The older we get the harder it is to lose weight. The one thing no one likes to hear is "you seem to be putting on a little weight" and it does not get easier to hear the older you get. There are many ways and many quick fix solutions touted to bring rapid, guaranteed weight loss solutions.
Do not believe them. They are only partial truths. Yes, you can probably drop 5 to 10 pounds in a week by the use of diet pills. This is a fine way to go to your reunion or have family picture made but if a long term solution and a happier, healthier health style is your goal it takes time, hard work and persistence.
I know, terrible to hear isn't it?'Even harder to live by! But the rewards are great when you do decide to follow this simple plan.
First, forget that diet, the word, means pain and hunger, instead focus on the word food and it will become energy! After all, isn’t that what food is? Food is fuel, food is energy, and food keeps us going…remember all those phrases? Of course you do!
Well here is where you start: omg say it isn’t so! Yes, it is so. Breakfast! The first and most important part of your day! Why?
Because it will set the tone, the feel, for the rest of your day.
If all you do is drink a couple of cups of yummy coffee and then rush around madly trying to get through your morning how far do you get? That’s what I thought. If you leave home at 6:45 AM with two cups swirling around in your gut, then traffic or a bus or a subway, then the workplace and another harried cup and a half of coffee then it is 10:25AM and your stomach is rolling. Before you dredge the bottom of your purse for a lint covered pepcid you think “well maybe if I ate a little something I would feel better” So you throw money into the gullet of the junk food machine and it spits out some stale crackers or partially melted chocolate candy and off you go rushing around madly for oh…maybe 80 minutes!
Go on, deny it, I dare you.
Hey, I am there! Coffee and Twix, food of the gods.
And here I sit, closing fast on sixty years, probably way less than the 5 foot in height I lied about twenty years ago and now 135 pounds.
We have to change the way we live, and think, and feed our bodies. If we don’t, we will not be able to walk and pick up beer cans off the side of the road in another 15 or 20 years and yes we will have to do that because there will NOT be any more money for our pitiful social security checks!
WOW what a wonderful run on sentence
Hey! Focus here people the NURSE is speaking!
This lecture is so easy to give, only takes a few moments, makes great sense and is true. Plus, IF you do follow this advice in one year you will have lost at the minimum 30 pounds and your health will have improved out of sight! If you keep it up, you will reach and maintain your ideal body weight in less than 5 years.
And all that influences the rest of your health, do you need to hear me spell this out?
OK Blood pressure, diabetes, heart disease, arthritis, back pain, respiratory distress and infections, the whole kit and caboodle will improve!
If all those disease systems improve guess what else you will lose? Medication and the bills that come with them! Yep, pretty good snag line isn’t it?
So what do you eat and how much will it cost?
How much pain will exercising cause you and how much do you have to do?
How often do you have to see your doctor and what do you do if the doctor says no walking or exercise of any kind?
Let’s address each question one at a time.
So what do you eat and how much will it cost? The best way to eat is as if you are a diabetic. I don’t mean the old diet plan of counting calories and weighing portion sizes and substituting carbohydrates. Don’t panic!
Diabetes is best treated with food and exercise along with medication. You are so lucky! If you are not already diabetic then no pills for you! Aren’t you so glad!
All you have to do is eat. I know, sounds like that TV commercial, I get that a lot. You eat small, frequent meals and you avoid foods that you know are not the best, rice, pasta, breads, cakes, sugary cereals. You know, white poison. Sugar and all its derivatives earned that title you know, that didn’t just get awarded to sugar for its good looks oh no! Sugar and all things white had to work extra long with mandatory unpaid overtime t get that title! Sugar is proud of that title! It will cheerfully kill you!
Sorry, I get carried away :)
OK, breakfast. It does not have to be eggs, bacon, fruit you know. If you want a hot dog, eat one. The whole thing here is to eat a LITTLE something and drink your water and your milk, not a huge glass of milk, just four to six swallows! I know, sounds weird, get over it.
Then go to work, drink your coffee, its fine, but no junk food! Take an apple, already sliced, or a carton of yogurt or fix yourself a few authentic peanut butter crackers at home and take them. No you cannot have graham crackers, geez. You may have Melba toast, wheat thins or saltines and just a tab of peanut butter not enough to choke you. And only fix four, no fair fixing six Melba toast or ten cheez its. Just four. That’s it. Drink your water.
At lunchtime eat a green salad or a fruit salad and no you cannot eat a tub full of the stuff. Salad does not have to be just greens; in fact it doesn’t have to have greens at all. You can have the tip of the serving spoon full of whatever is on the buffet as far as fruit and salads and you can fill your plate, just no fair creating Mt Everest! Drink your water and if you like you may have unsweet tea and or the same amount of milk.
Go back to work and laugh at your coworkers who can hardly keep their eyes open!
When you get home stay strong! Do NOT cave! Take a shower, whatever you do, supper must stay very light, grilled, baked or broiled meat or chicken or fish, the size of a deck of cards, any cooked vegetable, but only a piece of one, ,fruit and don’t forget to drink your water.
Why does it have to stay light at the evening? Because the night is the time for haunts and sorrow and for ice cream. See? Told you I was just the same as you !!!!!!
Hang in there, you will find what foods you love and you will lose the weight!
How much pain will exercising cause you and how much do you have to do? If you hate the “E” word as much as I do… (Right, I am the reason that treadmill just to the side of the guys’ weight equipment is broken.) Then you understand my pain and I feel yours. But it must be done and this “E” word is called Walking
That's all just walk.
