Wednesday, June 25, 2014

Free Hurst Review lectures

1) Introduction

2) Fluid Electrolyte (Lecture)
 

3) Acid base (Hurst)

4) Pediatric review (Hurst)
Pediatric Review (Lecture Note)
Pediatric Video I
Pediatric Review II

5)  Psychiatric Review (Hurst)

6) Burns Review (Hurst)

7) Respiratory Review (Hurst)

8) Maternity Review (Hurst)
Maternity Review 

9) Oncology Review (Hurst)
 Oncology Review

10) Orthopedic Review (Hurst)

Orthopedics Review
11) Neuro Review (Hurst)
 Neuro Review

12) Burns Review (Hurst)

13) Cardiac Review (Hurst)
Cardiac Review

14)  Endocrine Review (Hurst)
Endocrine

15) Strategic Review (Must Review)

Wednesday, June 18, 2014

Whose fault is it? and what is wrong if you think little outside the box?

           Nowadays I do have lots of free time since I am in transition of looking for new job, hence most my time is in computer doing school work and facebooking. While going through the facebook, I found this article titled, " 15 Dumbest Patients that doctors have had to deal with. Faith in humanity lost."http://www.tickld.com/x/15-dumbest-patients-ever. I usually don't click on these kind of links but when you have nothing to do, you do everything that you did not used to do. Invested my time to read all those 15 points, while going through each and every it made me to think about our healthcare system and our generation. Our generation thinks that we know each and every aspect of life and if someone does not know anything that we know, we think they are dumb or crazy. There are lots of nurses and doctors out there who does not know where exactly is Nepal, some even does not know that Nepal is a country, and some even does not know that Nepal even exists. That does not mean that those nurses and doctors are dumb for not knowing geography, that's what exactly my point is. If you know all the medical stuff that does not mean you know everything about other stuffs. The patient/person you are referring as dumb may be a farmer who knows each and every thing about farming and he may be your source who is helping you to have a food in your dining table tonight.
        
Here are the some scenarios that I want to talk about:

1) " I once had a 20 year old female patient who didn't know that having sex would lead to pregnancy. She had no idea."

            After reading this point thousands of people might have laughed and shared the story to other coworkers. That 20 year old female may be from different culture or may follow different religion. She might have been not only in abstinence but also restricted from sex education. If someone does not tell you or if you are not allowed to learn about something, how are you going to learn about sex? For those girls, someone who knows about sex when they are 12 years old and gets pregnant when they are 13-14 are crazy and dumb. But in reality no one is dumb or crazy, it is just the reality of different culture, level of education, and their experience of life.

2) " After looking at the patient's chart and seeing she had diabetes
Me: Do you have any medical conditions?
Patient: No
Me: Are you sure, you've never been told you have any disease
Patient: Never
Me: What Medications do you take?
Patient: Insulin, for my diabetes

           What you all think about this conversation, your first reaction may be what?, really? seriously? lol? and so on...... but think from the other side, think as a patient perspective. That patient did not go to medical school or nursing school nor worked in a medical field. None of her family members have any experience about medical terminology. When patient was first diagnosed with diabetes, did any of the medical person sat down and educated the patient about his new diagnosis. Did anybody informed the person that diabetes is a medical condition, or a disease. May be those nurses or doctors were too busy saving lives, that is our excuse most of the time.  Whose fault is it now in this situation and who is dumb or crazy. Hence, before you laugh and say someone crazy/dumb please try to think out of the box and try to stand on their feet.

3) "A middle aged lady in the operating theater once told us at the last minute (as she was being wheeled in) that she's allergic to latex. Everyone freaks out cos so much of the stuff we use in theater has latex in it, so we take her to the latex free theater and do her surgery there. When she's in recovery and awake I enquire as to what reaction she has to latex. " I just don't really like the sound the latex gloves make, dear". I just turned around and walked out."

       If I was that nurse/medical personal who heard that little lady saying she is allergic to latex, I might have same reaction or I might have walked out. But, if we think and evaluate it it is nurse's or that medical personal fault, who asked if patient have any allergic reaction or but does what kind of reaction, or verify it with patient chart. If someone at least had asked what kind of reaction? then they would not have gone through extra hassle.

