PERNICIOUS ANEMIA

Updated 3/24

Dear nurses,

The Clinical Setting Step by Step is no longer available.

Please use the links below for more updated information{

Bone marrow transplant

Quizmenurse

Pernicious anemia is caused by the absense of Intrinsic Factor,

a protein that is produced in the stomach.
For more helpful clinical information , simply click on the links:
Clinical Videos for Nurses and
The Clinical Setting Step by Step, chapter 13
and enjoy learning.

ADDRESSING APLASTIC ANEMIA

Scenario: Jim has been diagnosed with Aplastic anemia.

He received radiation treatment for cancer in the past. He

was admitted to the hospital with symptoms of fatigue,

dizziness and tachycardia.

Aplastic anemia is a form of anemia which may be idiopathic
or acquired. Idiopathic means the cause is unknown. Acquired
may be due to radiation therapy, anticonvulsants, or autoimmune
diseases. Aplastic anemia is said to be rare.

Bleeding under the skin may result from low platelet count. 
Blood transfusion and BMT( bone marrow transplant) are
forms of treatment. 

Learn more about the above topic by clicking on the link:
Chemo and BMT

GOUT

FOR MORE HELPFUL CLINICAL INFORMATION,

click on the links: Clinical Videos for Nurses and

THE CLINICAL SETTING STEP BY STEP - Chp 13.

IDENTIFYING SIADH ( SYNDROME OF INAPPROPRIATE ANTDIURETIC HORMONE)

Updated 1/26                 

Dear nurses,

The Clinical Setting Step by Step is no longer available.

In the image above, Chuck has been diagnosed with SIADH.

Lab values reveal hyponatremia ( low sodium). He had a 
seizure as a result. The doctor ordered Normal Saline 3%

via an intravenous infusion.

SIADH (Syndrome of inappropriate antidiuretic hormone)
is a hormonal disorder. This condition may be triggered by
cancer, autoimmune disorders, infections like meningitis,
head injuries, certain medications, pneumonia and
surgical intervention.

Hyponatremia ( low sodium) results as the body retains 
fluid. In the case of Chuck in the image above, low sodium
resulted in seizures.

Above is a 35 year old female who has been
having problems after a divorce. Alcohol
ingestion in large quantities has become a
way of coping. This is not a case study,
but an example of how pancreatitis and
autodigestion may come about. ARDS
may also result.

Learn more about :Autodigestion/ Pancreatitis
Hormones

                                     
The Adrenal glands

The adrenal glands are small endocrine glands
and are situated one on top of each kidney. The 

hormone adrenaline ( epinephrine) is secreted 

by the adrenals. This hormone is commonly 

known as  the gland of "fight, flight and fright".

Learn more about : The hormonal effect

    

Learn more about: PTSD

and The immune System

  

DIABETES INSIPIDUS

Updated 5/24

Dear nurses,

Dearnurses.net is no longer available. For more updated information, 
please click on the link: Diabetes Insipidus and also enjoy the video:

What are electrolytes

http://dearnurses.net/the_clinical_setting_step_by_step,

(chapter 5)

WHAT IS ICP?

Dear Nurses,

Updated 8/23

ICP ( Intracranial Pressure Monitoring) may be done for
several reasons, these include:
 - Trauma to the brain
 - Meningitis
 - Hydrocephalus
 or for any reason the doctor may choose to relieve
 excessive fluid on the brain.

Learn more about this helpful topic by

clicking on the link: 

Meningitis and ICP Monitoring

A skiing accident and admission to ICU

ANGELS

Also enjoy watching Sessions 3 - The Coma Patient

STOP!

Updated 6 /25

Dear nurses,

The Clinical Setting Step by Step is no longer available.

Please use the links below for more updated information.

Learn more about: Organizational skills

Quizmenurse

Understanding the standards of care

          

                      IV site care 

Always take the time to assess an IV site that is 
swollen and painful!

BLOOD TRANSFUSION PROTOCOL

Updated 7 /25

Dear nurses,

Dearnurses.com and  Dear nurses.net are no longer available.

A blood transfusion may be ordered by the doctor
for a number of reasons. When a blood transfusion
is ordered, the nurse should be aware of the unit's

policies and procedures.

 Plasmapheresis is a form of blood transfusion.

Please click on these links for more updated information:

The New Nurse-Blood transfusion

Blood transfusion

Plasmapheresis

Learn more about : The Immune System

ALTITUDE SICKNESS

Updated 10/24

Dear nurses,

Dearnurses.com is no longer available.

Altitude sickness may lead to cerebral edema.
Severe headache, lightheadedness, nausea and fatigue
are symptoms of altitude sickness.

          Altitude sickness

UNDERSTANDING WHEN CPR IS NECESSARY

Updated 8/25

Dear nurses, 

The Clinical Setting Step by Step is no longer available.

The image above shows a Code blue in progress. This is 
happening in the emergency Room. Always follow your

Institution's policies and procedures for Code Blue. 

The role of the nurse who is assigned to the Code Blue

The nurse has an important role in effective communication.
There are many responsibilities.

- staying calm in a chaotic situation
- giving clear instructions to coworkers
- ensuring that MD orders are conveyed correctly

- proper documentation of vital signs and all treatments /
  interventions that take place ( defibrillation for example)
  - the nurse becomes the " binding force.

It is important to recognize that as nurses, we may be floated 

to an unfamiliar environment. Having a good knowledge base

of such topics like CPR and knowing how to read an EKG is of
great importance. 

 Organizational skills in the clinical setting do matter.

A patient who has a straight line on the monitor,

requires immediate intervention. The nurse should
check the patient to make sure an electrode is not 
disconnected. 

