Phil Sones, RN

03/14/2022

Hi all - sorry I haven't posted in awhile. Today I thought I'd share a few tips on something just about every nurse needs to stay sharp on - starting an IV!
Tip #1 - Selecting a site. I always try to AVOID THE AC, if at all possible! If you place your IV in the AC, every time your patient bends their arm, it will kink the catheter and stop your IV flow. You'll have to deal with constantly silencing your pump and having to remind your patient to straighten out their arm.
Tip #2 - You will find veins with bigger lumens as you go more proximally (again, try to avoid the AC). You can always go for veins in the hand, but these tend to be smaller and more fragile.
Tip #3 - Use a warm pack or heated towel to apply to your patients arm for at least 5 minutes. This causes the veins to swell and give you a better target. Remember not to get your warm pack too warm, or you could burn your patient. If it's too hot on your own arm, don't put it on your patient!
Tip #4 - Anchor "roly poly" veins before you attempt a stick. This is common with elderly patients who have less collagen to anchor their veins under the skin. It works better if you apply traction perpendicularly across the vein vs. stretching the vein lengthwise.
Tip #5 - Apply your tourniquet NO MORE than 6" from your selected site to maximize vein distention.
Tip #6 - Watch out for valves in the veins and avoid them - a catheter tip up against a valve will not allow your infusion to flow properly, and you usually can't advance your catheter tip past the valve unless you "float" it in with saline - and this is super tricky to do.
Finally - practice, practice, practice!
If you have any tips you'd like to share - please feel free to post!
Happy hunting!

02/25/2022

Answer to the rhythm strip quiz: it's Second Degree Heart Block, Type I (also known as Wenckebach's). It's distinctive because the PR interval gets progressively longer until a beat (QRS) is dropped.

02/23/2022

Can you identify the following heart rhythm?

02/19/2022

The nurse asked the little southern lady how her breakfast was. "Well, I suppose it was all right, but I really didn't care for that Kentucky jelly." the lady said. The nurse was puzzled until she looked at her breakfast tray and saw an empty packet of KY jelly!

02/15/2022

02/10/2022

MASD or Moisture Associated Skin Damage, is something just about every nurse or caregiver will encounter at one point or another in their practice. MASD is caused by prolonged skin exposure to moisture and/or irritants such as urine, f***s, perspiration, wound exudate, etc.

There are several sub-classifications of MASD, including:
- Incontinence-associated dermatitis (IAD)
- Peristomal dermatitis
- Intertriginous dermatitis (intertrigo)
- Periwound maceration.

I'd like to ask you all to share differing ways you have found to be effective treatments/prevention, of MASD. What products and techniques seem to work the best for the specific condition present?

Please post your thoughts in the comments below!

02/04/2022

Has Omicron Peaked in Montana?

According to data published graphically in the Billings Gazette yesterday (2/3), it appears the numbers of new COVID-19 cases reached a peak of 2,408 on Jan. 28-30, and as of Feb 2 dropped down to 1,663. Does this mean we have put the worst behind us?

Not necessarily. We could still see some continued spikes in cases, but the numbers do look (somewhat) encouraging. One really encouraging set of statistics reveals Omicron to be a much milder variant of COVID-19 versus the Delta variant, i.e. it causes fewer deaths and ICU admissions.

On the other hand, Omicron is so contagious that hospital admissions have increased compared to figures from a year ago. One factor affecting the numbers is that people are getting vaccinated, and this is seen as a factor in preventing the disease from progressing to more serious complications.

Data from the Governor's office last week showed a correlation between the vaccine and improved outcomes: 82% of Montanans hospitalized with COVID recently are unvaccinated, as well as 78% of deaths.

01/28/2022

As of yesterday, I have joined the ranks of those who have been diagnosed with COVID-19. I did get both my shots, so hopefully I'll get through this quickly. I came home from work on Wednesday with just an irritating tickle in the back of my throat and a dry cough. This progressed to full-blown flu-like symptoms over the next few hours - fever, headache, body aches, and fatigue. Thank goodness no breathing problems! I feel a little better today, but still have a headache, cough, and low-grade temp. From what I've heard the cough can hang around for a long time.

Please feel free to share your personal experiences with COVID by commenting below.

01/27/2022

Stress Reduction Tips - Part 4

This week’s tip is Eat Your Way to Lower Stress

Now, that might sound counterintuitive. Many folks "stress eat" – in other words, when they feel stressed, they eat foods high in carbs or sugar to trigger feel-good hormones.

But eating foods high in antioxidants can actually help lower anxiety levels.

The stress response that causes generalized anxiety disorder (or "GAD," the most common type of anxiety disorder) involves antioxidants.

A brand-new study from the Journal of Affective Disorders showed that anxiety is associated with higher levels of oxidative stress.

Oxidative stress results from too many "free radicals." These damaging molecules bounce around your system, trying to pull electrons off healthy pieces of your cells. Too many free radicals can lead to massive damage. They alter your proteins, fats, and even DNA. They also can cause inflammation and cancer.

The trouble is, free radicals are byproducts of everyday living. But we can create an excess of free radicals by eating certain foods and exposing ourselves to things like medications, air pollution, and alcohol, or even by exercising too much.

Our bodies make antioxidants to fight these free radicals. They work as scavengers, seeking out and neutralizing the radicals, restoring order to the body. But sometimes we don't make enough.

Now, this study is an association only. However, other studies demonstrate the likely cause. An Indian study a few years ago looked at blood-serum levels in folks with and without GAD. Those with GAD had lower levels of vitamins A, C, and E. What's more, after receiving appropriate supplements of these vitamins, these patients experienced fewer and less severe symptoms of anxiety.

Because free radicals contribute to inflammation, which triggers a stress response, it makes sense that fighting them with antioxidants will help relieve stress.

That means you should eat an antioxidant-rich diet. The best way to get antioxidants and vitamins like A, C, and E is through whole foods. Plenty of fruits and vegetables provide these. In fact, my favorite, blueberries, are high in antioxidants including vitamins A and E. Vitamin A foods include salmon, butter, and hardboiled eggs. Vitamin E comes in leafy greens, nuts, and seeds. And you can get vitamin C from cruciferous vegetables (like broccoli), tomatoes, and tropical fruits like kiwis, papayas, and guavas.

Similarly, avoid inflammation-triggering foods. That means processed foods and the "white killers" (white flour, white sugar, and white rice).

For more information on the benefits of eating a whole foods diet, see Dr. Philip Ovadia's book: Stay Off My Operating Table below!

I hope you all got some value from this series! If you have stress-relief ideas of your own you'd like to share - please feel free to post!

01/26/2022

The Raptor Rescue Emergency Shears by Leatherman are AWESOME! Perfect for ER/EMS/Trauma professionals...

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