The Physiology of the Nervous System Part 3

Hello. This is our third video focusing on the nervous system’s physiology, primarily giving a quick review of the sympathetic and parasympathetic nervous systems.

Sympathetic Nervous System (SNS)

The sympathetic nervous system mainly controls the fight and flight response, which, in layman’s terms, would be the system responsible for responding during a stressful situation. And the two main organs that are involved in the sympathetic nervous system are the heart and lungs.

On the other side of the spectrum, when the sympathetic nervous system is turned off, the parasympathetic nervous system is turned on. So, the SNS and PNS have a teeter-totter- like communication.

Parasympathetic Nervous System (PNS)

You can think of the parasympathetic nervous system as the opposite of the sympathetic nervous system. The PNS is also known as the rest and digest system, essentially in charge of the gastrointestinal system and urinary system.

Anticholinergic vs. Cholinergic

If the sympathetic nervous system is activated, its anticholinergic properties are also engaged. Meaning, the client’s heart will race, and fast, deep breathing will follow. Anticholinergic is also known as sympathomimetic drugs that affect sight, pee, and poop in a way that they won’t work while the SNS is at peak.

Now, if the parasympathetic nervous system is triggered, the body will experience cholinergic effects which are opposite of what one feels when the SNS is turned on; the client will have normal eyesight, digestion, salivation, urination, and excretion.

Medications

Let’s discuss the different drugs under anticholinergic and cholinergic classifications.

Anticholinergic

Anticholinergic drugs are mostly:

  • Beta-1 (affects the heart)
  • Beta-2 (affects the lungs)

To easily memorize which beta works for either the lungs or heart, remember: beta-1 is for the heart because humans only have one heart, while beta-2 is for the lungs because there are two lungs.

Beta-1 vs. Beta-2

Beta-1 agonist causes cardiac stimulation which results in increased heart rate, contractility, and relaxation; these drugs shunts blood from the rest of the body to the heart and lungs to better supply these organs with oxygen, to sustain the fight and flight response during stressful situations. Epinephrine and dopamine are well-known beta-1 drugs. Caffeine is also a potent beta-1 adrenergic agonist.

On the other hand, beta-2 agonist causes lung dilation; the bronchial tubes and bronchioles will expand, resulting in better breathing. Medications ending in “-terol,” like Albuterol, the rescue inhaler, is a typical example of a beta-2 drug.

Cholinergic

Cholinergic drugs also known as anti-adrenergic drugs are those that block the receptors, mainly the beta-1 and beta-2 receptors.  Cholinergic medications cause contraction of the smooth muscles, blood vessels dilation, increased secretions, decreased heart rate.

Beta-blockers affect both the lungs and heart; which is why it is essential that blood pressure and respiration are monitored if the client is receiving this kind of treatment. Assessment is important to prevent lung collapse and other side effects.

So, that’s it for our nervous system review part three. Hopefully, this lecture has shed light on this confusing topic about the sympathetic and parasympathetic nervous system and the drugs involved.

This is only one of the many videos we have in store for you to help you pass the NCLEX®. To get all the videos, you can go to simplenursing.com or subscribe to our YouTube channel.

Client Health Assessment Part 4: Chest Pain

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In today’s lecture, we will focus on a member’s question sent out through SimpleNursing’s Ustream with Mike Linares. For those who are interested, this Ustream session is a weekly live meet-up of SimpleNursing members with a fee of $39 a month. Here, you get to ask any nursing-related question that you want to be personally tackled by Mike Linares.

For this session, we’ll be helping out a member who is interested in physical assessment, particularly one who is experiencing chest pain. We will give you details on how to chart a nursing process in a simple, clutter-free, concise manner which your clinical instructor will greatly appreciate.

Let’s begin.

The Guidelines

First, you have to make sure that you are following the strict guidelines when charting your nursing process; this guideline is known as D-A-R. DAR stands for data, action, and response.

Charting Data

When charting data, it is not necessary to give too much information when writing down positive findings. What we want to provide is the raw, ugly data. It is important to remember that when charting, you are not required to put everything down in a narrative form, starting from how the eyes looked, how the grip is better, and so on. What you should focus on are the negative occurrences that the client is physically manifesting and complaining about.

Charting in General

The guidelines for charting cover a huge scope; whether the issue is concerned with chest pain, diabetes ulcer, electrolyte imbalance (hypokalemia and hypernatremia), and so on. What you have to focus on is what the client is complaining about.

If the condition is hypokalemia, you can expect cramp complaint. If the condition is hypernatremia, you can expect fluid retention due to increased sodium; furthermore, there will be bounding pulses which is apparent with a jugular vein distention. The point is, whatever the client is experiencing, that would be your primary complaint which you need to chart, and it will be shown in physical signs and symptoms.

