The inpatient fall rates in this hospital were neither associated with days of the week, months, or seasons nor with lunar cycles such as full moon or new moon. Preventive strategies should be focused on patients' modifiable fall risk factors and the provision of organizational conditions which support a safe hospital environment.
Now, in case you're wondering, yes, glutamate is that glutamate, as in mono-sodium-glutamate (MSG). The glutamate that you don't put in food is called glutamic acid, but really MSG is just one form of glutamic acid. As you can see from the chemical structures, the only "difference" between MSG and glutamic acid is that MSG has an Na ion instead of an H ion. But as all good nursing students know from Chem271 Organic and Biochemistry, the Na or H come off in solution, meaning they provide same anion in the body.
Now, apparently this whole business about the "brain," or whatever, must be complicated stuff, otherwise they would have figured out a long time ago that Chinese food could cure psychosis. But they didn't. What I really found interesting reading about all this is that MSG really is excitotoxic and that the FDA has identified a grouping of symptoms that some people display after consuming glutamic acid... and I have some of them! Whenever I have eaten food from some unnamed restaurants in my town that advertise no MSG, I get extremely drowsy and weak (like falling asleep at my desk at work while I'm entering MD orders drowsy!), I sweat profusely, I get a warm, swollen face with a headache, and I seem to have palpitations. Lo and behold, here are the symptoms from Glutamate Symptom Complex (GSC):
- Burning sensation in the back of the neck, forearms and chest
- Numbness in the back of the neck, radiating to the arms and back
- Tingling, warmth and weakness in the face, temples, upper back, neck and arms
- Facial pressure or tightness
- Chest pain
- Rapid heartbeat
The latest issue of WIRED magazine has an infopr0n column that shows the relative strength of bacteria at different anatomic locations.
In med-surg we are studying urinary tract right now. Want to know why foley caths get infected so easily? See orange at right [click for larger image]. Also, notice that the numbers being used here are phylotypes, not species. The intestinal tract has something like 400-500 species of bacteria, most of which haven't been definitely ID'd yet. Pretty amazing.
Today, for the last few weeks, in recent months, and for a few years, I have been feeling pretty down, but today in particular. I definitely don't have the same burning desire to be a nurse that some of my classmates seem to have, and, by getting absorbed into the field, I often feel that I am losing myself. I think I am pretty much immune to the "professional socialization" process that we are supposed to be going through, but I can become branded (in the western sense). Part of the reason I didn't pursue the medical field from the start is that I see it as a type of labor, like "hyper-plumbers." Nursing is even worse in that in addition to being defined by your labor, there are extremely strong societal associations and pressure for conformity. Although I'm sure most nursing instructors and organizers don't see it, their desire to create a highly defined professional profile actually puts a ceiling on the amount of respect they can garner as a profession from other professionals. Several of my nursing instructors like to repeat the fact that nursing is the public's "most trusted" profession. The connection they don't make is that people trust nurses because they think of nurses as robotic dispensers of safe medical care. The public doesn't trust uncertainty, ambiguity, and experimentation. They do trust nurses because when nurses tell them to eat a certain way, they never qualify their statements by discussing the state of nutritional science. For biologists, anthropologists, or philosophers, the qualification would be more true and useful.
Anyhow, I was looking at Manolo's Shoeblog today, and he linked to this CD by one Philippe Jaroussky. As soon as I started listening to the samples, I was immediately transported back to myself. Yes, our lives are lived in the dirty, selective, unjust world of nature, but there is also a higher identity that comes from our internal lives. I may have to work in this uniformed, institutionalized, modern, conformist profession to make a living, but it is not who I am.
Understanding the important role of water, salt, and glucose in the body, the nurse can do her part to help restore the patient to health.
Revised 2-26-08 12:45...
Actually, revisiting that article, I found the graphical presentation of fluid balance pretty interesting. It is too inadequate, unfortunately, for teaching, but it is interesting to look at. Also, looking over the Nurse's Daily Worksheet for 1949, it was interesting to see what has and has not changed. You get the idea from studying the history of nursing in school that nurses didn't do anything in the past, but this I+O balance sheet looks pretty familiar...
