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Author Topic: A Nurse's Guide to Medicine  (Read 3252 times)

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Offline Pumpkin SeedsTopic starter

A Nurse's Guide to Medicine
« on: February 04, 2014, 12:39:44 PM »
Welcome everyone to my first and only blog to date.  My name is Pumpkin Seeds and in my non-elliquiy life I am a registered nurse.  I come from a long line of nurses and medical personnel, so many in fact that the line of nurses can be traced back before there were actually nurses.  My mother claims our family has ties to witchcraft and druids, but I’m not sure how trustworthy of a historian she is when talking about this sort of stuff.  Currently I hold a bachelor’s degree of science in nursing alongside a sociology degree and a few minors.  Before becoming a registered nurse I worked as an assistant and a volunteer at various hospitals.  As a child my mother took me to turn her nursing courses alongside my older brother where I can still remember running around the hospital waiting for my grandmother to pick us up.  So you can say that I have pretty much grown up around hospitals and nursing my entire life.

The inspiration for this blog came from a recent conversation in the politics and religion forum whereby I noticed a great deal of confusion over medical terms and concepts.  Of late this has made me take a second look at patient complaints and concerns that are voiced.  Medicine and nursing (yes the two are actually considered separate) is a very complex field which serves as a crossroad for science, philosophy and psychology.  I would also throw sociology into that mixture, but that is more a personal view point rather than an accepted fact.  So my aim with this blog is one of information so as to better equip my fellow members of Elliquiy for any future medical concerns and encounters.  Since I am a nurse, this will largely be from the perspective of a nurse which is an important detail to note.  I am not a doctor nor am I an expert in medical ethics, law or administration.  At the end of the day I work the floor beside my patients.

From here I am guessing a good place to start is what exactly a nurse is.  Unfortunately, I cannot tell you that because nobody actually knows.  Now before I lose all credibility here and you run off to WebMD, take a look at this.  The definition of a nurse is one trained to care for the sick or infirm, one who practices nursing.  If you define nursing, which a nurse practices, it is the practice of caring for the sick and infirm.  A nice, open-ended definition right?  One of the findings of a council convened by Robert Wood Johnson was that nursing required a comprehensive list of duties and responsibilities.  There is no actual, unified list of a nurse’s job responsibilities and duties.  Consider that nurses can be found in nearly every conceivable capacity of the medical field and there is a profession ripe for confusion.  Nurses work at the patient bedside providing direct care, they work in administration managing the budget and personnel of a unit, they run clinics, they are salespeople for pharmaceutical companies, educators in the community and in the local colleges, and the list goes on.  There is no field more diverse than nursing, partially cause nobody knows what the hell we do including us.  Thumbs up for us.

Part of this confusion comes from the expansion of medicine.  At one time a nurse’s responsibility was essentially to monitor the patient and provide direct care.  Bathing a patient, putting them on the bedpan and carrying out the doctor’s orders were considered the responsibilities of a nurse.  There was simply nothing else for us to do and we were not educated much beyond on the job experience.  Florence Nightingale is largely considered a pioneer at increasing the professionalism and responsibilities of nursing because she showed that not only could nurses make valid observations, but that the scientific method was an integral part to the field.  The Nursing Process is pretty much a direct result of this woman’s work.  If you ever have a chance to read her work, be advised she is actually a bitch with a pair of brass balls.  For her time she was a hell of a woman.