But, you have to walk every day, even if it only for half an hour. Actually it’s my favorite time; get to watch the cute butts swing by me, I don’t have to walk fast, and I just have to walk. You can do that I bet. So it’s really free, nothing to join…
How often do you have to see your doctor and what do you do if the doctor says no walking or exercise of any kind?
Your physician needs to see you at the minimum of every six months and your physician will tell you how often to come for a checkup. The first visit must start before you start this lifestyle change. Your Doctor can give you a more detailed (though, sadly, not a more humorous one) of this type of diet plan with more suggestions as to the kinds of foods to eat every meal. Your Doctor will be the one to say how much, how often, how strenuous your “E” program can be. Your Doctor will be the one to follow you on a regular basis.
What do you do if the doctor says no walking or exercise of any kind?
Your Doctor will be able to suggest an alternative program, perhaps a passive range of motion plan, which will help until your Doctor feels you would be able to attempt a more rigorous exercise program. Only your Doctor will be able to advise you on how much exercise is the best thing for your health.
There you have it. No diet pills, no MRE’s to order through the mail. Yes, Meals Ready To Eat, what else are we supposed to call them? You do realize that the armed forces MRE’s are prepared by gourmet chef recipes, right? So what you order from the commercial for how to lose weight by eating their meals is just the same as what our guys/gals get to eat in the field. Tasty. Watch the History Channel and the Gunny, he does a really good show about MRE’s and how they have changed over war time. Gourmet recipe or not, I bet your food and your choices will be a tad bit tastier than something that comes prepackaged, precooked and predelivered!
I know, no such word as predelivered but hey, I was on a pre roll :) How can something be delivered before it is delivered?
barbara bethard
Showing posts with label Barbara Bethard RN. Show all posts
Showing posts with label Barbara Bethard RN. Show all posts
Wednesday, September 2, 2009
Sunday, August 30, 2009
What is Different About the Swine Flu?
The best way to prevent the spread of any infection is with proper hand washing. This means you must use plenty of soap and water, you must apply pressure, and you must wash every portion of your hands, between fingers, nails, top and palms of your hands and finally wrists for at least fifteen seconds. Then you need to rinse your hands under running water with your hands pointed down and without touching any portion of the sink. Do Not turn the water off with your clean hands. Use paper towel to dry your hands then use that towel to turn the faucet off and another to open the door. Singing the ABC song or the Happy Birthday song twice is enough time to know that as many bacteria as possible have been removed from your hands.
The Swine Flu or H1N1 is a serious pandemic. The signs and symptoms resemble those of influenza type A, however, the symptoms worsen quickly and can be difficult to treat if not caught and treated promptly. The problem is there is already a resistant strain to the antiviral medication and many physicians and infection disease centers are cautioning against using the antiviral medication without absolute proof it is necessary.
The swine flu (H1N1) signs are cough, sore throat, gastric distress such as abdominal pain, nausea or vomiting, chills and fever, body aches and fatigue. These are also the signs and symptoms of the flu we are already used to seeing during the winter. What makes the swine flu different?
The difference with the flu we are used to dealing with versus the swine flu is that with the swine flu there will be a worsening of symptoms and it will seem unstoppable. Testing and research shows the swine fu is targeting the lungs. The virus becomes deadly when it gets into the lung tissue.
This virus also seems to be worse among young people, pregnant women and immune suppressed persons. Yet these are the people the WHO suggests get vaccinated. However, there is no research done on the upcoming vaccine at this time. The persons at the WHO and the CDC will be studying the effects of the vaccine on the persons who receive the vaccine in October of 2009!
There is also word that the WHO and the CDC will have the live attenuated virus (nasal spray type vaccination) available for young children. The difference between a live virus and a dead virus is that with a live virus what you are receiving will be a minute dose of the virus itself. With the live virus the risk of contacting the actual virus increases exponentially.
If a young person who has flu like symptoms becomes incoherent, unable to be consoled (crying or whining without ceasing) has uncontrollable vomiting, has very rapid breathing or bluish tint to skin, refuses fluids, uncontrollable coughing or cannot be woken take the child immediately to the emergency room or call 911
With an older adult watch for respiratory distress, unable to wake, mental status changes, uncontrollable coughing, dizziness or persistent vomiting. If any of those signs occur then call 911 or take that person immediately o the emergency room.
Continue to monitor the the television and radio as well as the Internet for updates on the swine flu but remember that common sense is your best friend! Cover your mouth and nose when coughing and sneezing, hand washing, plenty of fluids, avoid crowds, avoid persons you know have the flu, obtain the flu vaccine as soon as possible even if you decide not to take the vaccine specific to H1N1.
barbara bethard
The Swine Flu or H1N1 is a serious pandemic. The signs and symptoms resemble those of influenza type A, however, the symptoms worsen quickly and can be difficult to treat if not caught and treated promptly. The problem is there is already a resistant strain to the antiviral medication and many physicians and infection disease centers are cautioning against using the antiviral medication without absolute proof it is necessary.
The swine flu (H1N1) signs are cough, sore throat, gastric distress such as abdominal pain, nausea or vomiting, chills and fever, body aches and fatigue. These are also the signs and symptoms of the flu we are already used to seeing during the winter. What makes the swine flu different?
The difference with the flu we are used to dealing with versus the swine flu is that with the swine flu there will be a worsening of symptoms and it will seem unstoppable. Testing and research shows the swine fu is targeting the lungs. The virus becomes deadly when it gets into the lung tissue.