This is a student nursing blog that is more like what I had envisioned for my own blog here. It's much better than mine is, though. The author is probably just a lot smarter than I am.
One thing I'm struck by in perusing this blog is that it doesn't get very absorbed in the theoretical aspects of caring, holism, "health", etc. Although I am resistant and skeptical naturally in those areas, I get dinged so much and so uniquely on my clinical paperwork and care plans on not "knowing" patients better that I have started to wonder if it is really me and not an innate voyeuristic desire to peer into people's lives on the part of the instructors (which is what it seems like to me). Maybe it is because this is a male nuring student, or maybe it's the difference between an ADN and BSN program... although I have to say that we were never even exposed to the term "metrology," which I find embarassing...
I started off with a laparoscopic colecystectomy that I was told was going to be a laparotomy. From there, I went to get another case and was told that they didn't really have anything interesting and I should just wait around the nurses' station. So, I pushed until they let me go see a temporal artery biopsy. I think the surgeon didn't realize I was a student, because I ended up assisting by running the Doppler they were using.
After that I got a tour of the open heart operating room even though there weren't any procedures.
After lunch, the only things they had for me to see were a removal of a portacath and a haemorrhoid repair. During the repair, in which I assisted in a few very minor ways, the circulating RN said I was a lot more free than the other students who usually stand off to the side afraid. What can I say? I think growing up in a church and social circle that included doctors has made me a lot less intimidated by them than most nurses seem to be.
Anyhow, it wasn't the best day it could have been. The OR educator said I could come back on my own time to see an open heart procedure if I wanted, so I'm going to wait until this clinical rotation is over and then go back...
Since the aortogram set-up was similar to our cardiac cath lab, and since my work as a ward clerk involves managing MD orders for post-angioplasty cardiac patients, today was very satisfying. More work to be done on the nursing, though. It is very easy for me to see the patient as a piece of meat with a puzzle inside. A long talk in PACU was nice but not smooth by any means. It didn't help that I was starting to get quite hungry by the time were ready to leave.
Now, it is a fact that most all-white shoes that are a possibility for wearing into a patient care setting are ugly as hell. See if you don't agree:
Exhibit#1These New Balance MW576 are a horrifying study in banality. With their thick soles, stubby toes, over-padded ankle support, and perforations placed without consideration, they conjure the phrase "comfort care" from the very ether.
Exhibit#2If you don't know yet, the Dansko stapled clog is supposed to be the gold standard in nursing footwear. For this reason they are included at AllHeart.com. And if you go to buy some there, you will notice that women's and men's Dansko clogs are sized on the same scale. Why? Because women's and men's Dansko clogs are the same shoe. The Dansko has made it onto shoe guru Manolo's Gallery of Horrors for good reason. It is as clunky and formless as a shoe can get. On women, it is slightly too masculine looking. On men, slightly too fem.
Exhibit#3You knew they had to be here, right? Another freak from Manolo's Gallery. He sums them up best:
These they are indeed the shoes of a hypothetical distopian future, one in which the inmates they must be dressed in the footwear least likely to be useful in the popular uprising against the regime.
That pretty much describes a hospital. Anyhow, if a man is going to own crocs, it should be a pair of, maybe, these...
...but these are not a possibility for wearing into a patient care area.
So, what is one to do about this situation? My answer was the Timberland Fells Trainer:
The Fells Trainer has a number of advantages in the situation I've laid out:
- It is white enough not to be offensive with a white nursing uniform, but...
- it is not white enough to conform to the "handbook," while...
- one could plead ignorance about the silver stripes when ordering off the Internet...
- and the red lining matches our school colors, and, hence, our uniform patches, etc.
Is the Fells Trainer a comfortable shoe for shift work? Well, for some it might be. For me, not so much, but I weigh a lot. That's why I replaced the standard insole with a Moszkito.