Over the years, thanks to Florence Nightingale, schools developed for nurses.  At first most of these schools were run by hospitals attempting to train their own personnel to care for patients.  This actually lasted up until recently.  These schools were far from uniform in their education.  Some nurses were trained to handle psychiatric patients, others taught to handle surgeries and still others were more focused on the community.  Each hospital had their own method of teaching and their own emphasis.  As nurses were trained and then moved around, hospital administrators and doctors noticed a great deficit in the level of training these nurses held.  So a more unified system was put into place where nurses had to pass a test and selection process to hold a license (or at least what we think of as a license).  This test is now known as the NCLEX, dreaded the world over by nursing students.  My mother in fact spent two days taking this test whereas now I completed the exam in under an hour.  My grandmother did not even have to take the test to give you an idea of how new this all is for the profession.  From these little hospital schools came a more unified curriculum that developed into diploma schools which later became associate degree programs.  From here nursing has entered the academic field with bachelor degrees, masters and now even doctoral programs.  This all within the past one hundred or so years.  Florence Nightingale, the pioneer of nursing, was born less than two hundred years ago and so much of the changes she started are still happening.

If you are confused at this point then rest assured you are not the only one.   I would like to say there is no more confusion to be had, but I would be lying.  Still the additional confusion can wait as we tackle what exactly nursing and by extension your nurse does.  Rest assured nurses have largely come to a consensus on what their goals are when carrying out their duties.  So here it is the unofficially accepted list of job responsibilities of the modern nurse.

Patient advocate.

We aren’t a big fan of lists, what can I say?

Nurses largely consider themselves to be a patient advocate meaning a nurse speaks up and protects their patients in all ways possible.  This has grown from simply monitoring patients for signs and symptoms of medication problems and progression of illness to assessing for abuse and questioning the doctor.  Remember the list of jobs that nurses hold?  Well when seen through the eyes of this definition the responsibilities become clearer as everything pertains to the sick and infirm.  A floor nurse providing direct patient care obviously speaks up for their patient, a nurse administrators tries to ensure there are enough nurses and equipment on the floor to help the patient, an educator wants to provide the best training to future nurses so they can care for patients and even a salesperson has an obligation (yes they actually have this duty) to not only question their employer about medications being provided but report any abuse or misdealing.  Everything a nurse does and everything they are given responsibility over ties back to the central figure, the patient.  Without the patient there is no nurse.

Of course this definition lacks some key items such as how a nurse is supposed to advocate and what exactly their limitations are in performing this duty.  There is one key limitation that I will go into because this directly pertains to what a patient may expect from their nurse.  Nurses do not diagnose.  There, simply stated.  In fact this is so important I will do this.

NURSES DO NOT DIAGNOSE.

If you are in the hospital and a nurse comes into to tell you what you have then they are no longer practicing nursing, they are practicing medicine.  Doctors diagnose.  Ready for the confusion?  Nurse practitioners can diagnose but usually under the supervision of a doctor and that doctor’s license.  So ultimately a nurse does not diagnose.  This actually goes beyond simply telling a patient what is wrong with them, but also extends into discussion of lab values and findings.  Nurses cannot discuss with a patient initially their labs, test results or diagnosis until a physician has done so because doing any of that is practicing medicine.  So here is an area where patients become frustrated with their nurse and hopefully I can clear this up for you.  A nurse’s refusal to discuss findings, results and give a “guess” as to what is wrong is not due to “not knowing” or being a pain, but is actually enforced by their licensing board and by federal law. 

Anyway, that is probably enough for now.  Doubt I answered much, but I hopefully gave you a glimpse to the confusion and mad world of a nurse.

Offline Blythe

Re: A Nurse's Guide to Medicine
« Reply #1 on: February 04, 2014, 12:55:12 PM »
*bookmarks this blog*

This is a really informative read, Pumpkin Seeds, and the bit about diagnosing and the misunderstandings nurses have with patients about that was very useful to know. Looking forward to more!

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #2 on: February 10, 2014, 12:20:18 PM »
So the last blog post featured the almighty term, diagnosis.  I think there is a general lack of understanding by the public on how important a concept diagnosing is to the medical community.  To reiterate what was said before, diagnosing is almost entirely the realm of the medical doctor.  Physicians literally spend years researching, learning and practicing so that they can accurately make a diagnosis of a problem along with running through the proper tests to confirm or refute a diagnosis.  This is a serious business because without a diagnosis there cannot be an effective treatment and without an effective treatment the problem will likely continue or simply become an unresolved issue that could develop further.  There are also areas outside of medicine that require accurate diagnosis such as insurance, legal counsel, social workers and government agencies.  There is quite a bit riding on a doctor’s ability to give an accurate diagnosis. 

