Debbie's Supplemental Learning Classes

Here are the powerpoint presentations for Debbie O'Sullivan's Presentations

Saturday, January 10, 1200-1600

Topic: Respiratory System*

Location: Valley Brew (157 W. Adams St.)

Presenter: Paul Barraza, R.T.

* covering Antaran's N7 syllabus outline on the topic

Link to Respiratory Powerpoint

Monday, January 12, 1700-1900

Topic: Cardiac meds

Location: Fireside Room, Central Methodist Church, across from UOP

Presenter: UOP pharmacology student

Link to Cardiac Meds PowerPoint


Thanks Debbie!!

SBAR Review

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.
From: SBAR Technique for Communications -- a Situational Briefing Model

Other SBAR information:

• Talking the Talk: How Hospitals Use SBAR to Standardize Communication
• A Sample of How to Use SBAR
• SBAR report to physician about a critical situation (pdf)

Tis the Season

There's a Christmas tree in upper Danner that Gloria and her team of elves put together, and a toy drive for the kids at Family Ties is underway. SNA is looking for donations and volunteers!

Read more about these activities at http://sjdcsna.blogspot.com/

Also, the Student Nursing Association has just elected new officers. That information will be posted on the SNA blog soon...

Peds Cardiovascular Questions

1. which might be found indicating a cardiac defect when assessing a 1 month old infant?
a. Weight gain
b. Hyperactivitry
c. Poor nutritional intake
d. Pink mucous membranes
2. which statement about PDA is correct?
a. HF is uncommon
b. The ductus normally closes completely by age 6 wks
c. An open ductus arteriosus causes decreased blood flow to the lungs
d. It represents a cyanotic defect c decreased pulmonary blood flow
3. which drug is recommended for a preterm neonate to close a PDA?
a. Indomethacin
b. Prostaglandin E1
c. Surgical ligation
d. Cardiac cath
4. which finding is expected in a child c PDA?
a. Weak peripheral pulses
b. Machine like murmur
c. Narrowed pulse pressure
d. RV hypertrophy
5. which may be seen in a child c VSD?
a. Cyanosis of nailbeds
b. Above average height on growth chart
c. Above average weight gain on growth chart
d. Pink nailbeds c cap refill les than 2 secs
6. which conditions best describes VSD?
a. Narrowing of the aortic arch
b. Failure of the septum to develop completely between the atria
c. Narrowing of the valves at the entrance of the pulm artery
d. Failure of the septum to develop completely between the ventricles
7. which curative surgical intervention is recommended for a child c VSD?
a. Surgery c PA banding
b. Defect repair thru cardiac cath
c. Surgery c purse string suture or dacron patch repair
d. Surgery when severe pulm HTN is noted
8. a child c VS repair is receiving dopamine post op. which response is expected?
a. Decreased HR
b. Decreased UO
c. increased CO
d. Decreased contractility
9. which produces left to right shunt?
a. ASD
b. Pulmonic stenosis
c. Tet of fallot
d. Total anomalous pulmonary venous return
10. a child c AS respire is entering postop day 3. whch intervention would be most appropriate?
a. Child to be NPO
b. Maintain strict bedrest
c. Take VS q 8 hrs
d. Admin analgesic prn
11. which condition best describes coarctation of th aorta?
a. Absent tricuspid valabe
b. Narrowing in the area of the aortic valve
c. Localized constrxn or narrowing of the aortic wall
d. Narrowing at some location along RV outflow tract
12. what assessment finding would be expected c Coarc of aorta?
a. Normal BP
b. Increased BP in upper extremities
c. Decreased BP in upper extremities
d. Decreased or absent pulses in upper extremities
13. which procedure is recommended to tx coarc?
a. Drug therapy
b. Balloon angioplasty
c. Surgery s CPbypass
d. Surgery c CP bypass
14. which is an important assessment for a child c a possible cardiac anomaly?
a. HR
b. Temp
c. BP
d. BP in 4 extremities
15. which intervention is recommended post op for a pt c coarc repair?
a. Vasoconstrictor
b. Main hypothermia
c. maintain a normal to low BP
d. Gove a bolus of IV fluids
16. which is expected when assessing a child c tet of fallot?
a. Machine like murmur
b. Eisenmenger’s complex
c. Increasing cyanosis c crying or activity
d. Higher pressures in the upper extremities than lower
17. which is correct for achild c tet?
a. The condition is commonly referred to as “blue tets”
b. They experience hypercyanotic or “tet” spells
c. They experience frequent respiratory infxns
d. They experience decreased or absent pulses in lower extremities
18. which best describes transposition of the great arteries?
a. The body receives only saturated blood
b. Its classified as an acyanotic defect c increased pulmonary blood flow
c. the PA leaves the LV and the aorta exits the RB
d. It’s a condition in which the RA and the LA empty into one ventricular chamber
19. which statement about transposition is correct?
a. Dx is made at birth
b. Dx can be made in utero
c. CXR can show an accurate view of the defect
d. HF isn’t a related complication
20. which defect is associated c transposition of the great arteries
a. mitral atresia
b. ASD
c. Patent foramen ovale
d. Hypoplasia of the LV
21. which surgical prodecure is recommended for repair of transposition?
a. Jatene operaqtion
b. Fontan procedure
c. Balloon atrial septostomy
d. Blalock-taussig operation

Here are a couple of links related to shock I found on Bonnie's site:

• CCM tutorial
• Study stack

Also, back in October, Trina posted two sets of NCLEX-style questions below if you want to test yourself. (Just scroll down the page...)