The point of course is not to get you to buy the Fells Trainer (which isn't sold in white now anyway), but to think outside the box a little. There will be plenty of time for conformity when our RN licenses are on the line. For now, it is nice to tweak the nursing instructors a bit.
I wasn't sure which company to try, so I ordered several pairs of insoles from Zappos.com. The ones I settled on were these Moszkito brand rigid (red logo) insoles. I decided on Moszkito for several reasons:
- They offer a much greater range of sizes than any other brand.
- They are made out of PVC with a lifetime warranty, so they won't "deform" as I walk on them. (The SuperFeet insoles I tried said you would have to replace them, like, every year or so.
- When I called the company to ask a question, I got to speak with a man named Lauren who answered all my questions very directly and spent a really long time on the phone with me.
After wearing them in clinicals for a couple weeks, I find they are not quite what I was hoping, but I don't think it's the fault of the insoles. Moszkito has different sizing parameters--length of foot, width of foot, height of arch. Although I was thinking I had high arches based on the outline of my wet footprint and the measurement I took of my arch, I can feel the insole under my arch after I have been standing on it long enough. (This means that instead of getting rid of the pain, the insoles have just distributed the pain to a different location.) Salesman Lauren told me that this problem might be caused by the insoles being too wide. According to him, the heel is the most important part of the shoe, and if the heel doesn't fit, the foot won't fit correctly either. A heel descending on a wide shoebed will sort of spread out and allow the rest of the foot to spread/move as well. It certainly makes sense to me that, if a heel spreads out, the arch will get lower. Anyhow, the problem with his suggestion is that when I had a size narrower insole, I could feel the edge of the insole rubbing on the bottom of my heel. At first I thought that wouldn't bother me, but after you have been on your feet awhile, it doesn't take much to irritate them.
Final analysis: compared with other insoles, Moszkito was the best. However, they may not clear up your problem with sore feet. Get shoes with better support (i.e., more padding) first...
Moszkito on Zappos.com
I found this website over Christmas break, while I was trying to figure out how to keep my feet from getting very sore in clinicals. It has quite a lot of good information about general foot care. The rationale for shoe inserts is pretty straight forward, and this site won't help with trying to pick out the right one, unfortunately.
Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated multidrug-resistant MRSA.
Corpus Callosum notes this IEEE article on a new idea for 3D e-med recs. My first impression is that this is a waste of time. It is setting off my gimmick alarm, and I don't really see the advantage of showing a patient a 3D image from her own medical record that shows where her bone fracture is over showing her a picture of a bone fracture.
Second Life is not nearly as user-friendly as I had been led to believe by its popularity. I was expecting something that ran about as smoothly as the 1990s-era Marathon, but with a more manipulable character. It is not nearly at that level.
Elsevier's VCE, which I have been assigned in Nur360 Care of the Childbearing Family, is cumbersome, bug-prone, boring, and inefficient as a learning tool. I spent four hours on it last night, and I all I took away is the ability to identify the phases of Stage I pregnancy by their cervical dilation. I could have learned that in five minutes without all the crap! The CD runs slow as it occasionally has to load files while you are doing the excursions, and I was timed out inappropriately four times in a row after viewing a particular video!! At one point, there is a long process of virtual Fentanyl administration that taught me nothing, and there is a point in the workbook where the instructions take up half a page--half a page of "click on__", "Now select___". I absolutely hate it. It is definitely not an educational tool so much as a business model. Publishers like workbooks because workbooks cannot be re-sold in the used book market. Also, by transitioning ("evolve"--get it, duh!) to the web slowly with propriety programs integrated with websites, the publishers can help contribute to the illusion that information needs to be costly and protected in order to be useful and/or accurate. It's the opposite of what the Internet should be doing for information. It's a little like associating information with the occult, a mystery religion of secularism. A term? "Academic gnosticism"--the belief that universities hold special and privileged information.
So, sim-SimMan® is out, but free and open access textbooks are still in.
