Block-hard? Or Soft-serve?

February 28, 2012 By Leave a Comment

I remember when I was a kid that I liked my ice cream very frozen, chiseled away from the half-gallon block. I would pry off a bite from my precious chunk, and CHEWit. Melty ice-cream just wasn’t as good.

Now, the ice cream has to sit out on the counter for at least 10 minutes before I attempt to eat it, and I will even mix the deliciousness around in the bowl to make it all evenly soft.

I used to favor the fruity ice creams. Now, it’s all about chocolate and caramel!

Why did my preferences change? I have no fantastic explanations (PMS doesn’t count), so I’ve concluded that’s just how life goes.

When I was a new nurse, I loved trauma, blood, gore, IVs, and yanking patients back from the brink of death. I was scared, but exhilarated! I cared nothing for who a patient was inside her head…I only wanted to place the IV, draw the labs, slap a perfectly executed 12-lead in front of the doc, and solve all the outward problems by pumping stomachs out and pumping meds in. [Read more...]

Filed Under: Blog, Jessica RN, Profession Tagged With: , , , , ,

Role Models

February 23, 2012 By Leave a Comment

Yet another celebrity has lost her life too soon. Whitney Houston was found dead yesterday at the age of 48. We won’t know the true cause of her death for quite some time, but I’d venture to guess that many people – myself included – are left to wonder if her past (or perhaps present) drug use contributed to her early demise.  Whitney undoubtedly influenced many young women during the course of her career; one can only hope that people can learn from the tragedy and not duplicate her past errors in judgment.

Right or wrong, celebrities of all types often serve as role models for the rest of society. Young and old alike look to musicians, actors, athletes, politicians, and others to help them decide what to wear, what movies to see, what car to buy… [Read more...]

Filed Under: Blog, News, Profession, Rita RN Tagged With: , , , , ,

PALS, Lookup

February 22, 2012 By 1 Comment

Points to Remember:

  • Resuscitate with 100% O2 until appropriate air mixing/monitoring equipment become available.
  • Intraosseus access may be used for IV meds and for some blood tests, including type and crossmatch. Do not use for ABGs if sodium bicarbonate has been given through the line.
  • ETT dosing of emergency meds (lidocaine, epi, atropine, naloxone) is controversal. Use critical thinking to determine course of action.
  • Use adult pads for all children >10 kg.
  • Use infant pads for infants <10 kg.
  • Use a manual defibrillator (not AED) in infants < 1 yr old.
  • For treating non-arrest rhythms, refer to ACLS guidelines and use medication dosages listed in the chart
  • Consider therapeutic hypothermia for children who remain comatose following successful resuscitation.
Filed Under: Cardiovascular, Emergency, Lookups, Pediatrics, POC Stickits, Vital Signs

Eyes Open, Sword Sharp

February 21, 2012 By Leave a Comment

As I was waiting in line at the grocery store last year, the cover of the November 2011 edition of Reader’s Digest caught my eye. Did you see it? The RD has been running this column “X number of secrets your ____ (fill in the blank with some profession) won’t tell you” for the last few months. The column has been quite enlightening, I must say. So, I picked up that issue and read the article “50 Secrets Nurses Won’t Tell You.” Nothing new to me popped out—the points mentioned were major things that I’ve heard multiple times over the years within the nursing profession.

But what caught my eye was a recurring theme…that docs have their place and their value, but nurses make the difference. Again, nothing new, right? All nurses know this! Then it hit me. If we make the difference, what kind of responsibility does that place on our shoulders?  This realization of massive responsibility is not necessarily new to me and probably will not be to you, but perhaps I felt it again in a deeper way.

I think the responsibility hit me for the first time while I was working NICU in Arkansas.  At that time, NICU was a new specialty for me, and I fell in love with it. My co-workers, including the docs and NPs, were INCREDIBLE. [Read more...]

Filed Under: Blog, Jessica RN, Profession Tagged With: , , , , ,

Spreadin’ Some Love Around

February 14, 2012 By Leave a Comment

I think we all need a little more love and gratitude in our day.  So, for today’s post, I present you with this “love” letter, written to all those influential nurses in my life.  I encourage you to reach out to one or more nurses today, and tell them how much they mean to you.

Dear Notable Nurses,

A formal introduction that belies the gratitude I feel in my heart. I think back over the past years, and realize I have not expressed thanks for helping shape me into the nurse I am today. So, thank you.

Thank you for patient instruction during nursing school. Thank you for taking time to answer my many, many questions about nursing as a profession. Thank you for your dedication to working long hours in order to gain the experience to teach all of us future nurses. Thank you for continuing to work long hours grading our elaborate and lengthy care plans, and sticking with us during clinicals that lasted until 10pm some nights. [Read more...]

