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.

The CONS


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.

Wednesday, 18 April 2018

Question Of The Day, Gastrointestinal Disorders
Q. A home health nurse who sees a client with diverticulitis is evaluating teaching about dietary modifications necessary to prevent future episodes. Which statement by the client indicates effective teaching?

A. "I'll increase my intake of protein during exacerbations."
B. "I should increase my intake of fresh fruits and vegetables during remissions."
C. "I'll snack on nuts, olives, and popcorn during flare-ups."
D. "I'll incorporate foods rich in omega-3 fatty acids into my diet."

Correct Answer: B

Explanation: A client with diverticulitis needs to modify fiber intake to effectively manage the disease. During episodes of diverticulitis, he should follow a low-fiber diet to help minimize bulk in the stools. A client with diverticulosis should follow a high-fiber diet. Clients with diverticular disease don't need to modify their intake of protein and omega-3 fatty acids.


Tuesday, 17 April 2018

Q. The nurse is serving on the hospital ethics committee which is considering the ethics of a proposal for the nursing staff to search the room of a client diagnosed with substance abuse while he is off the unit and without his knowledge. Which of the following should be considered concerning the relationship of ethical and legal standards of behavior?

A. Ethical standards are generally higher than those required by law.
B. Ethical standards are equal to those required by law.
C. Ethical standards bear no relationship to legal standards for behavior.
D. Ethical standards are irrelevant when the health of a client is at risk.

Correct Answer: A

Explanation: Some behavior that is legally allowed might not be considered ethically appropriate. Legal and ethical standards are often linked, such as in the commandment "Thou shalt not kill." Ethical standards are never irrelevant, though a client's safety or the safety of others may pose an ethical dilemma for health care personnel. Searching a client's room when they are not there is a violation of their privacy. Room searches can be done with a primary health care provider's order and generally are done with the client present.

Monday, 16 April 2018

Q. Which of the following interventions would be most appropriate for the nurse to recommend to a client to decrease discomfort from hemorrhoids?

A. Decrease fiber in the diet.
B. Take laxatives to promote bowel movements.
C. Use warm sitz baths.
D. Decrease physical activity.



Correct Answer: C

Explanation: Use of warm sitz baths can help relieve the rectal discomfort of hemorrhoids. Fiber in the diet should be increased to promote regular bowel movements. Laxatives are irritating and should be avoided. Decreasing physical activity will not decrease discomfort.


Saturday, 14 April 2018

Nursing Skills, Nursing Tutorials and Materials, Nursing, Nurse Healthcare

Active shooter incidents are increasing at an alarming rate, and although they occur mostly in public places, at businesses, and in schools, they can happen anywhere, at any time – including in a healthcare facility. These incidents strike suddenly, without warning, and people are usually stunned into inaction. Being mentally prepared will help you to take action immediately on the “Run, Hide, Fight” continuum and could save your own and other’s lives.

An active shooter incident is defined as a situation in which the attacker is “actively engaged in killing or attempting to kill people in a confined and populated area.” The gunman does not come to the area with the intent to commit any other crime. Most often the incident is over within 10-15 minutes, even before law enforcement arrives. This emphasizes why it is essential for ordinary people to know how to react.

Chaos and panic usually characterize the scene – there is noise from gunshots and alarms, people are running and screaming. Even those who are trained initially experience the typical human reaction to fear and anxiety, often combined with disbelief and denial. Many of those who have suffered active shooter incidents say afterward that they didn’t know what to do or that they were just waiting to take the next bullet. Knowing how to react provides the mental preparation needed to gain self-control, recall some of what was learned and proceed to action. A single individual taking the lead can contribute significantly to their own as well as others’ chances of survival.

Run, hide, fight


The essence of action in an active shooter situation is to respond immediately with run, hide or fight – in that order. No one situation is the same and the specific circumstances, including on how close you are to the shooter, will determine the choice of action. One might not make the best decision, but any action is better than doing nothing.