Chest Pain Charting

Back to the member’s question, “How do you chart a client with chest pain?” Here are the following things that you need to do:

Start off with the narrative.

When checking the client, start off with his or her level of consciousness (LOC) along with the vital signs. Taking note of your client’s LOC and vital signs will provide a snapshot of how your client is doing bot neurologically and physically.

The vital signs are essential because it will give you a glimpse of how the client’s cardiovascular system, oxygen exchange, temperature, and respiratory rate are doing altogether.

When charting LOC, you should indicate “Alert and oriented x 4” or AO x 4.

How would you know if the client is an AO x 4?

You have to ask four simple questions that can determine your client’s orientation. The four questions are:

  • What is your name?
  • What is your birthdate?
  • What is today’s date?
  • Who is the current president? (or anything relevant and is happening at present)

If the client manages to answer these questions, that’s the time you can chart an AO x 4; this means your client is responsive to the four questions provided.

But, what if you’re caring for a comatose client?

If the client is comatose, write “unresponsive.” However, if the client is responding to pain or to a sterile rub, you can write down “responsive to stimuli.”

Alert and Responsive is Zero

If a client who is alert and awake does not respond appropriately to the questions asked – doesn’t know his or her name, the time, date, location – indicate on your charting an AO x 0. This means that the client is alert but is not responsive.

Charting Focus Assessment

In nursing school, it’s quite difficult to anticipate what instructors want because they have repeatedly inculcated in you that you should do a head-to-toe assessment with every client you encounter. This situation can be confusing at first because you are aware that doing head-to-toe means you have to do an overall physical assessment. However, a head-to-toe does not literally mean that you have to start from the head all the way to the toes.

A head-to-toe assessment basically means that you need to do a full body assessment, to look at the client, and check if he or she has anomalies. You need not document everything you see, just the necessary ones, especially conditions that are related to your client’s condition.

Focus assessment, on the other hand, is an assessment that is primarily focused on the client’s chief complaint; which simply means prioritizing on why the client is inside the hospital in the first place.

So, for a client who has chest pain, after taking the vital signs, you should ask if he or she is currently experiencing any pain. If the client says, “No,” chart it down. This is how focus assessment is done – Client complaining 0/10 pain. There is no need to go through OPQRST.

Then cardiac assessment must follow. This is when you have to listen to the heart sounds of your client – atrial, pulmonic, and tricuspid (earth’s points). You also have to listen to the apex for what?

The answer for this will be discussed in our next lecture. See you there!

Nursing Interventions for Acute Respiratory Distress Syndrome

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ARDS stands for acute respiratory distress syndrome – these are just some fancy words for a condition that’s causing severe alveoli inflammation leading to structural collapse and instability.

The Alveoli

For those who are unaware what alveoli are, they are those small sacs located at the end portion of the respiratory tract. You can think of them as apples attached to the branches of your trees (lungs).

It is in the alveoli that oxygen and carbon dioxide exchange happens. When people inhale oxygen, it is exchanged with carbon dioxide (CO2) that is breathed out by the body. In acute respiratory distress syndrome, this process is compromised due to the mass of fluid pooling inside, causing lung collapse.

Nursing Intervention for ARDS

Fluid rushing into the respiratory tract and reaching the alveoli is the primary cause for ARDS. So, how does one manage and intervene? How do you make sure that you’re decompressing and minimizing inflammation to the respiratory tract? What are the important nursing interventions that you need to do?

  1. Give Corticosteroids

Some common corticosteroids are Solu-Medrol and Prednisone. Clients are given corticosteroids to decrease inflammation in the respiratory tract. Take note; if you provide corticosteroids to your client with ARDS, you are also decreasing the movement of WBCs, thereby decreasing the immune response.

  1. Give Antibiotics

Since ARDS is a condition wherein there’s a pooling of liquid inside the lungs, the water becomes stagnant and is prone to becoming grounds for bacterial growth. Therefore, the client is likely to developing pneumonia. For this reason, antibiotics are necessary to protect the respiratory tract from developing complications and get rid of inflammation.

Remember that the primary goal why antibiotics are given is to alleviate inflammation and bring the client’s breathing back to normal.

  1. Turn the Client

Put the client in a 45-degree or 90-degree sitting position, and turn your client every hour to make sure that the fluid inside the lungs is not stagnant in one place. This will give parts of the lungs to breathe. Moving the client will also facilitate drainage as steroids are provided.

Critical Thinking

Here’s a critical thinking question:

As a nurse caring for a client with the late phase of acute respiratory distress syndrome, between diuretics and IV fluids, which one would you give to your client and why?