I found a good PowerPoint presentation -- Identification of shock states that Caralee Bromme put together when she taught N7, plus our ATI book's got a nice little review starting on page 341.

So -- once again -- we have lots of good information, just too little time to absorb it all!

Ah... the last exam of the third semester...

More respiratory for visual learners

Many of the following videos have more than one part. If you like the first part, look for the other parts once you're in YouTube. They should be listed nearby.

• Respiratory system (good overview)
• Gas exchange
• Microanatomy of the lungs
• Intubation during general anesthesia
• Mechanical ventilation
• Ventilator types and modes
• Mechanics of breathing
• Oxygen transport
• CO2 transport
• Flail chest - paradoxical breathing
• Chest tube insertion/pneumothorax
• Tracheostomy dressing change
• Tracheal suctioning
• Understanding COPD
  

Respiratory resources

Need a little refresher on ABGs? Here are a couple good links:

• ABG interpretation quiz
• ABG tutorial

Here's another good one:

• Pulmonary system (CCM tutorial)

The above links are on Bonnie Boss' Test Bank, along with lots of NCLEX practice.

Also, don't forget to check out Bromme's old N7 lectures. There are two good PowerPoint presentations there on the respiratory system.

Oxyhemoglobin dissociation curve links:

• Interactive tool
• The curve described

For visual learners

Videos you might find interesting...

• PCI (stenting)
• LVAD (left ventricular assist device)
• VADs for lifetime use
• VAD how it works
• CABG surgery (patient education)
• Bypass surgery
• Actual CABG surgery
• CAD treatment lifestyle changes
• Myocardial infarction
• Internal jugular vein catheter insertion
• Atrial fibrillation
• PR Interval
• Basic gross anatomy of the heart
• Cardiac cycle
• Myocardial infarction
• T wave inversion (diagnostic MI)
• ST elevation (MI)
• Understanding heart disease
• Cholesterol
• What is a heart attack?
• What is angina?
• Congestive heart failure
• Understanding cholesterol
• Emergency echocardiography

Plus...
Nursing 7 stuff on Docushare (C. Bromme, RN, MSN)

hemodynamics

Links to some handy resources:

• Swan-Ganz catheterization (article)
• Swan-Ganz catheters (article)
• Hemodynamics (article)
• Pressure changes (same as image above)
• Catheter placement (image)
• The catheter (image)
• Hemodynamic insufficiency
• Nurse Bob's hemodynamic overview (article)
• Hemodynamic monitoring (interactive)
• Good instructional videos -- scroll down to "hemodynamic monitoring" and "PA line insertion"

EKGs

Link here for EKG fun!

• EKG quizzers #1 and #2
• ECG rules quiz
• Six-second ECG (dynamic simulator)
• Waves (illustration)
• Remember the J point? (illustration)
• Cardiac rhythm interpretation
• ECG patterns in MI (image from heart attack treatment)
• What is wrong with this EKG? (a colorful printable pdf)

pediatric nursing and development questions

Click on the comments section to take a pediatric development quiz.

The answers are also in the comments section.

good luck!

Nursing 7 resources

Trina has posted lots of good stuff on this blog for Nursing 7, including the link to an explanation of the RAAS on Wikipedia. It was so helpful to me, I thought I should repost it, closer to the top... Check it out at this link... Renin-Angiotensin-Aldosterone System. (Thanks, Trina!)

Note: the author's starting point on the diagram is a decrease in renal perfusion, but -- in his/her notes -- points out there are other ways RAAS can be activated -- "...by a low NaCl concentration in the macula densa or by sympathetic activation."

Be sure to scroll down for all the Nursing 7-related information. There are lots of other good posts by Trina and others, like Bonnie's links to information on hemodynamic basics or links to videos to refresh your clinical skills, next to the Starbucks IV bag below. Drink it up, y'all!

Nursing 7 is the perfect time to reacquaint yoursef with (or introduce) the information available on Bonnie Boss' "original" student blog she created for fellow SJDC nursing students. In addition to her excellent test bank, bringing us tons of NCLEX practice, she includes many links to supplementary information on a variety of relevant topics under "practice tests and quizzes" and "helpful links." Get to know what's out there. Bonnie's already done a lot of the legwork for us.

(Muchas gracias, Bonnie!)

