # 604-4788
Part-time jobs are available with the Census Bureau.
Flexible hours $12.25-$14.oo/hour in the San Joaquin area.
Contact: Jennie Rillamas cell # 604-4788
Sunday, April 08, 2007
SNA Meeting reminder, Spread the Word...
SNA Meeting April 9, 2007
1:00 in Locke 314
Come join your fellow nursing/health students for snacks, raffles and prizes, and most of all, info about the SNA. Also find out the benefits of being an officer, leadership scholarships and more.
Don't forget, we need officers for President, Vice President, Secretary, Treasurer and ICC Representative. Description of duties listed below, if you are interested or know someone who is, please attend the meeting.
Elections for Officer Positions:
President: Oversees club activities, responsible for meeting agendas, representative of SNA at monthly faculty meetings, responsible for active club status with Student Activities, and delegation of other officers as needed.
Vice President: Supports President in planning and implementing ideas and club events.
Secretary: Makes and posts flyers for meetings, takes notes at meetings and formats minutes to be distributed at the next meeting.
Treasurer: Keeps financial records, makes deposits and payment requests for club events, manages inventory and ordering.
ICC Representative: Represents the SNA at the mandatory InterClub Council (ICC) meetings two Thursdays a month or as scheduled by Student Activities; this can be done by rotation of SNA members but MUST BE DONE or we cannot continue our Association.
Hope to see you there!! Spread the word.
1:00 in Locke 314
Come join your fellow nursing/health students for snacks, raffles and prizes, and most of all, info about the SNA. Also find out the benefits of being an officer, leadership scholarships and more.
Don't forget, we need officers for President, Vice President, Secretary, Treasurer and ICC Representative. Description of duties listed below, if you are interested or know someone who is, please attend the meeting.
Elections for Officer Positions:
President: Oversees club activities, responsible for meeting agendas, representative of SNA at monthly faculty meetings, responsible for active club status with Student Activities, and delegation of other officers as needed.
Vice President: Supports President in planning and implementing ideas and club events.
Secretary: Makes and posts flyers for meetings, takes notes at meetings and formats minutes to be distributed at the next meeting.
Treasurer: Keeps financial records, makes deposits and payment requests for club events, manages inventory and ordering.
ICC Representative: Represents the SNA at the mandatory InterClub Council (ICC) meetings two Thursdays a month or as scheduled by Student Activities; this can be done by rotation of SNA members but MUST BE DONE or we cannot continue our Association.
Hope to see you there!! Spread the word.
Sunday, April 01, 2007
Hey ladies and gents, our next SNA meeting will be Monday, April 9th at 1:00 in Locke 314. Please be sure to attend, we have lots of exciting info for you. We also need officers for the next election for SNA leaders. If you are interested or know someone who is, please attend the meeting. Just an FYI, the SNA meetings are for all students: ADN, LVN, Psych Tech, and those who are taking prerequesites. Support you fellow nursing/health students. A reminder with more info to follow as the meeting approaches. Thanks in advance.Sandra Hardy
Thursday, March 22, 2007
Test Taking Strategies
* Are you able to eliminate all but two choices on exams and always seem to choose the wrong answer?
* Do you find yourself over analyzing each question?
* Do you want to learn what key points to remember when taking an exam in the Nursing Program?
If you answered yes to any of these questions mark you calendar for…
What: Workshop on Test Taking Strategies
Where: Locke 313
When: Thursday March 29th
Time: 12:30 to 3:30 (open workshop-come when you can)
Facilitated By: Bonnie Boss, RN and Debbie Vogel, RN
For Further Details Contact:
Nursing Student Success Program
(209) 954-5445
Locke 304
* Do you find yourself over analyzing each question?
* Do you want to learn what key points to remember when taking an exam in the Nursing Program?
If you answered yes to any of these questions mark you calendar for…
What: Workshop on Test Taking Strategies
Where: Locke 313
When: Thursday March 29th
Time: 12:30 to 3:30 (open workshop-come when you can)
Facilitated By: Bonnie Boss, RN and Debbie Vogel, RN
For Further Details Contact:
Nursing Student Success Program
(209) 954-5445
Locke 304
Wednesday, March 21, 2007
Skills Lab Help
I was going to read for the skills lab tomorrow assessment. I opened my syllabus and found that I don't have the right text book or maybe I do. I don't know. I bought all of the required books at the bookstore. I bought the Dillon book Nursing Health Assessment. Then I look in the syllabus and it says to read the Gidden Wilson Health Assessment book. That is in the N2 required books not ours. So my question is to you people who already took N4 do we need to buy the other book or is the reading the same in our book?
