im a nurse now!

As I learn, I'll help you learn. :)

[erica-the-rn]

finding happiness with our plant friends, nature, and alternative therapies

my new blog, nurblrs and studyblrs :) please follow

[erica-the-rn]

closing for now..

One nursing degree, two years of experience, and 2000+ followers later, it is with a heavy heart I officially have decided to take a possibly permanent hiatus. With the ambiguity of that statement, I will say I no longer will be planned posting anymore. Now, being in the healthcare field, working during a pandemic, I have to say anxiety is at an all-time high: not just in the healthcare field, but in the world. I wouldn’t be being honest if I said I wasn’t experiencing sky-high anxiety, myself. Having said that, when I am home, I find it hard not to put pressure on myself to post, and when I try to post, I am reminded of how crazy healthcare is now. Still a passion of mine, I love it. I won’t say that I will never post again. I’m sure I’ll find my way back to teaching, as teaching nursing has been extremely fun for me in the past. 

Writing reviews, helping so many of you, and learning more about my own methodologies has been such an experience. I will continue to create another tumblr, about a separate passion of mine: alternative therapies and self-care. I will post links to it once it is up. 

Thank you all for the support. I love each and every one of you. :) Study hard, nurblrs, and join alongside me for the frontline fight of COVID-19. 

[erica-the-rn]

Non-pharmacological Interventions Series

I feel like I focus on medication A LOT on here. Most of that comes from the fact that during nursing school, we’re often not taught as much about the things that are not pharmaceutical. We hear it in passing, but we don’t go into much detail. 

So I’m going to do a series on these non-pharmacological interventions. Its important that we tell our residents/patients that there is more than “drugs” that fix their problems. In fact, most doctors and physicians will want you to try these interventions first before prescribing medications. 

Here’s my list I came up with. Let me know if there’s more you would like me to cover:

1) Yoga

2) Meditation

3) Essential Oils: Peppermint

4) Essential Oils: Lavender

5)  Essential Oils: Lemongrass

6)  Essential Oils: Eucalyptus

7) “Medicinal Teas” (Still should speak to a doctor.)

8) Dietary Modifications

[erica-the-rn]

Happy 2k Followers! :) (Special Surprise!)

WOW!! You nursing students and new nurses are absolutely amazing. Officially hit 2k followers two days ago. :) I just wanted to say thanks and I love you all. I hope my reviews have helped thus far. As a happy surprise for ya’ll (I guess if you consider learning helpful!), I would like to open up my mailbox for suggestions on disease processes I have not covered yet. :) PLEASE send your ideas in and lets keep the good time rollin’. I love you guys so much. Thank you for all the support!

[erica-the-rn]

Dementia vs Alzheimer’s

The terms “dementia” and “alzheimer’s” (all-timers, as some elderly say :) ) seem to be interchangeable in our language. However, these two words actually are not the same. If you are a veteran nursing student, you probably already knew that. At least you know that. But do you know what the difference actually is?

Dementia

So lets break the glass first. Dementia is not a disease. It is a cluster of symptoms caused by underlying diseases. 

What symptoms do we usually see with dementia? Usually, this is short term memory issues. Things like losing keys they just had, remembering to pay bills, and losing track of where they are. However, dementia isn’t just limited to memory problems. We can have word salads, personality changes, depression, hallucinations, and frequent misbehaviors. 

So here’s the thing. There is not any diagnostics that can determine definitively the onset of dementia. Doctors can determine based off of behaviors that a patient has dementia. After (or before) that, they will look to see the cause of dementia. This can be a slue of disorders and diseases. Remember, dementia is not a disease.  It is an umbrella term used to describe groups of symptoms associated with specific disease processes. One of these causes is Alzheimer’s Disease. 

