Bouvet Legal Nurse Consulting, PLLC

01/16/2023

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01/12/2023

I'm changing our logo! I've come up with a couple of options and I'd love your opinions on them! Please let me know what you think on the 3 pics below. Thank you!

12/31/2022

Happy New Year 🥳! Very excited for new growth and meaningful connections. I think this is my favorite “holiday”. I love the idea of new beginnings and goals met!
Big things coming in 2023 for Bouvet Legal Nurse Consulting ✨
To all of my fellow working tonight - thank you ❤️

11/28/2022

One thing I had a hard time with when I first started out as a baby nurse in a busy Level 1 ED 17 years ago, was reading 12 lead ECGs. We all learned inferior wall MIs in ACLS, but elevation (or depression) in V leads can sometimes be subtle.
I really like this picture. It gives a visual aid to what you are seeing on the 12 lead and how it corresponds to the area of infarction in the heart. When you know which coronary artery (culprit vessel) is being affected, you can often identify not only specific symptoms your patient is having (because they don’t all have “crushing” chest pain) but also what the patient’s vital signs might be doing…or what they are getting ready to do
What have you seen in your practice? Any particular patient event that you’ll never forget?

11/15/2022

Anyone else ever have trouble with AV blocks? In reality, unless you work in the ED, cath lab or a cardiac unit you almost never see much more than a boring old 1st degree…🥱
But - if you have to take a yearly telemetry test you do have to be able to recognize all of them. And I’m a visual learner - so I found this picture helpful!
Also remember - a 2nd degree type II and 3rd degree (complete heart block) are NEVER “normal” and have a high probability of decompensating. Make sure the docs involved are notified. Have pacer pads on your patient, code cart close and anticipate a trip to the EP lab for a permenant pacemaker. And call me - your friendly rapid response nurse 😉
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10/16/2022

Something I see new nurses (and some not so new nurses!) struggle with often is interpreting ABGs (arterial blood gasses). I think it’s because we try to overthink them.
In my role as a rapid response nurse I use them often to guide care. They can be invaluable, especially when the cause of whatever is making the patient sick isn’t obvious. Other times it’s a great way to say - see, I told you so - to a provider when you’re worried about your patient but no one else seems to be!
They are pretty simple, is the patient’s result acidotic, alkalotic? If yes - why? Can we fix it easily or will it require critical interventions?
In our role, as the bedside provider, we know acidosis is more common outside of an ICU setting, and can often be fixed with bipap. Or Narcan. The patient isn’t breathing effectively. Alkalosis is less common, and it often requires a nephrology or GI consult, it usually means the kidneys aren’t working effectively. Or the patient has been vomiting - a lot!
Yes, there is a lot more involved but for our part - it’s determining the basics and what we can do immediately to intervene before the patient gets sicker!

09/11/2022

Can you die from a broken heart?

I had an interesting call about a patient that was not “doing well” on a cardiac PCU (unit outside of the ICU). The nurse was concerned because the patient had developed a fast & irregular heart rate. ECG confirmed atrial fibrillation with a rapid rate in the 160’s. In addition, the patient’s blood pressure was trending down.
One thing I noticed when reviewing their chart, this patient had no cardiac history. A relatively healthy 60 year old. They had recently lost their daughter to an overdose. They were struggling. Their chest X-ray revealed an enlarged heart & fluid in their lungs. We placed the patient on bipap to assist their breathing and transferred to the Cardiac ICU.
A bedside echocardiogram showed a weak and enlarged left ventricle (the ventricle that pumps oxygenated blood into the body).
Eventually they were diagnosed with takotsubo cardiomyopathy. It’s pretty rare, I’ve only seen it 2 or 3 times in my career.

What is it?