This virus also seems to be worse among young people, pregnant women and immune suppressed persons. Yet these are the people the WHO suggests get vaccinated. However, there is no research done on the upcoming vaccine at this time. The persons at the WHO and the CDC will be studying the effects of the vaccine on the persons who receive the vaccine in October of 2009!
There is also word that the WHO and the CDC will have the live attenuated virus (nasal spray type vaccination) available for young children. The difference between a live virus and a dead virus is that with a live virus what you are receiving will be a minute dose of the virus itself. With the live virus the risk of contacting the actual virus increases exponentially.
If a young person who has flu like symptoms becomes incoherent, unable to be consoled (crying or whining without ceasing) has uncontrollable vomiting, has very rapid breathing or bluish tint to skin, refuses fluids, uncontrollable coughing or cannot be woken take the child immediately to the emergency room or call 911
With an older adult watch for respiratory distress, unable to wake, mental status changes, uncontrollable coughing, dizziness or persistent vomiting. If any of those signs occur then call 911 or take that person immediately o the emergency room.
Continue to monitor the the television and radio as well as the Internet for updates on the swine flu but remember that common sense is your best friend! Cover your mouth and nose when coughing and sneezing, hand washing, plenty of fluids, avoid crowds, avoid persons you know have the flu, obtain the flu vaccine as soon as possible even if you decide not to take the vaccine specific to H1N1.
barbara bethard
Do you get flustered when you have to give report to a physician or a nurse practitioner?
Everyone gets nervous in a big way or a small way whenever dealing with the physician or nurse practitioner. Nurses are geared to deliver information to one another; we are used to saying half sentences and waiting for the other nurses to jump right in there. We are comfortable around other nurses, we know that, well, for the most part, they have our backs.
This is not true whenever you must deliver succinct, complete, pertinent information to the physician. And we don't even want to talk about trying to get the physician on call to follow our line of reasoning!
Hopefully the following guidelines will help cure you silent groans of "OH God, it’s the doctor" the next time you must pick up that telephone!
First of all, if it is an emergency do NOT bother calling the doctor. Use your best nursing judgment! Send them to the hospital; call for back up, call the code or whatever you have to do according to where you and your patient are at that time. Just get that patient taken care of pronto!
You knew that! :)
Now, if you are in a hospital setting, find out what time your doctor is coming in, if you are in a nursing home, find out if your doctor is coming in. If you are in home health, all bets are off...call that doctors office and talk to that nurse then write it all down on your scratch paper.
Documentation is still the key to all of this! If you must, scribble it on whatever is handy but remember it MUST be in that patients chart to be of any use to you in the future! I agree, I hope you never need it in the future either!
Starting with the hospital: if the MD hasn't made rounds yet, great, make a list, give it to the charge nurse. If you are in a nursing home, make a list. If you end up with only the one patient to discuss, fine, call the MD before 11:00 in the morning.
If you have labs that need to be reported get as much of the other patients needs down on paper as you can but call those labs in first thing! Even if the lab work states MD office notified, you are responsible!
Why do you need to notify the MD of anything before 11:00 o'clock in the morning? Because, unlike you and I, the MD office gets to eat lunch, not only that but they get to eat their lunch in peace and quiet! Sometimes for as long as 90 minutes! I know, it isn't to be believed...
If you wait until after their lunch, chances are you will not get a call back until the next day. Most physicians take care of all their "outside" calls after their office closes. That means the physician or his nurse or both will start calling with the answer to your routine questions after 5:30 in the afternoon or even later.
What, you ask with a yawn, does this have to do with your talking to the physician phobia?
Everything.
Because my point is this: Make every call as if you are already speaking with the physician. Never mind if the doctors nurse is an old friend and you were in nursing school together or even if the MD nurse is an in law!
Stay professional.
The thing that helped me was when I started writing out a "script" of everything I wanted to tell that doctor. In the script I started at the head (figuratively speaking) and went through the body systems one by one. Just as if I were completing a physical. Except the script contained only the pertinent information.
For example; a patient fell on the previous shift, struck the back of his head and sustained a laceration of approximately 4 x 0.5 x 1cm behind left ear. Nursing called the family, MD on call and patient was transported by non emergency ambulance to the emergency room where patient received seven sutures. Sutures are clean, dry, intact, emergency room MD orders received but requests patient be seen by primary physician within next 3 days and requests patient return to emergency room for suture removal.
The 'usual' report to the physician the next day may be the following: so and so had a fall on the previous shift, was taken to ER, treated and returned, no problems noted.
Your "written" script to deliver to the physician may include the following:
Nursing has nearly completed the neuro checklist, no signs of complications due to recent fall noted. Patient remains awake and alert, does complain of slight headache. (Has or has not received as needed pain medication). Resident is (or is not) on Coumadin for (plug in diagnosis used for use of Coumadin. Proceed with patients vitals starting with most recent, even better is to give an average over the last six to eight hours.(or however long you have been doing neuro checks) For example: patient systolic averages 100-130 and diastolic averages 70-80mm/Hg,heart rate 70-86, no skips noted, no chest pan noted, skin cool and dry, patient with history of seizure activity taking depakote, last level drawn (give date) with level of (give level) and last known seizure was on (give date) and consisted of (give type) seizure lasting (give minutes).
May nursing remove sutures in ten days or do you wish patient to return to ER for suture removal?
May this nurse put a note in your MD book to remind you to check this patient on your next rounds?
Would you like any labs or other orders for this patient?
Then of course you document all of the above verbatim along with the physicians’ response in the patient chart.
Why should you give all this information? Better yet, why should you write it down then read it to the physician?
