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Answers to Your Nursing Career Questions

Using spacers with inhaled medications

March 8th, 2011 by – Sue Barton

  Should a spacer be used with asthma inhalers?  How should patients be taught to use a spacer?

Spacers are devices that function as holding chambers for aerosolized medications, typically for asthma.  Spacers improve the effectiveness of medication administration by capturing the medication so that the user does not have to coordinate inspiration as precisely with the puff of medication from the inhaler.  This allows for more of the medication to reach the lungs.  Use of a spacer is helpful in minimizing medication deposit in the oropharyngeal area, which can lead to thrush in the case of inhaled corticosteroids.  The MDI, or metered dose inhaler, fits into one end of the spacer, which is typically a plastic tube like device.  The opposite end is a mouthpiece or a face mask for young children.

To administer the medication, instruct the patient to shake the MDI and insert it into the spacer.  With the mouthpiece or mask in place, depress the MDI to release a puff of medication.  Maintain a seal while taking several breaths.  After a few minutes, the process is repeated.  This video from the Mayo clinic website demonstrates use of a spacer and inhaler.

A variety of brands of spacers are available.  Spacers should be cleaned with mild soap and water weekly and air dried.  When your patient understands how to use the inhaler and spacer most effectively, they are on their way to better asthma control.

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Posted in Common Nursing Procedures, General

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Nurses and doctors have fun while reminding you to wash your hands

March 2nd, 2011 by – Marijke Durning

We’ve heard it all before: Wash your hands. There are tricks to be sure you wash your hands long enough, such as singing the entirety of  “Happy Birthday” while washing. We know to be sure to  get in between our fingers and to remember to wash our wrists and thumbs.

We also know you’re supposed to wash your hands between patients, after you take off your gloves (yes, gloves aren’t 100 percent protective), after going to the bathroom and before touching food – and yet, handwashing audits show that many nurses and other health care personnel don’t wash their hands!

Here’s a bit of fun from a health care facility that got many employees and even a famous face (NHL hockey fans may recognize the famous dad) to participate in this video about washing hands.

The video is called Wash Your Hands.

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Posted in Common Nursing Procedures

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Smart phone apps for smart nurses

February 24th, 2011 by – Marijke Durning

Smart phones – they’re everywhere. Nurses have them and nursing students have them. But are they practical? What is it that a smart phone can do that a nurse can’t do without? Well, let’s see.

When you get a smart phone, you have the ability to download apps, or applications. While many people think of smart phone apps as games and things for business productivity, there are some apps that could  help make a nurse’s job easier. Here are five popular apps for nurses or nursing students:

1- Epocrates RX, is an app for iPhone/iTouch, Blackberry, Palm, Android, and Windows Mobile. This neat little program is a drug reference book at  your fingertips. It sure beats lugging around a book that gets out of date almost as soon as it leaves the publishing house. The company says that it updates the information as it becomes available. While there are pricier versions that offer more, this version is free.

2- If you’re studying nursing, the Mosby’s iTerms Flash Cards for Medical Terminology may be the perfect app for you. It has 811 digital flashcards to help you learn your medical prefixes, suffixes, abbreviations and much more. Afraid of saying a word incorrectly? This app tells you how to say them. However, this app must be purchased.

3- Also for nursing students, there is the NCLEX-RN Medications app. Also for purchase, this study guide helps you learn about medications and the conditions they are used for.

4- Eponyms (for students) is a free app for students. It describes over 1,700 medical eponyms. There is an app for purchase for those who are no longer students.

5- Wound care can be puzzling for many nurses. There are many products on the market that are particular to certain types of wounds and certain types of skin. With all this available, it is understandable how it could be confusing. The Clinical Guide Skin & Wound Care app covers these things and also the latest in pressure ulcer protocol.

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Posted in Common Nursing Procedures

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What is a ketogenic diet?

February 19th, 2011 by – Sue Barton

  Please describe how a ketogenic diet is used?

A ketogenic diet, which is high in fat and low in carbohydrates and protein, is used in some cases for the treatment of epilepsy.  It is thought that the diet works by inducing a state of ketosis.  It is used primarily in pediatric patients where it may help up to 50 percent of children with refractive epilepsy.  This diet is very restrictive, and families are closely supervised by a team of dietitians, pharmacists, nurses, and physicians.

Children are typically admitted to the hospital for the initiation of a ketogenic diet.  Nurses caring for the child need to monitor for potential problems such as acidosis, hypoglycemia, nausea, vomiting and dehydration.  Changes in lipid levels and liver enzymes should be evaluated.  Parents will need teaching and support in learning to prepare the diet.  After discharge, the family is  followed in an outpatient clinic.  Daily vitamin and mineral supplements are important because the high fat diet is not nutritionally adequate.  A child is  typically on the diet for one to two years.  If successful in stopping seizures, and eliminating medications, the dietitian will gradually attempt to wean the child off the diet by increasing carbohydrate intake and decreasing fats.

