ADDRESSING THE SKIN AND ITS PURPOSE - PART 2

The Skin and its Purpose - Part 2

Anasarca

Anasarca, which is also known as generalised edema,
may be caused by a number of conditions. These include:
- Heart, renal or liver failure. 
Learn more about: Anasarca 

In Anasarca, the skin is stretched and there is swelling.

Skin breakdown may occur in the patient confined to
bed. An air mattress may be ordered by the doctor, to 

prevent this from happening.

What is the Braden Scale used for ?

The Braden Scale is used for predicting
pressure ulcers on the skin.These may
develop in patients who are confined to
bed for long periods of time. Turning , 
positioning and good body alignment
are ways in which this can be prevented. 

Burns and the skin:

Scenario: Sam is a cook in a restaurant. He was

not prepared for his sleeve catching on fire. He 

suffered second and third degree burns. Sam was

transported to the Emergency Room.

Skin grafting is sometimes done to cover the 
burnt area. Healthy tissue is taken from another 
part of the body, to cover the damaged area. The
grafted area, eventually becomes fused with the 
tissue around it.

Most people who anticipate taking a long plane

flight may hardly stop to think about dehydration
and its consequences. 

This topic continues here : Dehydration

The skin gives clues to many problems

In the image above, a patient is in possible sepsis.
There is abdominal tenderness and redness at the
wound site. High fever and increased respirations
are also noted on assessment. The doctor's orders
include lab values : 

( WBCs, ABG, electrolytes and PT/ PTT ).

Learn more about : Sepsis

IV infiltration may cause damage to the skin and 

surrounding tissue.Learn more about: IV site care

The nurse should take
 the time to  assess an
IV site that is swollen
and painful. It may be
necessary to  change
the site, in order to
prevent further tissue
damage.

ADDRESSING THE SKIN AND ITS PURPOSE - PART 1

 ADDRESSING THE SKIN

The skin as we all know it , covers the body and 
appears to be of little importance. It is used to put
on makeup and improve appearances.

However , the skin can give clues to many things
happening to the body. 

Here are examples of the uses of the skin:
- It helps to regulate body temperature
through sweating , blood flow like vasodilation
( heat loss) or vasoconstriction ( heat retention).
- used for IV sites, checking blood glucose
- checking oxygen saturation
Learn more about:The skin

The skin creates a barrier to keep out infection.

It is the entry port for most surgical procedures.
It helps to regulate temperature.

The clinical scenario above, shows a patient
in Hypovolemic Shock. The skin is cool and
clammy. This is caused by blood loss. In an
attempt to preserve the body's temperature,
vasoconstriction occurs. 

The blood vessels narrow and blood is shunted
to the most vital organs like the heart , brain and
kidneys. This results in cool , clammy skin.

An assessment reveals:
- decrease in oxygen saturation
- decrease in BP, cool, clammy skin

- rapid respirations and heart rate

- decreased level of consciousness

 enjoy watching the videos:

 Sessions 43

Hypovolemic Shock  

Diabetes Mellitus may be Type 1 or Type 2. 

Peripheral vascular disease and gangrene

In the image above, a patient has PVD
( Peripheral vascular disease). The skin gives
clues to poor circulation. It becomes discolored
 and painful. Diabetes and cigarette smoking are
 some of the causes. His toes are gangrenous.

Learn more about: Diabetic complications

The patient with DKA has flushed skin. Checking
blood glucose frequently, will be done through the
skin. IV site used for fluid replacement, will be done
through the skin.

Learn more about : Diabetic education and

DKA ( Diabetic ketoacidos

INTERESTING FACTS ABOUT HEPARIN AND TPA ( THROMBOLYTIC PLASMINOGEN ACTIVATOR)

In the image above, a new nurse seeks information
about Heparin, an anticoagulant drug.

Heparin is an anticoagulant drug. It is used to
prevent clot formation in conditions such as 
Atrial fibrillation and DVT ( deep vein thrombosis).
Learn more about :Heparin Therapy

Heparin is given IV or SQ, but never via the intra-
muscular route. Side effects of anticoagulant therapy
include: bleeding of gums, hematuria, bleeding from IV
and dressing sites. Protamine Sulfate is the drug used to

counteract the action of Heparin.

A patient on Anticoagulation Therapy may experience 
bleeding of the gums, at dressing sites, in the urine, or
at IV sites. It is important for the nurse to assess and 
document any bleeding.

