MORE CLINICAL LEARNING FOR NURSES

Updated 10 /25

Dear nurses,

It is a pleasure to share my years of clinical
learning with new and inexperienced nurses.
Sometimes, the clinical setting can be viewed
as being of less value than high scores in the
classroom. 

However, after decades of experience in clinical
areas such as : ER, ICU, CCU, PACU , I cherish
all that I have witnessed and been a part of. 

I have continued to add many topics in the clinical
setting that can be of great value to any nurse.

Diabetes mellitus, if not well managed,
may be further complicated by conditions
such as cardiovascular disease, stroke,
Retinopathy, Neuropathy and PVD. 

What is PVD?
Peripheral Vascular Disease (PVD) is caused
by poor circulation. The diabetic patient is at
risk for this condition.

Gangrene resulting from poor circulation and
may lead to surgical  intervention such as amputation.

The image above shows a nurse trying to do
a math calculation. Please take a moment to
 read and understand what this is about.

Using Decimals  
Have a good day.

Learn more : Safe medication administration

WHAT IS WRONG WITH THIS EKG ? - ADDRESSING V-TACH

Updated 8 /25

Dear nurses,

In the scenario shown above, a young man is found
near the lake. Someone calls 911 and rescuers arrive
to start resuscitation. An assessment shows, he is breathing
and has a weak pulse. 

What is Ventricular Tachycardia ?

Ventricular Tachycardia is an EKG arrhythmia which is 
life threatening. An assessment may or may not reveal a
pulse. If there is no pulse, it is treated the same as
ventricular fibrillation.

Causes include: 

Coronary artery disease, myocardial infarction, electrolytes
imbalances and more. Treatment and intervention is directed
at the cause. AHA has guidelines in place, for treating

Ventricular tachycardia.

Learn about : the ABG and Code Blue

UNDERSTANDING VENTRICULAR TACHYCARDIA

Updated 9/25

Dear nurses,

The EKG Series is no longer available.

The image above demonstrates Ventricular Tachycardia.
Learn more by clicking on the link: Ventricular Tachycardia

It takes " all hands on deck" when an emergency occurs.
Learn more about: Hemodynamic Monitoring and

Cardiac Assessment.

Scenario: Mrs. R is a 48 year-old female who has a history
of a previous myocardial infarction. She was admitted 2 days
 ago with mild chest pain. She was resting comfortably when
she suddenly started feeling short of breath. She is anxious 
and calls the nurse.

What actions did the nurse take?
-The nurse reassures Mrs. R. She does an assessment, vital signs
, and oxygen saturation. She gives oxygen per protocol.

-The nurse notifies the doctor of what has occurred and her
assessment findings. She also mentions the vital signs, low
oxygen saturation, and steps that were taken to correct the
saturation. The doctor gives further orders, including a
transfer to CCU.

Why chest pain assessment?

It must be remembered that a patient with heart damage
 will also experience chest pain. Assessment of the pain
should also be included. This may be sharp, with radiation
 to the shoulder/jaw, or it may feel like chest pressure.

Helpful Hint:
Chest pain should always be assessed.
 Enjoy learning more about this topic by clicking on the link:
Simplifying Cardiogenic Shock

SUBARACHNOID HEMORRHAGE, A CASE STUDY

Dear nurses,

Updated 3/24

Updated information for this topic can be accessed by clicking
on the link : 

Subarachnoid hemorrhage

Are you the nurse who has never taken care of a patient with a SUBARACHNOID HEMORRHAGE ?

Well, here is A SUBARACHNOID HEMORRHAGE CASE STUDY that will be of help to you.

ENJOY LEARNING!

You may also enjoy watching the Clinical Videos called SESSIONS, in particular,

try Sessions 7.

HAPPY VALENTINE'S DAY TO ALL NURSES

Dear nurses,

Thanks for visiting my blog. If you have any special questions please let me know. I have tried to simplify *Heart Blocks for those of you who are not familiar with EKG reading. Read below.

I plan to continue the: WHAT IS WRONG WITH THIS EKG SERIES next week.

HAVE A HAPPY VALENTINE'S DAY AND BE SAFE NURSES!
* Chapter 11

WHAT IS WRONG WITH THIS EKG SERIES - THIRD-DEGREE AV BLOCK

Updated 4/24

Dear nurses,

The EKG Series is no longer available. For more updated information,
please click on the links: 
Chest pain assessment

Heart blocks

Third degree AV block

The above EKG demonstrates a patient with a *Third-Degree AV Block. When a third-degree AV block is present, the heart rate is usually slow (bradycardia). Typically, the heart rate would be less than 60 beats per minute. To learn more, just click on the link:

EKG SERIES-WHAT IS WRONG WITH THIS EKG and enjoy learning.
* Chapter 11 Part 2

IDENTIFYING THE CAUSES AND SYMPTOMS OF THIRD-DEGREE AV BLOCK

Symptoms of patients in Third-Degree AV Block will vary from one patient to the next. If the patient is symptomatic , drugs such as Atropine is ordered by the doctor to improve the heart rate. *IV Infusions such as Epinephrine or Dopamine(in the absence of hypovolemia) may be used to improve blood pressure. To learn more about this topic and EKG reading, simply click on the link: EKG SERIES-WHAT IS WRONG WITH THIS EKG and enjoy learning.