Now before I get too far along with this post, keep in mind that a diagnosis is really an educated guess by the doctor.  There is a harsh truth here in that science is part of medicine, but medicine is not a science.  While the doctor is looking to narrow down the possibilities, there does come a point where he has many options and he is simply selecting the most likely with the hopes the treatment succeeds.  Hence the reason follow up is so important and why nurses are so adamant in watching a patient after treatment is given.  Truth be told this has formed the frame work of the nursing process whereby a treatment is given and then evaluated for effectiveness.  Physicians want to make sure their treatment is working before releasing someone from their care or giving them the “thumbs up” to go back to normal life.  If you have ever been admitted to the hospital for observation then you now know the reason, the doctor wants to make sure she guessed right or that the treatment isn’t going to hurt the patient.

From here I will give a little bit of a soapbox speech on self-diagnosis. 

We all, understandably, like to take a guess at what is going on with our bodies.  Play doctor a bit to see how close we can get to the truth.  The problem is when this game develops into extensive research, alteration of reported symptoms and pressure on the doctor for treatment.  This is when self-diagnosis has become a problem.  A physician has well over a decade of training in most cases.  Even the lowly resident has years dedicated to research, study and practice.  These are not amateurs no matter how silly, stupid or uneducated they may come across.  On top of this each resident seeing a patient is also reporting their findings to a more senior doctor.  I have heard the stories of people going into the doctor’s office knowing what they have, being ignored and then wham this was exactly what they said it was.  The thing is people don’t tell the stories of people that wasted time, money and energy having the doctor chase down phantom symptoms that were not there and the patient only thought they experienced because they thought they had a certain diagnosis.  This happens more than the former.

Now do not think I am asking you to simply stand on the sidelines of your own care.  Far from it actually.  Be aware of your body because after all, nobody spends more time with your body than you.  Only you can tell the nurse and the doctor what is wrong.  Even a simple, “I just don’t feel right, something is wrong” speaks volumes.  So be aware of your body and of what is wrong when you go to the doctor.  Be forward and upfront with the medical team in charge of your care.  Also be knowledgable of any current medical conditions, diagnosis and medications you are using.  That is the time to start looking things up and becoming informed so that you can better manage your own care.  Remember the goal of the nurse and the doctor is to get you, the patient, to a point of self-care and management.  Also, while I do not recommend pressuring the doctor for treatment, make sure the physician knows what works and doesn’t work for you and your body.

So here I will go on the soapbox again in regard to advice from others.  Advice is great, advice is wonderful, diagnosis is not.  Unless your neighbor has a medical license they are willing to stake on their diagnosis, then do not take their words to be one.  As cold as this sounds, if someone is not willing to give you their medical license number then they are not investing much in their words.  Every diagnosis and treatment a doctor gives out involves his/her license, which is their livelihood and what they have worked so hard to acquire.  The neighbor, the girl down the street, the one at the herb shop and the nameless box on the internet screen are not investing that into their diagnosis and recommendations.  Keep that in mind when considering whose advice to regard as more important.  A doctor is quite literally putting their livelihood on the line when they tell you something; Joe Blow would just feel bad if he was wrong about that being a cough.