Alzheimer’s Disease 

While memory loss is a mainstay associated with Alzheimer’s disease, this is not the disease as a whole. Degeneration of brain cells cause the memory loss. This, also, can cause a reversal of age behaviors. A lot of patients with Alzheimer’s can revert (in their mind) to a time in their life when they were not in a nursing home. This is where their orientation may be skewed. I’ve had residents who believed I was “mommy” and they were only 12 years old. Alzheimer’s is a progressive disease. It gets worse, it does not get better. Therefore, as you probably know, there is no cure. Medications can treat the symptoms, but not reverse the degeneration.

Progression in this disease can cause difficulties swallowing, speaking, and some residents/patients can have their body stop breathing. 

For More information, go to https://www.alz.org/

Remember it is important to research and support foundations like Alzheimer’s Association. Support can help find a cure. 

[onlinecounsellingcollege]

“The most basic of all human needs is the need to understand and be understood.”

— Ralph Nichols

[erica-the-rn]

Can you name a few mental health hurdles you've had to overcome in nursing (and while studying nursing)? And how did you overcome them? -Asking because I'm interested in the field :) Thank you!

Oh wow. It seems like every field of nursing deals with mental health. Between split personality and generalized anxiety, the biggest advise I can give when dealing with any of these is to listen. They tell you to reorient the patient. If it's possible, absolutely reorient them. However, real world nursing usually involves a lot more acting on our part. Specifically, I can remember having a sundowner patient who swore there was a snake in their room. There wasn't. However, we have to remember that this is their reality. It may be a hallucination to us but it's real to them. So I pretended to catch the snake and throw it out the window. That was the only acceptable solution to a person hallucinating. Mental health is a part of all nursing fields. My biggest advise is listen and realize that this is their reality. You have to work within their reality, not yours.

[erica-the-rn]

Ask Me Anything...

Ask me anything about the following topics! I'm ready to spill the tea about first year nursing :)

1. Long term care vs acute care

2. Dealing with dialysis patients

3. Dementia and alzheimers

4. Poop and pee

5. Finding a job

6. Death and dying patients

7. Professionalism as a nurse

8. Blogging about nursing

9. Moving

10. Mental health as a nurse

Let's do it guys :)

[erica-the-rn]

Wear A Mask

So. *deep breath* As we all know, there is a worldwide pandemic going on. Coronavirus is... A whole different monster than what I, or any of us, could anticipate. What the heck happened? We were supposed to have a summer break from this disease. Lets analyze this together..

Wearing a mask is apparently controversial. I find this hilarious, as a nurse. However, I understand that masks are uncomfortable. I do. Every time I have a patient or resident that requires PPE, of course I groan. All nurses groan. Its hot, makes you sweat, its more difficult to breathe. I get it...

But then again, I don’t. This is not a matter of comfort-ability. This is a matter of life and death for many lives.  I know many people would say that I am a “fear monger”. Frankly, I’d like to drop some facts. I don’t believe that I am a fear monger. 

In the US, as of today, there are 134k deaths caused by coronavirus. That’s 134k deaths since January 20, 2020, the first recorded case in the US. (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/us-cases-deaths.html)

Influenza accrued roughly  24,000 – 62,000. Those are preliminary results as of April 2020, from our Center for Disease Control and Prevention. (https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm)

Lung cancer accounts for 135k deaths, according to NIH. (https://seer.cancer.gov/statfacts/html/common.html) 

Strokes account for 140k. CDC.

Heart attacks account for 647k. CDC.

As of recently, I’ve seen many people say that they won’t wear a mask because of the death rate of coronavirus being minute compared to other diseases (like cancer, strokes, etc)

So, here’s the thing... Death of any kind of cause is horrible. Its absolutely horrible. There’s no sugarcoating a death. However, I feel like I need to say this.

Cancer, heart issues, and a variety of other abnormalities in the body are HORRIBLE. This, though, is not an excuse not to wear a mask. 