4) "20- something year old patient comes to ER, chief complaint on the board is "private." This should be good. Go in, he is visibly depressed and sad. Tells a story about how he slept with a women, didn't use protection, and after he noticed she had a "plastic box on her." When she told it was an insulin pump for diabetes he was mortified. Came in immediately to be tested for diabetes. "

      This is similar to the first point I discussed here. It is lack of education. That patient is not aware of disease process of diabetes. If you think as a normal person without any knowledge of medicine, if you get HIV through sexual transmission why not another disease like diabetes. What is our responsibility here? provide education. There is still stigma around HIV it gets transmitted through mosquito, by sharing room and personal items with patients etc. Shouldn't we provide more education. 

5) " Don't eat or drink anything after midnight" Before his 3 year old daughter's surgery the next morning (tonsils and adenoids). While intubating his daughter the next morning, she vomited scrambled eggs, causing her to aspirate them into her lungs. Her heart stopped, and I did chest compressions on her for 25 minutes. We got her back, aborted the surgery, and transferred her to pediatric ICU on a ventilator. Her father's response..." she said she was hungry. I thought you were being too hard on her. It must have been something you did to her."

     We provide education in a way how we want to hear, but providing education means to provide education in the way how that person is going to take it. Do not eat or drink anything after midnight. That is not a education that is instruction or better an order that you are giving to the patient/ family members. You should provide an education when you verify with the patient/family members did they really understood what you are trying to teach. That medical doctor/nurse/ medical representative should have given extra 2 minutes to describe reasons for not eating before surgery. Also another questions arise, did anyone asked the father if patient have eaten anything that morning before surgery. May be not, because we think according to our way, if I said not to eat, patient might not have eaten, right?

6) "The best was the women who was feeding her 3 month old dog every few days for no other reason than she thought a dog should only eat that often. Came in for hypoglycemia(0f course). 
The nurse who spoke with her has no patient for this kind of jacked ignorance, and actually shouted at her "DO YOU EAT EVERY THREE DAYS!?""

      May be she has dementia like our grandmother or grand father have, may be that patient have some psychological problems that might have been ignored by the medical personals. And she might have genuinely thought that's how you feed dog.

 7) "Once had a patient who was prescribed an inhaler for his cat allergy. He came back a week later saying he was none the better. Turns out he was spraying the inhaler on his cat. 

--see below


8) " My favorite was when someone was prescribed estrogen patches and told a stick one patch on herself every other day. At the next follow-up she said she didn't like the patches because she had been running out of space." I didn't think to clarify to her that she should have been placing a new patch and removing the one from yesterday each day. Very amusing. She indeed was covered in sticky patches.

      During my last three of nursing career, I had a great group of co-workers, leaders and supervisors. I learned a lot from them, and still I have to learn more. One of the story that one of my supervisor shared was almost the same like above two. This gentleman came back to ER stating that he did not liked taking suppository for his constipation because it tasted bad. (By the way suppository should be inserted anally.) While she was saying the story she was not laughing and she was not pointing that patient as a dumb or crazy. She had a chance to learn something new during her initial nursing career and teach us about nursing education citing the story. In all the stories described above in points 7 and 8 and story of my supervisor's patient reflects that we are still lacking with good education in healthcare for our patient population. It's not even education. it's 10 second instruction. We still need to be more clear and concise with our patients. Put a patch every other day means putting a patch every other day, we also need to explain them that old patch needs to be taken out before patient applies the new patch. If that inhaler was the first prescription for that patient, we lacked to provide education how to use the inhaler, that's why patient came back to ER. That is not good for patients and also not good for the hospitals. We are using the resources that are always in shortage for some of the stuff that did not need us due to our own fault or negligence.

Out of those 15 examples, I talked about 8 of the above, that I thought there is lack of education for our patients, and lack of our common sense, since we do not think out of the box. Please start thinking something different than you think and please at least start to think what's going on the other end. It is just a feelings and thoughts that I shared here, no one have to think like me and no one have to agree with me too. I may not know how the plants of my favorite foods look like and I still enjoy it and I think a farmer does not expect me to know how those trees look like.

Thank you
Smita Sharma
Indiana.

Thursday, June 5, 2014

Kaplan's Video about NCLEX RN test.....

I really got surprised when I saw these videos yesterday. You might be surprised with the fact that I passed my NCLEX more than two and half years ago, but I do constantly do researches for the NCLEX resources to assist new graduates and for those who is planning to give the test. These Kaplan videos by Barbara Irwin, MSN, RN will be really helpful for you all. First video is overall about the NCLEX test and will help to decline your stress and fear, and will answers lots of questions that are arising in your mind about NCLEX