PDA PARTY!!!!!!!!

Please come to the first ever nursing PDA party!
Wednesday, 1600 - 1700ish in Locke 314!
I know this is last minute, but please get the word out. If you have a PDA or are thinking of getting one, this is the meeting for you. PDAs are new to us all. These are the medical items of the future. Hospitals are being rewired to accomodate their use. Some of us have had a couple of semesters head start in learning some of the ropes. I am figuring out new stuff almost every day, so come on and share what you have learned with the rest of us. If you are wondering about which one to get or which programs to put into it, this is the meeting for you.
These are fantastic devices that will help keep you organized with your information at hand.
Bring your questions, your knowledge, your programs, your laptop or anything else that you can think of.
This will be an informal show and share session. Hopefully we will be able to have more of these in the future. Please give your input on how we can make these sessions better. Get the word out to your instructors. Many of them are starting to use handhelds too.
If there is a lot of interest, we will have more of these sessions.

Pathomap

Hey Im working on my pathomap but feel like Im running in circles. Does anyone know where on docushare exactly I can find Carolee's examples of the pathomaps? I tried looking but was unable to locate the file. Please help me...Thank you!

N6 Heads Up for N7

As for N7, I LOVE THIS CLASS!!!! and Mrs. Antaran. She is a very good lecturer. I wish that I could take it for the whole semester and skip N6. ICU is a blast and I don't want to leave. This class focuses in on the pathophys of the disease process (my favorite). It's not bad. If you feel shaky on it, look in your phsio book or better yet, look in Thelan's Critical Care Nursing book and the pathophys book. She is going by the syllabus. Buy it ahead of time and learn page 33 It is the stress response. She calls this her gift to the nursing program.
Come to Caralee's study sessions on Tuesdays from 1115(30) to 1230. Ask Caralee how to pathomap. Look in the N101 under N7 for stuff to learn and print out ahead of time. Learn any meds that are mentioned in the syllabus.
If you want to study ahead, brush up on shock, the stress response and your heart stuff. Knowing the numbers for pressures are going to be a big thing in this class. ICP pressure, Central venous pressures, etc. I am in trouble there (numbers). The students before us said, know your meds. Emergency meds for shock and heart meds etc.
Don't let this class scare you. Take it one day at a time.
The only warning is, DON'T GET BEHIND.
The more that you have learned ahead of time, the more you will be relaxed. Practice NCLEX Tests from Saunders and other practice books. Keep checking out the test bank for new additions. I tend to hide new tests in past months, but I post all of the links into the test bank. Look at outlines. Practice your drug calculations and IV drip rates.
Are there any other N7ers that will add to this?

Fat Wallet Syndrome

Has anyone ever heard of this? This is what my husband was just Dx with, and no .......it does not mean he has a lot of money. He has been having pain and numbness in his left leg and has been getting phys, therapy for quite awhile. Well, they just figured out that his wallet is the culprit. He has been carrying it in his left back pocket his whole adult life. Years of sitting on a wallet and compressing his sciatic nerve, has caused him to have numbness and pain to the point of limping. This is a new one for me. Needless to say, he has changed pockets.

SNA Meeting

Reminder:

The first SNA meeting

for the spring 2006

semester will be this Monday January 30th

@ 1300 in Locke 313.

Please join us to share ideas, free pizza and raffle prizes.

Nursing Fun!

If you have ever forgotten why you chose to become a nurse, well here is a reminder.
Top 10 Reasons

N7 Shock

1.	Shock is a life-threatening response to alterations in:
	A. Circulation B. Elimination C. Mentation D. Respiration

2.	Large volume crystalloid infusion for hypovolemia can be accomplished with which of the following infusions?
	A. 5% dextrose B. Albumin C. Hespan D. Normal saline

3.	Fresh frozen plasma (FFP) is administered to replace:
	A. Clotting factors B. Erythrocytes C. Leukocytes D. Platelets

4.	In distributive shock, the major physiological problem causing the shock is:
	A. Blood loss and actual hypovolemia B. Decreased cardiac output C. Third spacing of fluids into peritoneal space D. Vasodilation and relative hypovolemia

5.	A primary goal in all shock states is to:
	A. Ensure adequate cellular hydration B. Maintain adequate tissue perfusion C. Prevent third spacing of fluids D. Support mechanical ventilation

6.	One of the greatest infection risks for critically ill patients who require mechanical ventilations is the development of _____________ pneumonia.

