Thursday, April 17, 2014

Nurses Week Promotion from Dansko!

Nurses Week is an event that I recognize on my blog annually. 
It's kind of a big deal.
  Capitol City Speakers Bureau National Nurses Week Speakers
Nurses week is always May 6-12. It begins on National Nurses Day (May 6) and ends on Florence Nightingale's birthday (May 12). (Here are my nurse week posts from 2012 and 2013.)
For 2014, I've got big plans. It includes daily nursing related posts with daily nursing related giveaways. Things you'll like, I promise. :) 
In the meantime, Dansko is getting ready to celebrate Nurses week by having an amazing contest! 
Go to Dansko's website and share with them WHY you celebrate Nurses Week and you could win a Dansko Appreciate Event for yourself and up to nine co-workers! Five teams of ten winners will each win a lunch and shoes! This promotion is currently running now through April 28th and the winners will be announced April 30th. 

What an amazing opportunity! Your co-workers will love you if you win. :) 

Wednesday, March 26, 2014

My Nursing ABCs [and linkup]

I have this massive medical dictionary book that I got in nursing school and it's one of the few I decided to keep. You can literally open it up and find something new every time. And there are pictures! I wanted to use it as a coffee table book but Mo said no because people eat in that room.
Anyway, I wanted to make my own personal version of that and share a little bit about my job by using the alphabet. Here goes.

A is for apnea.
Defined as the absence of spontaneous breathing. It can be induced by respiratory suppressing medications, like narcotics. Or it can occur in individuals while they're asleep. It's not normal. Get treatment.

B is for beta blocker.
A classification of medication that target the beta-receptors specifically on the cells of the heart muscle. Helps with hypertension, managing arrhythmias, and protecting against a second heart attack. 

C is for chest tube
So, so many chest tubes. Rarely do we have a patient without one. 
Picture of chest tube placement after lung surgery
Majority of the time, they're placed to drain blood and fluid after heart and lung surgery.

D is for dialysis
There are several types of dialysis but the one I have to know about as a nurse in an intensive care unit is CRRT (continuous renal replacement therapy). It's basically a slow, continuously running dialysis that the nurse manages. These patients are 1:1.

E is for Electrocardiograph (ECG or EKG). 
My heart patients have this done before surgery, right after, and as needed. Often times, the little stickers get left behind and we're pulling them off for days. Helpful hint: the longer those stickers are left on, the gummier they get. It's awful.

If you can't get an order for a rectal tube, these can save you!! And the patient's skin too. 

G is for gonorrhea
Actually, I never have to deal with this in my patient population (*knocking on wood). I was just stuck on G for a while. 

H is for heart
My favorite organ of the body. 
The real deal vs. the Hallmark deal
I is for Insulin
Our goal after surgery is to keep a patient's blood sugar well controlled to prevent infection and promote healing. We do this with the help of our amazing Glycemic Management Team and keeping the patient on an insulin drip for the first 48 hours (diabetic or not) or as long as needed. 

J is for jaundice. 
It's not just for those newborns, I'm telling you. It's often benign for babies, but for adults it's cause to worry and investigate. As a nurse, it's awfully uncomfortable watching someone turn yellow.

K is for kilogram. 
In the hospital, we use the metric system. And military time. Kilograms for weight, centimeters for height, milliliters of fluid, and Celsius for temperature, just to name a few. It's not so bad once you get used to it. The hard part is when a patient wants to know what their temperature is, but in Fahrenheit. Lucky for me, our hospital has a conversion table taped to the inside of the cupboard door where we can easily figure it out for them. 

L is for Lasix (also known as Furosimide). 
It's a diuretic. It makes people get rid of extra fluid in their body. Our heart surgery patients get a TON of fluid from surgery and we want to make sure they can get rid of that fluid. We keep track of their daily intake/output and weigh them every morning to see how they're doing. If the doctor thinks they need a little extra boost in getting rid of the fluid, they'll order Lasix. 

M is for myocardial infarction (aka heart attack).
Heart Attack illustration - Myocardial Infarction
MIs occur when blood flow to the heart is blocked long enough that part of the heart muscle becomes damaged or dies. Please take care of your heart. And if you EVER have anything that could possibly be chest discomfort, tightness, pressure, whatever... get checked out! Don't mess around with the heart!

N is for nosocomial infection (aka hospital-aquired infection).
It happens. Hospitals can be dirty places sometimes.

