Monday, February 28, 2011

Occupational Therapist Opportunities in USA

Hi The Tender Touch Rehab seeking Occupational Therapists to work at Skilled Nursing Facilities.
Full Time positions available throughout all of NJ and NY.
We pride ourselves in training and mentoring both new grads and seasoned therapists from abroad.

We offer top salary, free health insurance options and much more.
VISA sponsorship includes H1B and Green Card with EB2 and EB3 category.
If you have taken the NBCOT exam or need help with that and O.T.E.D. process please contact us today for assistance.

Contact Sara: 732-987-3819


Acute Pain | Nursing Care Plan (NCP) for Inflammatory Bowel Disease

Nursing diagnosis: acute Pain related to Hyperperistalsis, prolonged diarrhea, skin and tissue irritation, perirectal excoriation, fissures, fistulas

Possibly evidenced by
Reports of colicky, cramping abdominal pain; referred pain
Guarding or distraction behaviors, restlessness
Facial mask of pain; self-focusing

Desired Outcomes/Evaluation Criteria—Client Will
Pain Level
Report pain is relieved or controlled.
Appear relaxed and able to sleep and rest appropriately.

Nursing intervention with rationale:
1. Encourage client to report pain.
Rationale: May try to tolerate pain rather than request analgesics.

2. Assess reports of abdominal cramping or pain, noting location, duration, and intensity (such as 0–10 scale). Investigate and report changes in pain characteristics.
Rationale: Colicky intermittent pain occurs with Crohn’s disease. Predefecation pain frequently occurs in UC with urgency, which may be severe and continuous. Changes in pain characteristics may indicate spread of disease or developing complications, such as bladder fistula, perforation, and toxic megacolon.

3. Note nonverbal cues, such as restlessness, reluctance to move, abdominal guarding, withdrawal, and depression. Investigate discrepancies between verbal and nonverbal cues.
Rationale: Body language or nonverbal cues may be both physiological and psychological and may be used in conjunction with verbal cues to determine extent and severity of the problem.

4. Review factors that aggravate or alleviate pain.
Rationale: May pinpoint precipitating or aggravating factors (e.g., stressful events, food intolerance) or identify developing complications.

5. Encourage client to assume position of comfort, such as knees flexed.
Rationale: Reduces abdominal tension and promotes sense of control.

6. Provide comfort measures (e.g., back rub, reposition) and diversional activities.
Rationale: Promotes relaxation, refocuses attention, and may enhance coping abilities.

7. Cleanse rectal area with mild soap and water (or wipes) after each stool and provide skin care with a moisture barrier ointment (e.g., A&D ointment, Sween ointment, karaya gel, Desitin, petroleum jelly, zinc oxide, dimethicone).
Rationale: Protects skin from bowel acids, preventing excoriation.

8. Implement prescribed dietary modifications, for example, commence with liquids and increase to solid foods as tolerated.
Rationale: Complete bowel rest can reduce pain and cramping.

9. Provide sitz bath, as appropriate.
Rationale: Enhances cleanliness and comfort in the presence of perianal irritation and fissures.

10. Observe and record abdominal distension, increased temperature, and decreased BP.
Rationale: May indicate developing intestinal obstruction from inflammation, edema, and scarring.

imbalanced Nutrition: Less than Body Requirements | Nursing Care Plan for Inflammatory Bowel Disease

Nursing diagnosis: imbalanced Nutrition: Less than Body Requirements related to
Altered absorption of nutrients
Hypermetabolic state
Medically restricted intake; fear that eating may cause diarrhea

Possibly evidenced by
Weight loss, decreased subcutaneous fat and muscle mass, poor muscle tone
Hyperactive bowel sounds, steatorrhea
Pale conjunctiva and mucous membranes
Aversion to eating

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Demonstrate stable weight or progressive gain toward goal with normalization of laboratory values and absence of signs of malnutrition.

Nursing intervention with rationale:
1. Assess weight, age, body mass, strength, and activity and rest levels. Ascertain stage of disease process and its effects on client’s nutritional status.
Rationale: Provides comparative baseline.

2. Inspect oral mucosa.
Rationale: May reveal ulcerations and/or provide information about the integrity of the entire GI tract, affecting ability to eat and absorb nutrients.

3. Evaluate client’s appetite.
Rationale: Appetite may be suppressed because of altered taste, early satiety, meal-related cramping, diarrhea, or a combination of these factors.

4. Weigh frequently.
Rationale: Provides information about dietary needs and effectiveness of therapy.

5. Encourage bedrest or limited activity during acute phase of illness.
Rationale: Decreasing metabolic needs aids in preventing caloric depletion and conserves energy.

