Thursday, 26 April 2018

Nurse Expert Advice, Nursing Skills, Nursing Guides

Nick Angelis doesn’t get much flak from doctors or other nurses because he has built himself to be eccentric and people never know what will come out of his mouth. 

“I work with an improvisation group, and I do a lot of writing and acting. People bully those who they think will cower. If they aren’t sure how it will go over with certain people, doctors will pick out the weakest,” he says.

Angelis, C.R.N.A. and M.S.N., is the author of How to Succeed in Anesthesia School (and RN, PA or Med School) and co-owner of the Florida-based BEHAVE Wellness, which trains individuals and corporations about bully prevention.  

What is considered inappropriate behavior?

As a nurse, he has seen his fair share of bad doctors who bully, throw things, get in people’s faces, and make workplaces miserable for others and a whole bunch of other bad behavior. 

Understanding what is considered inappropriate behavior could be the first defense against a difficult doctor. According to Jacksonville, Fla., University, disruptive behavior from a physician can encompass abusive, demeaning or profane language; rage or violent behavior such as throwing objects and physical abuse; insulting or disrespectful comments to or about staff, patients or families; inappropriate sexual comments or touching; repeated failure to respond to calls; and failure to take recommended corrective action.

What should you do if you feel unsafe? If you do feel unsafe with a doctor, Angelis says that most hospitals and workplaces these days have policies in place for these situations. 

“If you go to your boss or the human resource department and say, ‘I don’t feel safe right now,’ or ‘this is a toxic environment,’ most the time every management will pounce on it right away,” he says. 

When should you report inappropriate behavior?

Nurses are masters of hiding their true feelings, Angelis adds. But when something doesn’t feel right, and you have to start walking on eggshells at every move around a doctor, it’s time to say something. Also, you need to get to know certain doctors to understand if they are just being a jerk temporarily and let it roll off your back, he says.  

If the situation allows you to talk with that doctor before turning them in, then do it. Stand up for yourself and explain what that person did to you. If things don’t change, then go talk to a superior. 

Here are some tips to help your situation with a bad behaving doctor:


The end goal is to have a better workplace for yourself, Angelis says.

“No one can work endlessly at a job always going with righteousness and truth. Sometimes, you just need to get along opposed to having right on your side all the time.” 

The Type A personalities will confront bullying, and the others will hope it goes away, Angelis adds.


When people around you and in the administration don’t care that the doctors are bullies, then it’s time to find another job. Sometimes, that’s easier than making a fuss. Being honest in an exit interview can be the tough part, especially if you are in a highly specialized nursing area. You don’t want to burn any bridges, he adds.


Angelis uses flippancy, apathy or goofiness, and it has worked for him. Several times, he has said to a ranting, raving doctor that “This isn’t as a big of deal as you think it is.” That is a more direct confrontational way. If you take that approach, it’s not giving the doctors the benefit of worrying about something. You are basically saying to the doctor that they are overreacting, he said.


Hear what it’s like at prospective employers and how not to be an easy, lonely bullying target, Angelis says. Compare the rumors and opinions of several people to get closer to the truth. 


“I have a great sense of humor and an absent sense of drama,” he explains. “I find fun in situations that others would find dreary or stressful, and I don’t get offended easily.” 

This combination allows him to work long hours in difficult situations long after his peers are burned out or discouraged. Someone not as random or carefree needs to mentally prepare for an always shifting work environment. This way, you’re not making drama over petty, possibly misinterpreted behavior from physicians. 


When Angelis has had a doctor get misbehaving, he would look really seriously at them and say things like, “Cheetahs can only charge at 65 mph for about a quarter mile, but the key is in the flexibility of their spine.” They get unsettled trying to find the passive or aggressive meaning behind his nonsensical statement and then leaves him alone. 


Doctors have bad days, too, and sometimes, those stresses make them say and do things against those around them – just like everyone else. Angelis says that even nice people who get unhinged at work are finding their self-worth from that. It’s much harder to force good behavior from someone whose very identity is tied to their clinical performance, he says.

Angelis has found through the years and through bullying research that no one needs to feel like they have to be the crusader if they take some other job. 

“The Type A personalities will confront bullying. The others will hope it goes away,” he says.
Q. When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include:

A. increased coronary artery blood flow.
B. decreased posterior thoracic curve.
C. decreased peripheral resistance.
D. delayed gastric emptying.