FYI, Bonnie's now a full-time RN working in ICU at Lodi Memorial.

more shock

1. Which is the most important goal of nursing care for a pt who is in shock?
a. Manage fluid overload
b. Manage increased CO
c. Manage inadequate tissue perfusion
d. Manage vasoconstrxn of vascular beds
2. Which nursing assessment finding indicates hypovolemic shock in a pt who has had a 15% blood loss?
a. Pulse <> 30mL/hr
b. Systolic bP > 110
c. Diastolic > 90
d. RR of 20 braeths/min
4. which is a risk factor for hypovolemic shock?
a. Hemorrhage
b. Antigen antibody rxn
c. Gram neg bacteria
d. vasodilation
5. what is a priority assessment for the pt in shock who is receiving an IV infusion of PRBC and NS?
a. Fluid balance
b. Anaphylactic rxn
c. Pain
d. ALOC
6. the pt who does not respond adequately to fluid replacement has an order for an IV infusion of dopamine hydrochloride at 5u/kg/min. the desired fx of the drug is
a. increased renal and mesenteric BF
b. increased CO
c. vasoconstrx
d. reduced preload and afterload
7. A male pt who has been taking coumadin has been admitted c severe acute rectal bleeding and the following lab results: INR 8, Hmg 11, hematocrit 33%. Which MD orders would the nurse expect to implement initially? Select all that apply.
a. IV D5 ½ NS
b. Schedule pt for sigmoidoscoy in the AM
c. Give 1 unit FF plasma
d. Admin vitamin K 2.5 mg PO
e. Begin polyethylene glycol-electrolyte solution in preparation for signoidoscopy
f. Admin fleet’s enema
8. the nurse in perop holding area keeps a pt c gastric bleeding in a dimly lit environment c one family member present. What is the primary rationale for these nursing interventions?
a. Stabilize fluid and lyte balance
b. Minimize O2 consumption
c. Increase pt and family comfort
d. Prevent infxn
9. when assessing a pt for early septic shock, the nurse observes for which of the following?
a. Cool clammy skin
b. Warm flushed skin
c. Decreased systolic bp
d. hemorrhage
10. a pt c toxic shock has been receiving ceftriaxone sodium, in add’n to culture and sensitivity studies. What other lab finding does the nurse monitor?
a. Serum creat
b. Spinal fluid analysis
c. ABG
d. Serum osmolality
11. what intervention is most important in preventing septic shock?
a. Admin IV fluid replacement therapy as orderd
b. Obtaining VS q 4 hrs for all pts
c. Monitoring RBC counts for elevation
d. Maintaining asepsis of indwelling urinary catheters
12. which is a indication of a complication of septic shock?
a. Anaphylaxis
b. ARDS
c. COPD
d. Mitral valve prolapse

Congenital Heart Defects

Thanks, Crista for the link to Mayo Clinic's slideshow on common congenital heart defects.

There are also some handy little animations of blood flow through various defects on our textbook's CD for chapter 48.

Peds was fun but we are definately ready to get 7 over with. How is it so far??

Shock it to me!!

1. DIC often results in complications initially associated c which of the following organs?

a. brain

b. kidney

c. lung

d. stomach

2. Which conditions is not caused by DIC?

a. organ tissue damage

b. depletion of circulating clotting factors

c. thrombus formation in the large vessels

d. activation of the clotting dissolving process

3. A 19yo pt admitted c heat stroke begins to show signs of DIC. Which lab finding is most consistent c DIC?

a. low platelet count

b. elevated fibrinogen levels

c. low levels of fibring degradation product

d. reduced PT time

4. Vasopressors may be indicated in which type of shock?
a. neurogenic
b. hypovolemic
c. respiratory
d. metabolic

5. For every unit of blood lost in trauma, how much crystalloid must be infused?
a. twice as much
b. equal amount
c. half as much
d. three times the amount

6. Which drug is a parasympathetic antagonist?
a. lidocaine
b. atropine
c. digoxin
d. dopamine

7. A heat exhaustion patient is suffering from what type of shock?
a. cardiogenic
b. neurogenic
c. hypovolemic
d. metabolic

ARDS and ABGs

1. which intervention would be most likely to prevent ARDS?
a. Teach cigarette smoking cessation
b. Maintaining adequate serum K levels
c. Monitoring pts for signs of hypercapnia
d. Replacing fluids, adequately during hypovolemic states

2. Which ND would be a priority for a pt c ARDS?
a. Ineffective breathing pattern
b. Pain
c. Ineffective health maintenance
d. Risk for infxn

3. Early sign of ARDS in a pt at risk?
a. Elevated CO2 level
b. Hypoxia not responsive to O2
c. Metabolic acidosis
d. Severe, unexplained lyte imbalance

4. pH 7.52, PaO2-50, PaCO2-28, HCO3-24
a. hypoxemia
b. hypoventilation
c. hyperventilation
d. o2 toxicity

5. Same condition as above, which conclusion accurate?
a. Pt severely hypoxic
b. O2 low but poses no risk for pt
c. Pt’s paO2 c/in normal range
d. Pt requires O2 c very low O2

6. same condition, possible cause?
a. COPD
b. DKA c kussmaul’s
c. MI
d. PEmbolus

7. which intervention should the nurse anticipate in a pt c ARDS?
a. Tracheostomy
b. Intermittent positive pressure breathing
c. Mechanical vent
d. Insertion of a chest tube

