Featured

Story Time About the Dog and His Owner.

"You must give everything to make your life as beautiful as the dreams that dance in your imagination"-Roman Payne.
My handsome big dog dedicated to his owner.Runs errand for the owner.
The dog is asked to go into the house and bring kola nut(this could be anything for
entertainment)

It is a bedtime story about a dog and his owner.The owner surprisingly had visitors that they were not expecting .So the owner started a song like this.

My handsome big dog go into the house in the living room and get me some kola nut, so that we can give to these uninvited visitors.I did not invite them and I am sure that you did not invite them.So come on big boy go into the house and get me some kola nut so that we can give to these strangers.Hopefully the kola nut will force them to tell us why they are here.

So the dog went into the house and got the kola nut.The uninvited strangers ate the kola nut.After eating the Kola nut (coca cola) they confessed that they are interested in buying the piece of land in their backyard so that they could be their neighbor.Sometimes a kind gesture can lead to meeting pretty nice people.The dog owner told them that she owns the land but the land is not for sale.So they left back to where they came from.The big dog and his owner live happily there after .The End.

Featured

My Honor As A Nurse.

On my honor as a Registered Nurse.


I will provide compassionate excellent Nursing care.

I will do my best now and tomorrow.
Be a good leader,not a follower.
I must Move Nursing Agenda Forward.
I must do my Best all the time.
I promise to update and obtain required CE every two years.
Advance my knowledge,education,and experiences.
I will be Knowledgeable not Knowledge Deficit.
Team player,work effectively with my colleagues and other ancillary.
Clock or sign in on time.
Clock or Sign out on time. Have all my equipment such as Stethoscope,Pen and Pencils.
I must Reason,and be Reasonable.
Perform my assigned role effectively and efficiently. Follow Hospital policies and Regulations.
Comply with JCAHO Standards of Care and Regulations.
Carry out Doctors Orders on Time.
Troubleshoot and be Supportive of my Colleagues. Know and Understand Patient Bill of Rights.
Respect Patient and Families. “The very First Requirements in a Hospital is that, it should do the sick no harm “Florence Nightingale .
Give medications by mouth and intravenously as ordered. Advocate for my Patients.
And provide TLC.
Must not Abuse Patients Physically, Emotionally or Sexually.
Promote Health and Prevent Diseases.
“I attribute my Success to this -I never gave or took any excuse”- Florence Nightingale .
Nursing Assessment.

STORY TIME. (Unpreparedness )

Once upon a time, there live a man who has no plans or goals,but he has confidence.So when his age mates started to get married,then it hit him that he also need to get married.Where are all my beautiful girlfriends.

It is time to get married, so he called the first girlfriend and she replied.Sorry I am married with children.He called the second girlfriend and she said the same thing.Then he called the least of his girlfriends and she replied sorry I am engaged.

Mr Confidence looked up and he look down.He has no solution. It seemed like he is beginning to loose his confidence.He said to himself I know what I am doing.I am Mr Confidence. But he quickly and quietly ran to his brothers, friends and sisters but they could not help him.So one day his nephew decided to help him.

She brought a beautiful Snake with multiple colors and he fell in love with the snake immediately.It was love at first sight or infatuation or a little bit of both.

So he planned for their wedding, organised and arranged everything but on the wedding day the snake refused to show up.So the wedding was cancelled.

She didn’t show up because she does not want people to see her.

She (snake ) moved in and they live together. As time goes the snake started to show her true color and he began to complain.

I did not know this side of you my wife.The Snake replied,I am the same is just that you did not look or pay attention.So he kept quiet.Two months later the Snake transferred all the money from their joint account to her account.He complained and the Snake replied, you are beginning to upset me.This is me, I did not change.Why did you transfer our money into your account.The Snake replied look before you leap .We have been together for ten years if you want separation let us go for it.

Mr Confidence started crying, I should have planned, I should have built my house on a solid ground.Where is Cecilia? Where is Jennie.These women were there for me,when I needed support.Mommy, daddy I am sorry I didn’t listen to you.

How can I make up for the lost love?How can I make up for the lost time.I thought that my good look and confidence will take me to the promise land.Who is this woman.Now I realized that I needed to be prepared to be able to embrace opportunities.Oprah Winfrey said this a lot.But I never realized that she is also talking to me.I thought that her message is for college students, losers, or people that lack confidence.