Answer: Neither.

First, this is a trick question. Second, the answer is neither because you should not give IV fluids nor diuretics to your ARDS client due to fluid considerations.

Intravenous fluids are not given because the lungs are already filled with fluid and, as the nurse in charge, you do not want to introduce further fluids that will add up to the ones that are already pooling inside the lungs.

On the other hand, diuretics are not given due to perfusion issues. Diuretics can cause concentrated blood, making it harder for hemoglobin and oxygen to move around the body. You have to make the most of the oxygen that’s left inside the body to be properly distributed to different parts and systems.

Summary

Remember, antibiotics and corticosteroids are essential in preventing infection and decreasing inflammation so that the fluid will not progress into multiple complications like pulmonary fibrosis or multi-organ dysfunction syndrome (MODS). Hopefully, this nursing intervention will reverse the condition, and the client will regain normal breathing.

That’s ARDS in a nutshell. For more relevant nursing topics, visit SimpleNursing.com.

Nursing Management and Risks of Peritoneal Dialysis

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Peritoneal dialysis is mainly concerned with the stomach and peritoneal cavity. The process is simply getting fluid out of the body when the kidneys have malfunctioned.

The kidneys’ primary role is to filter the blood and eliminate all the junk from the body into the potty through the urinary tract. If the kidneys fail to perform properly due to certain health issues, getting excess fluid and toxic wastes out of the body will be compromised; thus, peritoneal dialysis is recommended.

How does Peritoneal Dialysis Work?

In the belly, a tube is inserted to indwell within the peritoneal cavity. The primary purpose of this procedure is to fill the body up with a solution. The solution, on the other hand, is supposed to attract fluid and fill the body with sugary-type substances using a plastic encasement.

After filling the body with the prescribed solution, the tube has to stay inside the peritoneal cavity for a while to make sure that the body has been filtered from waste products. The solution for this procedure has high solutes that promote osmosis. All excess fluids inside the body are expected to become attracted to the solution that will then be extracted and drained from the body.

The Three Important Aspects

There are three important aspects concerning peritoneal dialysis – in, sit, and drain.

  1. In – when fluid is put inside the peritoneal cavity
  2. Sit – when the fluid is made to sit inside the cavity for a recommended period to attract excess fluid
  3. Drain – getting the excess fluid out of the body

A Home-based Procedure

Peritoneal dialysis can actually be done at home. Clients who opt to do the procedure at the comforts of their home are also hooked up to the machine and are provided with about a liter or two of fluid that should be introduced in the peritoneal cavity. The fluid will sit for about an hour and a half, and after that time, the fluid can now be drained out.

By using high concentration of solutes like high sugar or low potassium, they are bound to attract all the unnecessary waste products produced in the body that was supposed to be filtered out by the kidneys that have malfunctioned.

Weighing the Client

Before and after going into peritoneal dialysis, the client must be weighed to acquire information on the volume of fluid that was lost after the procedure. Weighing the client is important in assessing if the dialysis is effective or if the client has gained or lost any weight.

The Benefit

One of the main benefits of having peritoneal dialysis, aside from relieving the client of toxins, is the absence of shunts on the arm, or catheters sticking out of the chest. There are no malformations involved because there’s only a small tube that’s sticking out of the stomach which can be hidden if not being used.

The Risk

There is a high risk for infection when dealing with peritoneal dialysis since it’s a procedure that can be done at home for at least three to four times a day, on a daily basis or depending on the doctor’s order. People who opt for doing the procedure at home instead of doing it in clinics have a high risk of being exposed to infection due to the unsanitary environment.

Education is important in preventing infection from happening. Also, instruct them to watch out for signs of infection which is usually very cloudy and smelly output or drainage.

Test Question

Regarding the client’s output, do you expect the drainage to have the same amount of fluid introduced or to have more than what was given? For example, if you put in one unit, how much fluid is expected to get eliminated from the body?

Answer: At least more than one unit or reaching two units. Remember that the main goal of peritoneal dialysis is to allow people to release waste products in the form of pee which is why having doubled output is a good sign.

By remembering these critical factors, you are saving your dialysis clients from infection and potential complications.

For more essential nursing topics, visit us at SimpleNursing.com.

Newborn Assessment Part 4: APGAR Scoring

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APGAR scoring is probably one of the biggest topics concerning OBGYN and newborn. But what does APGAR stand for and how does it work?

Let’s get into it.

What is APGAR?

APGAR is a scoring technique that helps medical professionals, especially nurses, to do a quick head-to-toe assessment of newborns.