1. What if that patient has a seizure two hours after you go home? The next nurse calls and the physician could say they had no knowledge of this patient having a history of seizures nor were they informed of it when "you" gave them report! The physician may go so far as to question other information from the neurochecklist, the last known lab work, is this seizure the same as previous seizures and if so when was the last known seizure...Can you see what your next shift report will feel like? It will be a bit frosty! Worse yet, it may be very public!
2. No one likes to suffer through a verbal report filled with uncomfortable silences, repeated uh's, I'm sorry just minute and let me look that up for you. Imagine yourself as the physician or the nurse practitioner and you will realize they are depending on you for the correct information! You are an important member of their team! You will realize when you start doing this that you are powerful! You will discover that your time is as valuable as theirs and you will then find that you are on a level playing field with your physicians an your nurse practitioners.
The most important and self changing benefit of delivering all the information the physician and or the nurse practitioner needs is that you will get better and better at the critical thinking part that comes with going deeper than just the one or two sentence report!
Your report will be the one the physician will look forward to hearing, your work will be what the nurse practitioner will be proud of, your presence at the patient’s bedside will be the calming, and professional atmosphere that patient needs to improve.
Thinking about all the aspects of whatever you are giving report on will open your mind to all the different levels of care that are impacting that patient! You will be amazed at the difference you see and feel in your own work when you start this one small change. One change, how you give report, will cure your fear of speaking to the physician ad or the nurse practitioner and it will enrich your professional life on a daily basis, only getting better as time goes on.
Give it a try! You will pleased you did!
barbara bethard
This is not true whenever you must deliver succinct, complete, pertinent information to the physician. And we don't even want to talk about trying to get the physician on call to follow our line of reasoning!
Hopefully the following guidelines will help cure you silent groans of "OH God, it’s the doctor" the next time you must pick up that telephone!
First of all, if it is an emergency do NOT bother calling the doctor. Use your best nursing judgment! Send them to the hospital; call for back up, call the code or whatever you have to do according to where you and your patient are at that time. Just get that patient taken care of pronto!
You knew that! :)
Now, if you are in a hospital setting, find out what time your doctor is coming in, if you are in a nursing home, find out if your doctor is coming in. If you are in home health, all bets are off...call that doctors office and talk to that nurse then write it all down on your scratch paper.
Documentation is still the key to all of this! If you must, scribble it on whatever is handy but remember it MUST be in that patients chart to be of any use to you in the future! I agree, I hope you never need it in the future either!
Starting with the hospital: if the MD hasn't made rounds yet, great, make a list, give it to the charge nurse. If you are in a nursing home, make a list. If you end up with only the one patient to discuss, fine, call the MD before 11:00 in the morning.
If you have labs that need to be reported get as much of the other patients needs down on paper as you can but call those labs in first thing! Even if the lab work states MD office notified, you are responsible!
Why do you need to notify the MD of anything before 11:00 o'clock in the morning? Because, unlike you and I, the MD office gets to eat lunch, not only that but they get to eat their lunch in peace and quiet! Sometimes for as long as 90 minutes! I know, it isn't to be believed...
If you wait until after their lunch, chances are you will not get a call back until the next day. Most physicians take care of all their "outside" calls after their office closes. That means the physician or his nurse or both will start calling with the answer to your routine questions after 5:30 in the afternoon or even later.
What, you ask with a yawn, does this have to do with your talking to the physician phobia?
Everything.
Because my point is this: Make every call as if you are already speaking with the physician. Never mind if the doctors nurse is an old friend and you were in nursing school together or even if the MD nurse is an in law!
Stay professional.
The thing that helped me was when I started writing out a "script" of everything I wanted to tell that doctor. In the script I started at the head (figuratively speaking) and went through the body systems one by one. Just as if I were completing a physical. Except the script contained only the pertinent information.
For example; a patient fell on the previous shift, struck the back of his head and sustained a laceration of approximately 4 x 0.5 x 1cm behind left ear. Nursing called the family, MD on call and patient was transported by non emergency ambulance to the emergency room where patient received seven sutures. Sutures are clean, dry, intact, emergency room MD orders received but requests patient be seen by primary physician within next 3 days and requests patient return to emergency room for suture removal.
The 'usual' report to the physician the next day may be the following: so and so had a fall on the previous shift, was taken to ER, treated and returned, no problems noted.
Your "written" script to deliver to the physician may include the following:
Nursing has nearly completed the neuro checklist, no signs of complications due to recent fall noted. Patient remains awake and alert, does complain of slight headache. (Has or has not received as needed pain medication). Resident is (or is not) on Coumadin for (plug in diagnosis used for use of Coumadin. Proceed with patients vitals starting with most recent, even better is to give an average over the last six to eight hours.(or however long you have been doing neuro checks) For example: patient systolic averages 100-130 and diastolic averages 70-80mm/Hg,heart rate 70-86, no skips noted, no chest pan noted, skin cool and dry, patient with history of seizure activity taking depakote, last level drawn (give date) with level of (give level) and last known seizure was on (give date) and consisted of (give type) seizure lasting (give minutes).
May nursing remove sutures in ten days or do you wish patient to return to ER for suture removal?
May this nurse put a note in your MD book to remind you to check this patient on your next rounds?
Would you like any labs or other orders for this patient?
Then of course you document all of the above verbatim along with the physicians’ response in the patient chart.
Why should you give all this information? Better yet, why should you write it down then read it to the physician?