But, protests the straw-man professor, that's what nursing is, and when you get into practice, you will be doing plenty of paperwork then, too. Bullshit! The paperwork in the hospital may be heavy, but it's all designed to be done within the length of a shift. In school, paperwork is assigned of indeterminate length. And in the hospital, all you have to do is chart to the satisfaction of liability and patient safety. In school, you have to out-perform the other students. It's all baloney.
I wouldn't mind just blowing off the stuff I don't care about, but what if I want to go to grad school? I can't just get by with a 74 average.
Here is a resource for those interested in following peer-reviewed research.
- Bloggers -- often experts in their field -- find exciting new peer-reviewed research they'd like to share. They write thoughtful posts about the research for their blogs.
- Bloggers register with us and use a simple one-line form to create a snippet of code to place in their posts. This snippet not only notifies our site about their post, it also creates a properly formatted research citation for their blog.
- Our software automatically scans registered blogs for posts containing our code snippet. When it finds them, it indexes them and displays them on our front page -- thousands of posts from hundreds of blogs, in one convenient place, organized by topic.
And in related postings, Frontier Psychologist tries to define nervous breakdown.
- WALLACE, J., YOUNG, M. (2008). Parenthood and productivity: A study of demands, resources and family-friendly firms. Journal of Vocational Behavior, 72(1), 110-122. DOI: 10.1016/j.jvb.2007.11.002
Date: 2/18/2008 8:25:24 PM From: xxxxxxxxx To: All course individuals (NUR363 - Care of Adults II, Spring 2008) Subject: Important reminder about med-term
I just wanted to remind those of you who will be in the classroom lab tomorrow... that you should review the med-terms from Lesson 1 & 2 so that you will be able to recall them on the two fill-in the blank lists tomorrow. They will look like your lists I handed out. You will not HAVE to remember the audionym, but please review them. Try to relate the prefixes and suffixes to medical terms that you have heard or know (or can now define!). Quiz each other if you get the chance. If I get a chance, I'll mix the terms up on the lists, so that you won't just be remembering them from the order they are in. They will be averaged into the homework quiz grade, and that's good news!! :) See you tomorrow!
I am bringing earplugs and a Taber's medical dictionary, though.
Speaking of that, I went to get the Taber's yesterday and found one at our local second-hand shop, The Cornerstone Bookstore (in the first-floor Health/Medical section). I thought it was a real deal since the new edition is like $30, and this one was in great condition for $8. But it turns out, the one I bought yesterday is from 1974! The amazing thing is that it basically hasn't changed in all that time--same cover, same design, same size, same fonts and layout... I enjoy that, actually. I guess that part of the conservativism of the medical profession that people speak of, since doctors certainly aren't politically conservative.
0800 computer lab to study, finish clinical paperwork (nope!)
1200 work on clinical paperwork (nope!)
1500 to CVPH for PPD test (not open!)
1540 grocery shopping
1915 computer lab to finish clinical paperwork (nope!)
2345 home, bed
Laura Moon, 18, from Whinmoor, Leeds, is one of a tiny number of people to have four of the organs growing naturally. She only became aware of her unusual anatomy six months ago after undergoing an ultrasound scan to investigate stomach pains following a car crash...She is now undergoing tests to see if all four kidneys are functioning and if she will be able to donate at least one, although she would not be able to choose the recipient.
At 2'9" and a mere one and a half stone, Aditya "Romeo" Dev is the world's smallest bodybuilder.
He must have some sort of proportionate dwarfism.
Second day with the ... wound, and first experience of patient vulnerability. Today went much better than yesterday. I even had quite a bit of down time, which was nice, because it means if I had been a "real nurse," I would have had time to take care of some other patients as well...
The one thing that bothered me was that I had come up with a schedule: Percocet prophylaxis, out of bed for lunch, ambulate, dressing change. But the patient was in sort of a bad mood and told me to just go away and not bring any pain meds unless called for. But the patient has to eat, ambulate, change dressing! So, when do I go back in? My instructor kept saying, not now, not now... well, I ended up getting out of clinicals about 1.5 hours late... And I was standing around getting anxious in the meantime...
