cherry valley forever
JVL
tannertan36
Mike Driver
hello vonnie
Discoholic 🪩
No title available
Kiana Khansmith
🪼
Cosimo Galluzzi
"I'm Dorothy Gale from Kansas"
★
Andulka
almost home
art blog(derogatory)
Stranger Things
will byers stan first human second
RMH
The Bowery Presents
KIROKAZE
seen from T1
seen from Canada
seen from Saudi Arabia
seen from Malaysia
seen from United States
seen from Norway
seen from Malaysia
seen from United States
seen from India
seen from Malaysia
seen from United Kingdom
seen from Latvia
seen from Germany
seen from T1
seen from Uzbekistan
seen from United States
seen from Canada
seen from United States
seen from United States
seen from United States
@studywithdeesblog
if you’re reading this i hope in 2020 you get...
the grades you’re wishing for.
the motivation you require to work/study.
the people you need to help you get through the journey.
the materials you want to study with.
the happiness you all deserve.
Broken home not just your parents are divorce. But, more complicated from that. And ya, i fell my family is broke.
I feeling this after my dad gone stroke. At that time, if I am not mistaken, when I was in grade 4 at elementary school and a younger brother 3/4 years old. Since that time I felt everything had changed. This family is no longer the same. There was no such thing as a vacation together, felt the warmth of a family and for me it was quite difficult at my age, which was still 9 years old.
Since that time, I started wearing a mask. I did not tell if my father had a stroke. Not because I am ashamed, but I do not want to be pitied and I want to look normal as before. Sometimes I feel jealous of my friends who joke around with their families. Even now, I still feel that way. My friends who often display photos with their families on Instagram or make stories with their families.
My temperamental mother who likes to tell me this and that. Forcing this and that. Forbidding me this. Even though I don't want to. That's what makes me unable to get close to my family. Plus I am an introvert. I bury my own problems more. Resolve my own problems. So don't blame me if many people don't know who I really am. Outside I always cover myself with a thick mask that covers my origin and behind. I often cry in silence. Why my life like this? Before, I had a man who was able to keep me open. However, it only lasted one year. After that we broke up. And I returned again to my world to be an introvert.
After 12 years, my father had a second stroke and this time it was worse. I'm still like I used to act normal in front of my friends as if nothing happened. In my heart, when will everything end? When I get married tomorrow, my marriage guardian isn't my father either. All decisions are in my mother. I just want to tell, for my husband someday, embrace me, open my heart so that I can be close and open with you, my husband must also be strong and able to accept what I am and my family
Kadang aku merasa dimanfaatkan..
Aku juga punya schedule sendiri jangan maksa-maksa gitu lah :")
Thank you for this experience! :)
Tanpa kalian, paper ini tidak akan selesai. Terima kasih saling mendukung satu sama lain. Terima kasih sudah mau berjuang untuk menjadi yang terbaik. Terima kasih telah membuatku bersyukur.
Terima kasih telah memberikan pengalaman ini. Membuatku keluar dari tempat yang jarang aku jamah. Ke tempat dimana aku mengikuti perlombaan keluar yang pertama dan tidak terlalu jauh. Membawaku bertemu dengan berbagai orang hebat dari banyak universitas. Memberikanku warna-warna indah di dalam hidup. Lagi-lagi aku mengucapkan banyak syukur.
Namun, aku ingin mengucapkan kata maaf. Maaf karena tak berjuang secara maksimal. Tapi bukanlah kekalahan merupakan awal dari kemenangan? Aku tak sedih. Aku senang. Di cabang lomba pertama ini, aku bisa masuk sebagai finalis dan berada di peringkat ke lima. Itu sebuah pencapaian yang bagus. Lagi lagi aku sangat bersyukur.
Terakhir aku ingin mengatakan
Kegagalan adalah cara Allah mengatakan "Bersabarlah aku memiliki sesuatu yang lebih baik untukmu"
"Mungkin kamu tidak menyukai sesuatu padahal memiliki kebaikan yang banyak."