Thanks to anyone who can help.
Susan
Thanks to anyone who can help.
Susan
Just something to think about when you're taking care of the elderly
What Do You See Nurse?
What do you see, nurse, what do you see?
What are you thinking when you look at me?
A crabbed old women, not very wise
Uncertain of habit, with faraway eyes.
Who dribbles her food and makes no reply.
When you say in a loud voice, "I do wish you'd try."
Who seems to not notice the things that you do
And forever is losing a stocking or shoe.
Who unresisting or not, lets you do as you will
With bathing or feeding, the long day to fill
Is that what you're thinking, is that what you see?
Then open your eyes, you're not looking at me.
I'll tell you who I am as I sit there so still.
As I move at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters who love one another.
A young girl at sixteen with wings on her feet
A bride soon at twenty--my heart gives a leap
Remembering the vows I promised to keep.
At twenty-five, now, I have young of my own
Who need me to build a secure happy home.
A women of thirty, my young now grow fast
Bound to each other with ties that should last.
At forty my young now will soon be gone,
But my man stays beside me to see I don't mourn.
At fifty once more babies play round my knee.
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead.
I look at the future, I shudder with dread.
For my young are all busy rearing young of their own.
I'm an old woman now and nature is cruel.
Tis her just to make old age look like a fool.
The body it crumbles, grace and vigor depart.
There is now just a stone where I once was a heart.
But inside this old carcass a young girl still dwells.
And now and again my battered heart swells.
I remember the joys, I remember the pain.
And I'm loving and living life all over again.
I think of the years all to few-- gone so fast.
And accept the stark fact that nothing can last.
So open your eyes, nurse, open and see.
Not a crabbed old women--look closer--SEE ME.
What Do You See Nurse?
What do you see, nurse, what do you see?
What are you thinking when you look at me?
A crabbed old women, not very wise
Uncertain of habit, with faraway eyes.
Who dribbles her food and makes no reply.
When you say in a loud voice, "I do wish you'd try."
Who seems to not notice the things that you do
And forever is losing a stocking or shoe.
Who unresisting or not, lets you do as you will
With bathing or feeding, the long day to fill
Is that what you're thinking, is that what you see?
Then open your eyes, you're not looking at me.
I'll tell you who I am as I sit there so still.
As I move at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters who love one another.
A young girl at sixteen with wings on her feet
A bride soon at twenty--my heart gives a leap
Remembering the vows I promised to keep.
At twenty-five, now, I have young of my own
Who need me to build a secure happy home.
A women of thirty, my young now grow fast
Bound to each other with ties that should last.
At forty my young now will soon be gone,
But my man stays beside me to see I don't mourn.
At fifty once more babies play round my knee.
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead.
I look at the future, I shudder with dread.
For my young are all busy rearing young of their own.
I'm an old woman now and nature is cruel.
Tis her just to make old age look like a fool.
The body it crumbles, grace and vigor depart.
There is now just a stone where I once was a heart.
But inside this old carcass a young girl still dwells.
And now and again my battered heart swells.
I remember the joys, I remember the pain.
And I'm loving and living life all over again.
I think of the years all to few-- gone so fast.
And accept the stark fact that nothing can last.
So open your eyes, nurse, open and see.
Not a crabbed old women--look closer--SEE ME.
Tuesday, March 20, 2007
Lodi Memorial Hospital N4~ 1st rotation
The Lovely Ladies of Lodi Memorial
Forget Nursing, She is going to be a Sombrero Model!!!
This Was A VERY Happy Day!
Ohhh, What A KissADIOS Nursing 4!!!!!
Monday, March 19, 2007
SNA Today!
SNA meeting today in Locke 314 @1:00pm.
Elections for Officer Positions.
Guest speakers describe their Specialties.
Raffle prizes for SNA gear.
See you there!
Sunday, March 18, 2007
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