So far as Elliquiy goes, I am sure the staff will back me up on this.  If you have a medical problem the only response anyone should give you is, “Go see a doctor.”  That is it and that is all.  Even me, because here is another word of truth, anyone that says different either doesn’t have a license or shouldn’t.  There is no medical professional that will risk their license diagnosing and treating someone over the internet.  By treatment I also mean recommending Tylenol, Ibuprofen, over the counter medications and such.  In truth even “herbal” and home remedies can be problematic and I encourage people to exercise caution when discussing and recommending them.  I know people mean no harm, but harm can still result.  The reason behind this caution is quite simple, you don’t know them.  You are not physically seeing the symptoms, not aware of their medical history and not aware of their current lifestyle regiment.  So for instance…

Someone on Elliquiy says, “Hey Pumpkin, you are so awesome with your medical blog and you’re a nurse so what should I do about this pain on my foot.  My toe hurts and feels like I have a sore there.”  I, having a moment of sudden stupidity, respond with a recommendation for new shoes.  I am not aware that you have diabetes, I am not aware that your toe is cold and your capillary refill is sluggish and I am not aware that your sore is actually an open wound.  A month later your toe is black, being amputated and you have vascular issues.  So yeah, please…see a doctor if you think it’s important enough to go digging through forums and asking for advice.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #3 on: June 09, 2014, 06:48:54 AM »
I know there has been a great deal of time since my last blog post and this one.  Believe it or not, I actually had a few written up but just didn’t go through with posting them.  There are a great many topics to cover and I just couldn’t settle on one of them.  This time though I may have the right train to carry on my thought process.  Since the last two posts pretty much dealt with diagnosis as something a nurse cannot do then maybe moving onto the next step a nurse cannot do makes sense as well.  This next step is treatment.  So here, in nice bold lettering again, is what a nurse cannot do.

A NURSE CANNOT INTIATE TREATMENT

This is obviously void when dealing with a nurse practitioner and the more advanced nursing specialties.  The average floor nurse though cannot write for treatment.  So the next question is what exactly is meant by treatment.  The answer here is pretty much everything.

A physician provides a medical diagnosis.  The next step for that doctor is then to treat the patient by writing up a treatment plan.  Nurses typically refer to these plans as a set of orders.  A treatment plan includes items such as activity level for the patient (bed rest, ambulate with assistance, etc.), medications to be given, devices to be used, frequency of vital signs and other assessment activities and diet.  This is once more part of practicing medicine, which only a doctor can do.  A nurse is unable to make any of these determinations without the written orders of a doctor.  So what does this mean for the patient?

The nurse cannot provide a patient with food unless cleared by the doctor.  A physician must instruct the nurse on what diet is allowed.  Perhaps this seems cruel on the nurse’s part, but say for instance the doctor is considering a study or test that requires anesthesia.  Well an anesthesiologist will not provide anesthesia if the patient has eaten because they can vomit while under their care, aspirate and die.  So should the nurse feed the patient and then the physician writes for one of these tests, care is now prolonged and halted because of a nurse initiating treatment.  So the next time the nurse refuses to feed you or a family member in the hospital, this will hopefully give some context.

A nurse cannot assist or help a patient when there is no order for activity.  Someone recently admitted to the hospital with no activity orders is having trouble standing; the nurse will encourage that person to get back in the bed.  Without orders to ambulate with assistance, the nurse is risking themselves by initiating treatment of moving the patient.  People perceive assistance as allowance.  A nurse helping someone to the bathroom conveys to that patient that they are allowed to go to the bathroom, otherwise why would the nurse help them?  Now if the person is up, moving around and ambulating without assistance then there is little conflict here.  The misunderstanding always occurs when someone requires assistance and does not understand why the nurse, who is supposed to help them, won’t do so.  The context of the situation is that a nurse must have orders for a patient to move about, get up and do whatever. 