6. Recommend rest before meals.
Rationale: Quiets peristalsis and increases available energy for eating.

7. Provide oral hygiene.
Rationale: A clean mouth can enhance the taste of food.

8. Serve foods in well-ventilated, pleasant surroundings, with unhurried atmosphere and congenial company.
Rationale: Pleasant environment aids in reducing stress and is more conducive to eating.

9. Avoid or limit foods that might cause or exacerbate abdominal cramping and flatulence—milk products, foods high in fiber or fat, alcohol, caffeinated beverages, chocolate, peppermint, tomatoes, and orange juice.
Rationale: Individual tolerance varies, depending on stage of disease and area of bowel affected.

10. Provide nutritional support, for example: Enteral feedings, such as Ultra Clear Plus via nasogastric (NG) tube, percutaneous endoscopic gastrostomy (PEG), or J-tube
Rationale: Many clinical studies have shown early enteral feeding is beneficial in reducing the effects of malabsorption and providing essential nutrients. Although elemental enteral solutions cannot provide all needed nutrients, they can prevent gut atrophy.

Risk for Deficient Fluid Volume | Nursing Care Plan (NCP) for Inflammatory Bowel Disease for I

Nursing diagnosis: risk for deficient Fluid Volume

Risk factors may include
Excessive losses through normal routes—severe frequent diarrhea, vomiting
Hypermetabolic state—inflammation, fever
Restricted intake—nausea, anorexia

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Maintain adequate fluid volume as evidenced by moist mucous membranes, good skin turgor, and capillary refill; stable vital signs; and balanced intake and output (I&O) with urine of normal concentration and amount.

Nursing intervention with rationale:
1. Monitor I&O. Note number, character, and amount of stools; estimate insensible fluid losses (e.g., diaphoresis). Measure urine specific gravity and observe for oliguria.
Rationale: Provides information about overall fluid balance, renal function, and bowel disease control, as well as guidelines for fluid replacement.

2. Assess vital signs (blood pressure [BP], pulse, temperature).
Rationale: Hypotension (including postural), tachycardia, and fever can indicate response to and effect of fluid loss.

3. Observe for excessively dry skin and mucous membranes, decreased skin turgor, and slowed capillary refill.
Rationale: Indicates excessive fluid loss and resultant dehydration.

4. Weigh daily.
Rationale: Indicator of overall fluid and nutritional status.

The Slippery Slope

MUCH wailing and gnashing of teeth has followed Hearts' 0-0 draw at Pittodrie on Saturday, an outcome which meant that the Jam Tarts had missed a chance of, however temporarily, splitting the Old Firm at the top of the SPL table.

The club's failure to take their chance of some sort of glory is disappointing for the Gorgie club's fans, but, given the way "Grandpa Broon" and Archie Knox, or "Jack and Victor" as the still game veteran duo have been dubbed in some quarters have turned things around in the Granite City, emerging unbeaten from a trip to Pittodrie is no bad thing for the visiting side.

But, one thing about the match which has gone largely uncommented-upon was the attendance. When the two clubs which ought to be disputing the right to be considered "The Third Force" in Scotland cannot even half-fill the ground for a meeting, something is awry with the SPL.

OK, after the disastrous McGhee regime, for all the sunshine which Craigie and Erchie have brought to Aberdeen, the club is still languishing in the wrong half of the table. There have been some blips along the Brown/Knox route map back to the top three (or four), even the top six, factors which might have helped keep the attnedance down.

Hearts might not yet be carrying the travelling support they might, which is another factor, but, just over 9000 is a depressingly low turn-out for this fixture.

There is a general acceptance that things in Scottish fitba have to change, but, as yet I have yet to see a proposal for change which is sufficiently radical to avoid the game falling into previous traps.

We need new ideas, we need new energy, we need fresh leadership - from where might it come.

Top Law Enforcement Schools

Following are the top schools in the US for law enforcement programs:

Drury University
- The Drury University Law Enforcement Academy is certified by the State of Missouri Department of Public Safety. It provides professional training for those interested in pursuing a career in law enforcement.
- The academy meets the State of Missouri's minimum training requirement for Class A certification

Sunday, February 27, 2011

Peak Moment Interview: Reclaiming Childbirth

Check out our interview with Peak Moment TV!

ER hoppers

Lately there has been an explosion of ER hoppers in our ER. What are ER hoppers? They are those patients who yesterday, two days ago or whatever went to another ER but felt the need to come to our ER this time. They have various reasons for doing such an idiotic thing. The seven deadly sins. Among them:

1) I didn't get any pain meds for my neck injury from an MVA 2 weeks ago at the other hospital and I'm hoping you will be nicer.
2) I had surgery last week at another hospital, now I am having problems, and your hospital is closer.
3) I didn't like the way they treated me at XYZ hospital.
4) The wait was way too long at the other place
5) I want a second opinion.
6) They didn't do anything for me over there.
7) Family is not happy with care of other doctor, hospital, etc.