“When you experience a stressful event, your body produces hormones and proteins such as adrenaline and noradrenaline that are meant to help cope with the stress.
The heart muscle can be overwhelmed by a massive amount of adrenaline that is suddenly produced in response to stress. Excess adrenaline can cause narrowing of the small arteries that supply the heart with blood, causing a temporary decrease in blood flow to the heart.
Alternatively, the adrenaline may bind to the heart cells directly, causing large amounts of calcium to enter the cells. This large intake of calcium can prevent the heart cells from beating properly. It appears that adrenaline’s effects on the heart during broken heart syndrome are temporary and completely reversible — the heart typically recovers fully within days or weeks.” (AHA. 2020)
When I checked on the patient a few days later they were doing better. The doctors were using IV medications to support the left ventricle and diuretics to get rid of extra fluid - helping “offload” the workload on the heart.
They have a good prognosis to recover, while they continue to cope with the loss of their child.

08/28/2022

I fully admit I’m a about all things cardio-pulmonary! Even at this point in my career I learn something new regularly about our hearts & lungs and I love it!
I think this a great visual and thought I’d share!
Hope everyone is having a great Sunday!

08/24/2022

Let’s discuss ✨prone positioning ✨
This may seem like a random thing to talk about - but we saw it a ton more during the height of the pandemic, and I thought it would be interesting to discuss why, when and how we use it in critical care nursing.
Prone has been a position that has been used sporadically for patients with ARDS (acute respiratory distress syndrome). In my career it tended to be doctor specific and often a “last ditch” intervention for our super sick patients that remained hypoxic (low oxygen) despite max ventilator support.
With ARDS, the lungs become “heavy” with fluid and the alveoli cannot interact with the oxygen rich capallaries. By placing the patient on their stomach, it relieves the stress on the lungs (and therefore the heart) and supports them, allowing for better oxygen exchange.
It’s not without its risks, and any nurse who has cared for these patients can tell you it’s a special kind of scary when you flip them! Worse is when they are in a special bed, called a roto-prone, that looks midevel and makes it next to impossible to see the patient.
As we learned more about how severe covid was affecting our patients, we started encouraging “awake prone”. We’d have non ventilated patients lay on their stomachs, turn themselves. We saw some pretty amazing improvements in oxygen levels for these patients. We also learned the earlier they were prone, the better. No more waiting for them to get so sick it became unsafe to flip them.
I’d love to hear your thoughts about this, experiences you may have had with it and patients you saw do well!
For , if you have a case involving a client that had ARDS and you need an expert to review your case - I’m your legal nurse!

08/23/2022

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I admit I sometimes have trouble with finding balance in my life. Between growing my business, grad school and working full time I sometimes struggle to...

07/25/2022

It’s week! I am so proud to have ventured into this nursing speciality. I’m here to put my 16+ years of bedside experience to work for you and your & clients!
Still not sure all the ways a can help? Message me! I’m here to help 🙌🏻

06/11/2022

Let’s talk NIPPV (noninvasive positive pressure ventilation) 🤗
CPAP is likely the one everyone is familiar with. It’s the device most often used at home for OSA (obstructive sleep apnea). It provides constant pressure to help keep your airway open while you sleep. It’s a cool device and one I’ll discuss again for sure!
BIPAP is a device typically used in a hospital setting that provides positive pressure during inspiration and a lower amount of pressure during expiration. Why would you want pressure during expiration though?
**pulmonary edema (water in the lungs), usually from heart failure. Helps “push” water out of the lungs & into our circulatory system.
**respiratory depression (not taking effective breaths), because of overdose of sedating medications, high carbon dioxide levels (CO2), brain injuries, and other lung/cardiac pathologies. Assists in taking bigger, deeper breaths to move CO2 out & O2 in.
Why do nurses, lung docs & respiratory therapists love BIPAP? Because, when used appropriately, it keeps our patients off of a ventilator (life support)! I wish I could underline USED APPROPRIATELY!
I became a bit of a NIPPV expert during the pandemic! Have you recently had a case involving NIPPV?
If so - I’d love to review it for you!