1. What if that patient has a seizure two hours after you go home? The next nurse calls and the physician could say they had no knowledge of this patient having a history of seizures nor were they informed of it when "you" gave them report! The physician may go so far as to question other information from the neurochecklist, the last known lab work, is this seizure the same as previous seizures and if so when was the last known seizure...Can you see what your next shift report will feel like? It will be a bit frosty! Worse yet, it may be very public!
2. No one likes to suffer through a verbal report filled with uncomfortable silences, repeated uh's, I'm sorry just minute and let me look that up for you. Imagine yourself as the physician or the nurse practitioner and you will realize they are depending on you for the correct information! You are an important member of their team! You will realize when you start doing this that you are powerful! You will discover that your time is as valuable as theirs and you will then find that you are on a level playing field with your physicians an your nurse practitioners.
The most important and self changing benefit of delivering all the information the physician and or the nurse practitioner needs is that you will get better and better at the critical thinking part that comes with going deeper than just the one or two sentence report!
Your report will be the one the physician will look forward to hearing, your work will be what the nurse practitioner will be proud of, your presence at the patient’s bedside will be the calming, and professional atmosphere that patient needs to improve.
Thinking about all the aspects of whatever you are giving report on will open your mind to all the different levels of care that are impacting that patient! You will be amazed at the difference you see and feel in your own work when you start this one small change. One change, how you give report, will cure your fear of speaking to the physician ad or the nurse practitioner and it will enrich your professional life on a daily basis, only getting better as time goes on.
Give it a try! You will pleased you did!
barbara bethard
Wednesday, August 26, 2009
How to Obtain an In and Out Catheterization
As a student nurse (many years ago) in a bachelor's program the opportunities for writing case studies, care plans and memorizing side effects of medications far outweighed the opportunities to practice basic nursing skills. Always remember to first consult the nursing clinical policy and procedure book at the facility where you are learning however, These steps are fairly basic ... good for many facilities. Read, Practice on a doll or manikin (If you have one) then "Go for it"
Go to the patient's chart and review the physicians order. Even if the nurse who told you about this order gets a bit "cool" towards you, remember that they are human too. Remember, you worked hard for your license, so protect it! Now, write out the laboratory slip, place it in the outside pocket of the lab bag then write with magic marker on the specimen cup the pertinent information. That way you don't have to worry about contaminating your pen if you write on the cup after you collect the specimen!
!) Gather your supplies. Double check your supplies. There is nothing more frustrating or intimidating than to get halfway into something and then have to stop just to go back to you cart and get something small like a Q Tip!
Enter your patent's room politely by knocking and calling out a greeting including your name as a way of announcing yourself. Explain the procedure to your patient and provide patient privacy by closing curtain over windows and pull privacy curtain itself around bed.
Place your supplies on the overhead table, open your garbage bag and set it on the end of the bed or on the floor depending on the facilities policy. Now tell your patient that you are going to wash your hands, this is very important; this lets your patient know that you know the best way to prevent the spread of any infection is to...What? Right, go wash your hands.
Scrub your hands for 15-20 seconds with soap and water, letting the water stay running the tire time. The CDC says this is enough time to kill bacteria on your hands; besides you can use this time to go over the steps of the procedure you are about to perform.
When you come back to the patient's bedside you will begin to set up your sterile field, remember to open all items away from you, do not tear open items, and pull apart on the edge or on the dotted line. Even though you did the correct patient right steps at the nurses’ station, do it again. Double check your paperwork; starting with R's, right patient, right MD order, right site, right date, right time, right type
Verbalize every step as you are performing each step/this is a good to keep your patient calm as well as to keep your hands steady! And the more often you speak the steps out loud the easier it will be to continually perform the correct steps in the correct manner every time
The correct steps, the ones that will rarely vary from one facility to the next are as follows after you have washed your hands:
Open sterile catheter kit,
Remove sterile field maintaining aseptic technique and place in between the patients legs which are opened but patient is still draped for privacy, only the specific part of the body necessary for the procedure should be visible to you.
Do not touch the bed, the sheets, the patient, if you do you will contaminate it all and have to get new sterile gloves, wash your hands, do everything all over again so be careful!
Remove catheter from plastic sleeve and drop onto sterile field,
Don sterile gloves correctly,
Open betadine packet or Chloroseptic packet,
place swabs on sterile field next to catheter,
open lubricating jelly packet, place end of catheter into packet of lubricating jelly,
Decide now which hand will be clean and which hand will remain as sterile as possible.
If you are right handed you may find that being on the patient’s right side of the bed with the overhead table facing the head of the bed will work well for you. Regardless of whether catheterizing male or female the next step is the same.
With both hands, both still as sterile as possible at this time pick up the cath box with all items inside by the inside. Not as hard as it sounds, place both hands, palms down, into the box, spread your fingers, no you have a grip on the inside of the catheter box and you can lift it up and set it between your patient's legs.
Instruct your patient as you are doing all of this that you have now made him/her your assistant. Their job is to keep from touching or moving or knocking over that catheter box.
This is also the time to start speaking your steps to your patient. It lets your patient know what is about to happen so they stay calm, and the more times you say the steps out loud the more likely you will be to actually perform the steps in correct order every time.
With your unsterile or dirty hand pick up the penis of the male patient and hold it at 90 degree angle or spread the labia of the female patient so you can see the meatus.
Remember, male or female, the unsterile hand does not move from this point on, its' job is to keep the meatus visible and keep it from preventing contamination of the catheter as it is being inserted as that would make the UA results false.
With your sterile or cleanest hand each into the catheter box, for the swabs.
