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Answers to Your Nursing Career Questions

Thrombocytopenic Nursing Care Plan

July 19th, 2010 by – Derek Brocklehurst

What would be a nursing care plan for a patient with thrombocytopenia?

Thrombocytopenia is a blood clotting disorder in which there are decreased amounts of platelets in the blood. Patients with this disorder can be at increased risk for a number of things including infection, bleeding, secondary anemia, and fluid volume deficit. Ecchymosis, or bruising may be present on the impaired bed-ridden patient. It is especially important to turn the patient often enough that swelling and bruising are decreased around points of pressure between the patient and the bed.

For a patient with low amounts of platelets, the increased risk for bleeding may lead to an increased risk for infection. If there is a consistently-open bleeding wound on the patient’s body, bacteria and viruses may make their way in more easily, leading to systemic infections.

Anemia secondary to the bleeding may cause the patient to feel fatigued and short of breath. Evaluating frequent labs is extremely important in knowing whether to begin blood transfusions or treatment for low red blood cell counts.

If you have a female patient who is menstruating, or any other patient with increased bleeding, they run the risk of depleting the fluids in their body. Monitor hydration status by checking for wet mucosal membranes and urine output every hour.

Posted in Common Nursing Procedures, General

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Hands Off My Winnie the Pooh Scrubs!

July 19th, 2010 by – Marijke Durning

Ok, I’ve never owned a pair of Winnie the Pooh scrubs, but if I did, I would have worn them. I love Winnie the Pooh and I’ve proudly had my picture taken with him at Disney World. I also had a Winnie the Pooh watch – with a second hand – to wear at work.

There are so many types of scrubs available to nurses now, all types of patterns, all types of cartoon characters. Of course, this isn’t an issue where hospital rules say registered nurses (RNs) have to wear one color, licensed practical nurses (LPNs) another color, and certified nursing assistants (CNAs) yet another. But where such rules don’t exist, it seems that there could be a free-for-all when it comes to scrubs choice. Some are fun, some are bright and some of them make you think  “huh?” when you look at them. But, whatever they are, the nurses who wear them like them.

There was a long debate on a nursing Internet board I read on this topic. The person who started the thread doesn’t like cutesy tops and thinks that nurses who work in adult settings shouldn’t be allowed to wear them. After all, Hello Kitty doesn’t exactly scream “I’m a professional,” does it?

As you would expect, there were many posts that were pro and many that were con. But the underlying theme with those who didn’t like them was the professional issue.

When my children were young, their pediatrician wore Loony Tunes ties and others with cartoons – it didn’t make me think any less of him. Of course, the people who don’t like cutesy scrub tops did often make allowances for people who work in peds. So, that means they’d be ok with the doctor’s ties. But is it really unprofessional to wear cartoon scrubs when you work with adults?

Several nurses who worked with seniors said their patients enjoyed the colorful scrubs the nurses sometimes wore. Some scrubs are holiday themed and may cue the patients as to the time of year, sometimes bringing back memories. Other nurses who worked with a more general adult population said they liked the scrubs because it helped brighten up the otherwise drab environment. But what of the other side issue?

There are nurses who feel that you can’t be taken seriously if you have Daffy Duck on your scrub or rainbows all over. Doing CPR and answering serious questions from family members can be negated by Snoopy dancing all over your chest. And patient teaching? Forget the serious impact of diabetic teaching if your clothing has stars and moons shooting across the fabric. Those against the colorful scrubs also say that other health care professionals, particularly doctors, won’t and can’t take nurses seriously if they’re not dressed “professionally.”

This debate is internal to nursing. I’ve never heard of a conversation with people outside of nursing and their impressions of the cutesy tops some nurses wear. Have you?

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Posted in On-the-Job Fears

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Cough Medications

July 17th, 2010 by – Sue Barton

What is the medication for cough?

The treatment for cough will vary with the cause.  The cough associated with a common cold will improve with decongestant and expectorant medication such as pseudoephedrine and guaifenesin.  Coughs from allergy will respond to antihistamines such as loratadine, and steroid nasal sprays that reduce inflammation and mucous drainage.  These  sprays as well as nasal saline solutions are helpful with sinus infections which are another cause of cough.  Sinus infections often develop as a complication of a cold illness, and may require antibiotics.  Prolonged cough without illness is likely to be an asthma symptom and should improve with the use of an albuterol inhaler.  If asthma symptoms are persistent, maintenance medications will be needed.  Cough and fever are of course associated with pneumonia, which can vary from mild to severe, and usually requires antibiotics.  Coughing up blood may be a symptom of tuberculosis or other more serious lung conditions.  Smoker’s cough is best treated by quitting!

