IDENTIFYING PERNICIOUS ANEMIA

Updated 7/26

Dear nurses,

The Clinical Setting Step by Step is no longer availabl
Updated information and links have been added below.

Identifying pernicious anemia

Pernicious anemia is a condition which is caused by
a lack of intrinsic factor. This is a protein which is
 produced in the stomach and is responsible
for the absorption of Vitamin B12. Vitamin B12
injections are ordered by the doctor and given for
the rest of the patient's life.( See image above).

Learn more about: 

Bone marrow transplant

The New Nurse- Blood transfusion

What is Multiple Sclerosis?

Multiple Sclerosis is a very debilitating illness
which affects the Central Nervous System. It is
considered to be an autoimmune disease and
progresses over a period of time.

Symptoms of Multiple Sclerosis
- Arm and/or leg weakness
- Visual disturbances like diplopia (double vision)
- Ataxia (unsteady gait)
- Tremors
- Fatigue

See image above for treatment.

Enjoy the video: Multiple sclerosis

Learn more about : Anticoagulation Therapy and

Enjoy the video: Anticoagulation therapy

Learn more about: The Circulatory System

Learn more about  : Chest pain and the EKG

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 - WHAT IS IT?

Updated 7/26

Dear nurses,

Dearnurses.net is no longer available. 

Updated 7/26

Following Transphenoidal  surgery for a pituitary
tumor, a patient may be at risk for Diabetes Insipidus.
It is important to know how to recognize and treat this
condition. 

Enjoy the video:

What are electrolytes

Diabetes Insipidus ( DI) should not be confused with
Diabetes Mellitus Diabetes Insipidus is caused by a lack
of ADH ( antidiuretic hormone).
Surgical intervention may cause this problem.                               

Patients  who develop DI, dump large quantities of dilute
urine.If left untreated , dehydration may occur. DDAVP is
used to correct the problem. 
See above image for more helpful information.  

INSULIN - A HORMONE

Insulin is a hormone which is produced in the
pancreas, by special glands known as the
Islets of Langerhans.

When we eat a meal like hamburger,fries and
milkshake, Insulin is released in the blood stream
to control blood glucose. The liver stores glucose
in the form of glycogen. If the pancreas is not able
to produce insulin, diabetes ensues.
Diabetes Mellitus may be Type 1 or Type 2. 

Enjoy learning more : Diabetic instructions

Learn more about : Organizational skills

Chest pain may be brought on by stress. It may also
 be a sign of a cardiac event. It is important to seek
 medical advice if chest pain occurs. 
Learn more: Stress

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

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!

STOP NURSES, PAY ATTENTION !

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

The Glasgow Coma Scale is a very important
neurological assessment tool in the clinical 
setting.

Documentation of findings should always be done.

Learn more about: Cranial nerves and
Stroke and prevention

Learn more about: The Nursing Process

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. 

Scenario: In the above scenario, Mr. R is anxious
and feeling short of breath. 

The patient in Congestive heart failure, will display
signs of anxiety, due to lack of oxygen.The damaged
heart cannot pump blood as efficiently as a healthy 

heart. 

Chest pain and shortness of breath will likely be present. 

As a result of heart damage, fluid backs up into the lungs.

The patient who has an anterior wall myocardial infarction
may develop CHF. A higher level of care is usually needed. 

Watch the videos: Hemoynamic monitoring

CHF/ Cardiogenic Shock

The image above, gives an indication of what 
happens to the patient in Congestive heart failure.

Causes include : Hypertension, myocardial infarction,
cardiomyopathy are some examples. See above image.

ADDRESSING CEREBRAL ANEURYSM

Updated 8/23

Dear nurses,

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

Subarachnoid hemorrhage and quiz

 _____

The brain is protected by the skull. Injury to the brain may
result in swelling. The skull is made of solid bone and the
brain has no room to expand when swelling occurs. 

ICP Monitoring is done to reduce swelling and monitor
brain pressures.The brain injured patient is at risk for
 seizures. This should be reflected in the

plan of care. Learn more, by watching the videos:

ICP monitoring
The brain injured patient

Learn more about: Medical abbreviations - Part 2

                                                     

.

 

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 4/26

Dear nurses,

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

Chronic Obstructive Pulmonary Disease (COPD) is 

characterized by damage to the lung tissue and partial 

airway obstruction. See image below.

A pneumothorax may occur as a result of a rib fracture.
The punctured lung, collapses.

Scenario: A patient was involved in a car accident. 

Trauma to the chest area, has resulted in a pneumothorax.
He was also having difficulty breathing, so the medical team
initiated CPR and placed an ETT ( endotracheal tube). 
Learn more about: Pneumothorax

Scenario: The patient above, was in respiratory distress
and placed  on mechanical ventilation. It is difficult
for the patient on a ventilator to describe pain. Knowing
how to assess is very important.

This topic , including quiz questions continue here:

Mechanical ventilation

Learn more about : ARDS, DVT and PE

Scenario: Nick was admitted to the hospital with a history
of lung cancer. He calls the nurse with complaints of a sudden
onset of shortness of breath and sharp chest pain.This topic
continues : Here

What does TBI mean ?

This means Traumatic Brain Injury. 
In the image below, a surfer hits his head on the pier.

He sustains a TBI and a Subarachnoid hemorrhage.

He was admitted to the ICU for treatment. An EVD 

was placed by the doctor. Please click on the links for 

more helpful information:

  Medical abbreviations - Part 2

  ICP for the layperson

          Medical abbreviations - Part 2