I cannot hold the packet with my left hand; keep the labia open and meatus visible and swab the meatus of male or female without contaminating. I have to use one swab at a time, being careful not to touch anything but the tips of the cleaning swabs, and dropping the dirty swab into the garbage bag.
I swab down with one swab down either side of the meatus, then the last one right down and directly over the meatus.
Remember to drop the dirty swab onto the sterile drape you placed in front of the patient and not behind the cath box, that would mean you crossed over your sterile field and contaminated it remember Ghostbusters "Crossing the streams...I thought you said crossing the streams was bad Russ..."
Still with cleanest, sterile, gloved hand reach into your cath box and take out the catheter, curled into a ball with the end inside the open specimen cup. This is a bit awkward as well; remember you only need 10 ml for a UA, only 30 ml for a C and S.
For a male you may need to insert the catheter to the hub before any urine is obtained, for a female you should see urine flow when you 2-3 inches inside the meatus. This is because the area between the meatus nd the back wall of the bladder is further in a male as compared to a male.
Once you have enough for the specimen in your specimen cup you can empty your patient’s bladder the rest of the way but not more than 800 to 1000 ml and withdraw the catheter.
Withdraw the catheter, warning patient first. Try saying "OK, count to three, one, and two and then on three withdraw the catheter.
Reassure your patient; set aside the specimen cup with the top securely closed... spilling the catheter cup in front of your patient is bad!
Now pick up and put up. Tidy your patient first, betadine and Chloroseptic are both chemicals, do not let this stuff remain on your patient’s skin or their skin may be burned!
Again, provide privacy, ask patient if door can stay open and let the patient know that UA may come back in 24 hours; if a culture is done it takes 72 hours to know the results and the physician may or may not start the patient on an antibiotic right away
This is also the best time to instruct your patient on the signs of a urinary infection, ways to manage or prevent infection, starting with hand washing and how the infection may be treated according to the physicians orders
barbara bethard
Go to the patient's chart and review the physicians order. Even if the nurse who told you about this order gets a bit "cool" towards you, remember that they are human too. Remember, you worked hard for your license, so protect it! Now, write out the laboratory slip, place it in the outside pocket of the lab bag then write with magic marker on the specimen cup the pertinent information. That way you don't have to worry about contaminating your pen if you write on the cup after you collect the specimen!
!) Gather your supplies. Double check your supplies. There is nothing more frustrating or intimidating than to get halfway into something and then have to stop just to go back to you cart and get something small like a Q Tip!
Enter your patent's room politely by knocking and calling out a greeting including your name as a way of announcing yourself. Explain the procedure to your patient and provide patient privacy by closing curtain over windows and pull privacy curtain itself around bed.
Place your supplies on the overhead table, open your garbage bag and set it on the end of the bed or on the floor depending on the facilities policy. Now tell your patient that you are going to wash your hands, this is very important; this lets your patient know that you know the best way to prevent the spread of any infection is to...What? Right, go wash your hands.
Scrub your hands for 15-20 seconds with soap and water, letting the water stay running the tire time. The CDC says this is enough time to kill bacteria on your hands; besides you can use this time to go over the steps of the procedure you are about to perform.
When you come back to the patient's bedside you will begin to set up your sterile field, remember to open all items away from you, do not tear open items, and pull apart on the edge or on the dotted line. Even though you did the correct patient right steps at the nurses’ station, do it again. Double check your paperwork; starting with R's, right patient, right MD order, right site, right date, right time, right type
Verbalize every step as you are performing each step/this is a good to keep your patient calm as well as to keep your hands steady! And the more often you speak the steps out loud the easier it will be to continually perform the correct steps in the correct manner every time
The correct steps, the ones that will rarely vary from one facility to the next are as follows after you have washed your hands:
Open sterile catheter kit,
Remove sterile field maintaining aseptic technique and place in between the patients legs which are opened but patient is still draped for privacy, only the specific part of the body necessary for the procedure should be visible to you.
Do not touch the bed, the sheets, the patient, if you do you will contaminate it all and have to get new sterile gloves, wash your hands, do everything all over again so be careful!
Remove catheter from plastic sleeve and drop onto sterile field,
Don sterile gloves correctly,
Open betadine packet or Chloroseptic packet,
place swabs on sterile field next to catheter,
open lubricating jelly packet, place end of catheter into packet of lubricating jelly,
Decide now which hand will be clean and which hand will remain as sterile as possible.
If you are right handed you may find that being on the patient’s right side of the bed with the overhead table facing the head of the bed will work well for you. Regardless of whether catheterizing male or female the next step is the same.
With both hands, both still as sterile as possible at this time pick up the cath box with all items inside by the inside. Not as hard as it sounds, place both hands, palms down, into the box, spread your fingers, no you have a grip on the inside of the catheter box and you can lift it up and set it between your patient's legs.
Instruct your patient as you are doing all of this that you have now made him/her your assistant. Their job is to keep from touching or moving or knocking over that catheter box.
This is also the time to start speaking your steps to your patient. It lets your patient know what is about to happen so they stay calm, and the more times you say the steps out loud the more likely you will be to actually perform the steps in correct order every time.
With your unsterile or dirty hand pick up the penis of the male patient and hold it at 90 degree angle or spread the labia of the female patient so you can see the meatus.
Remember, male or female, the unsterile hand does not move from this point on, its' job is to keep the meatus visible and keep it from preventing contamination of the catheter as it is being inserted as that would make the UA results false.
With your sterile or cleanest hand each into the catheter box, for the swabs.