For example, you get this test question:

The nurse is assessing a newborn that has a heart rate 198, a strong cry, which resists when touched and has blue hands and feet. What is the APGAR score and condition of the client?

Think about this scenario, and we’ll get back to it later.

As a nurse, you have to efficiently and accurately classify those characteristics. Therefore, APGAR is like a scoring chart to identify the health status of a newborn baby. Just like everything else, there’s good, bad, and worst.

APGAR Category and Scoring

APGAR stands for:

  • Appearance or how the baby looks
  • Pulse
  • Grimace
  • Activity
  • Respiratory rate

In each category, a nurse can only score a maximum of two and a minimum of 0. Here, the higher the score, the better. The overall score is 10 points.

Let’s review each category and what their scoring stands for.

Appearance

If you have a blue core, you always have to equate that with low oxygen or cyanosis; therefore, it’s not a good appearance, so it gets a zero on the score sheet. Blue arms and legs or extremities are a bit better than a blue core, so it gets a score of one. A pink baby is the most desired appearance so it will get a score of two.

Summary:

0 – Blue core (cyanotic)

1 – Blue arms and legs

2 – Pink

Pulse

Without a pulse, that’s a zero and is not a good sign. If the pulse is less than a hundred, the score is one. If the pulse is greater than a hundred, it doesn’t matter if it reaches 200, the score would be two.

Summary:

0 – No pulse

1 – Less than 100

2 – More than 100

Grimace

Is the client moving? Does the newborn automatically cry and pull away when touched? When a newborn is stimulated, the normal reaction would be extending, retracting, or pulling away. If the newborn you’re assessing is not doing any of these reactions naturally, there is a need for stimulation.

If the baby does not react at all, that’s a zero. If the baby cries with stimuli, the score is one. For a baby to get a two, they should cry and pull away automatically even without stimuli. Six out of 10 babies usually require stimuli to get them to cry. Stimuli can be in the form of feet or back rubbing.

Summary:

0 – No normal reactions

1 – Cry with stimuli

2 – Cry and pull away automatically

Activity

No activity is a zero on the scoreboard. If you have a baby that shows no sign of activity, a code blue will take place because the baby is deteriorating. Minor flexion will get a score of one. Minor flexion means that the baby is not going to have full-on flexion-extension and he or she will not move around that much; there is also some sluggishness. Flexion and extension, when the baby is normal moving up and about, get two on the scoreboard.

Summary:

0 – No activity

1 – Minor flexion, slightly sluggish

2 – Flexion and extension

Respiratory rate

Does the baby have a strong cry or a weak one, like irregular gasps? With weak, irregular gasps, the nurse has to suction the baby because they might have aspirated some amniotic fluid while inside the uterus. As a nurse, you would want to suck out all the amniotic fluid and meconium to prevent brain damage.

If the baby’s breathing is absent, that’s a zero. If the baby has weak, irregular gasps, that’s a one. But the baby’s cry is strong, he or she has a good respiratory rate, which calls for a score of two.

Summary:

0 – No cry

1 – Weak irregular gasps

2 – Strong cry

APGAR Summarization

So, how do you assess if the baby is bad or good, or is doing well? Here’s how to summarize APGAR scoring.

Score 10 – 7 = Normal

However, do note that there is no such thing as an APGAR score of 10. Usually, eight is the average.

Score 6 – 4 = Okay but with five-minute monitoring

If the APGAR score is within six to four, the baby is doing okay; but constant monitoring is necessary, like every five minutes right after birth until the baby gets better.

Score 3 – 0 = Not good; needs immediate intervention

If the APGAR score is three below, assessment and monitoring must be done every minute. The nurse has to immediately call a code and inform the doctor since the baby’s health is quickly deteriorating.

APGAR Setting

If the score is an eight, the first thing to do is to warm the baby up because everything’s fine, there is no need for reassessment.

If the score is a five, reassess every five minutes until the baby gets a higher score. Pediatric clients need constant reassessment, especially newborns because their condition can either get better or worse in a matter of minutes. Newborns tend to spiral really quick.

But, if the newborn’s APGAR score is three, what is the FIRST nursing intervention?

Answer:

Call for help – doctor, and code blue team.

Answering the Question

So, going back to the question above:

The nurse is assessing a newborn that has a heart rate 198, a strong cry, which resists staff with flexion and extension when touched and has blue hands and feet.

Answering with your APGAR:

  • A – blue hands and feet (1 point)
  • P – more than 100 (2 points)
  • G – resists staff when touched (2 points)
  • A – flexion and extension (2 points)
  • R – Strong cry (2 points)

APGAR total score: 9 points

Points to Remember

APGAR scoring is done a minute after giving birth. If the score is below seven, you have to do it again in five minutes until the client gets a good score or is normal. It is a good thing to write this APGAR scoring down like a chart so you can carry it around with you.