Where did I go wrong?

A house built without Foundation will Fall.

NURSING QUESTIONS(MEDICAL/SURGICAL)

(1) A 40 years old man is admitted to the hospital. Admission orders include heparin 2000unit/hr in 5% Dextrose water.
Since patient is on heparin therapy.Which of the medications listed below did the Nurse need to have available?

(a)Protamine Sulfate.

(b) Warfarin.

(C) Nitroglycerin.

(d) Narcan.

(2)66 years old woman is brought into the Emergency room complaining of pressure in her chest.Her BP 150/96,pulse 89,Respiration 20.The admitting nurse gave nitroglycerin 0.4 mg sublingual as ordered by the doctor.For the nurse to evaluate the effect of this medication, the nurse should expect which of the following changes in patient vital sign.

(a)The heart rate will definitely change with respiration.

(b)BP and heart rate will decrease.

(c )BP 102/60,pulse 94,Respiration 20.That is reduced peripheral resistance,

will lead to decrease BP and pulse will increase while respiration will not change .

(d) Only blood pressure will decrease after getting nitroglycerin three times.

(3)The early signs of left CHF could be.

(a)Dyspnea, crackles and orthopnea.

(b) Insomnia.

(c)Pitting edema, weight gain,and distended neck vein.

(d)Confusion and increased CVP line.

(4) Who do you call when there is a problem with your patient(s)?

(a) You should call the supervisor.

(b) Call the primary or the doctor that is on call.

(c) Call the case manager and social worker ,because they are managers of cases.

(d) Tell charge nurse to call the doctor.

(5)Functions of chest tube drainage include.

(a)Prevention of escape of air from pleural space.

(b)Removal of air from pleural space.

(c) Encourage negative alveolar pressure.

( d) Equalization of air cavity pressure.

(6)Patient was admitted under the trauma team after a motorcycle accident, and he develop small pneumothorax to the right chest.He was placed on three-Chamber water seal drainage system at 20cm suction.

The nurse observed that there is a continuous bubbling in the water seal chamber during inspiration and expiration.

(a) The nurse suspected that there is a leak and notify MD.

(b)Nothing, after all the vital signs are stable.

(c)It was like that in the previous shift and they did nothing.

(d)Patient is  in stable condition.

(7)A 73 years old female sustains a fracture of her left femur in a car accident.

To  treat the fracture ,the orthopedic  doctor performs an open reduction internal fixation.Which of these statement if made by the nurse shows a clear understanding of

the advantages of performing of ORIF.

(a) The nurse educate the  patient and family on early mobilization with this procedure.

Your doctor ordered physical Therapist to help you regain strength and motion on the affected leg.Exercise is important for you to be able to use your leg again.I will medicate you for pain  before PT and as needed.

(b) With this kind of surgery you just need to rest.

(c) Your doctor do not  want you to move but just take your pain medications.

(d) None of the above.

(8) A sixty years old male”s family pushed the call light ,and the nurse went in to respond

to the call light,and the patient complained of shortness of breath  and crushing chest pain.

The doctor notified and ABG was ordered.What result will indicate respiratory acidosis?

(a) PH 7.5,Pao2 90,paco2 60

(b) PH 7.29,Pao2 75,paco2 46.

(c) PH 7.45,Pao2 80,paco245.

(d)PH 7.35,Pao2 76,paco2  56.

(9) Partial Thickness wound can be classified as

(a) Stage IV.

(b) Stage 111.

(c) Stage 11 loss of dermis,shallow open ulcer without slough.

(d)  Wound covered with eschar and some slough.

(10) The nurse received an eighty three years old female from emergency

room with the diagnosis of dizziness.She is very skinny,appeared malnourished,and weight  lost of  5lbs in the last three months.02 @ 3L NC,with a saturation of 93%,alert and oriented x3,stable,breath sound clear ,bowel sound normal.
But there is no doctor orders.The nurse will:

(a) Call the doctor and obtain admitting  orders and make the patient comfortable.

(b) Be patient the doctor will eventually put in the orders.

(c) Notify the doctor,charge nurse ,supervisor and patient family.

(d) A and C.