Nursing Skills, Nursing Tutorials and Materials, Nursing, Nurse Healthcare

The idea is to run away from the shooter wherever possible and to encourage others to do the same. Assess exits and have an escape plan in mind. Encourage or help others to escape – a forceful call of “Follow me” or “Gunshot! Get away!” can be used to pull bystanders out of their inertia. However, don’t get caught up by anyone who chooses not to follow and don’t try and move persons who are already wounded. Leave personal belongings behind and keep your hands visible while moving. You can call 911 once you are in a safe space.

If you are unable to evacuate the area the next option is to try and hide away where you will be out of the shooter’s view. Ideally, look for a space where you will be protected if shots are fired in your direction, for example behind a door or a piece of furniture. Wherever possible get into a room and lock the door, which can also be barricaded with heavy furniture. Remain quiet and avoid any noise by putting phones on silent and turning off any radio or television. You can dial 911 if it is safe, even just leaving the line open if you cannot speak. This will assist law enforcement in locating the shooter.

The last resort, if your life is in immediate danger, is to fight. Try to disrupt or incapacitate the shooter by acting as aggressively as possible towards him – yell, throw heavy items at him or even try and take him out with makeshift weapons. While this advice appears counterintuitive, your chances of survival if you can’t escape are much greater if the shooter can be distracted or taken down.

Co-operate with law enforcement officers once they arrive. Their priority is to stop the shooter as soon as possible. They could appear aggressive – they are armed, may use pepper spray or tear gas, shout commands and push people around. Follow the officers’ instructions and answer their questions promptly. The information they need is the location of the shooter/s, how many there are, and the type of weapons if known. Don’t try and get information from them, expect them to guide you or to attend to the wounded. Put down anything you may be holding in your hands, even bags or jackets, raise your hands and keep them visible.

Give help once it is safe


Injured people can be attended to once it is safe. As a nurse, you could provide life-saving assistance, such as quick hemorrhage control, while waiting for emergency medical staff to arrive. Bear in mind that once the shooter is incapacitated or arrested the location is a crime scene and nothing should be moved or touched except in relation to helping the injured. After initial treatment, casualties are usually moved to a central assembly point where a mass casualty plan will be implemented. Here you can also help in line with your knowledge, training, and skills.

Every healthcare facility is required to have an emergency action plan, and most of them conduct training exercises to prepare staff for emergency situations. These exercises are often limited to evacuation drills in the case of fire or bomb threats. The current reality, however, also calls for activities to prepare staff on what to expect and how to react in an active shooter situation. Arrangements can also be made with one of the various agencies to provide staff with active shooter preparedness training.
Question Of The Day, The Nursing Process
Q. During the health history interview, which of the following strategies is the most effective for the nurse to use to help clients take an active role in their health care?

A. Ask clients to complete a questionnaire.
B. Provide clients with written instructions.
C. Ask clients for their description of events and for their views concerning past medical care.
D. Ask clients if they have any questions.

Correct Answer: C

Explanation: One of the best strategies to help clients feel in control is to ask them their view of situations, and to respond to what they say. This technique acknowledges that clients' opinions have value and relevance to the interview. It also promotes an active role for clients in the process. Use of a questionnaire or written instructions is a means of obtaining information but promotes a passive client role. Asking whether clients have questions encourages participation, but alone it does not acknowledge their views.

Friday, 13 April 2018

Q. Which of the following client statements indicates that the client with hepatitis B understands discharge teaching?

A. "I will not drink alcohol for at least 1 year."
B. "I must avoid sexual intercourse."
C. "I should be able to resume normal activity in a week or two.
D. "Because hepatitis B is a chronic disease, I know I will always be jaundiced."

Correct Answer: A

Explanation: It is important that the client understand that alcohol should be avoided for at least 1 year after an episode of hepatitis. Sexual intercourse does not need to be avoided, but the client should be instructed to use condoms until the hepatitis B surface antigen measurement is negative. The client will need to restrict activity until liver function test results are normal; this will not occur within 1 to 2 weeks. Jaundice will subside as the client recovers; it is not a permanent condition.

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