Dear Nurses: January 2008

MENINGITIS - A CASE STUDY

Updated 1/25
Dear nurses,

The meningitis case study is no longer available.

For New information, click on the link below:

Meningitis and Quiz questions.

There is a video packed with helpful information.

So, click on the link : Sessions 23 ( Meningitis)

and enjoy learning.

GOD BLESS YOUR WEEK - THERE IS STILL LOTS TO LEARN

Updated 9/25

Dear nurses,

Dearnurses.com is no longer available.

New topics and links have been added below.

Learn more about : What if you were the nurse

Learn more about: Common causes of medication errors

Learn more about : Nursing communication

Learn more about: Pediatric facts

WHAT IS WRONG WITH THIS EKG SERIES

Learn more about : Atrial fibrillation - An overview

Updated 10/25

Dear nurses,

The EKG series is no longer available.
New information has been added below.

The heart is always at work. Even when you
are asleep, the heart continues to work.

Hemodynamics refers to blood flow.

Any obstruction to the flow of blood around
the heart, may lead to heart failure. Learn more
about the heart and the EKG by watching
the video: Sessions 68- Quiz 1

Learn more about : Post stroke- Why Therapy

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.

What is 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

WHAT IS WRONG WITH THIS EKG SERIES

THE DOCTOR WILL DECIDE THE BEST TREATMENT FOR ATRIAL FIBRILLATION. TYPICALLY , THIS IS BASED ON THE HISTORY.
FOR MORE HELPFUL INFORMATION ON ATRIAL FIBRILLATION
AND ITS TREATMENT, SIMPLY CLICK ON THE LINK:
http://www.dearnurses.com/ AND ENJOY READING:-
EKG SERIES -WHAT IS WRONG WITH THIS EKG
AND
CHEST PAIN SERIES-MASTER YOUR CLINICAL SKILLS.

WHAT IS WRONG WITH THIS EKG SERIES

Updated 4/24

Dear nurses,

Chest pain series is no longer available. Please click

on the links below, for more updated information.

Chest pain assessment and EKG quiz

Sessions 50-Atrial fibrillation

ATRIAL FIBRILLATION is discussed in greater detail in

CHEST PAIN SERIES -MASTER YOUR CLINICAL SKILLS

(A CASE STUDY of ATRIAL FIBRILLATION can be found on PAGES 21-26).
FOR MORE HELPFUL INFORMATION ON EKG READING, ENJOY:
EKG SERIES-WHAT IS WRONG WITH THIS EKG.

You may also enjoy watching the Clinical Videos called SESSIONS
In particular Sessions 16 through 18

ADDRESSING DIABETIC COMPLICATIONS

Updated 1/26

Dear nurses,

New information has been added below.

Enjoy learning!

The diabetic patient is at risk for many
complications. Here are some of the
complications that may occur:

- DKA- diabetic ketoacidosis

- Retinopathy

- PVD

- Poor wound healing

- Hypo/ hyperglycemia

Learn more about : Insulin reaction

Avoiding medication errors

Clinical appearance of the patient in DKA

Scenario: Tom was admitted to the ICU, with the clinical

picture of a patient in diabetic ketoacidosis (DKA). His blood
glucose was 600. Tom has an altered level of consciousness (LOC).
He also has hyperglycemia (elevated blood glucose).
Please watch the video below:
Dehydration

Signs and symptoms of DKA

The patient in DKA requires immediate intervention and a level
of care like ICU.

Some signs that may appear include:

- Hyperglycemia

- Tachycardia (rapid heart rate)

- Tachypnea (rapid breathing)

- Polyuria (excessive urination)

- Polydipsia (excessive thirst)

- Flushed face

- Breath has a fruity odor

Please enjoy the video:
Patient education

Medical management is necessary for the patient in DKA.
Frequent monitoring of blood glucose, Insulin IV, Potassium
replacements are included in the management.

Insulin - Hormone of the pancreas

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.

Diabetic complications

Scenario: Sara is a young adult who was diagnosed
with Type 2 diabetes, about a year ago. She has now
been admitted for visual problems.

Diabetic Retinopathy

Sara's eye exam reveals Diabetic Retinopathy. This
condition affects the blood vessels in the eye. Poor
vision and possible blindness may result from leaking
and weakening of the blood vessels.

Diabetic Nephropathy

This condition may further complicated diabetes.
Poor renal function and possibly renal failure may
result. Hemodialysis then becomes necessary.

The consequences of poor circulation

The patient who has heart failure,
is also at risk for stroke or renal failure.
The diabetetic patient is also at risk for stroke.

Learn more : Poor circulation

HAVE A GREAT WEEK/ ENJOY LEARNING MORE!

Updated 2/26

Dear nurses,

Dearnurses.net is no longer available.

New topics have been added below.

Have a great week and God bless you all!