	7.________ is the systemic response to infection manifested by two or more of the symptoms noted with systemic inflammatory response syndrome.

8.	Elderly patients who are taking selected medications such as _____________ have a decreased ability to increase heart rate in the initial phase of shock.

9.	In ____________ shock, nasal congestion, hoarseness, and dysphonia are common because of upper airway obstruction from edema of the larynx, epiglottis, or vocal cords.

10.

Match each description to the correct term related to shock and sepsis. 1. Anaphylactic 2. Cardiogenic 3. Compensatory 4. Distributive 5. Drotrecogin alfa 6. Neurogenic 7. Obstructive 8. Progressive 9. Refractory

A. A drug utilized in severe sepsis, which is an anti-inflammatory, antithrombotic, and profibrinolytic B. Shock resulting from a severe allergic reaction C. Shock resulting in blockage of the sympathetic nervous system leading to vasodilation and bradycardia D. Shock that occurs as a result of obstruction to adequate circulatory flow in the heart or great vessels E. Shock that occurs as a result of the failure of the heart to pump effectively F. Stage of shock in which systemic and microcirculation work in opposition and compensatory mechanisms no longer function G. Stage of shock resulting from prolonged inadequate tissue perfusion and ultimately contributes to multiple organ failure and death H. Stage of shock where the body is attempting to compensate for sustained reduction in cardiac output I. The commonality in this shock is widespread vasodilation with a decrease in stroke volume, cardiac output, and blood pressure Sole: Introduction to Critical Care Nursing, 4th Edition

N6 Feeding Tube Placement in Peds

Methods of Tube Placement
From the NUrsing Center
1.
To minimize the risk of aspiration, most clinicians prefer to position an enteral feeding tube so that feedings are administered into
a. the proximal portion of the stomach.
b. the first or second portion of the duodenum.
c. the duodenum beyond the ligament of Treitz.
2.
The risk of malabsorption increases when a complex formula is administered through an enteral tube with the tip placed in the
a. esophagus.
b. stomach.
c. duodenum.
3.
In children whose level of consciousness is decreased, delivering an enteral feeding to the stomach increases the risk of
a. aspiration.
b. diarrhea.
c. malabsorption.
4.
Theoretically, the best method of determining enteral tube placement is
a. enzyme measurement.
b. radiography.
c. tube insertion length.
5.
An infant's gastric pH typically changes to adult levels at the age of
a. 3 to 6 weeks.
b. 2 to 3 months.
c. 3 to 4 months.
6.
In a study by Metheny et al. (1994), small bowel aspirates were found to be
a. cloudy.
b. yellow.
c. tan.
7.
This study tested enteral tube placement in the intestines by confirming a higher concentration of which enzyme in the aspirate than in aspirates of tubes with gastric placement?
a. trypsin
b. rennin
c. pepsin
8.
The primary purpose of the author's study of methods of determining feeding tube placement in children was to
a. determine a cost-effective way to rule out lung placement of enteral feeding tubes.
b. replicate findings of previous studies of methods distinguishing stomach and intestinal placement.
c. discourage the use of nonreliable methods of confirming feeding tube placement in children.
9.
To correlate assessment findings with actual tube placement, the author incorporated which of the following into the study design?
a. using two distinct methods of enzyme measurement for each aspirated sample
b. collecting aspirate only if no tube-administered medications were given within the previous 2 hours
c. aspirating samples within 30 minutes of chest or abdominal radiography
10.
During the author's study, what percentage of the feeding tubes aspirated for the study had been incorrectly placed?
a. 5%
b. 13%
c. 21%
11.
The author's findings corroborated that the factor having the most influence on pepsin concentrates in the aspirates was
a. the method of enzyme testing.
b. how recently the child was fed.
c. the age of the child.
12.
Of the 56 aspirates studied, the two intestinal aspirates that did not meet the usual color criteria for intestinal contents appeared to be
a. partially digested blood.
b. clabbered formula.
c. medication residue.
13.
A green aspirate with pH of 4.5 indicates
a. stomach placement.
b. intestinal placement.
c. the need for radiography.
14.
A negative result of either pH, color, or enzyme testing for gastric placement
a. is a good indicator of intestinal placement.
b. confirms intestinal placement.
c. indicates the need for radiography.
15.
The author concludes that the most practical and low-cost method for testing feeding tube placement in a variety of settings is
a. enzyme measurement.
b. tube insertion length.
c. testing for pH and color.