O is for Oxygen
Interesting fact: I recently had a patient tell me that oxygen helps her nausea. She has been on chemo and has definitely had her share of nausea and has found that when they put oxygen on her, the nausea lessens. 

P is for pacemaker.
After heart surgery, our patients come out with temporary pacemaker wires to have as a backup way to help the heart beat if there are problems. 
There are also external pacemakers and permanent pacemakers and transvenous pacemakers. We get exposed to all of them. 

Q is for QRS complex. 

R is for Red Man syndrome
I've seen this once or twice during my 6 years nursing. It's like the jaundice thing, it's disconcerting to watch someone turn a different color, red being one of them. This one occurs as a drug reaction (Google image this one if you're feeling brave).

S is for sternotomy. 
This is probably one of the most common post-operative incisions that I care for (besides throcotomies, but see the letter T for more on that).
Sternotomy diagram, showing the sternum and incision
There are YouTube videos of this, if you're morbidly curious. Don't watch it if the idea of blood or retractors makes you squeamish. 

T is for tamponade.
Cardiac tamponade is a potentially life-threatening condition where blood or fluid gets trapped between the heart and the pericardium. It puts pressure on the ventricles and limits how much blood the heart can pump out to the body. Either the fluid must be drained by a needle (pericardiocentesis) or, for our heart patients, sometimes they have to take them back to the OR and open their chest again. 
When life gives you tampons, make tamponade. LOL..........

U is for underwear. 
It's something that patient's don't get to wear basically the entire time they're on my floor (or in the hospital, for that matter). They have to take everything off when they're admitted and don't get to be in anything but a hospital gown until they get their discharge order. 
But I think it makes them feel young again. For most of them, they haven't gone commando since they were 5. ;)

V is for valve. 
The heart has 4 of them. 

W is for walker. 
Not the zombie TV show. Walker as in "an extremely light, moveable apparatus, about waist high, made of metal tubing, used to aid a patient in walking" (Mosby's Dictionary).
Double Trigger

X is for Xarelto. (I bet you thought I was going to say x-ray, huh?)
Xarelto is a prescription medication that is used for preventing or treating blood clots. We occasionally have patients taking this, although Coumadin (Warfarin) is more common. And that's all I'm going to say about that so I don't sound like a drug rep. :)

Y is for yeast. 
Nystatin powder, anyone? 

Z is for Zaroxolyn
Another drug. This one is a diuretic that we use from time to time (usually with Lasix- see the letter L).
Did you learn something new? :) Link up with Paige and I below!
ps. April's topic is all about finding a nursing job! This is for the especially for the nursing students who are about to graduate!!

Wednesday, March 19, 2014

Happy Certified Nurses Day!

March 19!
It's National Certified Nurses Day!
A day to recognize and honor "the important achievement of nursing specialty and sub-specialty certification." That's what the website says. :)

If you follow me on Instagram (@anna_the_nurse), you'll have noticed I recently joined the ranks of certified nurses:
(It was a 2.5 hour computerized test of 125 questions. A little intimidating.)

So, in honor of Certified Nurses Day, I thought I'd do a little Question/Answer post to help you learn more about becoming a certified nurse. And since I'm a member of the AACN and my certification was through them, a lot of this will be about my experience with them.

Keep in mind, there are a BUNCH of nationally recognized professional organizations who offer certifications. Some of these include: American Association of Critical-Care Nurses (AACN), American Nurses Credentialing Center (ANCC), Cardiovascular Credentialing International (CCI), Emergency Nurses Association (ENA), Society of Gastroenterology Nurses and Associates (SGNA), Center for Improvement in Healthcare Quality (CIHQ), and Oncology Nurses Association (ONA).

Nursing Certification FAQ (According to Me)
Q. Don't you just take the NCLEX and become an RN? What is this nursing certification thing?

A. "Certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing." (source) So, you won't lose your job if you fail a certification test, but it's an extra something you can add to your registered nurse status. :) It's a milestone that not all nurses choose to pursue, but it does recognize personal excellence in a particular area.

Q. Why should I become certified?

A. There are a bunch of reasons! You can test your knowledge and be a more confidant nurse in the area you work. If you're not ready or wanting to go back to school, this gives you something to work towards. It looks great on a resume. The hospital I work for gives a bonus to nurses who become certified, which is awesome. I can sign my name Anna, RN, BSN, PCCN (if I wanted). My hospital also has a ladder system where nurses can level up and having a certification gives you points to go up the ladder. And then you can have celebratory fro-yo after you pass the test. :)
Q. How should I prepare to for the certification test?