On our next lecture, we will be discussing RH factors.

Renal Function Patho: Getting to Know Your Kidneys

Renal failure – an exam favorite and one of nursing students’ worst nightmare. If renal failure is making you anxious, let SimpleNursing.com make it stupidly simple for you.

But first, let’s go to the basics – kidney function and location.

Whenever you hear the word “kidneys” there should be a light bulb inside your head that immediately triggers you to think about the fundamental pathophysiology happening inside those two bean-shaped structures inside your body. Let’s break it down effortlessly.

The Washer Machines

As previously stated, the kidneys look like two beans which are connected to the aorta and have renal arteries. Now, think of your kidneys as washer machines. Never mind the glomerular filtration rates or nephrotic syndrome or those complicated terms that you’ve acquired from reading your nursing books. All you have to think about at this moment is how your kidneys are washer machines in your body.

The primary function of your washer machines is to wash (filter) your blood, making sure it’s clean before it goes into the different parts of the body. As clean blood is being distributed to the entire system, dirty blood becomes urine and is eliminated down the ureters to the bladder and finally, to the potty.

From the wise words of Mike’s instructor: “Into the potty and not the body.”

Get The HUC Out of Here

Basically, there are three main elements that kidneys filter and they go by the acronym: HUC. What does HUC stands for?

  • H – Hydrogen Ions
  • U – Urea
  • C – Creatinine

Hydrogen Ions

One word: very acidic. Hydrogen ions are the by-product of H2O (water) – two hydrogen and one oxygen atoms.

While the body utilizes oxygen, it needs to get rid of the hydrogen from the blood and into the potty. Why? Because if your washer machines are broken, hydrogen with not be properly filtered and will not be eliminated from the body. This will cause acid build-up that will lead to metabolic acidosis. Therefore:

  • Increased hydrogen = metabolic acidosis

Urea

How is urea created?

From the small intestines, specifically the duodenum, protein is broken down. Think of protein as a protein bar that comes in with a wrapper. The body absorbs the protein while the wrapper becomes ammonia. Ammonia goes into the liver and is broken down in the form of urea. Urea is then sent through the exit portals of the liver to the washer machines to be appropriately filtered and be excreted by the body.

If the washer machines are broken, there will be a build-up of urea (uric acid) and is evidenced by your blood urea nitrogen (BUN). Therefore:

  • Increased urea = increased BUN

Take note: When BUN is increased, it doesn’t automatically indicate renal failure. There is a high possibility that your client is just dehydrated. This happens when the person has been exposed to the scorching heat of the sun for quite some time; the person becomes hemo-concentrated which results to the very high BUN. You can remember that through “very burned BUNs.”

So you’re wondering what happens if BUN and creatinine are both elevated? Read on.

Creatinine

Creatinine is the by-product of muscle metabolism. This does not mean rhabdomyolysis or the rapid breakdown of your muscle. Having creatinine in the body only means that there is constant and healthy muscle tissue break down and the end-product is creatinine. When the washer machines are broken, creatinine level in the urine is low because it’s stranded inside the body.

Again, from the wise words of Mike’s instructor: “Into the body and not the potty.”

To answer what happens when both BUN and creatinine are elevated:

  • Increased BUN and creatinine = possible kidney failure

What are the stages of progression of kidney failure regarding acute renal failure? That will be discussed in our following video that’s mainly dedicated to the condition: acute renal failure.

See you in our next video!

Adrenal Glands Disorder Review: Cushing’s vs Addison’s

Probably one of the most requested topics, Cushing’s and Addison’s Disease are two adrenal gland disorders that are both confusing and difficult to identify.

A lot of people, especially nursing students, usually get the two diseases mixed up. When discussing Cushing’s Syndrome and Addison’s Disease, you will be talking about a lot of hormones involved. For that reason, SimpleNursing.com is cutting out the confusing parts and will be focusing on what really matters and what will come out in your NCLEX® exams.

The Gist

The contrasting factor between Cushing’s and Addison’s is cortisol; one is too much, and other is too little.

  • Cushing’s Syndrome – increased cortisol
  • Addison’s Disease – decreased cortisol

To better understand how the two diseases occur, we first need to know how cortisol is produced inside the body.

The Starting Point

All hormone regulation starts in the pituitary gland. The pituitary gland consists of the anterior pituitary and the posterior pituitary. Between the two, it’s the anterior pituitary that’s responsible for secreting the hormone that is responsible for Cushing’s and Addison’s – the adrenocorticotrophic hormone (ACTH). So, that is what we’ll be focusing on.