ANSWERS 1. A Protamine sulfate is an antidote for heparin.It helps to reverse the effect of heparin.

2. C

3. A.

4.B

5.B

6.A

7.A

8 B. Respiratory  acidosis  Because the lung is compromised  and is not getting rid of carbon dioxide so it stays in the blood and the  lung.

9.C

10.D

WHO ARE YOU?(ROMAN 2:5)

You are adamant.

Adamantine.

Hard-nosed.

Hardened.

Yes hardened.

Hardheaded.

Immovable.

Cannot be moved.

Inflexible.

Not flexible.

It is my way.

Or no way.

Implacable.

Self-willed.

Mulish.

In Hebrew you meant “turned away”.Deuteronomy 9:13,Esv.

You are the opposite of humility.

So who are you?.

You are a determination not to change behaviour.

You are against open mind.

“Do nothing from rivalry but in humility count others more significant than yourself “.Philippians 2:3.

“He who is often reproved yet stiffens his/her neck will suddenly be broken beyond recognition”.

You are more resistant to advice or counseling.

In some cases you are good but in most cases you are disaster.

Volcanic mountain that will erupt one day.

Psalm 32:9 “Do not be like the horse or the mule,which has no understanding and must be controlled by bit and bridle”.

Yes I know you,your name is STUBBORN.

But if it comes to following God’s commands

“we should not be stubborn”.

“We must not turn away and stiffen the neck”.

Exodus 7:13-14 talks about Pharaoh stubbornness and the negative impact on his family and the community.

“Stubborness and defiance of God and His ordained authority is a serious offense, one that can spread to family and the community”.

Have you ever thought about why some people are homeless?

Stubborness is the Waiting Room for homelessness.

Because you have everything within your disposal but you refused to listen to advice.

He/she that knows everything will often use basket to fetch water.

“You stiff neck people your hearts and ears are still uncircumcised”.Mark 3:1-6.

NURSING QUESTIONS (Wounds )

(1) Signs of chronic wounds are:

(a) Non healing wound >4 weeks old,lack of viable tissues, no vigorous healthy granular tissue. With dusty wound tissue and magins.

(b)Non viable tissues >4days old.

(c)Dusty wound tissues and margins >4months old.

(d) None of the above.

(2) Factors that can affect wound healing:

(a) Smoking.

(b) Diabetes and PVD

(c)CHF,ESRD,and Hepatic failure.

(d) All of the above.

(3) Infection of wound can lead to:

(a)Excessive pain and worsening of wound bed despite treatment.

(b) Discomfort and pain.

(b) None wound healing.

(c) High blood sugar.

(d)Hepatic Failure.

(4) Dry necrotic wound on the feet should not be debride without consultation of wound specialist.(doctor or specialized wound Therapist.)

(a) True.

(b) False.

(5)Full thickness wound without exposed bony areas, tendon,or slough should be classify as:

(a) Stage 11.

(b) Unstageable.

(c ) Stage 1V.

(d)Stage 111.

ANSWERS 1.A,2.D,3.A,4 A,5.D.

NURSING QUESTIONS (Health Promotion )

(1) The RN assessed her patient and found out that she has clammy skin,cool,and diaphoretic,low blood pressure of 101/58,pulse 115.The first immediate reaction of the nurse is:

(a) Check blood sugar and give dextrose and later give complex carbohydrates.If <60.

(b)Complain about your Charge Nurse and check blood sugar.

(C) Wait for the resource nurse or charge nurse to give dextrose.

(d) Do nothing after all it is normal for the patient.

(2) Normal potassium level is:

(a) 5.5mEq/L to 6.5mEq/L

(b)2.9mEq/L to 3.5mEq/L

(c) 3.5mEq/L to 5.0mEq/L.

(d) A &C.

(3) Flait chest can be caused by.

(a) Osteo Scoliosis.

(b) Multiple rib fractures.

(c)Small pneumothorax.

(d)Difficulty breathing.

(4)For patient with hyperkalemia,the doctor will order:

(a) Phosphate.

(b)Insulin, dextrose(glucose), and kayexalate.

(c)Nacl.

(d)Bicarbonate.

(5) Hypotonic solution is given for :

(a)Normal Blood pressure.

(b)Restoration of fluid volume in the intracellular space.

