nocturnalnurse

[nocturnalnurse]

I thought you said you didn’t read much. Well, what is much?

[nocturnalnurse]

Jess and Rory + All Too Well: The Short Film

[nocturnalnurse]

✨Destressing Ritual✨

Hello my lovelies! Lately I’ve started doing this little ritual every night that helps me release my stress and anxiety.

Needed:

Incense💨

Tea☕️

Wordless Soundtrack🎵

Fresh Air ☁️

A Non-Electronic Activity 📒

Directions:

Brew yourself a cup of Tea. (I will post a recipe. It’s super duper simple and great for sleep and relaxation.)

Find a peaceful place outside, whether it be out on the grass or on your balcony/back porch.

Get comfortable, turn on your music, and light your incense. I use either Vampire Blood or Violet, but you can use any scent that makes you feel relaxed.

Take out your non-electric activity. This can be reading, drawing, writing, coloring, knitting, or anything else.

Simple sit and enjoy the peace. Breathe deep breaths and focus on nothing if you can. Just be in the moment. Push out your negative thoughts. Just focus on the little things: the curl of the incense, the taste of the tea, the heat from the cup, the sound of nature, the activity you’re doing.

This ritual doesn’t need to be followed 100%. This is personalized to me, so feel free to add or take away anything. Crystals or plants may be a great thing to have around you!

Stay magickal my lovlies ✨

[nocturnalnurse]

Most bang-for-buck things every intern should know before starting inpatient wards

Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.

Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong

Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.

Pretty thorough review of fluid management on openanesthesia.org

2) Nausea. When to treat, how to treat and at what dose.

3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%

4) “Reflex” antibiotic choice for routine inpatient infections.

http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight

5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).

6) Initial work-up and treatment of oliguria/anuria.

7) A sensible initial approach to suspected ileus.

8) Blood. When, how, why to replace.

9) Pain. Optimal management without inducing narcosis.

Managing cancer pain: Frequently asked questions: CCJM

10) Potassium. When, why and how to shift or replace.

A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld

11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.

12) Resuscitation aka commit the ACLS algorithms to memory.

Current ACLS guidelines. https://www.acls.net/aclsalg.htm

Would love a video series, interactive cases etc.

13) Basic EKG interpretation.

Whole EKG video courses

A whole free youtube EKG video review course by meddit’s own u/ericstrong

An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/

I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.

EKG video cases

Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu

– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.

Practice EKGs with answers

Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.

EKG blogs

I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:

http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)

http://www.ems12lead.com

http://ecg-interpretation.blogspot.is

http://jhcedecg.blogspot.is

EKG resource libraries

Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.

http://www.practicalclinicalskills.com/ekg.aspx /u/collidge

14) Know when to order ABGs and how to interpret them.

Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)

Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg

Bonus 15) Basic CXR interpretation

CXR video lecture course

Again, Dr. Eric Strong has an excellent video course for free on youtube

Step-by-step guides to basic CXR interpretation

The Radiology Assistant: Chest X-ray - Basic interpretation

Radiology Masterclass step-by-step basic CXR

University of Virginia’s step-by-step basic CXR

All inclusive resources

The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.

UPenns CXR learning website

Loyola Universities excellent CXR Atlas Most outdated look but amazing content.

Checklist approach to CXR

Bonus 16) Overnight o-shit-what’s-that Head CT interpretation

Midnight radiology: Emergency CT of the head

University of Virginia’s guide to the Head CT

[nocturnalnurse]

When the doc orders 15 labs, an EKG, a bolus, 3 new antibiotics, and two scans and is pissed because all of that wasn’t completed in the past five minutes

Last time I checked I am not an octopus!

[nocturnalnurse]

I’ll just take my patient, please.

[nocturnalnurse]

Only a Nurse...