I cannot hold the packet with my left hand; keep the labia open and meatus visible and swab the meatus of male or female without contaminating. I have to use one swab at a time, being careful not to touch anything but the tips of the cleaning swabs, and dropping the dirty swab into the garbage bag.
I swab down with one swab down either side of the meatus, then the last one right down and directly over the meatus.
Remember to drop the dirty swab onto the sterile drape you placed in front of the patient and not behind the cath box, that would mean you crossed over your sterile field and contaminated it remember Ghostbusters "Crossing the streams...I thought you said crossing the streams was bad Russ..."
Still with cleanest, sterile, gloved hand reach into your cath box and take out the catheter, curled into a ball with the end inside the open specimen cup. This is a bit awkward as well; remember you only need 10 ml for a UA, only 30 ml for a C and S.
For a male you may need to insert the catheter to the hub before any urine is obtained, for a female you should see urine flow when you 2-3 inches inside the meatus. This is because the area between the meatus nd the back wall of the bladder is further in a male as compared to a male.
Once you have enough for the specimen in your specimen cup you can empty your patient’s bladder the rest of the way but not more than 800 to 1000 ml and withdraw the catheter.
Withdraw the catheter, warning patient first. Try saying "OK, count to three, one, and two and then on three withdraw the catheter.
Reassure your patient; set aside the specimen cup with the top securely closed... spilling the catheter cup in front of your patient is bad!
Now pick up and put up. Tidy your patient first, betadine and Chloroseptic are both chemicals, do not let this stuff remain on your patient’s skin or their skin may be burned!
Again, provide privacy, ask patient if door can stay open and let the patient know that UA may come back in 24 hours; if a culture is done it takes 72 hours to know the results and the physician may or may not start the patient on an antibiotic right away
This is also the best time to instruct your patient on the signs of a urinary infection, ways to manage or prevent infection, starting with hand washing and how the infection may be treated according to the physicians orders
barbara bethard
The Problems Associated With Insomnia
082509
Due to the recent death of Michael Jackson, the problems associated with insomnia have been in the media. As a nurse, it is easy to research and provide links to information that may be of some use; as an insomniac it is less easy to find or to give any concrete assistance.
Insomnia is defined not as an actual disorder but rather a symptom of a deeper problem or disorder. In other words, in order to treat he insomnia the person must discover the reason for the insomnia in the first place. Well, "easier said than done."
There are three specific types of insomnia, transient, chronic, and short-term. However, knowing the kind of insomnia you are experiencing may be helpful but it is not the ultimate answer. The ultimate answer still lies in defining the cause of the insomnia in the first place.
For some people this may lead to an unwelcome path of self discovery, especially if the signposts along the way spell out "alcoholism," "drug abuse" or "psychiatric problems." If so, this may be as far as the ordinary person on the street suffering with insomnia will pursue the cause and the relief for the cause. That is the most heartbreaking truth of all; that persons with insomnia continue to "suffer" because they cannot face their own reflection in a mirror and thus, change that reflection.
The reason for the insomnia may well be different from person to person or from instance to instance. As someone affected by insomnia most of my life the reasons change depending on the circumstances. Stress at work or at home, fear of the unknown, anxiety over an assignment or a grade or a test, all of these produce the inability to sleep. Then being sleep deprived causes whatever was causing the sleeplessness to worsen, and the cycle repeats itself.
If the person has access only to over the counter or herbal remedies the person may cause harm to themselves. An antihistamine such as diphenhydramine (Benadryl) is one popular sleep aide. Antihistamines can be dangerous for use by patients with heart or blood pressure problems as the vessels become constricted and the blood pressure can rise. Continuous use causes the effects to decreas, which can cause the user to repeatedly increase the dosage and this of course causes the potential for harm to rise.
Another over the counter drug for insomnia is Doxylamine (Unisom)
This drug can cause excessive sleepiness, which can definity become a problem is your commute time is over 20 minutes. If you wake up groggy, still sleepy then chances are the longer you are at the wheel on the way to work, the more likely you will be to fall asleep at the wheel. Not a good start to any day!
If the person with insomnia has access to a physician or a group of physicians the potential for harm increases exponentially. If the patient will not allow the current physician access to the previous physicians notes, if the patient tries to bulldoze the current physician, if the patient has so much "clout" the current physician feels unable escape the situation, then again, potential for great harm will ensue. However, it should be noted here that any physician and indeed, any patient has the RIGHT to “discontinue services” at any time. The physician must give a letter stating their services will be discontinued within thirty days and this allows the patient time to find another physician. The patient, on the other hand, does not need a letter nor does the patient need to give a thirty day notice.
The one thing that strikes this nurse as unusual in the Michael Jackson case is that the media states the physician asked for information about the other physicians’ orders and medications but that Michel Jackson refused to give this information. According to the JCAHO patient rights act, this release of information is signed before services are rendered at any physician office. However, HIPAA (Health Insurance Portability and Accountability Act) also states the patient has the right NOT to sign this form and that the patient will NOT be retaliated against by NOT signing this form or by filing a complaint or grievance against anyone who that patient feels has violated these patient rights. This may make a difference in the way this form is viewed in the future.
The important thing to remember this that BOTH the physician and the patient are protected, in some form, to some degree by their rights. The one that is most important as far as a physician, or a nurse, is the axiom they stand by; that of “First, do no harm.” The most difficult thing for any nurse to do is to stand up to a superior and say, “I do not feel comfortable with this order.”
There are multiple sites that will assist with ways to deal with insomnia.