Nurses also cannot distribute medication without these orders.  Typically patients will arrive to their floor or their unit or the emergency room wanting some sort of immediate relief.  Pain medicine is, not surprisingly, a popular demand of nurses.  No matter how much crying, hollering, clutching of the body is done a nurse cannot distribute pain medication without a doctor’s order.  Most hospitals have what is called a pyxis machine.  This is the machine that holds the medications.  When a doctor writes an order, that order is then faxed to pharmacy.  A pharmacist reviews the medication and then decides whether or not to allow the distribution of the medication.  If the medicine is located in a pyxis machine, they will communicate to the machine that this medication may be withdrawn by the nurse.  Only then is a nurse able to gain access to the medication.  So a nurse is not being impassionate when they do not automatically give morphine to the screaming man down the hall, they are usually waiting on an order or pharmacy to approve the order.

Medications are not limited to pain medicine either.  A common misunderstanding between patients and nurses is in regard to home medications.  Even if the nurse takes the pressure and it is high, there can be no medication administration until an order is given.  This includes home medications that the patient has with them.  Now a nurse cannot physical stop a person from taking their own medication if they so choose to do so.  A nurse will then report that to the physician and the doctor will adjust accordingly.  I do, however; recommend not going this route as you are sort of going off the reservation here and can lead yourself to some serious consequences with treatment.  This also applies to things like anti-rejection medications for transplant patients, cold medication and even over the counter medicine like Tylenol or ibuprofen.  A nurse simply cannot distribute anything without a doctor’s order.

As a side note there are a few things that people are surprised require an order.  Starting an IV requires an order and nurses have been fired for “practicing” IV starts on each other because they are practicing medicine by doing this.  Oxygen is considered a medication that does require a doctor’s order.   Ointments and creams that have medication in them are considered medicine.  Ones that do not contain medication can be distributed without an order. 

So I hope this clears up some confusion and perhaps hurt feelings about a nurse simply standing there and watching someone seeming to suffer.  The experience is as heart wrenching for us as it is for them painful.  Yet without orders, a nurse’s hands are tied and often times they cannot even physical reach the medication if they were willing to violate the laws and risk their license. 
« Last Edit: August 28, 2014, 05:15:54 PM by Pumpkin Seeds »

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #4 on: July 03, 2014, 12:32:48 PM »
Bowel Movement Information

I like this little chart because it answers some common questions in an easy way.  Enjoy!

Offline Caeli

Re: A Nurse's Guide to Medicine
« Reply #5 on: July 03, 2014, 01:46:59 PM »
The chart is awesome, Pumpkin. :-) Thank you for sharing it!

Offline ImaginedScenes

Re: A Nurse's Guide to Medicine
« Reply #6 on: September 02, 2014, 01:59:11 PM »
Do nurses also have to get orders to stop treatments? Suspect so. I had a really bad reaction to an IV with potassium in it and was in pain for an hour before the nurse finally said it was ok to for her take it off. I wanted to rip it out so many times but thought I could screw something up.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #7 on: September 05, 2014, 09:03:08 AM »
Potassium is one of those medications which burn when going through an IV site.  Very caustic to the vein and so the vein, being surrounded by nerves, ensures you know this situation.  A nurse actually does not need a physician’s order to stop treatment and as a patient you have the right to refuse a medication or have treatment stopped.  Still, potassium is an important element for many reasons and if you are receiving IV therapy potassium then odds are your lab values for potassium were low.  Odds are the nurse was not aware of Y-Porting the potassium with normal saline, which is a method of diluting the potassium with saline to reduce the burn.  This also allows an adjustment of the rates to find a more comfortable level.

If that happens again I would suggest asking the nurse to Y-Port the potassium, to see if the physician can order the medication by mouth or to slow down the rate at least.

Offline Amazee

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Re: A Nurse's Guide to Medicine
« Reply #8 on: September 05, 2014, 02:29:26 PM »
Admittedly I would be a bit nervous about receiving any bit of intravenous potassium especially since I know what it can be used for.

Offline Oniya

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Re: A Nurse's Guide to Medicine
« Reply #9 on: September 05, 2014, 03:29:29 PM »
Considering that hypokalemia is dangerous to your heart function, doing whatever is necessary to keep your electrolytes in balance is the important thing. 