Correct Answer: D

Explanation: Aging-related physiologic changes include delayed gastric emptying, decreased coronary artery blood flow, an increased posterior thoracic curve, and increased peripheral resistance.

Wednesday, 25 April 2018

Question Of The Day, Medication and I.V. Administration
Q. A client is scheduled for an excretory urography at 10 a.m. An order directs the nurse to insert a saline lock I.V. device at 9:30 a.m.. The client requests a local anesthetic for the I.V. procedure and the physician orders lidocaine-prilocaine cream (EMLA cream). The nurse should apply the cream at:

A. 7:30 a.m.
B. 8:30 a.m.
C. 9 a.m.
D. 9:30 a.m.

Correct Answer: A

Explanation: It takes up to 2 hours for lidocaine-prilocaine cream (EMLA cream) to anesthetize an insertion site. Therefore, if the insertion is scheduled for 9:30 a.m., EMLA cream should be applied at 7:30 a.m. The local anesthetic wouldn't be effective if the nurse administered it at the later times.

Tuesday, 24 April 2018

Question Of The Day, Basic Psychosocial Needs
Q. A worried mother confides in the nurse that she wants to change physicians because her infant is not getting better. The best response by the nurse is which of the following?

A. "This doctor has been on our staff for 20 years."
B. "I know you are worried, but the doctor has an excellent reputation."
C. "You always have an option to change. Tell me about your concerns."
D. "I take my own children to this doctor."

Correct Answer: C

Explanation: Asking the mother to talk about her concerns acknowledges the mother's rights and encourages open discussion. The other responses negate the parent's concerns.

Saturday, 21 April 2018

Question Of The Day, The Nursing Process
Q. When developing a care plan for a client with a do-not-resuscitate (DNR) order, a nurse should:

A. withhold food and fluids.
B. discontinue pain medications.
C. ensure access to spiritual care providers upon the client's request.
D. always make the DNR client the last in prioritization of clients.

Correct Answer: C

Explanation: Ensuring access to spiritual care, if requested by the client, is an appropriate nursing action. A nurse should continue to administer appropriate doses of pain medication as needed to promote the client's comfort. A health care provider may not withhold food and fluids unless the client has a living will that specifies this action. A DNR order does not mean that the client does not require nursing care.

Friday, 20 April 2018

Question Of The Day, Gastrointestinal Disorders
Q. Which of the following laboratory findings are expected when a client has diverticulitis?

A. Elevated red blood cell count.
B. Decreased platelet count.
C. Elevated white blood cell count.
D. Elevated serum blood urea nitrogen concentration.

Correct Answer: C

Explanation: Because of the inflammatory nature of diverticulitis, the nurse would anticipate an elevated white blood cell count. The remaining laboratory findings are not associated with diverticulitis. Elevated red blood cell counts occur in clients with polycythemia vera or fluid volume deficit. Decreased platelet counts can occur as a result of aplastic anemias or malignant blood disorders, as an adverse effect of some drugs, and as a result of some heritable conditions. Elevated serum blood urea nitrogen concentration is usually associated with renal conditions.

Thursday, 19 April 2018

My husband and I are both travel nurses and we started our journey in San Francisco. We got a taste for the real estate there when we found a studio apartment in the city for…wait for it…$2,600 a month. Yup, all 400 square feet of it. It was furnished, allowed dogs, and was leased to us for 3 months.

Travel Nursing, Nursing Skill, Nursing Pros and Cons

After a few weeks into our assignment, we became inspired to buy a Volkswagen Westfalia Vanagon, one of those nostalgic buses that look super cute on Instagram (#vanlife.) We bought a big orange one and used it as a means to see the country. We’ve used it to take multi-week road trips, as a temporary apartment when on assignment, and as a daily commuter.

This little van gave us a taste of setting up a portable living situation when going travel nursing and while living in this 60 square foot space was definitely challenging, there are many travel nurses that are doing it right! If you are considering taking your RV, camper, or any other home on wheels to your next travel assignment, add the following pros and cons to your research!

The PROs

It’s all about the money, honey.