Wearing a Mask Won’t Prevent Me from Getting Coronavirus (FALSE)

A mask won’t prevent you from spreading cancer. A mask won’t prevent you from spreading strokes. A mask won’t prevent you from spreading heart attacks. These sentences are so simple.. but let me spell it out for those who don’t understand. Wearing a mask won’t prevent you from spreading those diseases because they’re NONCOMMUNICABLE. You can’t spread them. 

The mask is not to prevent YOU from getting it. The mask is to prevent you, a possible/probable asymptomatic carrier, from spreading it to others. These others include your friends and family that you may see at the grocery store. No, it does not prevent you from getting the disease. It prevents you from spreading it. However, if two people wear masks, there’s an increased chance that neither of you will spread it. 

https://www.umms.org/coronavirus/what-to-know/symptoms-prevention/masks/wearing-mask

Wearing a Mask Will Cause CO2 Poisoning (FALSE)

That, my dears, is from the World Health Organization. 

Antibodies After Having Coronavirus (True...Kinda? Basically false.)

Well, yes, technically you will gain antibodies. However, most patients are showing that two months after you’re taken off isolation from coronavirus, your antibodies are disappearing. 

https://www.cidrap.umn.edu/news-perspective/2020/06/chinese-study-antibodies-covid-19-patients-fade-quickly

https://www.nytimes.com/2020/06/18/health/coronavirus-antibodies.html

https://www.iflscience.com/health-and-medicine/how-long-do-covid19-antibodies-last-new-research-weighs-in/

So PLEASE. Wear a mask. 

[erica-the-rn]

Hello. I am currently in nursing school and struggling. Any tips or know anyone willing to tutor? I would cash app/pay them. I'm in Fundamentals of nursing atm. We're about to have a test on gastrointestinal assessment (gi/gu), cardiovascular assessment, and oxygenation. My school grades on an ivy league, so it's easy to fail (93 = B and 76=failing). I'm very stressed. Thank you

I also struggled in fundamentals. I don't know personal tutors, however I can say I've left a good couple reviews if you want to read through them! We all struggled. Are you doing online classes due to covid-19?

[erica-the-rn]

Have You Ever...

Have you ever lived through something and just knew it was going to go down as something historical? Well, brothers and sisters, we are all going through it right now. The COVID-19 pandemic of 2020 has become a moment in history that people will remember years from now. Now, I’m not glamorizing this. This is SCARY stuff. As a front-line fighting and first responder to this, being in healthcare, I’m terrified for my patients, myself, my family, and the entire public.

I want to rally us all. Go back to your roots in nursing school. Remember the standards of hand hygiene and proper protocol with your PPE. To supervisors and charge nurses, remind your fellow nurses the importance of infection control. Wear your gloves and wash your hands. Most importantly, INFORM THE PUBLIC. As you admit, during your care, and when you discharge, make sure we are teaching our patients the importance of washing your hands. 

"Hand hygiene, a very simple action, remains the primary measure to reduce health-care associated infection and the spread of antimicrobial resistance, enhancing safety of care across all settings." 

 2005, WHO hand Hygiene Guidelines

[erica-the-rn]

Thyroid Disorders

Endocrine seems to be the one we all struggle with. Its fascinating and complicated and we all wish we were better with it. So let’s learn a little more about it together :) As always, this will be a series of processes. Any questions or add-ons you have, please fly with it! :) I’m always here to learn more <3 

So what the heck is a thyroid? 

The thyroid lies within the anterior neck. It is a gland of tissue that produces a couple different hormones: thyroxine (T4), ttriiodothyronine (T3), and thyrocalcitonin (calcitonin). 

Our T3 and T4 hormones are essential for our metabolism. They both are what gives our metabolism a little kick in the butt. They increase oxygen usage and produce heat in our tissues. They are created by the absorption of iodide into the thyroid. Once iodide is within the thyroid, it combines with tyrosine. This makes our T3 and T4. These two hormones bind to protein. The importance of calcitonin is the balance of calcium and phosphorus in the body. If serum calcium is high, calcitonin is released by the thyroid to suppress serum levels. If it is low, the thyroid doesn’t release as much. The reason why is that calcitonin lowers calcium levels in the blood. It reduces bone release of calcium and phosphorus.