Offline Amazee

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Re: A Nurse's Guide to Medicine
« Reply #10 on: September 05, 2014, 04:00:45 PM »
I know that, but they also use it the other way when it comes to erm...sentencing people.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #11 on: September 05, 2014, 07:40:17 PM »
Potassium chloride is part of the setup for lethal injection.  This is an important point to remember when dealing with medication.  Often times the difference between medicine and poison is the dose and the method of administration.  Potassium chloride is a medication that should always be hung as a drip and administered in a controlled environment and at a controlled rate.

Offline Oniya

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Re: A Nurse's Guide to Medicine
« Reply #12 on: September 05, 2014, 07:42:45 PM »
Often times the difference between medicine and poison is the dose and the method of administration. 

Like oxygen - administer it with a mask or trach-tube, and you're doing fine.  Administer it by IV, and you've got problems.  ;)

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #13 on: September 05, 2014, 07:54:34 PM »
At this point I would like to expand on the question asked in regard to a nurse’s ability to stop treatment.  A nurse is not able to initiate treatment and is actually unable to modify treatment (i.e. change the dosage of a medication) but a nurse is able to halt a treatment.  This might not make sense at first, but a nurse has a duty to protect their patient.  Being an advocate for the patient a nurse is empowered with the ability to cease treatment.  A nurse may also refuse to administer a treatment if they feel that the treatment would cause harm to the patient that is not outweighed by the benefits.  This plays into the nature of nursing since the bedside nurse is the first person to notice a problem the patient may be having with the current treatment regimen.  Therefore, pretty much by necessity, a nurse has the ability to discontinue whatever is causing problems for the patient.

Offline Amazee

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Re: A Nurse's Guide to Medicine
« Reply #14 on: September 05, 2014, 08:19:58 PM »
Potassium chloride is part of the setup for lethal injection.  This is an important point to remember when dealing with medication.  Often times the difference between medicine and poison is the dose and the method of administration.  Potassium chloride is a medication that should always be hung as a drip and administered in a controlled environment and at a controlled rate.

That's the part that scares me. Potassium can stop your heart quickly which is why it is the last drug administered. It burns like hell when you get it when you are conscious and you tend to spasm around due to the pain of it all. I know in lethal injection its different because it is injected through an injection machine and not from a drip line, but still it worries me that enough of it will kill you in seconds.

If I had to get some potassium administered, I would ask that they be careful. Even if I know that doctors are careful with how it works, I just can't get my head around the fact that states use it to execute people.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #15 on: September 07, 2014, 06:41:23 AM »
I hate to be the bearer of bad news, but most medications should concern you.  Medicine and medications needs to be treated with wary respect and those that know what they are doing need to have their advice, council and directions heeded.

Offline Beguile's Mistress

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Re: A Nurse's Guide to Medicine
« Reply #16 on: September 07, 2014, 08:18:16 AM »
This is very true.  I'm dealing with a laundry list of medical issues and a frequently changing team of doctors as few of them seem to be willing to prolong their stay at any one hospital these days.  Each prescribes medications for one thing or another and while I assumed they knew about how the medicines worked I was wrong.  The contraindications were not observed and complaints of problems not properly recorded while changes in the medications prescribed began to cause even more issues with my health.  It resulted in the need for a doctor trained in pharmacology to study all my medications, meet with my various doctors and review with them the best course of medication for me to follow.  This doctor is kept apprised of every new prescription I am given and every change in dosage and my general health status.

One of the most important things we can do as a patient is know our medication and the proper dosage and make sure every doctor - this includes dentists and eye doctors as well - know all the medicines we take.  Medicines interact and one new prescription can change the entire balance in our system.

