just a nurse.

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“I raised a doctor. You only raised a nurse.”

This phrase honestly doesn’t even phase me anymore. It makes me chuckle actually. It’s a clear source of ignorance of the different roles that healthcare has. I, for one, am comfortable in my role in the healthcare system. And we should all be, and go into it for the right reasons. God knows, with our evolving healthcare system, we all need each other. Our roles are all so precious and sometimes stretched so thin we may need more roles to work together efficiently for better patient outcomes. In an ideal world, we should get rid of the silos and come up with plans that start with “we” will do this for the patient.

As “just a nurse,” the role translates to being the 24/7 eyes, ears, hands, voice for patients who can’t do it for themselves. The nursing process is as such that we treat the patient not just as a disease, but as a whole- incorporating their social and spiritual belief to come up with a plan that best suits the individual patient.

 

(http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html)

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.
Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and lifestyle factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain medication.

Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses, as well as other health professionals caring for the patient, have access to it.

Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

 

 

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Imagine a day in the ICU per se without nurses. 

That aortic graft would have blown out because of a hypertensive episode and lack of monitoring and titrating of vasoactive medications. The patient would die.

Room 1 who is waking on the ventilator, would probably self- extubate, bleed go into respiratory insufficiency and climb himself to the floor. The patient would die.

That ECMO would have already clotted off. The patient would die.

Every chronic patient would have a pressure ulcer and die from it.

Every surgical patient besides one or two that PT can get to first will have atelectasis and catch pneumonia. The patient could prolong his hospital stay and run his medical bills through the roof.

That low flow alarm on the LVAD would go unaddressed, clot off, and the patient who waited so long for a potential heart transplant would… die.

That complaint of shortness of breath would go unwarranted as the patient turns blue.

That pulseless vtach would be dismissed as another alarm fatigue. The patient would die.

The absent bowel sounds with hardening and distension would only contribute more to his creeping lactate levels. Anaerobic metabolism. The patient would need emergent surgery, if at all possible.

Long story short, you need a nurse to save your life. There is a science behind our practice. You need the nurse’s assessments to relay your concerns to the team. To help during such a vulnerable time. To build that relationship for the next 12 hours. So we can help fix you. Doctors are important, yes, but they cannot be with you at the beside all the time or ever really if you’re a regular floor. Be kind to nurses, they will help you I promise.

 

 

 

 

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What you need to know to apply for CRNA school

  1. You need to be an RN.
  2. Are you ready to be broke for at least 27 months? Yes, broke because unless you wanna pull all your hair out working full time, only a per diem job is realistic for a grueling program like the CRNA one. Well, I’ve only heard so don’t quote me on it.
  3. Did you take your CCRN? Everyone who applies for CRNA school are all ICU- experienced nurses. For at least 2 years. You can start the program when your two years is up, meaning you can apply ater the end of your first year in the ICU. Everyone from the ICU’s is CCRN certified. I know, it’s almost like whatever to them, because EVERYONE has it. I recommend Laura Gisparis’s question book and her videos as study materials! 100%.
  4. What kind of ICU experience you ask? I am biased and say CTICU. When I interviewed at Columbia I would say 80% of the people who interviewed had CTICU experience. Well, because we are creme of le crop.
  5. Do you have to take a test? Duh…. it’s grad school. Can’t get off the hook that easy. Most schools require the GRE or the MAT. I recommend the Magoosh GRE prep program! They give you a nice qbank and video explanations. As well as practice tests that are much harder than the actual exam. Magoosh verbal flashcards on your mobile devices are extremely useful for knowing the frequently used words. Especially while you’re on the train or on the go. I also took all of the practice tests on Kaplan and the 5lb book of practice problems (SO HARD FOR NO REASON). I got a 70% on verbal and 60% on math. There is also a writing section. Anything above a 50% on each subject is considered competitive. So anything above a score of 350.
  6. GPA of atleast 3.0 if your experience isn’t all that great.
  7. Certain pre-reqs that vary with each school.
  8. Recommendations- atleast 3. I got mine from my first nursing manager, hi Nicole! I love you!, our ICU medical director, and a charge nurse. Just make sure it’s someone who can vouch and say nice things about you and mean it! Not something generic that they write for everyone else…
  9. Essays – why you want to be a CRNA etc.
  10. Interview! Some schools require you to have extensive clinical knowledge and others just want to get to know you as a person.

 

I think that summarizes it enough.  If you have any questions please comment below! 🙂

hyper “k” or nah?

Hyperkalemia: tall, peaked T-waves on your heart monitor (EKG reading). Deadly. Arrythmias. cardiac arrest.

Hyperkalemia is the medical term that describes a potassium level in your blood that’s higher than normal. Potassium is a nutrient that is critical to the function of nerve and muscle cells, including those in your heart. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L).

Right?  (Atleast that’s what the textbook says…or Laura Gisparis in her CCRN videos)

WRONG.

My patient was in normal sinus rhythm, no EKG issues. No PVCs (premature ventricular contractions, which usually means an electrolyte deficit), electrolytes on her blood gas was totally normal. But what I did notice is she did have a change in her mental status and complaining of nausea persistently throughout the morning unrelieved by the anti-emetics.

A casual ABG check reads : K 6.9, pt was basically obtunded, lethargic in her stupor, word- salading, and complaining of being extremely fatigued. Ding ding!

So, we treated it.

10u regular insulin 

1/2 amp of dextrose (to prevent hypoglycemia)

Insulin administered with glucose facilitates the uptake of glucose into the cell, which brings potassium with it

Calcium gluconate 

Furesomide (Lasix) – loop diuretic 

albuterol nebulizer

Medications such as calcium, insulin, glucose, and sodium bicarbonate are temporizing measures.