That Nursing Life

24 year old female. Hx of sweets addiction, sushi withdrawal symptoms, and caffeine dependence. Dx with anxiety & stress secondary to being new grad RN. Full Code.

[23pairofchromosomes]

[ednursey]

We fixed them

[kim-jisoo]

[pinkglitternurse]

[whatshouldwecallnicunursing]

daily reminder

[kim-jisoo]

[sarcasm-and-stethoscopes]

Who got a BINGO today?

[confessionsofanewgradnurse]

I WANT TO  PLAY!!

[asapscience]

One of these things is not like the other…[Via @biologyjokes]

[caffeineqhprn]

[caffeineqhprn]

50 Most Prescribed Medications

Top 50 Most Prescribed Medications in the USA, Look to the following Medications with their

[caffeineqhprn]

http://www.kaptestprep.com/toxidromes-cheat-sheet-every-ems-know/

A toxidrome is a syndrome (set of symptoms) caused by specific medications or toxins.

There are 5 big ones to know:

Anticholinergic: low potency antipsychotics, oxybutynin, ACh receptor antagonists (ipratropium, atropine, scopolamine) Cholinergic: ACh recptor agonists (pilocarpine), AChEIs (organophosphates, phyostigmine) Opioid: Morphine, heroin, hydromorphone, etc Sympathomimetic: epinephrine, cocaine, amphetamine (Aderol), methylphenidate (Ritalin) Sedative-Hypnotic: Benzodiazepines, barbituates, “Z-drugs” (zopiclone, zolpidem), antihistamines

[caffeineqhprn]

[showerthoughtsofficial]

It should be illegal to show CPR done incorrectly on tv or in movies.

[anothernursingstudent]

Pet peeve.

[caffeineqhprn]

Giving Drugs

Patient: "so how does this drug work?"

Me: "uh....." *desperately trying to put biotransformation and chemoreceptors into layman's terms*

"... witchcraft."

[caffeineqhprn]

[caringintensely]

A Cry for Help.

I seek the Word of @cranquis and the Word of @wayfaringmd on proper tick removal technique. Where I live we’re being warned that populations will be high this summer and that 50% of the ticks are testing positive for Lyme disease. Between the cat, the dog, and three kids I know I’m going to have to deal with them soon.

I’m hearing so many conflicting things, even from MDs. Burn them with a match? Pour olive oil on them? I thought we weren’t supposed to do that stuff? Should I buy that fancy tick remover thing? Or does each one require a trip to the office? Help me Crayfaring, you’re my only hope! 😩

[wayfaringmd]

If you’re my uncle working out on the plantation (yes we still have plantations in the South) and you get a stuck-on tick then you flick it with a credit card or try burning it. And then you burn yourself and end up with a more serious wound than you started with.

Srsly though don’t burn or use oil. It can make the tick barf up all its tick juice and it doesn’t particularly help remove them.

Where I live people don’t come in to have ticks removed. They come in with target lesions and say “oh yeah I had a tick last week”.

The evidence-based answer is remove them with tweezers or blunt curved forceps. You grasp at the head as close to the skin as you can get and pull hard and fast straight out without twisting or squishing the body. You still might not get the head but it’s supposed to be the most successful method. I’ve also heard of doing a punch biopsy to get retained heads out but that seems a bit overboard to me.

Oh- and you can put the tick in a specimen jar and send it to the lab if you want, or you can do prophylactic antibiotics depending on how long it was attached.

[cranquis]

The tool I use in my urgent care: The Tick Twister (you can get ‘em at your local vet or pet store for usually $5). WAYYYY easier than a tweezers (Oh man, I’m gonna patent my own tick-twisting device and name it Tweezier!)

Should you burn it/suffocate it/squeeze it/rub alcohol on it? No. Avoid doing anything that makes the little guy want to puke up the “tick juice” (ewww) – cuz that’s when your risk of contracting tick-borne diseases goes up.

Do you need to dig out the tick head with your pen knife (or pay a doctor to do a punch biopsy to remove it… seriously?!) after yanking the body off too hard in a panic? No. Let your body expel the mouthparts; slap antibiotic ointment and a bandaid on there and wait it out. Your risk for Lyme doesn’t go up even with the tick head left in your skin; on the other hand, the more you dig, the greater your chance for cellulitis! (PS: It’s only the mouthparts that are in your skin; ticks do NOT ram their entire body under your skin, contrary to what most of my patients seem to think! That would seriously hamper the tick’s planned getaway. They just stick a straw in you… a straw tenacious enough to rip the tick’s head from its shoulders if not retracted first!)