Hypothyroidism

What happens when the thyroid is lazy? 

The result of a lazy thyroid is called hypothyroidism. This means that our thyroid is failing to meet the needs of the body for thyroid hormones. This can happen for a couple reasons but we often see a failure of the body to absorb iodide and tyrosine. Due to this decreased amount of thyroid hormones, the body has a decreased rate of metabolism. We see a slowing down in the body.

What does that look like? (Symptoms)

Decreased heart rate

Difficulty breathing

Cold intolerance (The body doesn’t have the heat production that T3 and T4 make)

Depression

Lethargy

Decreased Libido

Amenorrhea

Myxedema (Edema caused by buildup of glycosaminoglycans)

Mucusy watery edema

How do you treat it?

Because of difficulty with perfusion (breathing and heart rate), we need to monitor gas exchange, via O2 saturation, respiratory rate, and listening to lung sounds. 

There’s also a drug, very important. Its called Synthroid, or levothyroxine. This is a thyroid hormone replacement medication. This is a medication they will have to take the rest of their life. Your MD will usually start the dosage off very low and slowly increase over time until a therapeutic level is maintained. These patients need to be instructed to take this medication at the same time every day. 

There is a condition you will monitor for called a myxedema coma. I plan on doing another short blog on it. What you need to know right now is that it is usually caused by an acute sickness or a patient that has suddenly stopped complying with their Synthroid regimen. It leads to respiratory failure, coma, low shock, low blood sugar, and low body temperature. Very important treatments for it are maintaining the airway, synthroid via IV STAT, and IV glucose.

Hyperthyroidism

What does an overactive thyroid do?

An increase in the production of thyroid hormones will result in an increase in metabolism. 

What does it look like? (Symptoms)

Increased sweating (diaphoresis)

Chest Pain

Tachycardia

Weight Loss

Globe Lag

Heat Intolerance (too much heat production from T3 and T4)

Goiter

Exophthalmos

How do we treat it?

Monitor the patient’s temperature. If there is a raise in temperature, this needs to be reported. A thyroid storm can happen very fast. 

Reduce the stimulation in the room to help promote cardiac rest. Keep the temperature down in the room to keep the patient comfortable. 

There are drugs available. Two of which are PTU and methimazole. 

Radioactive iodine therapy is also used for patients. This is radioactive treatment to the thyroid. Iodine reduces blood flow to the thyroid, reducing the amount of hormone released by it.

There is also the option of a thyroidectomy (removal of thyroid). Now, if the thyroid is removed, there is absolutely no hormone being released. Therefore, a thyroidectomy patient will have to be given thyroid replacement hormone.

[erica-the-rn]

An Assessment o/ the Endocrine System

The endocrine system helps to aid in metabolism, temperature control, and many other countless body functions (elimination, fluid control, reproduction, and growth). In other words, the endocrine system is essential to homeostasis. 

So to understand the endocrine system, we need to know what it is composed of first. The endocrine system is composed of glands. Through a vast network of checks and balances, the endocrine system controls hormones that affect each different function in our body. What glands do we have?

Hypothalamus **

Pituitary (Anterior and posterior) **

Adrenal

Thyroid

Parathyroid

Gonads

I’ve asterisked hypothalamus and pituitary. Why? These two are what I consider master glands. Hypothalamus is responsible for secreting coordinating hormones. These are the hormones that go to the other glands and stimulate the release of our common-knowledge hormones. Specifically, the hypothalamus stimulates the pituitary gland, which is broken into two separate lobes, the anterior and posterior. 