A. Remember the NCLEX? Sort of like that.
-Get study materials. I used the AACN's PCCN review course online and the audio from David Woodruff's PCCN review (a friend hooked me up with downloads of his review). I studied for about 3 months. I listened to the review in the car between home and work. I spent a few hours each week reviewing material. I spent the last couple weeks taking practice questions/tests.
-Form a study group. While I did not have a study group for my PCCN certification, I DO plan on having one for the CCRN certification! If you do well learning in a group environment where you can talk through ideas and ask questions, it's smart to do it. If you're looking for a study group/review course, check with your hospital and with AACN. They have chapters scattered throughout the nation and they will sometimes organize group reviews for certification. This website will help you find an AACN chapter if you're interested.
-Use ALL your resources. Google the certification and see what's out there. I read through some nursing forums that had suggestions of how people studied and other helpful tips. Youtube the certification. The PCCN, for example, had several videos posted of people doing reviews for the certification and there were questions on the actual test that I got correct BECAUSE I watched those youtube videos! Ask other certified nurses about what they did to study and what they'd recommend to someone preparing to take their test.
-Take practice tests! Just like NCLEX. :) You need to get into the groove of how they ask questions and what they are looking for.
-Be confidant. Believe in yourself and believe that you will pass. It helps.
-Test day. Know where the testing center is. Don't be late. Most of the places offer ear plugs, which is nice. I tested at a H&R Block in March, so even though I was in a separate room with the computer, you could still hear customers coming in and talking. Ear plugs made a difference! Also, you find out the SAME day if you pass or fail! That's something I actually appreciated. Last time I took a test like this, it took 3 days to hear the results. These certification tests can be re-taken. If you don't pass, they'll let you know what to do next.

Q. Okay, I'm certified. Now what?

A. You will have to maintain said certification. For example, mine is renewed every 3 years. I have to maintain my RN license and work so many hours in the area that I'm certified in. Then I need to either take the exam OR complete a certain amount of continuing education recognition points (CERPs). Not so bad, right?

I hope this helped  a little bit! As a new nurse, I didn't know much about certification and I probably could have taken this test years ago if I knew more. :) If you have other questions, leave them in the comments! If you're on the journey to become certified, good luck!

Thank you to all you certified nurses out there! 

Wednesday, March 5, 2014

I know what you're thinking. "Cookies, again?!"

We made it home! Portland was amazing, I'll share the details in a later post. :) 
But today, I wanted to wrap up my Valentine's Day/Heart Month contest! 
Here are the answers to this post:
(*keep in mind, these are my interpretations and because they are neither real or on ekg paper, my answers might not be the same answer that another person might get)
1. Normal sinus rhythm. All of you got this one right! Jill nailed it with the MOST correct answer of "normal sinus beat" because it doesn't show how much space there is between complexes.
2. Indeed, it is ST elevation. Harder to frost on a cookie than it looks.
3. Atrially paced. With 100% capture, as Drew helpfully identified.
4. Atrially paced with a failure to capture. 
5. Atrial flutter. I attempted to represent a 3:1 conduction, but ya know, with frosting... it's hard. Atrial fibrillation is also acceptable.
6. Accelerated junctional is what I was TRYING to do here, but forgot my t waves. :) So I guess this one and #8 are up to interpretation. It's too narrow of a QRS to originate in the ventricle but there's no p-waves to make it SVT... so I think I just made up a rhythm.If this were an actual heart rhythm, check on the patient, get an EKG and call the doctor.
7. Sinus rhythm converting into ventricular tachycardia. 
8. See #6. (putting this one in twice was not intentional. I had planned on using this one:
This is what happens when I write a post at 6 am before work. :)
9. Ventricular fibrillation. Just like NSR, everyone identified vfib! Excellent work! :)

So, I brought these cookies to work on Valentine's Day and by the afternoon, there were a bunch of vfibs, asystole, and vtach cookies left... none of the nurses wanted to eat those ones and get jinxed! Goes to shoe how superstitious we nurses are. :)

Drew, Jill, and Stormy, you three win for the most correct answers!
I'm shooting you all emails and I'll send you a prize in the mail. :)

Thanks for playing Lauren, Drew, Jill, Stormy, and Breanna!

