14 Apr

Cartwheel by bobbipop

credit the artist on deviantART by clicking on the picture.

I like to do cartwheels. I do them all the time. Anywhere, anytime I feel like my heart needs it. On the grass, or on the black top, I am that 4 pointed object wheeling around the lot. Cartwheels are better in the grass. I like to take my shoes off when I do them so I can point my feet to the sky. Seriously, it is all about the heart. I bet when I do cartwheels it increases the venous return to my heart, and that makes me feel good.

I mock trend on my bed all the time too, but cartwheels are way more fun.

I want to go do cartwheels and round-offs right now, but I have to make sure that I know what it is that I do at work every week, and why I do it. I guess that is what certification is. I am already doing this, I already learned it, so I should just pass the test with pretty colors.

There is only 5 questions on the Endocrine system, and they will be about DKA and hypoglycemia.

Here is what I will remember!

When a DKA patient goes pee pee they will dump glucose and electrolytes out and that includes potassium. Insulin drives potassium into the cells. So the patient needs insulin and electrolyte replacement.

Hypoglycemia yikes. Half the time, hospitalized patients are not eating! Feed the patient. We do not have to run and push D50 all the time. That amp of D50 is caustic to the veins, if the patient is awake just feed them!

Hematology and Immunology have 3 questions, that is 2%.

Here is what I will remember!

The rule of 3s cake.

The RBCs x 3=the hemoglobin

The hemoglobin x3= the hematocrit.

If the Hb times 3 is less than the hematocrit the patient is dehydrated.

If the Hb times 3 is greater than the hematocrit there is fluid overload.

Platelets. Bleeding for nothing can happen with platelets less than 25.

For sure I am not inserting a rectal tube into a patient with super low platelets.

Gastrointestinal has 6 questions that is 5% of the exam. Yuck.

GI has lots of information for only 6 questions. Do you remember from nursing school that for acute pancreatitis, Dilaudid is the drug of choice for pain relief because Morphine may cause biliary colic or spasms of the sphincter of Oddi? Yeap, start laughing but I got that question right in nursing school.

There is Ranson’s Criteria to determine mortality and acuity. Acute pancreatitis patients just look sick, and they are sick. Imagine an organ eating itself.

Remember for the test that: Grey Turner’s sign bruising blue around the flank and that Cullen’s sign is around the umbilicus.

The GI hemorrhage, well it really smells bad and that is all I have to say about that. Most of these bleeds are caused by peptic ulcer disease, and next in line is the esophageal varices. Actually, I wonder why coumadin therapy is not on the top of this list, because certainly I care for lots of anemia for the coumadin patient!

Hepatic Failure, is ugly. The yellow, poopy, lactulose, change of mental status climbing out of the bed mess is just awful. The ascites, hypotension and tachycardia is nerve wrecking.

Yeah I am bored now, if you are bored too, well that makes this less painful for me somehow, sorry. I am not going to kill myself writing about portal hypertension, or the lovely memories of that first GI bleeder.  After this is over, I will write some poetry to make up for this pain.

Here are some practice questions. I am not going to write the multiple choice answers because well, I am out of time for that trickery.

1. What is the peak of rapid acting insulin?

60-90 minutes

2. A new diabetic should be closely monitored when taking which cardiac medication?

beta-blockers *can lower blood sugar

3. Treatment of metabolic acidosis from DKA consists of

a.insulin administration

b. bicarbonate

c. low salt diet

d. fluid volume resuscitation

* you can not mask the acidosis with HCO3

4. The patient has a blood glucose of 400, with lethargy and deep gasping resps. The ABG is pH 7.28, CO2 30, HCO3 14 (partially compensated metabolic acidosis) is most likely from:

diabetic ketoacidosis

5.Symptoms of thrombocytopenia include:


6. Ocreotide is often used to control bleeding from esophageal varices, the primary action of this drug is to:

decrease the blood flow.

*it also decreases gastric secretions.

7. An elderly patient is with severe abdominal pain. What should always be ruled out?

bowel infarction

8. Pulmonary complications from acute pancreatitis may include:

ARDS and elevation of the diaphragm and bilateral rales and atelectasis, especially in the left base.

9. Which lab finding is most specific for pancreatitis?

elevated serum and urinary amylase

10. I am not doing this anymore.

Tomorrow I will blast through the neurological section. I already know I have a whacked out limbic system, but I love it. I mean I love my limbic system.

I will go do cartwheels now.

2 Responses to “Cartwheels”

  1. Dennis Hoffrogge August 19, 2010 at 19:26 #

    I enjoy your humor and trying to make this est taking
    a little less boring and stressful

    • seejanenurse August 20, 2010 at 02:25 #

      Well thank you. I like to mix it all together till it becomes one big circle of understanding. Try not to stress, eliminate the wrong answers, and do your best. You can do it.

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