Offline Kavitai

Re: A Nurse's Guide to Medicine
« Reply #17 on: February 03, 2015, 09:14:03 PM »
As a PN student currently going through school right now, I found this incredibly useful and most definitely will be saving this page! I honestly didn't expect to find stuff that would help me with school here, but I'm glad I did.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #18 on: February 04, 2015, 08:01:37 AM »
Thanks!  I will hopefully be getting back to this blog soon.  Have written and deleted a few posts recently, so things are cooking in my head.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #19 on: February 17, 2015, 03:06:52 PM »
Nursing Injury


I just really feel this article addresses a slice of nursing life and felt this should be placed here.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #20 on: February 21, 2015, 02:35:30 PM »
Urine

Since we had poop, only fair that urine gets its own chart as well.

Offline Oniya

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Re: A Nurse's Guide to Medicine
« Reply #21 on: February 21, 2015, 02:53:16 PM »
I remember seeing something about excess B-vitamins causing 'bright green' or 'neon green' urine.  Of course, my experience with highlighters makes me suspicious of whether that might be on the yellow side of chartreuse.

Offline The Dark Raven

Re: A Nurse's Guide to Medicine
« Reply #22 on: February 22, 2015, 01:28:01 PM »
I remember seeing something about excess B-vitamins causing 'bright green' or 'neon green' urine.  Of course, my experience with highlighters makes me suspicious of whether that might be on the yellow side of chartreuse.

Yes, excess B vitamins give a chartreuse or "electric yellow" color.  Green is usually Pseudomonas, trichomonas, birth control meds, or asparagus coloration (to be fair, asparagus urine also has a particular nasty odor...so does trich, but it...moves).

Offline Flower

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Re: A Nurse's Guide to Medicine
« Reply #23 on: February 23, 2015, 02:58:33 PM »
I just wanted to say this is super awesome. I like the little infographs.

Offline Pumpkin SeedsTopic starter

Re: A Nurse's Guide to Medicine
« Reply #24 on: March 17, 2015, 07:15:04 PM »
So I want to address a pretty serious subject right now.  Before I continue there does need to be a disclaimer that I am in no way trying to advise people how to diagnosis this illness and that the information regarding the following disease process is changing.  Mainly what I am doing is attempting to convey current knowledge and disseminate that information in an accessible format. 

Strokes are a large problem in the United States.  Rank number 5 for fatalities and number 1 for causing disability in the elderly population; this is a very serious issue.  Strokes are also known as cerebral vascular accidents (CVAs) in the medical community, because that is pretty much what is happening.  Blood flow has been altered to the brain tissue so that the tissue is not receiving required oxygenation and nutrition to survive.  The brain does not do well without these necessary components and drastic alterations occur.  For example if the brain is not being perfused properly, people faint.  This should show you how important the body considers feeding the brain is that the body will actually risk injury to get blood to the brain by falling over.  So obviously a stroke is a serious issue for not just the brain but the entire body.  There are two types of major strokes.

The first is an ischemic stroke.  This is a blood clot that is occurring either before the blood reaches the brain or within the brain to prevent the flow of blood to certain areas.  Oxygen and glucose are not stored by the brain; the brain actually has no ability to build up a reserve of needed materials but instead relies entirely on the supply of blood to survive.  This means that such a block can lead quickly to problem with the brain functions, brain death and eventual death.  A common phrase is that time lost is brain lost because every minute the brain is without blood, 2 million brain cells die. 

Hemorrhagic stroke is the second type.  This one is commonly caused by a brain aneurysm bursting, which an aneurysm is a weak section of a vessels wall ballooning out.  An aneurysm that expands to such a level should lead to a severe headache and one that bursts will cause “the worst headache of your life.”  Remember the skull is an enclosed space, so pressure there can only go so far.   Another common cause of hemorrhagic stroke is brain/head injuries through trauma.  Essentially what happens in a hemorrhagic stroke is that the blood flow is interrupted because the blood is pouring out somewhere else and not reaching parts of the brain. 