8. Which condition can put a pt at risk for ARDS?
a. Septic shock
b. COPD
c. Asthma
d. HF

9. which assessment would be most appropriate for determining correct placement of ETT in a mech vent pt?
a. assess skin color
b. monitor RR
c. verify amount of cuff inflation
d. auscultate lung sounds bilaterally

10. which nursing intervention would promote effective airway clearance in a pt c ARD?
a. Administer O2 q 2hrs
b. Turn pt q 4hrs
c. Admin sedatives
d. Sxning if cough ineffective

11. which is a complication associated c mechanical ventilation?
a. GI hemorrhage
b. Immunosuppression
c. Increased CO
d. P Emboli

12. The nurse would anticipate which of the following ABG results in a pt experiencing a prolonged, severe asthma attack?
a. low PaCO2, high PaO2, low pH
b. High paco2, low pao2, low pH
c. High paco2, high pao2, high pH
d. Low paco2, low pao2, high pH

13. A pt’s ABG values are as follows:
pH 7.31, paO2-80, PaCO2-65, HCO3-36
Which s/sx would the nurse expect?
a. cyanosis
b. flushed skin
c. irritability
d. anxiety

Answers in the comments section.

Brush up on Acid-Base imbalance

Acid - Base Quiz

Memorial for one of our own

One of our fellow SJDC nursing students passed away on September 5th in a motor vehicle accident. Melissa was a nursing 4 student from Tracy. Her obituary is below. Donations can be made to Tracy federal credit union, acct #22363.

Melissa Granados
05/23/1981 — 09/05/2008
Services will be Friday for lifelong Tracy resident Melissa Granados, 27, who died Sept. 5 in a car accident that also led to the death of her 5-year-old son, Ayden Weaver. Ms. Granados was born in Tracy and lived here her entire life. She was a nursing student at San Joaquin Delta College and had received a scholarship to study nursing from the National Trucking Association’s San Joaquin County chapter. She was also involved in breast cancer awareness activities, in remembrance of her mother, Darlene, who died of the disease in 2002. Ms. Granados was also an avid San Francisco Giants and 49ers fan and enjoyed playing basketball and soccer. Ms. Granados is survived by her father, Donald Granados, of Tracy; sisters, Tricia Rittger and Staci Granados, both of Los Osos; and many aunts, uncles, nieces and nephews. She was preceded in death by her mother, Darlene Granados; and grandmother, Connie Basruto. Friday’s services, which will include a service for Ayden, will begin at 1 p.m. at Fry Memorial Chapel, 550 S. Central Ave. Burial will be private. Donations in Ms. Granados’ name may be sent to the Ayden Weaver and Melissa Granados Memorial Fund, Tracy Federal Credit Union, account No. 22363.
Published on 09/10/2008

Heart Dz Quiz

1. Which condition most commonly results in CAD?

a. atherosclerosis

b. DM

c. MI
d. Renal failure

2. Atherosclerosis impedes coronary artery blood flow by:

a. plaques obstruct vein

b. plaques obstruct artery

c. Blood clots form outside vessel wall

d. Hardened vessels dilate to allow blood to flow thru.

3. Which serum cholesterol level increases risk of CAD?

a. 100mg/dl

b. 150

c. 175

d. 200

4. which is done first for a pt exhibiting s/sx of CAD?

a. decrease anxiety

b. enhance myocardial O2ation

c. Admin sublingual NTG

d. Educate pt about sx

5. Landmark for obtaining apical pulse

a. left 5th intercostal space, midaxillary line

b. left 5th intercostal space, midclavicular line

c. left 2nd intercostal space, midclavicular line

d. left 7th intercostal space, midclavicular line

6. which blood test is most indicative of cardiac damage?

a. lactate dehydrogenase

b. CBC

c. Troponin I

d. Creatine kinase

7. Primary reason for administering Morphine to MI pt?

a. sedate

b. decrease chest pain

c. decrease anxiety

d. decrease O2 demand on heart

8. Most commonly responsible for MI?

a. aneurysm

b. HF

c. coronary artery thrombosis

d. renal failure

9. Which Dx tool used to most commonly deterine location of myocardial damage?

a. cardiac cath

b. cardiac enzymes

c. echo

d. ECG

10. First intervention for pt experiencing MI?
a. morphine

b. O2

c. sublingual NTG
d. obtain ECG

11. Most common complication of MI?

a. cardiogenic shock

b. HF

c. arrhythmias

d. pericarditis

12. which sx might a R sided HF pt exhibit?

a. adequate UO

b. polyuria

c. oliguria

d. polydipsia

13. Dyspnea, cough, expectoration, weakness, and edema are classic s/sx of:

a. pericarditis

b. htn

c. MI

d. HF

14. after undergoing cardiac cath, pt has a puddle of blood under his buttocks. which step should you take first?

a. call for help

b. obtain VS

c. Ask the pt to "lift up"

d. apply gloves and assess the groin

15. which type of pain characteristic of angina?

a. knifelike

b. sharp

c. shooting

d. tightness

16. drug of choice for angina pectoris?

a. aspirin

b. lasix

c. NTG

d. nifedipine

17. predominant cause of angina?