More information on ketogenic diets is available through the Epilepsy Foundation.

Source: Poglsted, S.  (2010). The ketogenic diet. ICAN: Infant, Child & Adolescent Nutrition     Journal, 2, 370-376.

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Breast pain and breast cancer

February 1st, 2011 by – Derek Brocklehurst

My breast hurts. Is that normal?

“Normal” for anyone, male, female or otherwise, should not mean that your breast hurts. If something in your body hurts, you should get it assessed and evaluated by a medical professional as soon as you recognize the pain.

When you go in for an evaluation for breast pain, you should tell the provider which breast the pain is located in, what part of the breast, how long it’s been there and if you have done anything to alleviate the pain. It could be any number of ailments including blocked mammary gland ducts, a bacterial skin infection or breast cancer.

If caught early enough, breast cancer survival rates are very high, according to the American Cancer Society. You can screen yourself for breast cancer with three different stroking and massage techniques at home. Check out the American Cancer Society’s guidelines for administering a self breast exam. This might be a good idea if breast cancer runs in your family or if you are a woman over 35 years old. You would be feeling for any lumps, nodules, painful areas, and asymmetric spots compared to each breast. Make sure to catch it early for a better prognosis.

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Scoliosis screening and scoliometer use

January 29th, 2011 by – Sue Barton

  What is a scoliometer and how should it be used?

A scoliometer is a very low tech gadget that resembles a small carpenter’s level.  It is used as a screening tool to detect scoliosis.  Scoliosis is a curvature of the spine which may be due to a variety of causes and may occur across the age spectrum depending on the cause.  In young children and in adults, scoliosis may be due to musculoskeletal disorders or thoracic abnormalities.  Idiopathic scoliosis refers to spinal curvatures typically seen during the pubertal years in which there is no underlying pathology.

To evaluate for scoliosis, you need to look at the spine in both the standing and the forward bending positions.  Standing, look for obvious curvature and for asymmetry in the level of the iliac crests and the shoulders.  Then ask the patient to bend forward at the waist with their arms and head dangling down.  Looking along the spine as you stand behind the patient, evaluate for asymmetry in the back musculature along the length of the spine.   You may see a “hump”  in the thoracic or lumbar area.  If you place the scoliometer over the spine the air bubble will give you a measurement.  As a general rule, a measurement of over 7 degrees, especially in a growing preadolescent, deserves a baseline x-ray evaluation.  At subsequent exams, the scoliometer can help you measure clinical changes.  If radiology reports show a significant curve, a referral to an orthopedist is indicated.

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Nursing care plans 101

January 28th, 2011 by – Derek Brocklehurst

How many days does a care plan need to be completed upon admission of a patient? How many days does it take for it to be evaluated?

Nursing care plans are an integral part to a patient’s long term care and well being. As nurses are pushed to work longer shifts and see more patients, it becomes even more vital to complete a comprehensive nursing care plan for new admissions at the end of every shift. When a new nurse comes on to shift and takes over for your patients, your nursing care plan should already be completed and easily understood. All newly admitted patients should be comprehensively assessed in order to formulate an adequate and proactive care plan.

Nursing care plans can be evaluated by the primary care providers, other RNs, charge nurses or nurse supervisors. This might happen over the duration of the patient’s stay in the hospital. The Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, may perform an audit of your hospital, thereby scrutinizing your charts, care plans and work. It’s important to always keep care plans up to date, refreshing lab data and altering nursing diagnoses as the patient’s health deems so.

Check out Medi-smart’s Nursing Care Plan Resources directory for more information!

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Posted in Common Nursing Procedures, On-the-Job Fears

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Temporomandibular joint disorder care plans and diagnoses

January 21st, 2011 by – Derek Brocklehurst

What are some nursing diagnoses and care plans for temporomandibular disease?

Temporomandibular joint disorder, or TMD, is an acute or chronic inflammation of the joint connecting the mandible to the skull. TMD can lead to many other impairments if not diagnosed and treated in a prompt fashion. Different specialties may be brought in for consultation on this disorder including neurologists, dentists, orthodontic surgeons, dietitians, internists and nurses. As the nurse, it is your job to assist in the day-to-day living of such patients.

Pain management is key to a successful recovery and healing process. Oftentimes the acute pain will affect other aspects of treatment (eating, moving, etc.) Check out some examples of nursing diagnoses for this delicate patient population:

  • Risk for impaired diet related to pain and swelling of the TMJ
  • Impaired healing related decreased protein intake
  • Knowledge deficit related to teeth grinding and pain management

Managing this disorder requires a multifaceted approach. In order for the patient to heal, they need to consume enough healthy protein-rich foods. In order to chew and swallow properly, their pain needs to be managed effectively. In order to manage their pain effectively, nerve damage needs to be assessed. Make sure to include all appropriate parties in the care for this population. Check out Medi-Smart’s Nursing Care Plans directory for more information.