Anyhow, after having that triple lumen drain come out yesterday, the wound was sopping with liquid today. The surgeon came in just as I was starting the dressing change, poked (poked!!) his finger all around the wound, and declared a dry packing rather than a wet-to-dry. After the surgeon, the patient was in quite a bit of pain, and today I experienced for the first time the feeling of having a patient be extremely vulnerable and the de facto trust in the nursing staff that must occur.
It was a strange, not pleasant, but not unpleasant experience. I myself am quite emotionally vulnerable but keep tight control over the information that people get about me in order to manage that. I don't have much experience of other peoples' vulnerability, either. Or maybe that's not true. Perhaps it is that normally when people seem vulnerable to me, it seems to be because of their own hang-ups and misperceptions, not because of a non-elective surgery or circumstances beyond their control. I found myself feeling quite bad for this person and rather distressed that I didn't have a better and faster technique for changing the wound.
Well, I just don't understand why there isn't a free, possibly open access, possibly open source textbook, at least for med-surg... or at least for fundamentals. I mean, nurses are more flexible and creative than medical personnel, right? Yet, Textbook Revolution has 15 free biology textbooks and 34 health sciences and medical textbooks. And I know that the US government has even more free medical textbooks. I'm just not sure where they are, but you can find 'em, I guarantee. Some might be listed at New York Emergency Room RN, but a lot the links there seem to be broken.
I found Textbook Revolution through the blog ScienceRoll, which takes the issue even further (the way it should be taken) with this post on Second Life. There should be:
- A wikipedia-style textbook that doesn't look like wikipedia. I know this sound stupid, but I really think that part of the legitimacy issue with wikipedia is its user interface. In the beginning it was cool. Now it looks amateur-ish. The "wiki" part of wiki-textbooks needs to be hidden behind a fascade.
- A sim-SimMan®. Second Life would be, like, the totally cheaper and idealer way to run bedside simulations. This is so obvious that it can't even stand elaboration!
Today I took care of a ... wound. This was my first real dressing change, as my previous wound care--last semester--was on a quite old incision requiring only a change of abd pad. Today's wound had had trouble in the past and the surgeon had taken the patient back to the OR to have a "triple lumen drain" placed.... I read about this in the chart the day before, and I was expecting some little thing like a JP tube. Woa, did I have a surprise.
When I went in to see the patient, the catheter had come out and was on the floor. Rather than a small tubing, it was a long, flat silicon tube with holes all along both sides, like a soaker garden hose. I had never seen anything like it, and neither had my nursing instructors. I can't find any pictures of this type of wound drain on the internet, but it was marked "Axiom," so I assume it was one of these. There was a plastic flange sutured to the abdomen, and I'm not really sure where the drainage tubing went from there. The surgeon was not happy that the tubing came out, but he elected not to replace it.
The wound change went okay, but the day in general was pretty crappy. Nursing school is difficult for me partly because by nature and by previous training, my memory works in abstractions and generalities. So... at our hospital, Lovenox comes in special pre-drawn syringes, but I had to give heparin, which I found in a vial. Now, when I found it, I was thinking that I was going to find it in a special pre-drawn syringe, because in my memory I generalized Lovenox/heparin/special syringe. When I found the vial, I thought, "well, it must be that the syringe is not pre-drawn, but one of these syringes with a pre-applied needle [an insulin syringe, which we don't use in our hospital because we have the insulin SQ pens, but they're still stocked for some reason...]." So, I drew up 1ml of heparin in a 1ml insulin syringe that is marked in units (duh!). This made me feel like a real idiot. It didn't help that I double-checked the syringe with a nurse who gave me the wrong information before I went to the instructor. Oh well, at least I had the right dose of heparin.
0800 Feinberg library for work (procrastination)
1400 back to Feinberg
1900 dinner at cafeteria
1930 back to Feinberg
~2330 wrap up, missed gym
This day had a decently high level of productivity and included mapping out several chapters of pharmacology information.