There are multiple clinics, so named sleep centers, which will assist with insomnia.
There are multiple physicians that will or will not assist with any prescription medication available for insomnia.
The one person that will be of most benefit to the person with insomnia is the person with insomnia.
The above information is given to you, the reader, not only as one insomniac to another, not only as one curious onlooker into the Michael Jackson demise to another, but as one good nurse attempting to assess and instruct. (AKA mean nurse that will not tell you what you’d really like to here like how to find a doc that will give you the really good stuff!)
The above information is give to you, the reader, as an insomniac who found the best physician in the world, who finally told me all that I have just written (AKA mean doc that wouldn’t give the really good stuff!)
Sleep tight; don’t let the bed bugs bite!
Hey! I could have told you what my Daddy always told me when I complained of not having the time or not being able to sleep or not knowing what was going to happen etc. He would just say
“What are you doing at two o’clock in the morning anyway? You could be UP Doing Something!”
And my physician wonders why I have problems sleeping…geez!
barbara bethard
082509
Due to the recent death of Michael Jackson, the problems associated with insomnia have been in the media. As a nurse, it is easy to research and provide links to information that may be of some use; as an insomniac it is less easy to find or to give any concrete assistance.
Insomnia is defined not as an actual disorder but rather a symptom of a deeper problem or disorder. In other words, in order to treat he insomnia the person must discover the reason for the insomnia in the first place. Well, "easier said than done."
There are three specific types of insomnia, transient, chronic, and short-term. However, knowing the kind of insomnia you are experiencing may be helpful but it is not the ultimate answer. The ultimate answer still lies in defining the cause of the insomnia in the first place.
For some people this may lead to an unwelcome path of self discovery, especially if the signposts along the way spell out "alcoholism," "drug abuse" or "psychiatric problems." If so, this may be as far as the ordinary person on the street suffering with insomnia will pursue the cause and the relief for the cause. That is the most heartbreaking truth of all; that persons with insomnia continue to "suffer" because they cannot face their own reflection in a mirror and thus, change that reflection.
The reason for the insomnia may well be different from person to person or from instance to instance. As someone affected by insomnia most of my life the reasons change depending on the circumstances. Stress at work or at home, fear of the unknown, anxiety over an assignment or a grade or a test, all of these produce the inability to sleep. Then being sleep deprived causes whatever was causing the sleeplessness to worsen, and the cycle repeats itself.
If the person has access only to over the counter or herbal remedies the person may cause harm to themselves. An antihistamine such as diphenhydramine (Benadryl) is one popular sleep aide. Antihistamines can be dangerous for use by patients with heart or blood pressure problems as the vessels become constricted and the blood pressure can rise. Continuous use causes the effects to decreas, which can cause the user to repeatedly increase the dosage and this of course causes the potential for harm to rise.
Another over the counter drug for insomnia is Doxylamine (Unisom)
This drug can cause excessive sleepiness, which can definity become a problem is your commute time is over 20 minutes. If you wake up groggy, still sleepy then chances are the longer you are at the wheel on the way to work, the more likely you will be to fall asleep at the wheel. Not a good start to any day!
If the person with insomnia has access to a physician or a group of physicians the potential for harm increases exponentially. If the patient will not allow the current physician access to the previous physicians notes, if the patient tries to bulldoze the current physician, if the patient has so much "clout" the current physician feels unable escape the situation, then again, potential for great harm will ensue. However, it should be noted here that any physician and indeed, any patient has the RIGHT to “discontinue services” at any time. The physician must give a letter stating their services will be discontinued within thirty days and this allows the patient time to find another physician. The patient, on the other hand, does not need a letter nor does the patient need to give a thirty day notice.
The one thing that strikes this nurse as unusual in the Michael Jackson case is that the media states the physician asked for information about the other physicians’ orders and medications but that Michel Jackson refused to give this information. According to the JCAHO patient rights act, this release of information is signed before services are rendered at any physician office. However, HIPAA (Health Insurance Portability and Accountability Act) also states the patient has the right NOT to sign this form and that the patient will NOT be retaliated against by NOT signing this form or by filing a complaint or grievance against anyone who that patient feels has violated these patient rights. This may make a difference in the way this form is viewed in the future.
The important thing to remember this that BOTH the physician and the patient are protected, in some form, to some degree by their rights. The one that is most important as far as a physician, or a nurse, is the axiom they stand by; that of “First, do no harm.” The most difficult thing for any nurse to do is to stand up to a superior and say, “I do not feel comfortable with this order.”
There are multiple sites that will assist with ways to deal with insomnia.
There are multiple clinics, so named sleep centers, which will assist with insomnia.
There are multiple physicians that will or will not assist with any prescription medication available for insomnia.
The one person that will be of most benefit to the person with insomnia is the person with insomnia.
The above information is given to you, the reader, not only as one insomniac to another, not only as one curious onlooker into the Michael Jackson demise to another, but as one good nurse attempting to assess and instruct. (AKA mean nurse that will not tell you what you’d really like to here like how to find a doc that will give you the really good stuff!)
The above information is give to you, the reader, as an insomniac who found the best physician in the world, who finally told me all that I have just written (AKA mean doc that wouldn’t give the really good stuff!)
Sleep tight; don’t let the bed bugs bite!
Hey! I could have told you what my Daddy always told me when I complained of not having the time or not being able to sleep or not knowing what was going to happen etc. He would just say
“What are you doing at two o’clock in the morning anyway? You could be UP Doing Something!”
And my physician wonders why I have problems sleeping…geez!
barbara bethard
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