a. increased preload

b. decreased afterload

c. coronary arty spasm

d. inadequate O2 supply to the myocardium

18. which dx test used most often to dx angina?

a. CXR

b. echo

c. cardiac cath

d. 12 lead EKG

19. Primary tx goal for angina?

a. reversal of ischemia

b. reversal of infarction

c. redxn of stress and anxiety

d. redxn of associated risk factors

20. Earliest sign of Cardiogenic shock

a. tachycardia

b. decreased UO

c. presence of 4th heart sound

d. ALOC

CV questions

1. which of the following is a compenstory response to decreased CO?
a. decreased BP
b. ALOC
c. dec. BP & diuresis
d. inc. BP and fluid volume

2. which is used to describe the amount of stretch on the myocardium at the end of diastole?
a. afterload
b. cardiac index
c. CO
d. preload

3. one hour after administering IV lasix to a pt c HF, a short burst of Vtach appears on the monitor. which lyte imbalance should the nurse suspect?
a. hypoCa
b. HyperMg
c. hypoK
c. hyperNa

4. to reduce risk of coronary artery spasms, whicy type of med is the physicial most likely to prescribe?
a. Beta blocker
b. ACE inhibitor
c. inotropic vasodilator
d. Ca channel blocker

5. pt c HF is receivfing lasix 40mg IV. the MD orders 40 mEq KCl in 100mL D5W, to infuse over 4 hr. the pt's serum K level is 3.0. at which infusion rate should the nurse set the pump?
a. 25mL/hr
b. 10
c. 100
d. 50

6. a pt being tx'd 4 Vtach, why should teaching include eating foods such as bananas?
a. bananas high in carbs
b. high in K
c. low in Na
d. high in fiber

7. BP 126/80, MAP is

Also, links to test bank questions
med I
med II
med III
med IV
med V

Swan Ganz Insertion and Waveform

This shows actual insertion of a Swan Ganz and what the waveforms look like. I don't know about you guys, but I am always pleasantly surprised when I learn something and it is actually like real life!!

Swan Ganz Insertion and Waveform

You really only need to watch 3:20-5:30 of this video.

Oh, by the way. . . it is in Spanish, which is interesting, and you kind of feel like you should be on E as you listen to it (you will know what I am talking about when you watch it).

Also, this man made a good analogy for hemodynamics.

Understanding Hemodynamics

N7 Hemodynamic Basics

Hey guys, check out this Nursing CEU site. Quick easy read with mini quizzes

HEMODYNAMIC BASICS

Take the test in the comment section.

You can also check out Nurse Bob's Hemodynamic monitoring in the ICU

Early bird questions

Here are some questions regarding cardiac, so that I can actually practice before I get the test!!

Be forewarned that there is sound on the cardiac quiz site, so check your volume!
EKG simulator

Cardiac Quiz

Heart meds

Rhythms and Meds

Links to test banks

http://deltarnstudents.blogspot.com/2005/09/n4-test-neuro-icp-chapter-55.html
http://deltarnstudents.blogspot.com/2005/09/n4-test-head-injuries-and-icp.html
http://deltarnstudents.blogspot.com/2005/09/n4-test-cerebral-bleeding-and-icp.html
http://deltarnstudents.blogspot.com/2005/12/n4-n7-critical-care-neuro-quiz.html

http://deltarnstudents.blogspot.com/2005/12/n4-neuro-and-cranial-nerves-quiz.html

http://deltarns2007.blogspot.com/2005/10/disorders-of-fluid-volume-osmolality.html
http://deltarnstudents.blogspot.com/2005/10/n4-test-fluid-imbalances.html

http://futurenurses2008.blogspot.com/2008/04/n7-pharmacology-positive-inotropic.html
http://futurenurses2008.blogspot.com/2008/03/n7-pharmacology-antidysrhythmic-agents.html
http://futurenurses2008.blogspot.com/2008/04/n7-pharmacology-antianiginal-agents.html
http://futurenurses2008.blogspot.com/2008/03/n7-pharmacology-antihypertensive-agents.html
http://futurenurses2008.blogspot.com/2008/03/n7-pharmacology-diuretic-agents.html

RAA system

here is a great diagram showing how the RAAS works.

thank you wikipedia!!

RAAS diagram

Nursing 6 study resources

Companion website:
There are some great resources in our textbook's companion website. Check out this link: Maternal & Child Nursing Care.

It offers printable versions of the "Critical Concept Reviews" appearing at the end of each chapter (good quick chapter reviews!), and it also provides NCLEX questions (about 10/chapter).

Here are links to the first assigned chapters:

• 33 - Growth and Development
• 34 - Nutrition
• 35 - Pediatric Assessment
• 36 - Influences on the Child
• 37 - Health Promotion and Maintenance (infancy/early childhood)
• 38 - Health Promotion and Maintenance (older child/adolescent)
• 42 - Pain Assessment and Management

For additional NCLEX practice, animations and more, see the companion CD that should have been included at the back of your textbook.

Charting Errors

These are from actual medical charts.