0030 try to start studying for exam, falling asleep, procrastinating, etc.
0900 get ready for "the day"
1000 MED-SURG EXAM #1 in Nur363
1200 lunch and nap
1300 Nur360 (zombie zone)
1500 to CVPH for clinical research
1730 decide to take short nap
1900 wake for dinner
1940 fell asleep on couch
0030 woke up and went to bed
This day went not as well as hoped, but better than it could have. It's hard to say how the exam went because I was so tired. I think I either did very well (>93) or very badly (<80).>
Failures today includes bad use of time while staying up all night to study as well as total lack of research for clinicals.
I can't give unqualified endorsement to any project that takes an aggressively atheist (i.e., anti-religion) viewpoint, but SEED magazine has some good articles.
For nursing students, some of their cribsheets might be useful, or maybe not...
Cribsheet #1 Stem Cells
Cribsheet #3 Avian Flu
Cribsheet #12 Genetics
- The theory does not take into consideration the interplay of different types of development in the life cycle. For example, we know from ADD that different parts of the brain can mature at different rates, resulting in different types of emotional responses. And we know that adolescents normally present with stage 3-like thinking--idealistic and so on. Do these emotional responses over-ride other cognitive styles of decision-making? Temporarily? This question leads to...
- "Moral development" doesn't measure anything real. Is it a cognitive process, an emotional response? Does it have a place in the brain? Ideas about "goodness" involve all sorts of assumptions and beliefs about metaphysics, psychology, relationships. Kohlberg is making a way of measuring not a narrow development, but whole Weltanshauung. This leads to...
- Kohlberg is arbitrary. Is it any surprise that the highest level of moral development corresponds to the type of political and philosophical outlook of people in Kohlberg's socio-economic circle in his time? This leads to...
- Are there higher levels that Kohlberg couldn't measure because he couldn't understand them? If Level 6 isn't just a pretentious subset of one of the other levels, it is based on the idea of uniform dispersal of utility, which is based on an assumption of uniform value. Julius Evola might critique this by questioning, from a metaphysical perspective, uniform value. Charles Murray might critique this by questioning, from a biological perspective, uniform value. Some economists might critique this by questioning whether the self-effacing attitude implied at Level 6 actually leads to increased utility for all parties. They might also wonder about the free-rider problem...
- How does an "immoral" person fit in? The Kohlberg stages are predicated on the notion that test subjects' reasoning will lead to a justification of "good" action. What about someone who says Heinz should follow the will-to-power? This person may be cognitively out of Levels I+II, but their reasoning seems to be like stage 2. How does Kohlberg deal with them?
- How does game theory fit in? What if there's only a few doses of drug left and many Heinzs and wives?
Anna Sophia (Ona) Vasconcelles, 63, from Primrose underwent an angiogram in Glynwood Hospital in Benoni on January 14...Not the best advertising for male nurses, but this one wasn't registered properly.
After the procedure, she suddenly started bleeding profusely from the wound to her thigh.
The bleeding was stopped and she was admitted to the intensive care unit.
"A nurse was supposed to monitor my mom's condition, be he mostly sat talking to a patient in the bed next to hers.
"Shortly after 11:00 her stomach was distended like a stone. I called the nurse, but he just told me to go home.
"I insisted that something was wrong, but he said it was his job and not mine to monitor her...
Her mother's blood pressure suddenly dropped and James called the cardiologist.
The cardiologist asked a female nurse to check if Vasconcelles was bleeding, and the nurse denied it.
The staff apparently shortly afterwards again called the doctor because they could hardly detect Vasconcelles's blood pressure.
The doctor rushed to the hospital and battled to save her mother's life. She had to receive three units of blood and one unit of plasma.
While remaining aware of the limitations of wikipedia and liking the idea of a free, open-access encyclopedia by scholars, I don't think scholarpedia is going to make it. The whole point of the wiki encyclopedia project is to harness the distributed knowledge and productivity of millions of web users around the world. There aren't enough scholars, even if they could agree.