Wednesday, February 26, 2014

Nursing Bucket List

February is ending and it's time for another nurse link up with Paige and any of you lovely nurse bloggers out there who'd like to join us!
Did you watch that Grey's Anatomy episode where Christina gets to make a bucket list of all the surgical procedures she's ever wanted to do? Speaking of Grey's Anatomy, anyone else get burned out   watching it? (talk about never-ending story).
Back to the bucket list. I've got one, except for nursing. It's always changing. I'm either adding to it, changing it, checking things off... but here's a general idea of where I am at, as of TODAY. 
1. Go on a nursing conference cruise. 
They really have these! Most nurses have to get so many continuing education hours each year and I can't think of a better way to get them than on a cruise ship. Who's with me? 

2. Volunteer more.
My hospital always has volunteer opportunities for the community events they hold. I've been apart of some of these and it's always such a rewarding experience. 

3. Become a certified nurse. 
In the nursing world, there are all sorts of certifications we can get. While I'm currently set to take the PCCN soon, my bucket list absolutely includes getting my CCRN (certification as a critical care nurse).

4. Get a master's degree in nursing. 
While I'm not currently working on this one, it's on the bucket list as more of a 'long-term' goal. First, I have to convince myself to go back to school. It's hard to get back on the horse when it's really nice to be off it! :) Then I'll have to figure out what sort of program I'd want to apply to. There's so many options: advanced practice registered nurse roles like nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse midwife (CNM). There's nursing research, nurse educators, clinical nurse leaders (CNL), nurse administration, and more!
So much to think about. 

5. Try out a nursing leadership role. 
Now's as good a time as any to mention that we've had some management changes in the CVICU recently. Our wonderful manager of 5 years transferred to the ER to manage their unit. So now we have an interim manager and the hospital is interviewing for a new manager.
To make a long story short, I interviewed.
And it went really well! When all the changes first started happening, I thought I'd maybe consider  an assistant manager position or something, but after some reflection and some external encouragement, I decided to show some initiative and go for it.
Round 2 of interviews is coming up later in March and I can honestly say that I'll be excited for whatever happens. Even if I don't get the position, I'm so happy with the unit and the co-workers and we'll all get to adjust to a new manager together. If I'm chosen to take over the role, it'll be a wonderful opportunity and I'll have a ton of learning opportunities coming!
I'm sure you all will hear if something happens. :)

Speaking of buckets...
I found this in Portland. And I took a picture of it specifically so I could include it on this post. :) 

What do YOU want to do with your nursing career? 
Let me know, I'm curious!
ps. last chance to guess these heart rhythms! I'm choosing a winner next week when I'm back in town!

Thursday, February 20, 2014

5 Reasons to Read This Book (Even if You Don't Have Cancer)

Fact: February is National Cancer Prevention Month!

Maybe you were like me and thought that cancer was part random and part genetic. Or maybe you knew that things like diet, weight, and exercise could actually affect your chances of having cancer?

Either way, knowledge is power, and this book is POWERFUL.

I was emailed a couple months ago to see if I'd be interested in reading 100 Perks of Having Cancer plus 100 Health Tips For Surviving it and then blogging about it. Reviewing this book hasn't been easy. It's hard to summarize 400+ pages of valuable information! So I decided to take a leaf out of the authors' book and to create a numbered list of why people, with or without cancer, should read it.

So here ya go.

5 Reasons to Read 100 Perks of Having Cancer plus 100 Health Tips For Surviving it! (even if you don't have the Big C)
First, let me tell you a little bit about the authors, Florence and Susan. What a team they make! Flo is a registered psychologist and Susan is a registered nurse. They both went through their own breast cancer experiences and then collaborated to create this book. Flo shares 100 perks of having cancer (inspired by her blog) and Susan includes 100 health tips for surviving it (more on her blog). Their sense of humor makes this book easy and enjoyable to read. Plus, there are some great illustrations and personal photos in here. After reading this book, I sort of feel connected to them!

Aren't they amazing? :) So, here's why you should read the book:

1. It inspires you.
Like, in the way those Olympic stories inspire you. Everyone loves to see a person overcome obstacles and succeed in life. It talks about living in the moment, making the most of your life, and building relationships. Susan and Flo don't even beat around the bush. They dive right into the gritty details, like health tip #2, the effects of estrogen on the lady parts, or health tip #28, all about having normal bodily functions. :) The book talks about the power of prayer and of a strong support group. Really, it tells you how to get through challenges in life and that's something that anyone, with or without cancer, can appreciate.