(c) To support the adequate perfusion of a healthy kidney.

ANSWERS 1.A,2.C,3.B,4.B,5.B

*NB* There are other new medication to treat Hyperkalemia. Follow doctors order.

FOLLOWING GOD’S WORD.

God so love the world,that he gave his only begotten son that whoever believe him will live

and not perish.This is telling us to do the right thing.

Doing the right is easier than doing the wrong thing.

When you are doing the right thing your response will be smooth and direct.

But when you are doing the wrong thing you cannot give a quick response, for example you might repeat yourself then choke a little bit in your own saliva before answering.

Remember the story of Eve in the bible as soon as she did the wrong thing,

they starting hiding away from God.

And he said unto the woman ,yea hath God said.

Ye shall not eat of every tree of the garden.

And the woman said unto the Serpent, we may eat of the fruits

of the trees of the garden. But of the fruit of the tree which is in

the Midst of the Garden, God hath said, ye shall not eat of it,neither

shall you touch it lest you die.

And the the Serpent said unto the woman, you shall not surely die.

For God know that in the day that you eat the fruit, then your eyes shall be as god,knowing good and evil.That is knowing right and wrong.And when the woman saw that the tree was good for food, and that it was pleasant to the eyes and a tree to be desired to make one wise,and she took the fruit ate it and gave some to her husband. Their eyes were opened and they knew that they were naked.They went and hide.(The beginning of deception and lies)And they heard the voice of the Lord walking in the garden. Adam and Evil hide themselves from the presence of God.They have done wrong and could not face the truth.GENESIS 3:1-6.

As a young child you go to pre-school then to elementary school finish, go to middle school, then go to high school finish, go to college.If you do not want to go to College then let your parents know. If you are not going to College then you Must get a job or learn a trade because an idle mind is a devil workshop.This is doing the right thing.

Life is not complicated at all only if you make it to be complicated then it becomes complicated, there are bumps on the roads, there are no straight lines.All these minor obstacles is to motivate,energize ,encourage and force us to focus on the right path.We must not deviate to the wrong path since it leads to pain and suffering.

That is lying over simple thing is not necessary.

For example 08am should be morning but you said that it is evening,

even though that you are looking at your watch. Acts 17:28-29

“For in him we live and move and have our being”.

When you do good you are leaving behind a positive legacy,but when you do wrong it will continue to hunt you and you have left Nothing behind but shame.Anything that is worth doing is worth doing well.Do not suffocate the people you love,your co-workers and friends by not doing the right thing.

For example 1+1=2,2+2 =4, 4+4 =8 ,but 4×4 =16,17×6 =102,5×5=25,30 x7 =210.

There is no confusion.

HUMOR ME (NON NURSING)

Three men with pre-existing conditions died and went to heaven.

On the gate to heaven, angel Gabriel asked the First man what is your pre-existing condition? He replied I have asthma and COPD ,sometimes it is difficult to get some air.

But I feel better when I saw you.God replied pre-existing condition is not accepted here.

We have no room to babysit anyone.Go back on earth and get rid of your pre-existing conditions. Before you will be accepted.

The second man came forward and angel Gabriel asked him about his pre-existing condition.

He replied ,the only pre-existing condition that I have is that, I know that God is the controller of all pre-existing conditions.And I have no other God before him.

God replied you have answered well.So go into my kingdom,relax and enjoy since you have no pre-existing conditions. I created pre-existing conditions and do not want to hear about it.Because you are all qualified before God.”Hear thou ,my son and be wise and guide thy heart in the way” Proverb chapter 23:19

The third man came and angel Gabriel asked about his pre-existing condition.

He replied what pre-existing conditions do you want to know? Are you not the cause of my predicaments?.God replied since you are ungrateful and disrespectful ,I will send you to Hell where there will be weeping and grinding of your teeth.So he left for hell.

This is my humor.Thanks.


NURSING QUESTIONS.(Blood Transfusion).

(1) The nurse admitted a patient with a low blood level H/H 7.3/24.4.

The doctor ordered to transfuse PRBC of one unit.Five to ten minutes into the transfusion,

patient started itching all over,complain of chill and hives.

The first immediate reaction of the nurse(RN) will be :

(a) Tell the patient that this is normal ,and will stop at the end of the transfusion.