QS. Annisa : 19
Aku bangga sama kalian. Jangan patah semangat. Dan jangan kapok untuk berjuang
Mungkin ini memang kesalahanku yang tak bisa mengatur waktu dengan baik. Pikiran yang bercabang membuatku tak bisa fokus pada satu hal. Emosi yang terpendam membuatku tak bisa benar-benar perpikir jernih. Tapi aku percaya, even the darkest night will end and the sun will rise again
Bandung, 17 Oktober 2019
Source gambar : pinterest
I don't like patronizing people
I just ask, but you answer me like i don't know about that. And you judging me
Mungkin aku yang terlalu baik. Atau aku yang terlalu lelah?
Ya, aku sudah mulai lelah atas keinginanmu yang ini itu makannya aku kadang menghilang. Bukannya aku meninggalkan tugasku, aku hanya ingin mencari pengalihan sejenak. Aku bukan orang yang mampu untuk mendapatkan banyak keinginan dalam satu waktu.
My desk decor done :") and i like it so much❤❤❤❤
medical field stereotypes
Family Medicine - personality: easy-going, family-oriented - quirk: low self-esteem - 7 deadly sin: gluttony - hobbies: hanging out with your significant other and other family medicine docs
Internal Medicine - personality: ambitious, jack-of-all-trades - quirk: over-confident - 7 deadly sin: pride - hobbies: cooking, moderate physical activity
Pediatrics - personality: patient, childlike - quirk: eccentric - 7 deadly sin: gluttony - hobbies: maintains “childish hobbies”, love of Disney, music, and games
General Surgery - personality: daring, high-achiever - quirk: narcissistic - 7 deadly sin: pride - hobbies: secretly slovenly at home, loves going and eating out
Ob-Gyn - personality: well-rounded, grounded - quirk: catty - 7 deadly sin: pride - hobbies: your children > your spouse, always doing or planning something
Psychiatry - personality: loquacious, social - quirk: diva - 7 deadly sin: envy - hobbies: going out to town, having people over, selfies and social media
Emergency Medicine - personality: confident, outgoing - quirk: impatient - 7 deadly sin: lust - hobbies: working out/aggressive physical activity, teaching
Neurology - personality: efficient, organized, quiet - quirk: odd - 7 deadly sin: pride - hobbies: the kinds that can be done alone like reading or gardening or raising goats
Radiology - personality: down-to-earth, eloquent - quirk: self-centered - 7 deadly sins: lust - hobbies: travel, fine dining
Please reblog this if you are a studyblr/aesthetic blog! ✨I need to follow some people❣️ 😂
If you are studying English Literature or are at Oxford University, plss contact me✨
IV Initiation Tips
Consider the key factors!
The patient’s medical history and current medical state If the patient is critically ill or if they could “go south” quickly, vein preservation is crucial. These patients are most likely to require rapid administration of fluid and/or rapid access to a vein for bloodwork in an emergency setting. Ensure that IV access is obtained from the most distal site first and moving upward with alternating sites as required. Patients with a history of multiple hospitalizations or chronic illness where IV access has been an ongoing requirement often know their veins very well and will not hesitate to tell you what areas never work!! Although their insight is incredibly useful, always assess BOTH arms regardless before making your decision
Age, body size and weight, skin and vein condition, level of activity If possible, try to initiate the IV on the non-dominant arm to reduce the risk of losing the IV during patient activity. Confused patients who are prone to pulling at tubes are often “tricked” by IVs that are placed in hidden spots like the ventral forearm with a light sleeve to cover the area. Remember it is never appropriate to cover an IV site with gauze and tape, you should always be able to quickly assess the site especially during continuous infusion. Elderly patients lose subcutaneous tissue as they age, their distal veins are frail and roll easily and are prone to blowing. These patients will also experience worse complications if infiltration or phlebitis occurs at a distal site. The general rule that I use for the elderly is to try to find the straightest distal vein that is available, usually in the forearm. Obese patients may not have veins that are visible. Practicing identifying veins by touch first may help you to improve your IV access skills on heavier patients where visualizing veins is challenging.
The type of IV fluid or medication to be infused IV fluid or medications with a high osmolality or low pH will require a larger vein that can tolerate the infusion Vesicant medications cause tissue necrosis and can damage surrounding tendons and ligaments in the hands/distal forearm. These medications should ideally be administered at a more proximal site with a larger IV. It is also important to ensure that there is adequate blood flow around the IV site to carry fluids and medications into circulation, especially if they are vesicants. Consider this: Vancomycin has a pH of ~3.9. Lemon juice has a pH of 2.5-3. When administering Vanco through a peripheral IV, not only does the site have to be large enough to tolerate the drug, but there has to be enough bloodflow AROUND the catheter to carry the drug into circulation and prevent local damage.