EKG generator

http://www.skillstat.com/learn.htm
You need to go to tools and EKG generator. It is really great. I have not tried the rest of the site yet but my co-worker says it has lots of information.

Blogger Updates

Don't forget to check out the other nursing blogs. Keep up to date on the current news and resources!
1st Semester Blog
2nd Semester Blog
Helpful stuff is being added all of the time.

N4,N7, A Stimulating Coma Test

Coma Stimulation
From the Nursing Center
1.
A coma stimulation program (CSP) should be
a. avoided in a patient who is dependent.
b. initiated as early as 72 hours to one (1) week post injury.
c. initiated once the Glascow Coma Scale Score is greater than 10.
d. avoided in a patient with a Rancho Los Amigos Scale (RLA) less than V.

2.
According to this author, an expected finding when assessing a patient in a coma is
a. an absence of a sleep/-wake cycle.
b. eye opening limited to painful stimulation.
c. a Rancho Los Amigos Scale (RLA) score of III.
d. a deep state of unconsciousness lasting less than one (1) week.

3.
To avoid habituation, Wood suggests
a. exposing the patient to soft background noise.
b. speaking to the patient at a normal conversational rate.
c. limiting nursing activities to 15 minutes out of each one (1) hour.
d. providing uninterrupted sleep rest periods of at least 30–45 minutes.

4.
Before starting any stimulation program it is important for the nurse to
a. document the patient's cerebral perfusion pressure.
b. explain the procedure to the family at the patient's bedside.
c. determine that the patient has just exited a true sleep/rest period.
d. determine that the patient's vital signs have been stable for the past 48 hours.

5.
Which of the following activities should be performed to help "normalize" a patient's environment?
a. Keeping the door to the patient's room open
b. Limiting the number of people in the patient's room to 2 or 3
c. Exposing the patient to casual conversation between family members
d. Playing the patient's favorite music while performing activities of daily living

6.
Auditory stimulation requires the use of
a. Cranial Nerve III.
b. Cranial Nerve IV.
c. Cranial Nerve VIII.
d. Cranial Nerve X.

7.
When providing auditory stimulation to a patient the nurse should
a. avoid placing headphones on the patient.
b. avoid turning on the radio or television.
c. recognize that the startle response is an expected finding.
d. recognize that blinking may be considered a favorable response.

8.
Vision requires impulse conduction via
a. Cranial nerve I.
b. Cranial nerve II.
c. Cranial nerve VII.
d. Cranial nerve IX.

9.
When providing visual stimulation, the nurse should
a. avoid having the patient in the supine position.
b. recognize that closing of eyes is a favorable response.
c. use variations of light if the blink response is not intact.
d. stop the stimulation if the patient demonstrates a change in pupil size.

10.
Which of these is the most commonly injured cranial nerve?
a. Cranial nerve I
b. Cranial nerve III
c. Cranial nerve V
d. Cranial nerve VI

11.
When performing olfactory stimulation it is important to
a. withhold the stimulation if the patient has a nasogastric tube in place.
b. expose the patient to the aromatic stimuli for at least 30 seconds.
c. avoid getting the aromatic stimuli on the patient's skin.
d. initially use a strong scent such as vinegar.

12.
Which of these cranial nerves is not involved in eliciting an effective gustatory response?
a. Cranial nerve X
b. Cranial nerve IX
c. Cranial nerve VII
d. Cranial nerve II

13.
When performing gustatory stimulation
a. avoid massaging the gums if the patient is intubated.
b. discontinue stimulation if the patient demonstrates spitting or grimacing.
c. avoid sweet sweet-tasting stimuli if the patient has a hard time managing secretions.
d. discontinue stimulation if the patient exhibits a defensive reaction to oral care.

14.
When performing tactile stimulation, it would be appropriate for the nurse or family member to
a. gently rub the patient's sternum.
b. avoid firmly stretching any tendon.
c. briefly apply ice to the patient's face.
d. stop the session if a sucking response is elicited.