2. It makes you count your blessings.
Some of things I realized I'm grateful for while reading this book:
-I don't have cancer (knocking on wood as I type this).
-I'm learning ways I can prevent cancer and I didn't have to do any of the research!
-I have eyebrows. Therefore, I can communicate by giving 'the look.'
-I don't have to schedule myself around 'good days' and 'bad days.'
-I don't smoke and I'm thankful for that (fact: on average, it takes a smoker 3 ties to quit).
-I'm thankful for humor and how it helps me cope with my job and with life.
-I don't have medical bills to pay.
-I'm already really good a sleeping, and apparently poor sleeping habits are linked to a lot of really bad things (high blood pressure, obesity, depression/anxiety, diabetes, impaired immunity, and even cancer).

3. It makes you more aware. 
Reading this book was similar to my experience watching Food, Inc. or Super Size Me. It was almost shocking how many things have links to cancer and are seen as 'normal' in society. Examples include health tip #60 warns against "added sugar" (sad), #66 talks about the problem with eating fast food (also sad), and then #24 says I have to ditch my microwave popcorn (triple sad)! I relate to Flo in the fact that I feel like I lead a healthy-ish lifestyle. But everything is backed up with research that specifically states why cancer loves and thrives on those things and it suddenly makes it a lot less appetizing. At the same time, you learn about healthy fats, nuts, vitamins, seeds, fruits, veggies... the list goes on and on. There are beauty tips (skin care and hair care) and exercise tips (how to make the most of your walking and how dancing counts as working out).

The book also made me aware that goldfish keeping is actually a hobby. So I had to Google it. And apparently, back in September 2013, here in Boise, Idaho, we held the 20th annual Koi and Goldfish Show. I didn't even know such a thing existed! So, naturally, I'm making plans to go for 2014. :)

If you get the chance to read this book, don't skip Perk #57 Handsome Doctors and Health Tip #57 When Good Doctors Go Bad. It basically gives you some really good insider tips on how to choose a medical provider, which is huge!

4. It gives you a bunch of great recipes
The kitchen is my happy place, so I got really excited when some of Susan's 100 health tips were some fantastic recipes to try! There's vegan chocolate beetroot cupcakes, kale chips, pumpkin soup, a version of quinoa sloppy joes, granola, and dandelion salad.

The book also gives a list of cancer fighting foods: garlic, berries, avocado, Chile peppers, broccoli, raw carrots, mushrooms, red grapes, and olive oil. There are PAGES devoted to olive oil! Specifically, extra-virgin organic olive oil. I found my bottle at Costco and made this carrot ginger soup in the picture below: (I did stray from the recipe and added a dash of hot sauce. So good!)
This book also introduced me to Clara, a sweet little lady who shares recipes from her childhood during the depression on YouTube (she passed away in 2013 at age 98). She basically has me convinced I need to try Dandelion salad this spring. I think I can convince husband to eat it, he's been on a 'wilderness survival' kick recently. :)

5. You will (probably) live longer if you read and heed this book.
Here's what I mean by #5: this book will help you make changes in your life that can boost immunity, make your body healthy and strong, and build up relationships with others. It helps you focus on having a healthy body and soul. For example, health tip #18 (one of my favorites) is all about the benefits you receive personally from helping others. There is research that looks at the effects of kind acts on health and well-being and they find that being good is good for you! Focusing on helping someone else takes your mind off your own problems and distracts you from your own stress-provoking thoughts. You release endorphins, reduce feelings of despair and isolation by providing hope to others, and it improves symptoms of depression (page 80). How cool is that? So now I've added another book to read to my list: The Healthing Power of Doing Good: The Health and Spiritual Benefits of Helping Others, by Allan Luks and Peggy Payne.
What I'm MOST excited about is using what I've learned and sharing it with my patients. I work in a Cardiovascular Intensive Care Unit and a handful of our patients come in with lung cancer and need tumor resections or whole lobes of their lungs taken out. Some of them go on to do radiation or chemo, others simply need the surgery. Either way, they're all going through the cancer scare and need some extra support.

While I doubt I'll get them to find the perks of cancer while they're dealing with a fresh incision and a chest tube sticking out of their side, I DO think they'll be receptive to learning all they can about how to avoid going through that experience again!
Want to learn more?
Here are some website that can tell you more about the book:
If you're interested in reading the book and joining the virtual tour, check out this website!


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