Now there is a third type of stroke, but this really isn’t a stroke.  Trans ischemic Attacks (TIAs) are basically ischemic attacks that resolve themselves.  Stroke like symptoms will exhibit themselves but then resolve as the blockage is removed by the body.  These are serious and should not deter you from calling 911 if stroke-like symptoms occur.  For the purposes of anyone out in the world, a TIA should be treated as a stroke because well..you won’t know if this is a TIA or an ischemic stroke anyway.  Don’t feel bad, I wouldn’t either and I’m stroke certified.  Also a TIA is sort of a warning stroke and should alert you that changes are required to your health before a true stroke occurs.

Alright, so the part everyone wants to really know is how to spot a stroke.  Now keep in mind that all warning signs of a stroke are SUDDEN.  I capitalize this for emphasis because there are no early warning signs.  A stroke just happens all of a SUDDEN.  The acronym to keep in mind here is F-A-S-T. 

(F) Facial Droop or numbness – Here you want someone to smile fully.  Tell them you want to see teeth, not them just making an upside down frown.  If you can see teeth on both sides, their smile is symmetrical, then they are not exhibiting facial droop.  Facial numbness is not something anyone aside from a medical professional can appropriately assess and if they complain of numbness to one side of the face then take them at their word.

(A)Arm Weakness/Numbness – Grip strength is all well and good, but doesn’t actually test for this.  Ask them to raise both their arms at the same time.  Once arms are raised, start counting slowly to 5.  If one arm starts “drifting” down then they have arm weakness.  Once more do not try to assess for limb numbness on your own.

(S) Slurred Speech – Easy enough really, just have the person say a few sentences.  Sometimes they will not be able to speak at all. 

(T) Time – If the person is exhibiting any of these symptoms SUDDENLY then call 911.  Time lost is brain lost. 


Do not try to give someone suffering from a possible stroke aspirin.  Honestly don’t try to give them anything as people suffering from a stroke have difficulty swallowing and may aspirate.  Aspirin though is an anti-platelet medication and until the determination is made about ischemic vs hemorrhagic, best not to give them a blood thinning medication. 

If you feel like you are having a stroke or someone else feels like they are having one, do not be afraid to dial 911.  I am in no way giving you information to exclude other symptoms or concerns, but merely giving you the most commons signs/symptoms.  This is serious and needs to be taken seriously.

Preventing a stroke is easy to know but difficult to do.  If you smoke, then stop.  I know, I know everything is blamed on smoking these days but really the stuff is bad for you.  Chemicals inside cigarettes constrict blood vessels which can lead to strokes and also kidney failure.  Also of course are diet and exercise.  This would require a whole new section on the benefits of diet and exercise, but let’s just go with lifestyle habits are the main contributors to stroke risk. 

Finally, I am going to place emphasis again on time.  Do not simply let yourself or someone else go wandering off after possibly having a stroke.  Many times a patient will come into the hospital saying their arm has been weak for the past three days.  Too late, we can’t do anything but rehab at that point.  Strokes can be helped and their impact minimized if a physician can get to the person fast enough to administer clot breaking treatments, mechanically remove the clot or close off the bleed.  I have literally watched a physician remove a clot and the feeling return to the patient’s arm within minutes.

Should a loved one have a stroke, inform the triage nurse or EMS or the physician or whomever when was the last time the person was “normal.”  What time did the symptoms appear or at least when was the last time the person was seen being normal.  This will help the doctor determine if the patient is a viable candidate for some of these treatments.  The window for TPA (the clot buster) is around 4 hours, the recommendations are changing from 3 hours to 4.  Mechanical thrombectomy, removing the clot physically, has a window of around 8 hours but is also dependent on many factors such as the person’s ability to even have surgery.  Hemorrhagic stroke, as I said, is also fixed mechanically and the sooner the better. 

So anyway, I am hoping this information will prove useful to everyone.  Be safe people and I honestly hope this information will never be of use to you.