15.
Which of these is an effective strategy for performing kinesthetic stimulation?
a. Spinning the patient
b. Raising and lowering the patient's bed
c. Placing the patient on a cooling blanket
d. Rolling the patient from side to side repetitively

N7 Tachyarrhythmias, Pacemakers, Congestive Heart Failure, and Syncope

I recommend that you follow this link. This article is written in easy to understand question and answer format. I learned a lot.

Cardiac Pearls

1. A patient with a rapid, regular, narrow complex tachycardia with no P waves could have any of the following dysrhythmias except:
	a.	Atrial fibrillation
	b.	Wolff-Parkinson-White (WPW) syndrome
	c.	Narrow complex ventricular tachycardia (VT)
	d.	Paroxysmal supraventricular tachycardia (PSVT)
2. Which medication is the most appropriate?
	a.	Adenocard 6mg, then 12 mg bolus; followed by verapamil if no response
	b.	Dipyridamole (Persantine), PO.
	c.	Lidocaine 75 mg; followed by verapamil if no response
	d.	Propranolol 2 mg IV
3. Which of the following cardiac abnormalities has been associated with increased incidences of supraventricular tachycardia?
	a.	Tetralogy of Fallot
	b.	Transposition of the great vessels
	c.	Epstein’s anomaly
	d.	Patent ductus arteriosus
4. A patient with an irregular narrow complex tachyarrhythmia is most likely to have what diagnosis?
	a.	Atrial fibrillation or atrial flutter with variable AV block
	b.	Complete heart block with frequent premature ventricular contractions
	c.	Sinus tachycardia
	d.	Sinus bradycardia
5. In a patient with acute atrial fibrillation with a rapid ventricular response, which drug is the first drug of choice?
	a.	digoxin
	b.	adenocard
	c.	diltiazem
	d.	magnesium
6. Which drug has the broadest usage for supraventricular and ventricular tachydysrhythmias?
	a.	Lidocaine
	b.	Bretylium
	c.	adenosine
	d.	amiodarone
7. Rare cases of brief runs of ventricular tachycardia after adenosine boluses have been reported. The most likely anatomic origin of this dysrhythmia is:
	a.	The left atrium
	b.	The right atrium
	c.	The inferior left ventricular septum
	d.	The pulmonary outflow tract
8. Even though the ACLS manual does not indicate it, this drug is 40% to 60% effective in converting stable VT.
	a.	lidocaine
	b.	magnesium
	c.	atropine
	d.	digoxin
9. Unstable WPW should be immediately treated with:
	a.	Amiodarone
	b.	Lidocaine
	c.	Electrical cardioversion
	d.	Magnesium
10. Using an NG tube and a pacer lead can provide you with an ECG called a:
	a.	NG ECG
	b.	Esophageal ECG
	c.	Retrocardiac ECG
	d.	15-lead ECG
11. A patient has an ECG showing biphasic T waves in V2 and V3. The patient is found to have a critical stenosis of the left anterior descending coronary artery. This sometimes called:
	a.	Biphasic disease
	b.	Wellen’s syndrome
	c.	Wellness disease
	d.	Widow’s lesion
12. Twiddler’s syndrome is seen in a patient with
	a.	SVT
	b.	VT
	c.	A dysfunctional pacemaker due to loose leads
	d.	Dementia
13. The patient with a pacemaker and an acute MI may present with Cabrera sign on the ECG. This is best described as:
	a.	Rabbit ears in the QRS
	b.	A U wave
	c.	Notching of the S wave in leads V2 and V3
	d.	A new bundle-branch block pattern
14. All of the following are helpful in determining VT except:
	a.	The age of the patient
	b.	Superior or marked left-axis deviation
	c.	Completely negative (QS complexes) deflections in all three limb leads I, II and III
	d.	QRS morphology identical to a previous PVC
15. In digoxin toxicity what is the drug of choice?
	a.	dioxin
	b.	digitoxin
	c.	Digibind
	d.	lidocaine
16. The patient is expected to react to Digibind within what period of time?
	a.	Immediately
	b.	Within 3 minutes
	c.	Within 30 minutes
	d.	Within 24 hours
17. What two tachyarrhythmias are almost never seen with digoxin toxicity?
	a.	VT and A-fib
	b.	A-fib with a rapid ventricular response and Mobitz II AV block
	c.	Mobitz I and II
	d.	PAT and A-fib