As an experiment, I looked up INR, PT, and prothrombin on scholarpedia and found zero entries. The ones at wikipedia are quite nice...
1230 gym (upper body resistance)
1330 family dinner
1445 work (again, no Vickie; also, Bob came in to see Jason, seemed to give me a snub on the phone, did I do something on Tuesday? I'm no good at this friends business...)
2230 clinical paperwork; falling asleep at computer; hating life...
0845 clinical paperwork "finished", shower, etc.
0915 try to study for class quiz
1000 Nur363 (quiz was not on the reading I did...)
1200 reading for Nur356
1500 walk across campus to Feinberg lab, print clinical paperwork, walk back across campus to Hawkins and turn in paperwork
2000 watch some bonus material from Jon's THX1138 DVD
2115 try to get some work done at Feinberg lab
2340 gym closed, so no cardio workout, then to bed...
Yes, no sleep Sunday night. These two days sucked.
Not in the near future, I hope.
By the end of the day yesterday, my ... patient had been discharged, so I picked up a ... patient. This patient seems to be pretty much being dismissed by the staff, especially as is apparently waiting for nursing home placement. The patient was reported to be "totally out of it."
After working with the patient, I found the situation better than reported to me. The patient had trouble ..., but instead of the problem being from inability, it seemed to be more about distraction and communication. Actually, the nurses said I had gotten the patient to eat more than anyone else. Patience? I don't know.
The instructor wanted me to try balancing two patients as well, so I picked up a patient with ... problems who just wants pain relief with the occasional attack. Of course, you don't get admitted for pain relief. ... was also elevated in the ER workup and ... and furosemide were administered overnight. Discharged before I went home....
Highlights of the day included working with a really good-looking RN. (This type of thing is a perk of being a man in nursing.) What I took out of clinicals this week was the need for more complete learning outside of clinicals. When more patients start getting added, it is way too much work to do research on each of them.
Junior-level clinicals happen on Thursdays and Fridays. We have to go into the hospital on Wednesday night to get our assignments and then do research on conditions, medications, etc. Our clinical paperwork includes a short history of the current admission. Here was my patient history for today:
...Love those question marks? In the H&P, the surgeon wrote he was going to do an open surgery, but then wrote "lapxxxxxxxx" in his procedure note. Also, no reason for admission given or rationale for tele/ox.
The patient was supposed to have an NG and Jackson-Pratt, but when I got there this morning, the NG and JP were out, patient was up and passing gas, and the surgeon discharged.
What's a student to do? I got a ... patient awaiting nursing home placement for tomorrow...
In the e-mail today, I received the latest newsletter [pdf] from the National Society for Nontraditional Premedical and Medical Students. I had forgotten that I was even a member (which really just means signing up for the website, I think).
I just don't have enough dedication to all the memorization necessary for med school, so I guess I've given up on that idea, but some of the forums are really quite interesting, and there is one woman who posts there who went from RN to BSN to NP to MD. Quite a path taken. That seems like way to much time in school to me. I believe she did her nursing at Georgetown if I'm not mistaken.
Sent: Thu 2/07/08 9:41 AMThat's the way buying nursing books should be. I can't wait to pass on my textbooks as well. Thanks, Kelly, and good luck to you, too! (Now, we'll have to wait and see if the textbook is any good...)
I know what that's like--I was in the same situation with a textbook earlier in the semester. I have just shipped the book via Priority Mail.
It should be there in a day or two. Good luck with your studies!
Wednesday: 1600 clinical research; 2145 gym; 2230 supper; 2300 bed
So, yesterday, I put on my radio shows and interspersed them with the SEAL cadences, and I had a very interesting experience... At one point, I was nearing the end of one of the radio shows and nearing a point of breathing exertion that usually makes me slow down--it's the point where your breathing starts getting irregular and shallow and your footfalls lose their pacing. Then the show ended and a cadence started and all of sudden my breathing became deeper, more regular, more productive, and my running regained its pace.