Filed Under: Blog, Inspire/Lead, Jessica RN, Learn Tagged With: , , , , , ,

Professionalism: Should Appearance Matter?

February 13, 2012 By Leave a Comment

I went to a retirement party last night for a nurse at my institution. She’d been employed there since 1984 and finished her career as an executive director of nursing. During the after-dinner festivities, many stories and photographs were shared with the attendees.

One picture (from her early years with our hospital) showed her with another nurse. The two were dressed in the traditional nursing garb of white cap, white uniform, white tights, and white shoes – something that isn’t seen much any more (especially the cap! Do you all know where your caps are? I’m very sad to say that mine has gone missing over the years.)

This picture – and the image – made me think of my own attire and appearance back when I was a staff nurse, most recently in critical care and the emergency department. In those two places, nursing whites are rarely seen. I believe that part of this is due to the impracticality of wearing white in such an atmosphere – one busy shift in the trauma bay or with a post-op or cardiac arrest, and your whites are history. [Read more...]

Filed Under: Blog, Profession, Rita RN Tagged With: , , , , , ,

Lab Values, Hematology

February 8, 2012 By Leave a Comment

HEMATOLOGY

NORMALS

SI UNITS

Blood volume

8.5-9% of kg weight

80-85 ml/kg

Red blood cells (RBC)

4.2-6.2 million/mm3

4.2-6.2 1012/L

Hemoglobin (Hgb)

12-18 g/dl

7.4-11.2 mmol/L

Hematocrit (Hct)

37-52%

0.37-0.52

MCH

26-34 pg/cell

0.40-0.53 fmol/cell

MCHC

32-36 g/dl

320-360 g/L

MCV

82-98 mm3

82-98 fL

White blood cells (WBC)

4,000-10,800 cells/mm3

4.0-10.8 x 109/L

Bands

< 5%

.03-0.08

Basophils

< 1%

< 0.01
Eosinophils

1-4%

0.01-0.04
Lympho-cytes

25-40%

0.25-0.40
B-lymphs

10-20%

0.1-0.2
T-lymphs

60-80%

0.6-0.8
Monocytes

2-8%

0.02-0.08
Neutrophils

54-75%

0.54-0.75
Platelets

140,000-400,000/mm3

140-400 x 109/L
Estimated sedimentation rate (ESR)

Male: < 13 mm/hr

Female: < 20 mm/hr

same
Filed Under: Laboratory Values, POC Stickits

Lab Values, Cardiac Markers

February 8, 2012 By Leave a Comment

CARDIAC

NORMALS

SI UNITS

Troponin-I (peak 12 hrs)

< 0.35 mcg/L

same

Troponin-T (Peak 12-48 hrs)

< 0.18 mcg/L

same

Myoglobin (Peak 6-10 hrs)

Male: 10-95 ng/ml

Female: 10-65 ng/ml

10-95 µg/L

Hs-CRP

0.02-0.80 mg/dl

0.2-8.0 mg/L

CPK (CK)

(Peak 10-24 hrs)

Male: 55-170 U/L

Female: 30-135 U/L

0.51-2.89 µkat/L

CPK-MB

(CK-MB, Peak 12-24 hrs)

< 5 ng/ml

< 5 µg/ml

Hs-CRP

0.02-0.80 mg/dl

0.2-8 mg/L

LD

140-280 U/ml

2.34-4.68 µkat/L

BNP

< 100 pg/ml

< 100 ng/L
Filed Under: Laboratory Values, POC Stickits

Lab Values, Coagulation

February 8, 2012 By Leave a Comment

COAGULATION

NORMALS

SI UNITS

ACT

90–130 sec

same

PTT (activated)

21–35 sec

same

PTT

30–45 sec

same

PT

10–14 sec

same

INR (target therapeutic)

2-3

same

Thrombin Time

10-15 sec

same

Fibrinogen

160– 50 mg/dl

1.6-4.5 g/L

Plasminogen

62-130%

0.62-1.3

Bleeding Time

3-7 min

same

D-dimer

< 250 mcg/L

< 1.37 nmol/L
Filed Under: Laboratory Values, POC Stickits

ECG/EKG Rate Calculations

February 7, 2012 By Leave a Comment

Steps:

1. Multiply the number of QRS complexes in one 6-second strip by 10.

2. Divide 300 by the number of large boxes between two R waves.

3. Divide 1500 by the number of small boxes between two R waves.

4. Memorize the rate sequence below as it corresponds to the number of large boxes between each QRS complex.

Rapid Lookup

Large Boxes

Rate

1

300

2

150

3

100

4

75

5

60

6

50
Filed Under: Cardiology, POC Stickits
« Older Posts