The anterior pituitary releases hormones that stimulate our other glands, like the adrenal and thyroid. The posterior pituitary is a holding cell of sorts. It holds ADH and oxytocin until needed into the blood stream. I remember this by thinking about your ANT (aunt). Your aunt will always share. You put up POST to fence things in until you want them out. 

Now that we know what triggers these other glands, lets talk about the major ones. 

Thyroid

Located in the neck

Stimulated by thyroid-stimulating hormone (TSH)

Releases T3, T4, and Calcitonin

Controls metabolism and calcium/phosphate balance

Protein and iodine is needed for healthy thyroid

Adrenal

Located on top of kidneys

Stimulated by adrenocorticotropic hormone (ACTH)

Releases mineralocorticoids (aldosterone) and glucocorticoids (cortisol)

Controls fluid and electrolyte balance (specifically sodium and potassium)

Affects sex hormones in small levels

Adrenal Medulla

Located in adrenal glands

Releases catecholamines (epinephrine and norepinephrine)

Aids in stress response (fight or flight response)

Parathyroid Glands

Located within very close quarters of the thyroid gland

Releases parathyroid hormone (PTH)

Regulates calcium and phosphorus

PTH increases bone resorption

Pancreas (specifically islets of langerhans)

Located.... in the pancreas :)

Releases glucagon, insulin, and somatostatin

Regulates blood glucose levels, storage of carbohydrates, and GI function

Assessing the System

Nutrition

Anything can affect the balance of hormones within the body: aging, diet, lifestyle, medications. Asking about changes in diet can be very informative to a proper assessment of the endocrine system. You’ll need to ask about sugar intake, carbohydrate intake, iodide containing food, and protein. 

Family Hx

Endocrine issues can be genetic, as with a lot of other disorders. Diabetes tends to run in families, as does thyroid problems.

Current Physical Hx

What are the symptoms? How long have they noticed them? Ask about bowel and urination elimination. Has there been changes?

Since a lot of these hormones secreted affect metabolism, ask about weight changes and energy changes. Ask about libido changes or reproductive problems. For women, have their periods changed recently. 

Physical Assessment (A Quickie Assessment)

A lot of these glands can actually be palpated. That’s why I put the location above. The thyroid can become enlarged (goiter). Adrenal glands can even be palpated. 

Beyond that, you can see changes. Edema is noted with a lot of hormonal problems. Skin color changes or discolorations can occur (hypo and hyperpigmentation) . Body hair can be present. An increase in hair being hirsutism and a loss being alopecia. 

Changes in chest and truncal symmetry and size can be indicative of certain problems. 

Diagnostics

Labs

24-hour urine collections (adrenal gland)

CBG and fasting blood glucose exams

HgA1C testing

Suppression and Provocative Testing

Sometimes, what doctors will order are blood tests that require injection of a simulator hormone to examine the effect on the gland itself. 

Provocative Testing

Baseline blood levels are drawn. Afterwards, a provocative drug is injected into the body. After a given amount of time, another blood level is drawn. If the levels have not increased, this is indicative of hypofunctioning glands.

Suppression Testing

Baseline blood levels are drawn. Afterwards THIS TIME, a suppression drug is injected into the body. After a given amount of time, more blood is drawn. If the levels have not decreased, hyperfunctioning of glands is suspected.

Along with blood levels, imaging can be used. MRI, CTs, x-rays, and ultrasounds can be used. 

Hope this helps! :)

[erica-the-rn]

“Coffee is the nurse’s penicillin.”

—

[erica-the-rn]

“Being sick as a nurse is both ironic and fitting.”

—

[erica-the-rn]

Hepatitis

What is it? (patho)

Hepatitis is the widespread inflammation in the liver and liver function. Viral Hepatitis is caused by exposure to a virus. We have five major categories of viral hepatitis:

Hepatitis A virus

Hepatitis B virus

Hepatitis C virus

Hepatitis D virus

Hepatitis E virus

So as the liver is exposed to inflammation (the -itis we talked about), inflammatory cells swell the liver, causing buildup and discomfort. 