The ACTH is like a domino hormone that triggers the adrenal release of steroids. You can think of ACTH as a messenger that goes to your adrenal glands (the glands sitting on top of your kidneys) and says, “Hey adrenals, release some hormones.”

Message Received

Once your adrenals receive the message, it will produce MAC. What does M-A-C stand for?

  • M – Mineral steroids (aldosterone)
  • A – Androgens (hair and sex)
  • C – Corticosteroids

Mineral Steroids

One of the notable mineral steroids that the adrenal glands produce is the aldosterone or what Mike likes to call “Aldos Tyrone.” Think of Aldos Tyrone as a bouncer who stands at the door of a nightclub (kidneys). What this bouncer does is he holds back sodium from getting out of the kidneys and because of that, water is also retained.

What happens if there is increased water retention?

  • Increased pressure in the vascular beds or vascular system
  • Increased blood pressure

If Aldos Tyrone is eliminated using an aldosterone blocker (Spironolactone), it will decrease or eliminate sodium from the body and water will follow; thus, decreasing blood pressure.

Androgens

Androgens, like testosterone, are mainly responsible for the production of hair and sex hormone. Therefore, if you have increased androgens in your body, you will produce a lot of hair, and your sex drive will be heightened.

Corticosteroids

This is where Addison’s Disease and Cushing’s Syndrome come in. Corticosteroids are your cortisol. Cortisol a natural hormone produced in the body where Prednisone, a known corticosteroid, is derived from.

What are the functions of corticosteroids?

Think of your corticosteroids as your airbags. What is the primary function of an airbag? To protect you from harm caused by vehicular accidents. Corticosteroids are produced to act like an airbag to protect you from the inflammation caused by stress.

Adverse Effects of Corticosteroids

Though corticosteroids help in relaxation, it also triggers water retention. Fluid retention can cause:

  • Increased potassium level
  • Weight gain
  • High blood pressure

Going back to the airbag concept, yes, airbags are great because they save your life, but take up a lot of space; same with corticosteroids. Corticosteroids decrease stress and inflammation but will eventually smother you and add extra weight. Therefore, long-term Prednisone intake can cause water retention and high blood pressure.

Cushing’s versus Addison’s

Taking cortisol as the primary regulatory factor, you can now quickly enumerate the difference between Addison’s Disease and Cushing’s Syndrome.

Addison’s Disease – too little cortisol that leads to:

  • Weight loss
  • Low blood pressure
  • Hair loss
  • Sexual dysfunction

Cushing’s Syndrome – too much cortisol that leads to:

  • Weight gain
  • High blood pressure
  • Thinning of hair
  • Decreased libido and fertility
  • “Smothering” effect

In our next lecture, we will be going into the nitty-gritty details of the signs and symptoms of Cushing’s Syndrome and Addison’s Disease. See you there!

Fundamentals of Nursing: Client Prioritization Part 1

Client prioritization is a favorite topic in the majority of nursing exams. Why wouldn’t it be? A huge chunk of the National Boards and NCLEX® questions fall under client prioritization and delegation. We’ll be delving into client prioritization and discuss delegation in a separate video.

Prioritization Matters

It is vital for nursing students to know how to prioritize clients to identify which client gets care first easily. Considering that nursing has a lot of elements involved and time management is vital, one must be critical in managing a wide array of responsibilities that can be quite overwhelming. Not only is this important in a hospital setting but also prioritizing gets quite tricky in the exams.

Prioritization without the ABCs

They don’t make it like they used to – the nursing exams. Because sometimes, the questions that come out are the ones you least expected. We all know prioritizing is tied to the ABCs – airway, breathing, and circulation; technically, you are figuring out the client who has the higher chance of dying first.

But what if, during your exam, you were given a client prioritization question that is not an ABC? How are you going come up with the correct answer?

Currently, test questions about client prioritization don’t only focus on the ABCs; they also focus on matters like safety, infection and laboratory values among other things. So, how are you going to deal with questions without the ABCs?

  1. Safety

After your ABCs, safety comes next in the hierarchy. So, if your client has an altered state of consciousness, it will be directly correlated to his or her safety; making it a huge priority because clients who are at risk for fall may hurt themselves and will endure further injury.

  1. Sepsis and ABGs

Between a client who just came out of a surgical procedure versus someone who is going through sepsis, who should receive immediate attention? It would be the client with infection. Neutropenic precaution for people who have cancers is also included in this hierarchy.

ABG results showing respiratory acidosis which may lead to criteria for acute respiratory distress syndrome (ARDS) is another priority since it will be related to the ABCs. So between someone who has infection versus someone who has respiratory acidosis, the respiratory acidosis client comes first.