18. A patient asks you to look his chest x-ray to determine the status of his St. Jude’s cardiac valve. What can you tell from the x-ray?
	a.	That a radiologist would have to make that judgment
	b.	That is impossible to see a St. Jude’s valve on x-ray because they are not radio-opaque
	c.	Say all the valves look alike even when they are not functioning properly
	d.	An over-penetrated X-ray will have to be ordered to best view the valve
19. Pleural effusions are almost always on which side of the chest?
	a.	Bilaterally
	b.	Right
	c.	Left
	d.	There is no predominance
20. Which of the following is not a cardiac cause of a stroke in a young patient?
	a.	R to L shunts from a patent foramen ovale
	b.	Fossa ovalis aneurysms
	c.	Occult atrial septal defects
	d.	Athlete’s heart
21. Aminophylline has now found its use in what possible cardiac dysrhythmia treatments?
	a.	AV block and asystole
	b.	LBBB
	c.	PAT with block
	d.	Atrial fibrillation
22. In congestive heart failure, pulmonary edema is likely to occur when the pulmonary capillary wedge pressure first approaches:
	a.	12mm Hg
	b.	17mm Hg
	c.	25mm Hg
	d.	35mm Hg
23. The following is true of diastolic heart failure:
	a.	It occurs in 80% of all cases of CHF
	b.	It is more common in younger patients
	c.	It is usually caused by alcohol
	d.	No single feature of the history, physical examination, chest radiograph, or electrocardiogram reliably differentiates systolic from diastolic dysfunction
24. Using ACE inhibitors in an older adult puts the patient at risk for:
	a.	Liver failure
	b.	CHF
	c.	Renal dysfunction
	d.	Hypokalemia
25. The addition of spironolactone to selected patients’ standard CHF therapy has been found to:
	a.	Increase mortality
	b.	Reduce mortality
	c.	Have no effect upon mortality
	d.	Induce renal failure
26. All of the following agents have been found to be useful in treating diastolic heart failure except:
	a.	Nitrates
	b.	Beta blockers
	c.	Calcium channel blockers
	d.	ACE inhibitors
27. Name three causes of syncope in a patient under 35.
	a.	psychiatric, arrythmia and cardiac
	b.	psychiatric, WPW, Long QT syndrome
	c.	psychiatric, drug induced and orthostatic
	d.	psychiatric, neurocardiogenic and neurally mediated
28. Which of the following rhythms would not cause syncope?
	a.	SVT
	b.	Atrial Fibrillation
	c.	Complete AV block
	d.	Normal sinus rhythm
29. Elemental mercury has been found to be present in the myocardium in some cases of idiopathic dilated cardiomyopathy. Of the following, the most likely source of high dose mercury is:
	a.	City water
	b.	Tuna fish
	c.	Thimerosal (ethyl mercury) found in some vaccines
	d.	Air pollution near coal fire power plants.

Monday Study Group

I will not be able to be at the school on Monday. I have an ACLS class to attend for work. If I don't get the class in I can end up without a job. Given that as an option, I decided to take the class ASAP. I will be there on Tuesday after class. I can be there till 4 p.m. Anyone who wants to study after Caralee's study session please let me know. You can email me or post a reply. Hope everyone had a great first two days in clinical.

Getting Lectures from PDA onto CD

How do I keep lectures to hear again? How do I get them safely off my PDA and onto my computer or a CD? If you have done this, please share your info on how you did it please.

Newsletters Revisited

Mindy, I couldn't find the old newsletter post to change the date so I copied this from the 1st semester's blog.
These are some of the newsletters that are sent to me in my email. If you are interested, here are some links to check out their sites or sign up. You can find info for the current subjects that you are learning throughout the program. They have lots of practice questions too. Good resources.
Heart Center Newsletter Online
Advance for Nurses newsletter and free magazine
Medscape Nurses
Nursing Center Newsletter
Nurse practitioner enews
Diabetes Health online newsletter
Cancer Health online newsletter
Kaplan Nursing Newsletter