How do you get it? (Risks/Causes)

You risk getting Hepatitis when you do any of these:

Hepatitis A

Ingest contaminated food or water, but ESPECIALLY shellfish

Close person contact with infected individual

Hepatitis B

Unprotected sex with infected individual

Congenitally

Contact with infected blood

Substance Use Disorders

Hepatitis C

Substance Abuse Disorder

Blood, blood products,or organ transplants before the 90′s

Contaminated needle sticks, tattoo equipment

Sexual contact

Hepatitis D (coinfection with HBV)

Substance abuse disorder

Unprotected sex with infected individual

Hepatitis E

Ingestion of contaminated food or water 

The hepatitis that healthcare employees are most at risk for is Hepatitis C. Accidental needle sticks is the cause. Please be careful with needles, people. :)

Labs to be familiar with?

**Bilirubin**

ALT

AST

ELISA test (initial screening tool for patients suspected of having HCV)

What does it look like? (s/s)

So remember that we said the liver will become enlarged and congested. With that enlargement comes discomfort. The first thing I want you to take away is that the liver is in the right upper quadrant. If there is any pain or discomfort that takes place in the RUQ, the liver should be evaluated.

Since the liver is a part of the gastrointestinal system, we are also going to see (gastrointestinal symptoms). Most often these changes are clay-colored stools, diarrhea OR constipation, and RUQ abdominal pain. So, first of all, why do we get  clay-colored stools? Remember our friend, Bilirubin? Bilirubin is transferred during blood filtration from blood to stool by the liver. This is the same substance that produces the brown color of our feces. So, therefore, a decrease in bilirubin excretion produces a lighter colored stool. Bilirubin is actually going to try to reroute itself out of the body through urine, so we will see darkened urine r/t the effect of bilirubin. We’ve established that bilirubin causes a darkened yellow effect, so also remember that jaundice is a symptom any time the liver has taken significant damage. Jaundice is the direct affect of bilirubin in the body. While I’m here, let me mention that since bilirubin is not being excreted properly, you will see an increase in serum bilirubin levels. Why? Its stuck in the body!!!

Might I, also, add lastly that this is an inflammatory disease. Therefore, fatigue/malaise, fever, nausea, vomiting, and muscle/joint aches and pains are common. 

How do we treat it? (Treatment!!)

The hard thing about treating hepatitis is that you have to weigh the risks and benefits of drugs and drugs dosing. Why is this hard? The liver metabolizes drugs. If the liver is damaged already, the effect of the drugs could be altered. More importantly, though, is that most of the medications we have to treat the symptoms of hepatitis can be hepatotoxic if taken chronically. There ARE treatment medications, though, and I want you to remember that they are treating a VIRUS. So, a lot of these medications end in…. -vir! 

Rest is important for the patient with hepatitis. They are going to feel flu-like symptoms a lot. By resting,it help to encourage hepatocyte regeneration (healing). If possible, coordinate your care in bulk sessions to allow for longer periods of rest. 

We can also teach the client about dietary changes to a high carb-high calorie diet. You should also mention that small, frequent meals may be tolerate better than three moderate sized meals. This is to help decrease nausea/vomiting. These patients should be taught to avoid alcohol. AVOID, not decrease.

Something that we overlook teaching is the importance of proper handwashing and hygiene. We need to tell them that they should avoid sexual contact until antibody results are negative. We want to help prevent the spread of this disease. 

For those who have chronic hepatitis, we want to also recommend them support group information like these:

http://hepc.liverfoundation.org/

http://hcvadvocate.org/

[erica-the-rn]

Cardiac

If you are in Adult Health/Med-Surg, you have dreaded your cardiac tests for a while. I just took my cardiac test (40 Qs on Cardiac, 10 on Peri-Op).