The baby was delivered, the cord clamped and cut and handed to the pediatrician, who breathed and cried immediately.

Exam of genitalia reveals that he is circus sized.

The skin was moist and dry.

She stated that she had been constipated for most of her life until 1989 when she got a divorce.

The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.

Bleeding started in the rectal area and continued all the way to Los Angeles.

Both breasts are equal and reactive to light and accommodation.

She is numb from her toes down.

While in the emergency room, she was examined, X-rated and sent home.

The lab test indicated abnormal lover function.

Occasional, constant, infrequent headaches.

Examination reveals a well-developed male lying in bed with his family in no distress.

Patient was alert and unresponsive.

When she fainted, her eyes rolled around the room.

Nursing 7 Lecture Audio

In the right-hand column there are links to the Nursing 7 lectures.

Keep checking for more audio links.

Revving back up

Student Nurse Journey is a great general site you might want to peruse. You'll see there are lots of good resources there. Among many other bits of relevant information, it offers nursing fundamentals videos on many basic skills, such as:

• Mixing insulin
• Catheter insertion
• Priming an IV bag
• Intramuscular injection
• Reconstituting powder

Other areas of interest on the site include:

• Pediatric nursing
• Med-surg topics (by body system)
• Assessments
• Writing, charting and reporting
• Medications (classes, administration, etc.)
• Care plans

N6

School is almost here again!! I got a message from Julie Kay and if you don't already know.... Nursing 6 doesn't start until monday Aug 18th. I was confused about thursday being the first day of school, but we get 1 more week. See you all in soon.

-Maureen

Next SNA Meeting

The Nursing Market isn't what it used to be!! Get your foot in the door, gain some experience, get to know about your hospitals.

Two speakers will be at the next SNA meeting this Monday (note the different time) to talk about work experience/study and Versant.

This meeting is essential to get a jumpstart on your nursing career.

See you there!

Mrs. McAtee's Group

Just wanted the group to know I called county to set up a shadow day with Mrs. McAtee and according to the person answering the phone in the volunteer center, they no longer do shadowing and haven't for about a year now. I'm going to ask Mrs. Ippolito to pass that message along to McAtee to see what that's all about. Just thought I would let you guys know! N5 is just about over and so is our first year. Yay!

Nursing 4 -- renal system exam topics

Links:

Renal failure (from Critical Care Medicine Tutorials)
Summary of Renal and urological systems (from Docushare/FSison)
BPH (short animation/video)
Prostate Cancer (video library)

Take Me Out to the Ball Game!!

Take me out to the ball game . . .
and support the SNA!

Who: Stockton Port’s and SNA
What: Relaxation and fun!
When: Sunday May 18th at 2:05
Cost: $5.00 per person on Homerun Hill
(with one dollar benefiting the SNA)
Bring a blanket and your family!

Order forms and money must be turned in to the nursing office or any SNA officer by Wednesday May 7th!

Reiki SNA Meeting

Reiki proved to be a new, exciting topic for us at the SNA Meeting! Below are the Meeting Minutes...

SNA Minutes for April 21st

I. Nominations for SNA positions next semester
a. Lisa read all position descriptions
b. Michelle Berlin nominates self for president - lisa Newbold second, nomination accepted
c. Lisa Newbold nominates Sue Barnes for vice president – Kristin Morone second, nomination accepted
d. Trina eagal nominates andrea traylor-cwik for secretary - Kristin morone second, nomination accepted
e. Sonya gill nominates self for treasurer – Kristin morone second, nomination accepted
f. Ana Hernandez nominates Ogechi for president elect – Kristin morone second, nomination accepted
II. Approval of monetary request form
III. Vote on Nicole/Danielle’s request for money for graduation
a. Kristin - $400 for graduation flowers
i. Sue Barnes moves that we give $400 to graduating class
ii. Wendy seconds
iii. Motion passed
IV. badges – requesting students purchase 2 – 3 patches for lab coats and scrubs
a. motion requested, second and passed
V. Port’s game Interest
a. $1 off if 25 tickets purchased, $2 off if 100 tickets purchased
b. May 18th
c. Collect money first, then order tickets
VI. Fundraising ideas
a. BJ’s 28th 11am-11pm, bring flyer
VII. Memorial day – traveling Vietnam Wall Interest – tabled to next meeting, need more information
VIII. Announce next meeting topic
a. Versant
b. Work study
IX. Reiki (Toni Barnett)
a. Body and mind heal self
b. Take responsibility for your own healing…does not conflict with any religions
c. Chakras – energy vortex (feed energy to organs and glands)
d. Aura –
i. Purple/blue – giving, love, service to others
ii. Green – money
iii. White – spiritual protection
** shows up in aura before it manifests in the physical body
e. healing addresses cause, curing addresses symptom
f. aura_maven@yahoo.com, 916-723-7052 – does the aura photos
g. All people have auras and chakras, so this type of healing is within all of us
h. Nurse developed therapeutic touch, which is more acceptable in the nursing world.
i. $60 for a Reiki treatment, generally

SNA Meeting this Monday!!