If you are looking for short term symptomatic relief of a cough, one of the best options is codeine, which suppresses cough.  Of course codeine is a narcotic and has the potential for sedation and respiratory suppression in large doses.   Guaifenesin is an expectorant found in many over the counter cough medications.  Lozenges may soothe and suppress coughing, fluids in general are helpful, and the use of home remedies such as honey is gaining ground now that cold and cough medications are not recommended for use in young children.  Remember that honey should not be given to children under one year of age because of the risk of botulism.

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Posted in General

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Gallstones and Cholesterol

July 16th, 2010 by – Derek Brocklehurst

I am 17 years old and I have been diagnosed with gall stones. I don’t see my doctor until Tuesday. What can I eat until then?

Gall stones are formed by increased abnormal amounts of bile. Bile is a substance produced by your liver that aids in digestion and is stored in your gall bladder. The abnormal contents from bile that increase the likelihood of gallstones are increased amounts of cholesterol. Some diets low in fiber and low in nutrients and vitamins may also contribute to gallstone formation.

In general, eating foods that are high in fiber (to help aid with digestion and easy passage of stools), high in vitamins, and low in cholesterol  will decrease your risk of gallstone recurrence. For a balanced diet high in protein, high in high-density lipoproteins (HDL cholesterol) and low in low-density lipoproteins (LDL cholesterol), try eating more fish rather than red meat, as red meat tends to be higher in LDLs and lower in HDLs. HDL is the “good cholesterol” that lowers your risk of heart disease and other cardiovascular conditions. LDL is the “bad cholesterol” that may increase your risk of gallstones and cardiovascular conditions.

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When Was the Last Time You Had to Do CPR?

July 16th, 2010 by – Marijke Durning

There are three letters that mean a lot in the world of lifesaving: CPR – cardiopulmonary resuscitation. As a nurse, have you had to do CPR? When was the last time?

When I was in nursing school, although we were taught the basics of CPR, we weren’t certified. That was for us to do on our own. It turned out that the colleges in our province went on strike when I was almost finished my RN program. Not wanting to waste time, a group of nursing students got together and arranged for an accredited CPR class at a local hospital. This is when and how we became certified.

I didn’t need my CPR skills until a good while into my nursing work. I rarely had patients who got to full codes; we usually got them to ICU before they got to that point. I ended up transferring to work in that ICU where, of course, we had many codes. I found the best way of learning how to run and react in a code was by doing the compressions. When you’re doing the compressions, you’re right in the middle of things (literally) and not in anyone’s way.

I never got completely confident with being part of a code, but it was interesting to learn how the system worked and the different roles the team members had. And although I wasn’t confident, I was able to do my part when the codes occurred.

Not long after that work in the ICU, I was walking down the street and found a man doing CPR on a woman who had collapsed on the side of the road. I went to help him and found that any skill doing CPR I had in the hospital had deserted me in real life. Without the backup of the machines, other people, and the drugs, I was unsure of myself.  I ended up taking my cues from the man who was already there, which is how it should have been anyway. After all, he did have the situation in hand.

Sadly, the woman didn’t make it. She wasn’t very old – she was out trick-or-treating with her child because it was Halloween night. I was ok about the whole thing; after all, we tried our best and knew that maybe something else had happened that just wasn’t fixable, but what stunned me was how I was slow to react outside of the hospital environment. I just wasn’t thinking in the same mode as I would at work. It made me wonder if I would always be like that in an emergency situation.

Luckily, I’ve not come across a similar situation since and I hope to never come across one. But maybe I learned something and will have more confidence 25 years later than I did that Halloween night.

Do you have any CPR stories to share?

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Posted in On-the-Job Fears

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Nurse Practitioner and Physician Assistant College Majors

July 15th, 2010 by – Sue Barton

 If I want to be a nurse practitioner what should my college major be?

If you want to be a nurse practitioner, your college major will be nursing, and you will need a bachelor of science in nursing degree in order to go on to graduate school.  Nurse practitioners currently need a minimum of a master of science degree in nursing to sit for certification exams and licensure.  It is of course possible to begin with an associate degree in nursing, which is the two year degree and to build on that by then taking an RN to BSN program before exploring graduate schools.

Perhaps your question comes from confusion with physician assistant programs, which are also graduate level programs lasting 2-3 years.  Applicants to PA programs typically have a college major in a field such as biology.  While there are many similarities in the roles of NPs and PAs and both are sometimes lumped together in the categories of  “physician extenders” and “mid-level provider” (personally, I have to confess that I dislike both terms, as neither accurately describes an advanced practice nurse or NP), there are also significant differences.  As nurses, NPs are licensed independently and do not technically require physician supervision to practice.