The expected duration of I.V. therapy If the patient is expected to receive IV therapy for less than one week, start with the most distal site in the upper extremities and move upward. This is extremely important for vein preservation and keeps vein selection high if IV access is lost. If the patient is expected to receive IV therapy for longer than a week, and/or requires frequent blood work and intermittent IV meds but has poor venous access, discuss the option of a central line/peripherally inserted central line as a more appropriate alternative with the medical team and/or venous access support team at your work
Your level of experience - If the patient’s veins are a level 4 or 5, consider observing a more experienced nurse insert the IV until you have become more comfortable with your skills, or have them guide you through vein selection.
Consider the vein level! The lower, the better.
Consider where NOT to poke!
NEVER place an IV in:
Veins below (DISTAL to) a previous I.V. infiltration or phlebitic area
Areas of skin inflammation, disease, bruising, or breakdown
An arm affected by a radical mastectomy, edema, blood clot, or infection
An arm with an arteriovenous shunt or fistula.
Avoid veins in the wrist for venipuncture as they run in close proximity to nerves. The cephalic vein on the lateral (thumb) side of the lower forearm/wrist is right next to the radial nerve, I always avoid this site and consider it a last resort for this reason.
Avoid valves. Where two veins conjoin into one there will be valves. Valves can also be visualized as distinct bumps along a straight vein during vein engorgement. You cannot pass an IV catheter through a valve. It will be met with resistance and it will be painful for the patient.
Consider appropriate gauging!
24- to 22-gauge for children and elderly patients
24- to 20-gauge for medical patients and postoperative surgical patients
18-gauge for surgical patients and for rapid blood administration. Blood can be infused through smaller-gauge catheters, but the flow rate will be slower.
16-gauge for trauma patients and those requiring large volumes of fluid rapidly.
Consider useful techniques!
Warm the arms for 3-5 minutes prior to searching for a vein
Position the arm at or below the level of the heart to encourage blood flow
Use a blood pressure cuff in the elderly. The tightness of a tourniquet can actually blow a punctured vein and a cuff is much more pressure sensitive against the skin of these patients
Use moist compresses or rub the site to encourage blood flow
When cleaning the site, apply good pressure, this can really help you to visualize the vein better immediately prior to puncturing it
Stabilize the vein throughout the IV insertion. Pull downward on the skin distal to the puncture site with your non-dominant hand and maintain that stabilization UNTIL THE CATHETER IS IN. Before puncturing the skin, make sure you are stabilizing far enough down the arm or hand that you can get a low enough angle to go into the vein and not through it.
Insert the catheter with the needle bevel up at a low angle. When blood return is observed, lower the angle level to the arm and advance the unit slightly to confirm placement. Blood return should continue during advancement, at which point the catheter should advance smoothly while the needle is retracted.
Learn to insert the IV holding it with your thumb and middle finger. This eventually allows you to advance the catheter with your index finger while retracting the needle with your thumb and middle finger.
Once the IV is in, follow the two T rule: Transparent Dressing and Tourniquet. As soon as the dressing has secured the site the tourniquet should come off.
It is okay to instruct the patient to clench their fist during IV initiation, this helps with venous filling. However this should be avoided if the IV site is being used to draw blood on insertion (often seen in ED) and should always be avoided with blood work. Fist clenching can result in inaccurate lab results due to hemolysis and excessive local muscle contraction.
New video! Stationery haul. You can check it on this link
Don't forget to like, comment, subscribe, and share guys!!
My favorite space :)
Now, i know different between the real friends and the fake friends. Hahaha Fake friend just need me if he/she need my help and then when he/she find a new friends with more benefit, she/he not need me again. Ok. Thanks.
Ingin menangis, tapi tertahan dan memang bukan saatnya. Beginikah rasanya di kecewakan dan mengecewalan?
Semua akan kembali pada orang yang benar-benar saling mencintai tanpa saling menyakiti hatinya sendiri
Bandung, 8 April 2018