Nursing is an innovative field with specialties that are focusing on more than just medicine. Join us at the next SNA Meeting to learn about the spiritual aspect of healing.

SNA Agenda for April 21st

I. Approval of monetary request form
II. Vote on Nicole/Danielle’s request for money for graduation
III. Port’s game Interest
IV. Fundraising ideas
V. Memorial day – traveling Vietnam Wall Interest
VI. Announce next meeting topic
a. Versant
b. Work study
VII. Reiki (Toni Barnett)

Interpreting arterial blood gases (ABGs)

Here's an excellent online tutorial on ABGs from Hansen Nursing.

Also, if you want something printable to refer to, here's some good information from the Kozier site:

• Normal Values of Arterial Blood Gases
• Interpreting ABGs

Congradulations

only 5 more tests to go
don't forget to study for your ATI test next monday.
treat yourself to something special today you deserve it.
Jenn Stevens

HIV in 3D (video clips)

For the visual learners among Nursing 4 students, here are some outstanding short clips showing the retrovirus in 3D:

Targeting HIV replication
HIV replication and life cycle
HIV resistance
Protease inhibitors

more books

If you haven't registered into your evolve textbook site yet, do it now. You'll find the link on the inside of your textbook cover or 1st page.
You can register for as many of these books as you want, you do not have to buy the books to register for them. You just register for the free online resources. I have registered for about 10 of them right now. There are assessment books, and patho books- I like to just look under the chapter subjects and find questions to answer. Gives you all the rationales. You can find a lot of good links to study on the subjects that you want.

HELP

did anyone go to the study skills with Semillo on Wednesday - I forgot
anything would be helpful. thanks and smart studying we will do great
Jennifer Stevens

Learning can be fun!

The online resources that come with our Lewis book include Web links to lots of good additional information. People are always trying to explain complicated stuff in creative, new ways. I am grateful they do! Here's just a sample of supplementary information you can find on the Evolve site:

HIV Infection Overview (from Cell's Alive!) with animations and video clips

Cell-mediated and humoral immunity - includes a good visual of different types of cells

Immune System Defender Game - well-done, and fun!

Cartoon-like illustrations - from NobelPrize.org - the cells in the immune system with clear, simple descriptions. Highly recommended for anyone who's having trouble picturing things (like me!).

Tootsie Pops = viruses: an immunologist's "dumbed-down" description of the cells of the immune system and HIV. (Not too dumbed down for me, though. I need this sort of thing to reach those occasional "aha" moments!)

Fluid, Immune response and HIV

One click away from questions! Oh the excitement!!

Fluids
Disorders of Fluid Volume, Osmolality, and Electrolytes
Immunoglobulins
How the Immune System Protects
MedSurg Immune Responses
Inflammation and Infection
Immune Response and Inflammation
Autoimmunity
Infection Interventions
Inflammation and the Immune Response
Med Surg and HIV
HIV

Test Taking Tips for Nursing Students

• The key is to move quickly but carefully through each question. If you miss one important word, the whole meaning of the question could be changed.
• Don't spend too much time on any one question -- skip the hard questions (or take a guess, and mark them) and then come back, if you have the time.
• Before you look at the answer choices, try to understand what the question is asking – is it an assessment question? Does it relate to another stage in the nursing process? Is patient safety an issue? Identify key words in the stem that may set a priority, indicate negative polarity, etc.
• Also – before looking at your choices – try to think of what YOU would do, THEN look at them. Maybe the one you thought of is there.
• There are many people who will advise that your first choice is usually right. If you find that you're second-guessing yourself, and going back to change answers, only to discover that you've changed to the wrong choice, this one may apply to you!
• Maslow's hierarchy of needs is a good guideline, where basic physiological needs come first.
• Remember your ABCs (airway, breathing, circulation). Anything related to oxygenation is usually the #1 priority.
• Positioning can be big, too. Especially if the patient is at risk for aspiration.
• Therapeutic communication is also an area you'll encounter again and again. Be sure you recognize the hallmarks of therapeutic communication. The answers that sound client-centered, respectful, and promote maximum client independence are usually your best bet.
• Practice doing NCLEX-style questions every day (Bonnie Boss recommends a minimum of 10 a day). For starters, do the questions in your textbook, accompanying study guide and using online resources from the publisher that relate to the chapters you're studying.
  
  Other good resources for test-taking:
• Book: Test Success – Test-Taking Techniques for Beginning Nursing Students (authors: Patricia M. Nugent and Barbara A. Vitale). The whole book is good, but Chapter 7 (Test-taking techniques) is especially good for helping you to analyze questions.
• Free online: Top Ten Test-Taking Tips (Link to: Evolve student development videos) with Linda Anne Silvestri
• Interactive tutorial: MEDS Successful Problem Solving and Test-Taking for Beginning Nursing Students (This tutorial software is available on the medspub.com site or free in the computer lab)

SNA Meeting Minutes

We had a GREAT turnout at the most recent SNA meeting, which provided all those who attended some great tips on how to survive different semesters in the nursing program. Here are the minutes from that meeting.