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Menstruation Questions

July 14th, 2010 by – Derek Brocklehurst

I had a period for 3 or 4 days. Does this mean I could be pregnant?

A “period”, or menstruation, is the female body’s way of ovulating and getting rid of unused eggs. A typical period will last one-to-two days but it is not unlikely or uncommon for it to last longer than this. Every female body is different. The length of a period may depend on your age, ethnic or racial background, genetics, environmental stressors, diet, and any exercise regimens.

Women start menstruating, or ovulating and discarding unused eggs, around puberty, typically between the ages of 10-14. This is when your body matures and start showing signs of secondary sex characteristics (breast development, hips widen, body hair growth, etc.)

Having a period occur, regardless of the length of days it occurred, means you are in fact not pregnant. This is just your body’s way of discarding unfertilized eggs from your ovaries about once a month. If you are concerned about your menstrual flow rates, the amount of blood coming out, or anything out of the ordinary, you should consult your primary care provider.

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Nursing in a Heat Wave

July 14th, 2010 by – Marijke Durning

Depending on what part of the continent you live in, you may be used to hot temperatures all the time or you may only experience them during the summer months. Either way, there’s a time when hot outside becomes too hot and we experience a heat wave.

Of course, with heat waves come the air conditioning battles. If you work in an air conditioned environment, the temperature may rise and fall depending on how hot or cold the “Thermostat Queen” (or King) decides it should be. These temperatures can vary considerably and change if there are hot flashes or heavy physical work involved. A nurse or certified nursing assistant (CNA) who is doing physical patient care, particularly on large patients, is going to be getting hotter while working than the unit secretary who is at the desk. This isn’t confined to health care facilities though – many offices and other work places have the same problem.

So what is fair? Should the people who are really hot be allowed to turn the a/c so high that others are shivering? Should those who get cold very easily keep the a/c turned low so it doesn’t get too cool?

Look at it this way: if you’re too cold, you can always bundle up. Wear a thicker pair of socks, a sweater, even an undershirt or camisole under your scrubs. But if you’re too hot, short of stripping to your underwear, there’s not a lot you can do about it, is there? We also know that overheating is dangerous and can lead to heat-related health problems. With heat often comes humidity, also related to health problems.

Of course, there’s even a better solution, or some people think. Have a centrally controlled temperature, say 72 degrees Fahrenheit, and make it so the thermostat can’t be changed by the people on the floors or units.

What do you think?

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Posted in On-the-Job Fears

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School nursing CEU’s

July 13th, 2010 by – Sue Barton

I’m a school nurse, and I’m looking for CEUs that deal with school nursing.

I’m a big fan of the nursing organizations that support specialty practices in nursing, and in this case it’s the National Association of School Nurses, which may already be familiar to you.  Their website has a section of continuing education offerings tailored to the needs of school nurses.  Medi-Smart of course also has CEU information that may be helpful to you.    Another avenue to explore is pediatric nursing groups such as  the National Association of Pediatric Nurse Practitioners,  some of which have sections for school nurses, and who also offer continuing education programs. Since you need to be informed about changes in immunization requirements and trends in infectious disease in the school age population, as well as mental health issues, these general pediatric groups are resources that can keep you up to date.  NAPNAP for instance has state chapters that offer CEU meetings.  The American Nurses Credentialing Center also is a good source of information about continuing education as well as specialty certification for school nurses.

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Reconstructive Surgical Nursing

July 12th, 2010 by – Derek Brocklehurst

Where can I be trained as a burn nurse?

While there is no specific burn nurse training program, you could end up specializing in plastic or reconstructive surgery, thereby working with some burn victims and getting the experience you desire. Working with burn victims can be emotional and saddening. Many burn victims were casualties of arson, building fires, and disasters so it might be difficult hearing their stories and relating it to their wounds. The nurse in this situation can play an important role in listening and reflecting statements back to the patient, making them aware of their condition and how to sort through some of what has happened to them (despite how traumatizing it may be to relive).

As a burn nurse, you may want to start out working in the ICU, ER, or OR. Any of these sites would be a good place to begin learning about traumatized skin and assessing skin integrity, managing pain medication and anesthesia, and evaluating care plans for the long-term needs of the patient. From here, you may focus more on reconstructive surgery at a local clinic, office, or hospital that houses such a specialty.

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

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