If there is no disconnection, the patient may have 
gone into Cardiopulmonary arrest. This calls for 
CPR.

A Cardiopulmonary arrest is called a Code Blue.
This means the heart has stopped beating and the
body's cells are deprived of blood supply and oxygen.

Immediate action is taken by the staff , to call a Code
Blue overhead. This summons trained personnel to
that patient's bedside. 

CEREBRAL ANEURYSM

Updated 8/23

Dear nurses,

Please click on the link below for updated information on this topic:

Subarachnoid hemorrhage and quiz

 _____

DEFINING PNEUMOTHORAX

Updated 8 /25
Dear Nurses,

A pneumothorax may very readily occur following trauma.

The clinical picture would include: shortness of breath, tracheal 

deviation and distended neck veins. PLease enjoy watching the 

video: Sessions 8 - Trauma- Chest, abdominal and spinal.

Dearnurses.com is no longer available.

Learn more about : Central and PICC lines

COPD AND RESPIRATORY DISTRESS

Updated 11/24

Dear nurses,

Dearnurses.net is no longer available. Below new topics
have been added.

Respiratory Distress may occur for a number of reasons.

thees include:

- pneumothorax

- congestive heart failure

-ARDS

- pneumonia

- brain injuries  that involve the respiratory center

and many more.

Chronic Obstructive Pulmonary Disease (COPD) is characterized by
damage to the lung tissue and partial airway obstruction. See image below.

BRONCHITIS AND OTHER RELATED RESPIRATORY PROBLEMS

                                     Bronchitis

Bronchitis may be acute or chronic. This condition is characterized by
inflammation of the bronchioles. Acute bronchitis often occurs after a 
cold or infection.

Fever, shortness of breath, fatigue and mild chest pain may occur. 
Patients who have chronic bronchitis may experience this condition
for an extended period of time. Habits such as cigarette smoking may
become a contributor.

A chest xray and sputum specimen will confirm diagnosis. Antibiotics,
bronchodilators and Tylenol for fever may be ordered by the doctor.

Learn more about : Code Blue and Mechanical ventilation.

Scenario:In the image above, Steve is one day
 post-op laminectomy. No one has explained to him,
about the danger of postoperative pneumonia.

Learn more about: Cardiogenic Shock

WHAT IS INSULIN / REACTION

Updated 11/24

What is Insulin?

Insulin is a hormone which is secreted by special 
cells in the pancreas. They are called Islets of 
Langerhans.

Types of diabetes

- Types 1 and 2

- Gestational diabetes
- Diabetes Insipidus

It is important for the nurse to be aware of the types
of diabetes and what an Insulin reaction is. Learn more,
by clicking on the link: Insulin Reaction

You may also enjoy watching the video:
Diabetes Mellitus

 

ADDRESSING INTRAVENOUS INFILTRATION / ASSESSMENT

Updated 10 /25

Dear nurses,
New information and links have been added.

Assessment and documentation of the condition
of the IV site, is of paramount importance. Every
institution has policies and procedures in place,
 for IV site care.

Helpful hints:

-Never run IV fluids through an infiltrated site. Coolness, swelling
and pain may be signs of infiltration.

Remember the damage done to the soft tissue close to the IV site may be permanent.

- follow your institution's
policies for IV site care/infiltration.

Also enjoy watching the video:

IV site care

Learn more about: Medical abbreviations - Part 2

                                                     

Learn more about : Critical thinking

Learn more about: Triage

Scenario: A patient was involved in a car accident. 

Trauma to the chest area, has resulted in a pneumothorax.

Learn more about: Pneumothorax

POSTOPERATIVE CARE

Updated 4/25

The postoperative patient is faced with many challenges.
The nurse is responsible for not only assessing , but also
documenting and notifying the doctor with any significant
changes like bleeding that may occur.

Below is a Mini Casr Study that demonstrates what happens
to a trauma patient before and after surgery.

Scenario: Nick is a 21 year old male, who was on his way 
to work , when he became involved in a head on collision.
Someone called 911 and paramedics arrived on scene, to
resuscitate him. See link below.

Mini Case Study involving Sepsis

What is Paralytic Ileus?
A paralytic ileus is a postoperative complication.
It may occur in any surgical patient
and is caused by anesthetics.

Absent bowel sounds, abdominal pain and distention.

Learn more, by clicking on the link: Bowel obstruction

The surgical patient is at risk for: hypothermia, dehydration,
postoperative pneumonia , DVT , paralytic ileus or a cardiac
event. Pain management should not be overlooked.

ADDRESSING PULMONARY EMBOLISM AND VQ SCAN

Updated 10/25

A pulmonary embolus may start in a vein in the calf.
When a blood clot forms in a vein in the calf and
travels to the lung, pulmonary embolism results. 

The consequences can be grave. 

New information and links have been added below.

Scenario: Tom is anxious and short of breath. He has
been confined to bed for a few days. His complaints
may be suggestive of pulmonary embolism.

Pulmonary embolism is caused by a blood clot in the
leg, breaking free and migrating to the lungs. The patient 

on prolonged bedrest is at risk. The problem should be
reflected in the Care plan. See below.

Anxiety, shortness of breath, tachycardia, 
chest pain and hemoptysis ( coughing up
blood ) are all warning signs.

The doctor may order a VQ scan to confirm
the diagnosis. A VQ scan is a diagnostic test
that can determine how well the lungs are being
ventilated ( ventilation) and how well the lungs
are being supplied with blood ( perfusion).

Anticoagulation therapy is used in the treatment
of pulmonary embolism.

Learn more about: Care planning