SNA Meeting Minutes for March 24th

Meeting began at 1305
I. Continued research on fundraising and community service projects
II. NSSP – Robin Shum and LaShonna Parker–
a. Stress Management – time is a big factor
i. I’M SOR
1. Identify goals in life, what do you like? (*if you enjoy what you are doing, your stress will be lower. Have a positive attitude!)
a. Don’t get too worried about details. Look at big picture.
b. Don’t wait until the last minute to complete assignments/study.
2. Modify
3. Simplify
4. Organize – split up your time accordingly
a. Planner
b. Look at one week. How much time did you spend on different activities? Analyze it.
c. Modify your lifestyle to make best use of your time and reduce stress.
i. Grocery stores not as full at night (time saver!)
ii. There is always a solution to things that happen in life. Don’t let stress affect your health.
iii. Planning doesn’t mean anything unless you take action.
5. Recognize
**I LIKE NURSING!!
**Knowing and not doing is like not knowing. (I like that!)
ii. Relaxation and Health
1. eating habits – eat breakfast
2. get exercise
3. emotional health is important
4. schedule time for yourself to sit still or do something you enjoy
5. relaxing music
III. Danielle Mathias-Lamb
a. Don’t study more, study smarter
b. Nursing 4 very important!!
c. Know how theory applies to real world
i. Ask questions to instructors and nurses
d. Keep pamphlets that can and will come up again in later classes
i. Organized into body systems or what will work for you
e. grasp the concepts, everything else will follow
f. Books that helped Danielle
i. Critical Care Nursing Care Plan, 2nd Ed. - Delmar
ii. Study guide for Medical-surgical Nursing; Critical thinking in client Care, 3rd ed. – Lemone/Burke
iii. Nursing Diagnoses reference manual, 5th ed. – sparks/taylor
iv. Illustrated Study guide for the NCLEX – RN exam, 6th ed - Mosby
v. Memory notecards – pathophysiology and fluids and electrolytes (Mosby’s)
IV. Erin Shelby
a. Use your resources/study guides!!
b. It is very beneficial to study in groups
c. Prioritize
d. DON’T STRESS!!
e. Theory is only a few hours a week vs 12-20 hours of clinicals.
i. Get through theory and focus your learning on clinicals.
V. Ana Hernandez
a. Study smart!! – article, “Undergraduate Medical Education is NOT Rocket Science: But that does NOT mean it’s easy!
VI. Questions
a. Nursing 4?
i. Romena’s lectures follow the textbook
ii. Use study guide that goes with Lewis textbook.
1. It is a guideline for what to study
2. Why are the answers in the study guide wrong (not just right)
3. You may not get to all reading, doing questions, look at tables is good
4. Taking tests in nursing skills lab
b. don’t wait until you are failing to speak with the Nursing Student Success program
c. Everyone learns different, so find the person who learns how you learn.
VII. Nominations for SNA Leadership Award
a. Majority vote for Danielle Mathias-Lamb and Nicole Porter to be given award
VIII. Raffle
IX. 4th semester students, Nicole Porter and Danielle Mathias-Lamb requested funds from SNA for graduation flowers. TBD at next SNA meeting
Meeting adjourned at 1435

Using SBAR for more effective professional communication

SBAR is a standardized way of communicating with other healthcare givers. It promotes patient safety because it helps physicians and nurses communicate with each other. Staff and physicians can use SBAR to share what information is important about a patient. It improves efficiency because this standardized form of communication helps caregivers speak about patients in a concise and complete way.

Utilized extensively in medicine, and originating from the nuclear submarine service, SBAR stands for:

• Situation
• Background
• Assessment
• Recommendation

A sample of how to use SBAR

Talking the Talk — Hospitals Use SBAR to Standardize Communication (from NurseWeek)

Good stuff

The student development site from Evolve offers nursing students tips on time management, test-taking, and includes some nifty printable "quick reference guides" at the bottom. Try it, you'll like it...

Hi guys going into Nursing 4. If I did it than you all definately can do it. I am available if anyone needs help.....it's all still somewhat fresh in my mind! Good luck all, I will be enjoying Mental Health....Whew!

Maureen

N-04, the very LAST day at Dameron. A few of us are missing... SHAME ON YOU, Michael!

SNA Agenda for March 24th

I. Community service projects
a. Canned food drive
b. Family ties
c. March of dimes
i. Support Delta Heat, represent SNA
ii. May 17th, Weber Point Event Center – 221 North

Center St.
d. Cystic fibrosis walk

II. Fundraising projects
a. Cell phone/toner collection
b. Donating back for dinner after pinning ceremony – Outback Steakhouse, BJ’s, Elephant

Bar, Bud’s, etc
c. Donating back if delta student eats at Baja Fresh (or other eatery)

III. Danielle Mathias-Lamb (4th semester student)

IV. Erin Shelby (3rd semester student)

V. Kristin Morone, Lisa Newbold, Michael Dorsey, Trina Eagal (2nd semester students)

VI. Q&A

VII. Confirm nominations for SNA Leadership Award (Nicole Porter and Danielle Mathias – Lamb)
a. Any other nominations
b. Vote

VIII. Raffle