Learn more about : Diabetic education and
DKA ( Diabetic ketoacidosis

Berries are rich in vitamins , potassium
and magnesium. They are also said to have
anti-inflammatory and antioxidant properties.

Learn more : All Things food

Learn more about : Potential problems and
Care planning and The Digestive System

WHAT IS WRONG WITH THIS EKG SERIES

The above EKG demonstrates the absence of the P wave which signifies no effective atrial contraction. When the atria contract blood is forced into the ventricles.The interruption of blood flow will affect blood going to the body's organs. More EKG strips to follow. AN UPDATE ON EKG READING CAN BE ACCESSED BY CLICKING ON THE LINK:EKG SERIES-WHAT IS WRONG WITH THIS EKG.
You may also enjoy watching the Clinical Videos called SESSIONS

PACEMAKER INTERVENTION

Updated 2/25

In the image below, Pam has a known cardiac history.
Her own natural pacemaker is not functioning well.
She is having episodes of chest pain, shortness of
breath and dizziness.

Her cardiologist evaluates her cardiac status and
decides to put in a permanent pacemaker.

The doctor usually decides when a permanent pacemaker
should be inserted. Typically, a patient has cardiac problems
which cause symptoms such as the ones described above.

A 12 lead EKG and other studies are also done.
If the patient's symptoms are considered an
emergency, a temporary pacemaker or external pacing
(TCP) may be used.

Dearnurses.net is no longer available.

Hemodynamics refers to blood flow.

The heart is a pump, which pumps blood around the body.
If there is damage, like a myocardial infarction, the heart's
function will be impaired.

PACEMAKER INSERTION OVERVIEW

Here is an OVERVIEW of PACEMAKER INSERTION. Hope this has been helpful in understanding the use of PACEMAKERS. PACEMAKER INSERTION will be discussed
in greater detail in the coming weeks.
UPDATE- Information on EKG reading and pacmaker intervention is ready for you. Enjoy learning.

PACEMAKER OVERVIEW

The heart has its own natural pacemaker, known as the SA node. When it loses its ability to do its function, a permanent pacemaker may have to be inserted. To learn more, enjoy reading:
http://www.dearnurses.com/ekg_series_-_what_is_wrong_with_this_ekg

HAVE A GREAT WEEK NURSES / LEARN MORE ABOUT THE DIABETIC PATIENT

Updated 2/26

Dear nurses,

Dearnurses.net is no longer available.

New topics and links have been added below

The diabetetic patient is also at risk for stroke.

Learn more : Poor circulation

Diabetes Mellitus may be Type 1 or Type 2.

Learn more about: Diabetic complications

Learn more about : Diabetic education and
DKA ( Diabetic ketoacidosis

WHAT IS WRONG WITH THIS EKG?

Updated 10/25

Pacemaker implantation may be done for different reasons.
Any damage to the heart muscle, or the electrical conduction
system, will interfere with the ability of the heart to function
normally.This may be an indication for a pacemaker.
Sick sinus syndrome (though rare) or myocardial infarction are
examples. Learn more about : Pacemaker implantation

Here are some diagnostic tests that are done frequently.

Follow the links below:

1. Chest X ray
2. CAT scan
3. EKG
4. MRI scan
5. Ultrasound
6. Echocardiogram

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

TPN ADMINISTRATION IN THE TRAUMA PATIENT

Updated 1/26

What is TPN?

TPN means Total Parenteral Nutrition.
It is a type of nutrition which is given

intravenously. This topic continues here.

Learn more about : Sepsis

The surgical patient is at risk for infection, related to
surgical intervention.

- Paralytic ileus may occur .

- Hypothermia due to fluid loss and bodily exposure
during surgery. Hypothermia increases the body's need
for oxygen and possibly may lead to a cardiac event.

Warming measures are necessary.

Learn more about:
Dehydration on a long flight
Abdominal Aortic Aneurysm

An intravenous infusion may be started in a peripheral
site or a central line site.

Learn more by clicking on the link:
IV assessment

TPN OVERVIEW FOR NURSES

Updated 1/26

What is TPN?

TPN means Total Parenteral Nutrition.
It is a type of nutrition which is given

intravenously. This topic continues here.

Clinical scenarios are a normal part of nursing.

Above there are five clinical scenarios unfolding.

Scenario 1- A patient who is admittCed to a healthcare

facility and will need teaching. Click on the link:

ER experience for the layperson

Scenario 2- The patient on mechanical ventilation
and the nurse is unsure what to do.Click on the link:

The patient on mechanical ventilation

Scenario 3 -A patient has arrived in the Emergency
Room, both the doctor and nurse are at the bedside
to do an assessment. Learn more by clicking on the link:

An ER experience

Scenario 4 - A nurse does an assessment. Click on the links:

IV assessment
An arterial line

Scenario 5 - A nurse tries to encourage a patient to
do breathing exercises. Click on the link:

Care planning

Learn more about : Diabetic education and
DKA ( Diabetic ketoacidosis