Side note: To avoid confusion between septic clients or those going into the Systemic Inflammatory Reactive Syndrome (SIRS) criteria versus those who have problems with their ABGs, you first need to have basic knowledge of the different components. By being familiar with what goes on between your SIRS and your ABGs, it would be easier for you to identify which should be prioritized.

  1. Laboratory Values of the Lungs and Heart

Prioritizing clients with regards to their laboratory values, you have to consider the normal and abnormal values of the cardiac enzymes – CRP, CPK, and troponin. If you were given a question that focuses on laboratory values of the heart or lungs, you mainly have to point out which client is more likely to die. That would be the one who has the profound laboratory values.

  1. Diagnosis

When referring to diagnosis, it’s usually the post-operative clients that get immediate care. Therefore, if you get a question that asks you, “Who among the following would you see first?” The post-op client is a priority.

Example:

Which of the following clients must be checked first?

  1. The client who has been in the hospital for three days after being diagnosed with COPD exacerbation
  2. The post-MI client who’s been around for a day or two
  3. The client who just came out of the operating room after having an angiocath

In this scenario, you will choose letter C since there are a lot of complications that may happen within the first few hours after the operation. These clients are sedated and are at risk for bleeding; which is also the reason why assessment and care for post-op clients are not delegated. Asthma exacerbation is also high on the diagnosis list.

  1. Pain

Pain is low on the prioritization list because people do not die of pain. You have to keep in mind that prioritization is always based on the idea of choosing the client that has an increased chance of dying. Pain is manageable, and the discomfort can be tolerated for a certain period.

What to Remember

Client prioritization depends on the client’s status at a given moment. So you just need to identify who is at risk for danger or who is at risk for death. If you’ve observed, these clients who are post-operative, who have acute asthma attacks, or who have neutropenic precautions can all be qualified under top priority. Therefore, choosing your answer will greatly depend on the changes seen in the client and the severity of the condition.

Pass Your Exams with Mike Linares’ Efficient Study Tips

Are you having a difficult time studying for your upcoming exams? Here at SimpleNursing.com, Mike Linares will let you in on a little secret – his study techniques to help succeed in your test.

It is imperative that you know these three things that Mike has emphasized so you can:

  • Cut your study time by 60%
  • Score a B on your next nursing exam

Who is this for?

  • Anyone who is going through a troublesome time reviewing and recalling all the nursing subjects
  • For those who have been out-of-school or out-of-service for a period of time and wanted to start again
  • For students whose exams are just around the corner

Finally, if you feel like you’re one of those students who has been given all the books, tools, PowerPoint materials, and nursing resources yet still don’t have any idea how to cross the bridge, this is for you.

The Three-Tip Manuscript

Mike has specified and outlined three study tips and called it the “Three-Tip Manuscript.” According to him, these are the techniques you need to pass your exams.

Tip 1: 15-Minute Increments

Blocking out two to three hours of straight study time is, according to studies, ineffective. Research has shown that comprehension and retention of information only work at the beginning and the end of every study session. Everything you’ve read in between will be forgotten the next day.

For that reason, it is advisable to cut study time by 15-minute increments with a quick break; and then proceed to the next 15 minutes. This technique is used so that distractions will not get in the way of your tedious three-hour traditional study time.

For example, if you’re studying cardiology for this day, choose a topic within cardiology and study that for 15 minutes. Once your 15 minutes is up, take a five-minute break, then review again for 15 minutes. You can repeat this until you’re done with the subject, or you’ve had enough studying for one day.

Basic rule: No distractions within those 15 minutes!

For 15 minutes, you will block out everything and everyone and just focus on the task at hand. So, that means there will be no social media, kids, hubby, household chores, and mobile phones. It is essential that whenever you “get in the zone” of those 15 minutes, you devote all of your attention to it. Do not allow time vampires to suck that time from you.

Also, you can make as many 15-minute increments as you want. So, set that timer and get a hold of those 15 minutes you deserve.

Tip 2: Note Cards

After those 15-minute increments, go through all the information you’ve highlighted which you think are crucial to review. Now, take all of those highlighted information and write them down on note cards. What are you expected to write on your note cards?

  • Important keywords and phrases
  • Five thought-provoking questions that will be written on the back of every note card
  • Answers to the questions

Why choose note cards?

  • They will cut your study time by understanding only the key concepts
  • They are more convenient to carry; you can bring it anywhere and study instantly
  • They are fun and friendly because note cards help you focus on the fundamentals

Tip 3: 50 – 100 NCLEX® Questions

Now that you have your note card packed with all those vital concepts, you can use what you’ve learned, then apply it by answering 50 – 100 NCLEX® questions. When studying to answer NCLEX® questions, always think about keywords. Every NCLEX® question has a specific keyword that you need to watch out for and relate to. So your keywords will come in handy once you read through those NCLEX® questions.