(b)Call the charge nurse to assist.

(c)Complain about unfair assignment.

(d)Stop the transfusion immediately and notify the doctor.

(2) The nurse admitted a patient with low H/H 8.1/26.2.

The patient told the nurse that she takes ferous sulfate medication

in empty stomach.What will be the nurse advice?

(a) To take with meal to avoid upset stomach.

(b) Take with orange juice for better absorption.

(c) Monitor for constipation.

(d) All of the above.

(3) The doctor ordered for a 75 years old man to receive two units of PRBC

(Packed red blood cells).The nurse received a PRBC from the Blood

Bank labelled AB+.The patient’s blood type is 0+.

What will be the nurse first reaction.

(a) Return the blood to the blood bank immediately because type 0 can only

receive type 0 blood components but can be a donor for all other blood types.

(b) Patient with AB+ can receive ABO.

(c) I have verified name,ID#,blood type for patient,unit type,

donor type and expiration name.

(d) Let me talk to the Charge nurse and resource nurse first

to see if universal donor is the same as universal recipient.

(4) One unit of packed red blood cell is ordered for patient in room 4300

who is anemic.After the transfusion is started ,which of the following

actions taken by the nurse is most appropriate.

(a) Nurse to stay with patient during the first few minutes of the transfusion

to monitor and recognize early transfusion reaction.

(b) Blood Transfusion should be given  18gauge needle or 20gauge

needle and normal saline solution.
Check vital sign before starting to establish a baseline.

(c) Start transfusion slowly .Signs of reaction are usually seen in the first 50ml-100ml.

(d) All of the above.

(5) A 56 years old woman is to receive two units of packed red blood cells.

At the beginning of second unit patient develops a transfusion reaction.

The nurse called the doctor ,and the doctor ordered benadryl.

The nurse recognizes that the side effect of benadryl is :

(a) Dry mouth. Antihistamine use to relieve allergy activity ,side effect

is drowsiness ,nausea,tiredness and fatigue.

(b) Sleepiness and irritable.

(c) Angry and dry mouth

(d)It is contraindicated to take benadryl while receiving blood.

ANSWERS (1)D,(2)D(3)A (4)D(5)A

NURSING QUESTIONS

(1) The Nurse immediate action for patient admitted with Alzheimer/dementia disease will be:

(a) Assess level of orientation

(b) Put the bed alarm on and ask God why.

(c)Put patient in the sitter room and restraint her.

(d)Complain about your  assignment.

(2) A 68 years old woman had CVA ,and her left temporal lobe is affected.

She is admitted to the hospital.

What should the nurse expect when performing physical assessment of the patient.

(a) The left hemisphere which controls speech ,math skills and analytical thinking is affected.

(b) Nothing is affected except the inability to move the left leg.

(c)The patient cries all the time but cannot talk.

(d)She is a lovely,pleasant patient.

(3)A 64years old man was admitted into the hospital due to nonstop lower back pain.

The nurse placed patient in 30degree position with his hips and knees

moderately flexed. The rationale for this position is ;

(a) Relieve tension at the lumbar-sacral region.Knee flexed relieves pressure on sciatic nerve or disk.

(b) The most important thing is to medicate the patient first.

(c)30 degree position is not recommended at all.

(d) Patient is already old why all the pain.

(4) A 48years old man with rheumathoid arthritis wanted to know why he should perform range of motion(ROM) excercises .The nurse response should be based on the

understanding of the benefits of ROM:

(a) It is a good excercise for the body.

(b) To prevent contractures and deformities .Improve and maintain ROM.

(C) No need for ROM when you are not in the mood.

(d) Range of motion is contraindicated.

(5) A 12 years old boy is discharged from outpatient surgery clinic after a

arthroscopy of his left knee.Non weight bearing on his left leg for two weeks.

He has to use crutches.The nurse teaches the boy how to use crutches.

The nurse should educate the boy that to go downstairs ,he should

(a) Advance the affected leg and both crutches together.And to go upstairs

the unaffected leg first,then both crutches,then affected leg.

(b) It does not matter as long as you are using the crutches.

(c)Use the crutches only o\when necessary.

(d) Why crutches if you can use the wheelchair.

ANSWERS 1 A,2 A,3 A,4 B,5A