Poor circulation may occur for a number of reasons.
Any obstruction to the flow of blood may lead to conditions
such as stroke, heart failure, and or renal failure .The 
diabetic patient is also at risk.

Learn more about : ARDS, DVT and PE

What is a stroke?

A stroke is also known as a brain attack.

Identifying strokes and treatment

A stroke may be hemorrhagic (caused by bleeding) or
ischemic (embolic) caused by a clot or plaque in a blood
vessel. 

Bleeding ( hemorrhagic) into the brain may be caused
by trauma or rupture of a blood vessel due to high
blood pressure. ICP monitoring may be necessary for 
the patient with a hemorrhagic stroke.

In the case of an embolic stroke, a blood clot may
obstruct the flow of blood in the brain. This will also
affect oxygen to the brain.

Embolic strokes are usually treated with drugs such
as TPA ( Tissue Plasminogenic Activator). Antihypertensive
drugs and anti- seizure medications may also be ordered.

Reperfusion Therapy and its uses

Reperfusion Therapy is a form of treatment that
is used for patients who have a myocardial infarction

(MI) with STEMI. Typically, the patient with a
completely blocked coronary artery, would
demonstrate STEMI on the EKG.

TPA ( Thrombolytic Plasminogen Activator)
is not only used for reperfusion in patients
who had a myocardial infarction, it is also
used in the treatment of embolic strokes.

ADDRESSING HELPFUL TOPICS FOR THE CLINICAL NURSE

 Dear nurses,

As a nurse we must strive to do the best
job we can. The clinical setting is sometimes
challenging, but that does not mean we cannot
perfect our learning skills.

Enjoy learning!

In the image above, Mr. R is admitted to the hospital
with a history of congestive heart failure. His doctor
has ordered a fluid restriction of 500 cc/day, 
Learn more about: Fluid restriction in the heart patient.

Learn more about : The importance of Therapy

Please watch the video to learn more about : Bowel obstruction

Helpful suggestion:

The care plan 

Patient and family education should always
be included in the plan of care. The nurse is
responsible for initiating and updating the
care plan. 

   The Nursing Process

UNDERSTANDING NARCOTIC USES AND SIDE EFFECTS

 

Narcotic uses

Narcotics are controlled substances that are frequently
used in the clinical setting. They may be used for reasons
such as pain control, as anesthesia, pain control and more.

Commonly used narcotics include: Morphine, Oxycodone,
Fentanyl and Hydromorphone. It is important for the nurse
to be aware of the side effects, when administering these
types of drugs.

Side effects include: lethargy, hypotension, nausea, vomiting,
mental confusion or hallucinations. It is also necessary for the
nurse to document pain scales and reaction to medication given.

Medication is frequently given in a healthcare facility.
When the doctor orders medication, different routes
of administration may be used. 

Drugs may be given through different routes:
- orally, by inhalation, sublingually ( under
 the tongue)
- by injection in the muscle( IM), subcutaneously( SQ)
  or intravenously ( IV or IV infusion).

Medication errors should be avoided at all costs.

In the image above, Nancy requested a pain shot.
The nurse did not read the doctor's order correctly
 and drew up 5.0mg of the medication, instead of
0.5mg.

It is extremely important to pay close attention to the 
placement of the decimal point.

I

HAPPY NEW YEAR 2026

 

Relaxation is a beautiful thing. It decreases

anxiety and helps to reduce stress.

Learn more about : The spread of infection

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: Foods and their properties

A VERY MERRY CHRISTMAS TO ALL

 

Dear nurses,

Wishing you the very best for Christmas and 
the New Year.

Please enjoy the videos:

Sessions 38 - Happy Holiday
and Sessions 61- From holiday cheers to horrors

Learn more about : Travel and eating

Learn more about: All things food

UNDERSTANDING SAFE NURSING PRACTICES - A NURSE'S PRIORITIES

 

When a nurse's priorities are wrong

In the image above, Jenna is a new nurse.
She has not fully understood the importance
of safe nursing practices.

Her desperation to be on time to meet a friend
for lunch, took priority over patient safety.

Jenna works in the ICU. The monitor alarm 
of the patient in her care, was going off. She
made no attempt to check if something was
wrong.

It is important to understand that a patient who
is cared for in the ICU, requires a higher level
of care.

It is unfortunate Jenna did not prioritize.

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.

Learn more about: The Nursing Process

Learn more about : Nursing communication

Common causes of medication errors

Like the artist perfects painting skills, so does the
nurse perfect clinical skills!

Nursing Fundamentals