Take as many NCLEX® questions as you can because the more you answer, the less anxious you become and the more relaxed and comfortable you’ll feel once you take the actual test.

For complete access to unlimited NCLEX® questions, visit us at simplenursing.com. Become a member and have an all-access pass to all nursing materials, articles, videos and NCLEX®-related resources to help you cut your time and study better.

EKG Interpretation in 3 Easy Steps: An Overview – Part 3

In our part 3 of EKG rhythm interpretation, you will get a quick rundown on the anatomy of the heart and how a typical rhythm malfunctions, progressing to the different types of heart rhythm abnormalities.

The Heart Set-Up

First, we go to the basics – the anatomical parts of the heart mainly involved in transmitting impulses.

  1. Left and right atriums and the left and right ventricles – functioning as the pumping stations of the heart
  2. Tricuspid and bicuspid valves – separates the upper and lower chambers of the heart
  3. Septum – found in between the left and right heart chambers of the heart
  4. SA node and AV node – electrical conductors
  5. Intranodular/Internodal tracts – also known as Bachmann’s bundle
  6. Bundle of His – responsible for transmitting impulses coming from the atrioventricular node to the heart ventricles
  7. Bundle of branches – transmits cardiac activity from the Bundle of His to the Purkinje fibers
  8. Purkinje fibers – responsible for ventricular contraction or the squeezing of the ventricles

The abovementioned parts of the heart are how you expect the heart to function and react. By the way, the SA node has 60 to 100bpm while the AV node has 40 to 60bpm. So, that’s how the heart routinely works.

Heart Rhythm Abnormalities

We have broken down the heart into three parts to give you a clearer view of the irregularities that happens in each section.

  1. Atrium

Here, you have your atrial fibrillation and your atrial flutter. Here’s how you can easily distinguish the two:

  • Atrial Fibrillation. Here, the faulty SA nodes fire rapidly all over the place, kind of like a Fourth of July in your heart or like a machine gun that shoots electrical charges all over the right atrium. Thankfully, the AV node is there to keep the pulses from getting into the ventricles. The AV node serves as your border control that blocks all the erratic and unnecessary impulses to enter the ventricles.

Impulses created by atrial fibrillation: 350 – 650bpm

How it looks at an EKG strip: “Fibbing out” with no P waves

  • Atrial Flutter. This irregularity can be compared to someone lighting up a box of fireworks and have left it inside the left and right atriums; affecting the pacemaker cells. Compared to atrial fibrillation, atrial flutter acts succinctly showing up as saw-tooth figures on an EKG strip. You can think of this as someone sawing wood, then woodchips and wood shavings flutter off in different directions.

Impulses created by atrial fibrillation: 250 – 350bpm

How it looks at an EKG strip: Saw-tooth with intervals of normal QRS waves

  1. AV Node

In your AV node, you have the bundle branch blocks (BBB) which basically refers to the bundle branches extending from the Bundle of His (looks like viper fangs); one of two branches can be blocked for whatever reason. In the BBB, you can have:

  • Right bundle branch block
  • Left bundle branch block
  • 1st-degree block
  • 2nd-degree block
  • 3rd-degree block (deadliest among the three degrees)

That’s just an overview. Detailed discussions of these bundle branch blocks are available in other lectures.

  1. Ventricles

It is in the ventricles where the two deadliest rhythms are occurring – ventricular fibrillation (V-Fib) and ventricular tachycardia (V-Tach). In hindsight, the ventricles squeeze or contract to provide oxygen to the body; the left ventricle pushes the afterload (blood) into to the body through the aorta.

Therefore, if the ventricle is not squeezing, you’re basically suffocating yourself; also known as ventricular flutter. Clients who present with ventricular fibrillation and ventricular tachycardia will have an altered level of consciousness. What do clients manifest?

  1. The alert and oriented is zero, so clients are usually unresponsive.
  2. If they are awake, they will feel extremely lightheaded due to decreased oxygen perfusion.
  3. They will be very anxious and disoriented.

To address the urgency of V-Fib and V-Tach, healthcare practitioners usually result to:

  1. Shock administrations with chest compressions
  2. Pharmacological drugs (i.e., epinephrine) that realigns your ventricular rhythms to normal rhythms

So that’s just an overview of what happens in the heart if in case it goes out of hand. Now, for our next lesson, we’ll be having a comprehensive discussion about atrial fibrillation and atrial flutter.