I know that there have been quite a few nursing studies done on the effects of music on patients, but I wonder if there are any studies on cadences. Does this only work when you're running (i.e., the autonomic breathing is effected through the motor cortex but not the auditory cortex) or could it work when you're just listening?
I searched the CINAHL and Medline databases. CINAHL doesn't return anything related to "cadence" and "breathing" or "dyspnea." Medline returns an article that confirms my anecdote:
We describe a breath-by-breath method to test for entrainment of breathing and walking cycles... The majority of subjects showed some evidence of entrainment (29 +/- 23% of breaths on average), which occurred intermittently, usually lasting less than 10 breaths at a time. The precision of phase locking during spontaneous entrainment was similar to that in 10 subjects who attempted to maintain deliberate entrainment. The results suggest that the walking cadence provides a persuasive, but not dominant, input to the central breathing pattern generator.
Medline also returns an article on cadence at the cellular level:
Observing the macroscopic complexities of evolved species, the exceptional continuity that occurs among different cells, tissues and organs to respond coherently to the proper set of stimuli as a function of self/species survival is appreciable. Accordingly, it alludes to a central rhythm that resonates throughout the cell; nominated here as primary respiration (PR), which is capable of binding and synchronizing a diversity of physiological processes into a functional biological unity... In all probability, PR emerges within the crucial organelles, with special emphasis on the DNA (5), and propagated and transduced within the infrastructure of the cytoskeleton as wave harmonics (49). Collectively, this equivalent vibration for the subphylum Vertebrata emanates as craniosacral respiration (CSR), though its expression is more elaborate depending on the development of the CNS...These don't address my question, though. Could cadence be used to help control breathing in dyspneic patients? Can the appropriate brain centers be stimulated with electromagnets without physical activity? Food for thought... or research.
Revised 10/13/08 - I don't know if this is really kosher, but I've gone back and added a Researchblogging tag to this post. None of the content is changed...
- Hill et al. (1998). Short-term entrainment of ventilation to the walking cycle in humans Journal Of Applied Physiology, 65 (2), 570-578
- P Crisera (2001). The cytological implications of primary respiration Medical Hypotheses, 56 (1), 40-51 DOI: 10.1054/mehy.2000.1106
Anyhow, I "forgot" to hand in the pre-test, so I can make a copy of it and learn the terms on my own. I SWEAR IF I REMEMBER THESE CARTOONS FOR THE REST OF MY LIFE, IT WILL RUIN MY APPRECIATION FOR MEDICAL TERMINOLOGY AND MAKE ME HATE THIS INSTRUCTOR AND SCHOOL FOREVER. There, I said it to you, the internets, instead of her...
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.
On average, healthy people lived 84 years. Smokers lived about 77 years, and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
- Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. PLoS Medicine Vol. 5, No. 2, e29 doi:10.1371/journal.pmed.0050029
I assume everyone knows about BioMed Central, location of free, open access biomedical journals. Well, I haven't looked through their list of journals in quite some time, I guess, as I just noticed BMC Nursing.
However, at the local North Country Food Co-op, I discovered Real Sugar Blue Sky Cola, which is made with sucrose instead of HFCS and (just as importantly to me) without the strong acids that go into Coke, Pepsi, RC, etc. If you think it can't taste good, just try it. I actually like it better. The flavor of HFCS just doesn't compare with sugar, and Blue Sky doesn't have that "I'm drinking flavored battery acid" quality that you get with a Coke.
Blue Sky Real Sugar has been developed for consumers who have allergies to High Fructose Corn Syrup or wish to eliminate HFCS from their diets. 100% Natural, No Artificial Flavors or Colors, No Preservatives, No Caffeine, No Sodium, Kosher Certified, GMO free, and No High Fructose Corn Syrup.
I have a lot of trouble keeping straight what's going on in my life, when schoolwork is due, and how much time I have left. So, I tried to put together a semester minder. It ended running to 40 5.5" x 8.5" pages. The cover I chose was this image called "... curing a woman's diseased eye with a beryl gemstone" from Ortus Sanitatis, 1491