…can bite their tongue when the doctor comes around and rips off the wound dressing that they just spent the last 20 minutes perfecting. …silently notes a subtle change in their patient’s once sunny disposition. …knows exactly what the patient is asking for through the mumbling and garbled speech that is now their new norm. …watches from sun-up to sun-down, dusk til dawn, day in, day out, to see if the patient will improve. “Will they ever improve?”, they ask themselves. Sometimes silently, sometimes out loud. …wishes their patient’s family makes them a DNR so that when their time comes, they can go peacefully; let the illness take their body quietly while they sleep. Let their suffering end with a quiet sigh, not the bone crunching, heart breaking sound of an already frail body turn to dust underneath adept hands. …will cry when the day comes that they must say their final goodbye. A nurse is there to hold a hand, a tissue, a bucket, a life. They balance the good and bad, the happy and sad. They do not wish for death to come to end a life abruptly. A nurse walks beside death every day, sees it in the faces of their patients. A nurse can calm the crying colicky baby, the scared teenager who just can’t seem to quit no matter how many times they tried, the elderly hospice patient desperately clinging to the last embers of an explosive life. When everything seems bleak and the end seems near, look beside you and see a nurse there. For they hold a spectrum of knowledge, experience and life in their hands. But what do I know…I’m only a nurse.

[nocturnalnurse]

Twin girls infected with Zika at nine weeks of gestation. Both were born with extremely small heads, shrunken spinal cords and extra folds of skin around the skull. Scientists think this extra skin forms when the skull collapses onto itself after the brain, but not the skull, stops growing in the uterus. The images of the girls’ heads were constructed on the computer using CT scans.

Read the full story here

[nocturnalnurse]

The collective response to Nurses’ Week:

(and staff meetings… and in-services… contact hours… CEUs…)

[nocturnalnurse]

WHEN MY PATIENT SAYS SHE IS ALLERGIC TO ALL PAIN MEDS EXCEPT DILAUDID

[nocturnalnurse]

Happy Nurses Week.

To the student nurses, who are just getting their feet wet and wondering what they’re in for.

For the new grad nurses, whose feet are wet, are still wondering what they’re in for and I’m sorry but what is this on my shoe?

For the experienced nurses, who know better than to look at their shoes any more.

For ortho nurses, who can wrangle anyone into a brace and know how to get you to the bathroom when you’re in a knee immobilizer, a shoulder immobilizer, and two wrist splints.

For cardiac nurses, who can read a rhythm strip from a mile away, are no strangers to pacer pads, and aren’t worried until your run of Vtach hits 20 beats.

For post op nurses, who can identify every drain you know and a few you don’t, who can pop stitches and staples out in 10 seconds without making you flinch, and change a surgical dressing in their sleep.

For med-surg nurses, who will handle the highest ratios and become pros at doling out 120 pills before 9am. 

For renal nurses, OR nurses, emergency nurses, observation nurses, palliative and hospice care nurses, home health nurses, wound nurses, PICC nurses, infusion nurses, clinic nurses, nurse practitioners, nursing professors, oncology nurses, critical care nurses, neuro nurses, and the literal hundreds of other nursing specialties I can’t name.

Thank you for all that you do, and all that you will do.

[nocturnalnurse]

I didn’t always know I wanted to be a nurse, but I suppose the desire was always there; the curiosities of science and the human body’s response…the complexities of the human mind. The idea that we could heal the broken, comfort the vulnerable - and the realities of duty that threatened my commitment. I didn’t always know I wanted to be a nurse, but I knew on some level I was supposed to make a difference, even if it’s a small one every day.

Med Surg Nurse, approx 4 years in.

(Reflections on Nursing, National Nurses Week)

[nocturnalnurse]

[nocturnalnurse]

Little poster of my biological love

[nocturnalnurse]

I found these gifs I made a while back for a site that’s not running anymore, so I thought I’d post them here. It’s a description of psychiatric symptoms and states of mind using a pink box and some other stuff. 

[nocturnalnurse]

Nursing students and midterms

Sorry about my sabbatical, grad school and crazy personal craziness.  I love you all (seriously)!!!  I hope this semester/nurse life is going well  xoxo  

[nocturnalnurse]

8 Ways To Improve Brain Power / Source: neomam