Labs

So the thing about Adult Health is it relies heavily on labs. If you don’t know your electrolytes and CBC, now would be the time to learn. Also, for this test, KNOW YOUR CARDIAC ENZYME MARKERS (Myoglobin, BNP, Troponin).

Here is a list of the lab values that my school uses:

Sodium: 136-145 Potassium: 3.5-5

Chloride: 96-106

Magnesium: 1.3-2.1

Calcium: 9-10.5

WBC: 5k-10k

Hgb: 12-18

Hct: 34-52

Platelets: 150k-400k

BNP: <100

Myoglobin: < 90

Troponin I: <0.03

Troponin T: <0.1

Pathophysiology So, the next suggestion I would give is that you should understand what an elevation in those labs is indicative of. For example, high levels of BNP indicate Heart Failure. So, for me, I like to know WHY BNP raises when signs and symptoms of HF are present. To know that you have to understand the patho.  According to EMedicine, the patho of HF (word for word) is  “ Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure.” That’s a lot to take in, so I’ll summarize. Basically, the heart had been wore down or defected to a point that its not pumping correctly. When it doesn’t pump correctly, fluid starts to build up in the backwaters (There’s your s/s of fluid volume excess). So, what happens when the fluid backs up?  Your veins and heart can only stretch and relax so much. They’re not built to take just any amount of fluid possible. So, when your veins and heart begin stretching in response to the fluid accumulation, the hormone BNP is released. Basically, BNP is a hormone that promotes further relaxation of the veins and heart.  So, your problem with heart failure is the backup of fluids. BNP is released to accommodate the prolonged exposure to FVE. Why is this a problem? Think about when you have that perfect pair of pants (the heart). You start gaining weight (FVE), stretching them and stretching them (BNP release) until what? If you’ve gained so much, the pants don’t fit like they used to and even if you lose the weight back to what you were, its just not a perfect fit anymore.  Your heart muscle with BNP has been stretched and relaxed to the point of permanently not pumping like it should. BNP is a compensatory hormone that raises and raises the more your heart fails to try to band-aid a permanent problem. Signs and symptoms So your full of fluids!  Traditionally, this first occurs with the left side. So lets look at left sided heart failure. On the left side of your heart, we are dealing with oxygenated blood. So, as the fluid backs up from your left side of your heart, it is only natural that the backflow goes to the….lungs. So, as a nursing student, you need to read that and know what happens when fluid is in the lungs: crackles can be auscultated. increased respirations. dyspnea. This is where we see the pink, frothy sputum. Cyanosis.  If you don’t understand, shoot me a message. 

Okay, so the fluid had backed up further past the lungs. Guess where its going?… Right back to the heart! This time it backs up into the right side and into the system. So we start seeing what’s called systemic signs of heart failure. The fluid is backing into your veins even more so and your organs, particularly I like to note the kidneys. So when you think about this being an “all-around-the-body-symptoms” kind of thing.. Think dependent edema. The fluid starts leaking out of your veins causing tissue swelling. What else? Your kidneys have excess fluid so we’ll see polyuria. Because your kidneys aren’t working properly now, you want to keep an eye on what? BUN and Creatinine labs. Also, remembers your going to have your classic signs of FVE now: JVD and organ enlargement. High urine specific gravity. 

Treatment:

So you’ve heard the whole schmidt about “Lower their sodium!” Why? Because sodium causes fluid retention. Lower their sodium. Put them on a diuretic (to get rid of excess fluids. Which type of diuretic are they put on? Do you encourage a low potassium or high potassium diet with this diuretic? Those are things to think about. What about oxygenation? They have low cardiac output, meaning they are going to experience deoxygenation. Get them O2 as prescribed. For God’s sake, remember to ELEVATE THE HEAD OF BED. :) 

This is just a walk through of one cardiac disease process. It is also my first. So please I’m open to pointers, tell me if it helped, and I will catch ya’ll next time with pulmonary!