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Posted in Common Nursing Procedures

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Top 10 traits for being a good nurse

January 20th, 2011 by – Marijke Durning

OK, you’re studying nursing and thinking of the kind of nurse you’re going to be. You’ve been watching the nurses around you while you’re in clinicals, and you definitely know what you’re never going to do, right? But what is it that makes a good nurse? Let’s have a look at the top 10 traits a good nurse has:

1- Continual desire to learn

In nursing, as in life, learning is a life long process. You should never stop learning because the world is constantly evolving. Once you’ve graduated from nursing school, your learning process as a nurse is really just beginning. It’s often said that a new nursing graduate learns more in his first year than in his entire formal education, and it doesn’t stop there. Between continuing-education credits, workshops in your facility, conferences, and hands-on experience, a good nurse is constantly learning. Of course, returning to nursing school to further your education is always a good thing.

2- Curiosity

Curious nurses are generally good nurses. They want to know how to do procedures, understand why certain things may not be as they should, and the reasoning behind treatments. They ask questions and they look things up. This curiosity is what helps them continue to learn, our first good trait.

3- Teaching skills

A good nurse is one who can and does share her ability and knowledge with others. Whether it’s helping a new nurse find her nursing feet or speaking with auxiliary staff about why they should be doing a procedure a certain way, a good nurse is able to teach to others.

4- Ability to remain calm under pressure

There’s no doubt about it, nursing can be a very stressful occupation. Even in areas where nurses may be in a generally-calmer environment, emergencies can and do happen. Being able to stay calm, assess the situation and react assertively goes a long way to being a good or even a great nurse.

5- Being observant

One of the best tools a nurse has is the senses. What the nurse sees, smells, hears and touches – these all can tell a part of a story about a patient that may not be noticeable to everyone. A good nurse is always watching for signs of something that doesn’t seem quite right and can pick up on them.

6- Good team worker

Let’s face it. A good nurse can’t work alone. A nurse needs to be able to work with a team of health care professionals in order to provide good, quality care. Whether the nurse is dealing with certified nursing assistants, physiotherapists, lab techs or doctors, the nurse needs to be able to be part of the team.

7- Good communication skills

Just as a good nurse can’t work alone, a good nurse must be able to communicate those around him. Whether he is communicating through the written or spoken word, what he needs to say must come through loud and clear. Communication with patients and families is paramount. They are undergoing tremendous amounts of stress and sometimes don’t always understand what they are hearing. A good nurse works on finding a way to get the message across.

8- Asking for help

Asking for help is not a sign of weakness if it’s done appropriately. This means a nurse asks for help when she needs it and can’t manage on her own. It could be that the nurse doesn’t understand how to do a procedure, needs an extra pair of hands for something, or just cannot do a specific task. In these situations, it’s always best to ask for help than to try to muddle through.

9- Admits mistakes

Everyone – absolutely everyone – makes mistakes and nurses are no different. Unfortunately, when a nurse makes a mistake, the results can be catastrophic. A good nurse does all he can to avoid making mistakes, but when one is made, he admits to it and learns from it. Chances are, he’ll not make that mistake again.

10- Plus a bit of selfishness

Do you think that nurses are selfless, giving to people and having no time for themselves? Not for good nurses. Good nurses are able to balance work and life, and keep work from sucking them into a life where all they do is work and care for others. Nurses must take time for themselves to rejuvenate and to be by themselves or with those they love. They have to have downtime where they can play games, participate in a hobby, or just be with their family and friends.

These are just examples of what it takes to be a good nurse. What do you think makes a good nurse?

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Posted in Common Nursing Procedures

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Managing sickle cell disease

January 19th, 2011 by – Derek Brocklehurst

How is sickle cell disease characterized and how is it managed from a nursing perspective?

Sickle cell disease is a genetic disease that causes a change to the shape of red blood cells. Red blood cells will take on the shape of a sickle, which decreases the surface area and ability to carry adequate amounts of oxygen to vital organs. Patients may experience a sickle cell crisis that can occur and manifest in a number of ways. Smaller blood vessels in the body (i.e. splenic vessels) can be easily occluded by an aggregation of malformed red blood cells. This can cause ischemia, or permanent tissue damage, as well as pain, decreased blood counts, and trigger compensatory measures.

As a nurse, you should always document if a patient has a sickle-cell trait. This will mean you should assess for pain in the extremities where blood vessels tend to be smaller in size and more easily occluded by sickle cells, a decrease in hemoglobin and/or hematocrit, decreased capillary refill, decreased oxygen saturation (via a pulse oximeter), increased respiration (compensation for decreased amounts of oxygen to the organs), and increased heart rate. If you have any questions about managing SCD, make sure to consult the primary provider or your nurse supervisor for assistance.

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The material on this site is for informational purposes only, and is intended as a supplement, not as a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.