Cost of renting an apartment can be steeply more expensive especially when renting apartments in highly populated areas. From deposits to pet fees to up-charges for short-term rentals, these costs all add up and don’t “go anywhere” in comparison to spending the same money investing in an RV or RV-like home. If you’re able to get your hands on a deal for a mobile living space - your savings have begun. Oh and that housing stipend? Straight to the bank, baby. 

The space is always yours.

No matter what happens, you always have a furnished space that feels like home. You know exactly where everything is. You know the intricacies and the idiosyncrasies of your space. And for all my healthcare germaphobes out there – you at least know that it’s only your cooties you’re dealing with, and not any previous unknowns.

Paws and portable snuggles. 

We have always traveled with our two dogs, and from experience, transitions are the hardest on them. The quicker we get into a routine, the better for their digestive systems – and our sanity. When we’ve moved around in our VW van, however, our home stays familiar to them and they go through a more minimal period of acclimation. The tricky part is keeping the space cool, especially during times when we leave for the day or night.

You get to change your mind as easy as one, two, free. 

There are a lot more RV parks than you’d think! If you claim your stake somewhere and decide you’re not vibing with it after a few weeks, you have all the freedom to pick up and head out to the next park that has a cafĂ© and a swimming pool. (Seriously, don’t underestimate RV parks. There are some pretty sweet ones out there.)

Greater connection with the outdoors. 

This comes naturally when living in a mobile space. It’s easy to get good sunlight and campsites typically have picnic tables and other outdoor amenities that draw people to enjoy the outer space. In contrast, it’s easy to get cooped up in an apartment, and there are way too many first-floor units out there that don’t get enough sunlight…even in the sunniest of cities.


You don’t get to move into a space that’s unique to that city.

Sometimes, I want to get a feel for the city, which to me means living in a space unique to that area, carving my place in the local community of permanent residents and transients alike. It makes me feel like I am truly “living” in the city, not just passing by.

You carry everything with you, like a turtle and its shell. 

There’s something kind of freeing about only packing your clothes, laptop, and yoga mat when you move somewhere for three months. Walking into furnished apartments and setting up life doesn’t take but maybe half a day, and when the assignment is all done, packing up and peacing-out is a breeze. Maybe you even board a plane and hit up your next destination without a second thought.

What’s your bathroom situation?

You could have one of those sweet RVs that have a shower and toilet (and maybe even a tub). Or the camping site may have community showers and bathrooms. But if you’ve parked your VW Westy in the hospital parking lot like we did for a bit, you better get creative about how to stay hygienic and how to manage your waste. We have spent many weeks showering after work in the cath lab employee bathrooms, using a bucket and kitty litter when the going was inevitable, and stocking up on enough scrubs to make it through a couple weeks without needing to visit a laundry mat. Ideal? Not really. Adventurous? Arguable. 

Any breakdowns and it’s your issue. 

This is true of any renter vs owner situation. If you’re renting and the pipes freeze, your landlord better be high-tailing it over. But if you didn’t take proper precautions of your camper and find out the hard way about cold weather, now you’re shouldering that cost and labor, and it may not be pretty. Not to mention breakdowns that could happen in-transit; if you’re on deadline to make it to your first day, you may find yourself ditching your kombi - with half of your things in it - at a storage facility en route to your next assignment, coming back to save it later (been there, done that).

Storing the thing.

What do you do with this home on wheels when you’re done with it? If you’ve got a place to park it in between assignments, you’re set. But sometimes parents’ homes are already overcrowded with cars and a 5th wheel doesn’t do much to help. Also, if you take an extended break from using it, you must stay mindful of sun-damage, mold, and other unfortunate things that could happen when a space goes unoccupied for long.

The Bottom Line

When you decide to go travel nursing, you must ultimately do what makes you happiest; this will get you through the toughest time of either option - and there will be tough times. Whether it’s fixing the AC on your home at a truck stop in 100-degree weather, or when you’re on your hands and knees scrubbing your apartment floor (after spending all day moving out) in order to avoid the $300 fee your complex will charge you if you’re unit is not “move-in ready.” Make the decision that best speaks to your soul (and your wallet) and those rough times will all be worth it!
Q. The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect which of the following?

A. Increased forced expiratory volume.
B. Normal breath sounds.
C. Inspiratory and expiratory wheezing.
D. Morning headaches.

Correct Answer: C

Explanation: The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations, there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found with more advanced cases of COPD and signal nocturnal hypercapnia or hypoxemia.




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