You may also enjoy watching the Clinical Videos called SESSIONS, in particular
watch Sessions 16 through 18.
* Sessions 51

TREATMENT OF THIRD-DEGREE AV BLOCK

Updated 5/24

Dear nurses,

The EKG series is no longer available. Please use the
link :Third degree AV block

for more updated information.

Transcutaneous pacing is a form of treatment used to treat patients in Third-Degree AV block.(chap 11)

The type of treatment used will depend on the severity of symptoms. Transcutaneous pacing will help the heart to beat and improve cardiac output until a permanent pacemaker is inserted. Patients may need analgesia and sedation to keep comfortable, during this period.To learn more about this topic and EKG reading, simply click on the link:

EKG SERIES-WHAT IS WRONG WITH THIS EKG and enjoy learning

TREATMENT OF THIRD-DEGREE AV BLOCK

It is important to remember that the treatment of third
degree AV block ,will depend on the severity of symptoms.
The history and physical will also play a role in the course
of treatment to be implemented. 
Always refer to your ACLS guidelines. 

The doctor will also decide whether to use drugs such as Atropine.

For more helpful information on this topic and EKG interpretation,
simply click on the link:

Sessions 16, 17 and 18

Third degree AV block

Updated 4/23

RED ALERT FOR NURSES

Updated 6/25

Learn more about: Your Critical Thinking

HAVE A GOOD WEEK NURSES

Updated 5/25

Dear nurses,

Learn more about : Heart facts and the EKG 

WHAT IS WRONG WITH THIS EKG / FIRST DEGREE AV BLOCK

This graph paper has been enlarged just to make learning the EKG easier. A first degree AV block may be present in athletes and never cause any disruption in the heart's natural
rhythm. To learn more about EKG reading and chest pain assessment, simply click on the link:

http://www.dearnurses.com/

and enjoy WHAT IS WRONG WITH THIS EKG and CHEST PAIN SERIES-MASTER YOUR CLINICAL SKILLS.

There is also a video available for you, simply click on the link:

http://www.dearnurses.com/clinical_nursing_videos_called_sessions

UNDERSTANDING THE HEART AND ITS RHYTHM

For more helpful information on EKG interpretation and cardiac issues, just 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.

You may also enjoy watching the Clinical Videos called SESSIONS,
in particular watch Sessions 16 through 18

WHAT IS WRONG WITH THIS EKG SERIES / SECOND DEGREE AV BLOCK

This is an example of how a cardiac event can occur. History and physical is a very important part of the assessment when a patient is admitted. Character and the duration of the chest pain should also be documented.
http://www.dearnurses.com/clinical_nursing_videos_called_sessions
PLEASE CLICK ON THE LINK AND LEARN MORE :
http://www.dearnurses.com/
1)CHEST PAIN SERIES- MASTER YOUR CLINICAL SKILLS and
2)WHAT IS WRONG WITH THIS EKG
FOR MORE INFORMATION!

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

WHAT IS WRONG WITH THIS EKG SERIES / SECOND DEGREE AV BLOCK

Admission to the CCU/ICU is necessary to begin treatment of a heart attack. Methods of intervention following a heart attack, is usually decided by the doctor. To learn more about the above topic, simply click on the link:http://www.dearnurses.com/

and enjoy learning.

SECOND DEGREE AV BLOCK /TRANSCUTANEOUS PACING

FOR MORE HELPFUL INFORMATION ON THIS TOPIC, CLICK ON
THE LINK: EKG SERIES -WHAT IS WRONG WITH THIS EKG.

A second degree AV block may be classified as TYPE 1( MOBITZ 1 or WENCKEBACH) or

TYPE 2 ( MOBITZ 2). TYPE 1 may be the result of a myocardial infarction ( heart attack)involving the inferior wall of the heart. Depending on the degree of damage, it may be transient and only require observation.

TYPE 2 is more serious and may be the result of a myocardial infarction ( heart attack) involving the anterior wall of the heart, which is where the heart has its pumping power. If the anterior wall of the heart is damaged and the heart's pumping power is affected, symptoms of chest pain, shortness of breath, lightheadedness and hyotension( low blood pressure)may occur.

TCP ( Transcutaneous Pacing )may be ordered by the doctor. It is often used as a bridge until a permanent pacemaker is inserted. Patients may need analgesia and sedation during this period. The doctor will order whatever is necessary to keep the patient comfortable. Assessment and documentation of the neurological , respiratory and cardiac status is essential.

You may also enjoy watching the Clinical Videos called SESSIONS, in particular

watch Sessions 16 through 18