Typically, your risk for contracting Lyme disease from a tick bite – IF it’s a deer tick (not all are), and IF it’s a deer tick with Lyme disease (not all have it) – is less than 3% if the tick has been feeding on you for less than 36 hours. Then, after that point, the tick is fully inebriated on your blood, and like any good drunk, it throws up a bit before leaving the bar and heading for home. (I’m not kidding – the tick feeds until it is over-full, then regurgitates tick juice [aw man I don’t want to keep calling it ’tick juice’!] into you, and THAT is when the transmittal of the infection usually occurs.)

So the best way to not get Lyme disease is (1) use bug spray on your legs and arms, (2) seal off your pant legs with rubber bands etc, and (3) do a naked skin check after spending the day in tick territory. Remove any ticks you find within that 36-hour window, and you’re golden. If it’s been less than 36 hours, CDC and I say don’t bother getting the tick tested; it won’t change management.

Similarly, if you don’t have any symptoms of Lyme disease, getting a Lyme blood test on yourself isn’t recommended or useful. I treat people based on their risk of exposure (>36 hours of tick attachment) and/or symptoms typical for Lyme, regardless of a blood test result.

Remember, ticks can carry more than just Lyme, so this advice doesn’t account for all possible permutations of tick-borne infections – just the most common disease.

(TSK Bonus - should you chew the tick off of your skin using your own teeth, and then cauterize the wound with a cigarette? Hell no.)

(And no, I have no reprintable opinion on testing/treating Chronic Lyme Disease, so don’t ask…)

[skeletonmug]

I AM REBLOGGING THIS SO HARD!

This is not limited to the US.

There are ticks and Lyme disease in the UK. If you LARP outdoors, especially if you go into woods or grazing land, then keep an eye out for ticks. The best protection is coverage with clothing and LARP costumes can be pretty good at that but, ticks are good at finding that one square centimetre of uncovered skin, or dropping inside a collar. DEET repellants are mildly effective with ticks, but not great. Lemon Eucalyptus essential oil is actually better than DEET (for ticks, not mosquitoes)

Check your skin for ticks at the end of the day or when you take a rest or bathroom break. Pay attention to your underarm, back of neck, groin and any folds of skin where they can hide.

See this: it’s a nymph tick. That’s about as small as you’ll find them. Sometimes they are bigger. 

If you find a tick on your body, use a pair of tweezers to grasp the tick firmly as close to the skin as possible - get the tips of the tweezers between your skin and the tick.

Pull gently back and upward to remove the tick. encouraging the site to bleed a little can be good, but isn’t essential. Clean it like any other insect bite.

If you develop a rash around the bite site (or anywhere else really) see a GP and tell them you where bitten by a tick. If you develop the following rash see a Dr and tell them you were messing about in the woods. This is a classic “bulls eye rash”:

HOWEVER! rashes only show up in about 50% of cases, aren’t always that distinct and are less easy to see on dark skin.

Be aware of other symptoms:

“Flu like” feelings of body aches and fatigue

vertigo

joint pain

fevers

feeling of swollen lymph nodes

If this develops within the week following a tick bite go to your GP and tell them. Awareness of Lyme in the UK is increasing, but many GPs may never have encountered it so it is important to describe the scenario and ask for a test.

If you develop these symptoms without a definite tick bite, monitor them closely. If they worsen, go to your GP. If they are not accompanied by usual flu or cold symptoms (sore throat, sniffles, blocked sinuses etc) go to your GP and discuss the circumstances and ask for a Lyme test. Some GPs may go ahead with a course of antibiotics, some may want to wait until there is a clear test result.

If treated within the first 2-4 weeks, with a course of antibiotics (usually two weeks) Lyme disease doesn’t have to be a problem. If left untreated it may “run it’s course” and get better on it’s own. However long term Lyme Disease infections can cause systemic damage and lead to Tertiary Lyme Disease or Post Lyme Disease Syndrome, both of which can be disabling conditions.

Remember:

cover up if you are in woodland

check for ticks

remove ticks using tweesers, pulling smoothly back and up

look out for a bulls eye rash

be aware of any unusual flu like symptoms

Lyme disease and ticks are found across the UK including Scotland and NI

[cranquis]

Reblogging for extra-useful commentary!

And since this is turning into a Lyme Disease Master Post:

If you do have a tick removed from you, and it’s confirmed to be a deer tick, and you can estimate that it was attached for >36 hours but <72 hours… studies show that one dose of Doxycycline (200mg x 1) will reduce your risk of Lyme back down to <3%.

Once you get past 72 hours of tick attachment, or you don’t know how long it was attached, or you get symptoms of Lyme… then the 2+ weeks of Doxy kick in.

Doxy shouldn’t be used in kids under 8 years of age. Amoxicillin is used in this age group for Lyme treatment.

[pnwnurse]

Giving report back to the nurse you got report from

[nurseyjess]

UpDAAATES “girl nothing changed. Bye”

[caffeineqhprn]