ER hoppers are sometimes dumb enough to tell us they were at another hospital. Then there are those who don't. They think we won't find out. But BEWARE, these days we can see if you have been to another hospital in our system. We are also connected to other hospitals as part of a network that shares info, with your kind permission of course.

When I ask people why they didn't go back to the hospital that treated them before, did surgery on them, they are often offended, like I shouldn't ask that. It should be okay to come to a hospital that has no records of your surgery, history, etc. Sorry if I think thats stupid.

Find out the cost of medical travel and medical tourism

Medical travel and medical tourism, was not limited to patients who want to get a particular care. But also given to doctors who want to medical travel and medical tourism in relation to managing a particular treatment in a State.

Please note, that in doing this trip there are differences in price that occurs in one region to another. It costs like airfare and lodging. Of course for the patient, the cost of certain care in a State may be more expensive than other countries or vice versa. As for doctors, provided of course fees will vary from one State to another State.

Usually between medical travel and medical tourism is often the cost of medical tourism will be far greater drain your pocket instead of pocket medical travel.

Find lots of information, to which country you will make medical tourism, so there will be no major unexpected expenses, you should spend.

Medical Billing and Coding as an alternative choice in a career

The road to success in whatever career began with a strong desire that comes from yourself, the right attitude, education, training, and network of friends. Medical billing and coding for instance.

If you are looking for information on the internet will you find a lot of medical billing and coding, and also you will find a variety of training.

You also will find a variety of tips to start your own medical billing business from a small home office (or rent) as a part-time worker, or a serious effort to manage a career and as a provider of medical billing and coding as well as a consultant.

Medical billing and coding is a fast growing field of business today. Activities of medical billing and medical coding to work for a dentist's office, chiropractors, pediatricians offices, rehabilitation centers, and insurance companies. Including the responsibility of this activity such as accounts receivable follow up with a maturity until they pay. So with this practice causes the doctor will have income.

Sometimes there are patients who use the insurance proceeds to pay for treatment in one of the practice of medicine. With the medical billing and coding. A doctor does not need to bother to take care of this, because it was handled by the medical billing and coding will ensure that payments made by the patient.

Protect Your Home, with the Cheapest Home Insurance

The home is your greatest treasure. And that more mainstream again, home is a place where you keep valuable personal property and memorable. But however you home safe, still remain vulnerable and open possibilities for various risks. Unexpected accidents, such as fires, riots, looting, floods and many others.

Your home might have been engulfed in flames or devastated by floods, and becomes unfit for habitation. It may take weeks to clean up the debris and expensive temporary accommodation which would drain the family finances. Before falling into such a situation, it's better to think first how to reduce this burden. Who is able to overcome this problem and restore the situation if the tragedy befalls your house?

Products Home Insurance has the advantage that is easily understood and provides comprehensive protection against various risks is one solution that can be selected.

Home Insurance circuit package options provide flexibility that is not confusing. You just choose which level of protection that suits your needs and your capabilities and options Cheapest Home Insurance.

Various risk protection offered by the Home Insurance Company, including the Cheapest Homeowners Insurance, you need information to stay as Comparison Insurance Home ownership you choose. The following risks can be covered by an insurance company:

1. Fire, Lightning, Explosion, Fall Aircraft and Smoke
2. Riots and Strikes
3. Robbery / Theft
4. While for Rent Houses Accommodation
5. Cost Extinction Fires and Debris Cleanup
6. Earthquake, Volcano, Fire Underground, which overflowed Sea Water
7. Flood, tornado, storm, water damage.
8. Responsibilities of the law against third parties for the insured and all family members from potential third party lawsuits
9. Protection against fatal accidents due to fire or theft
10. And also many other additional benefits such as workers compensation or domestic helpers, household water pipes overflow, collision of vehicles, animals, falling trees or radio equipment or a satellite dish, the cost of architects, surveyors and legal and others.

By selecting the product the cheapest house insurance and you are comparing it with others. Your home and property therein, shall secure from risks that can happen anytime.

If the problem comes, deal with the wise

There was a man who knew a woman who is beautiful, polite, smart and independent. He was very fond of her, as well as with the woman. Some months they knew each other, until one day the man wanted to apply for women who already knew that. But it was not an easy struggle. Many times he expressed intentions toward the woman. Always ended with the rejection. The woman refused to be smooth.
Actually she was very happy to receive requests the man, but because she has only a father. And her father don’t agree his daughter are associated with anyone.

The days turned into weeks, weeks turned into months and months of the year was changed. The man was still maintains relationships with a beautiful woman. Until one day, the man finally decided with confidence and is sure to meet her father and the point.

Apparently the meeting, it is known that the reason the woman's father had never approved her daughter's relationship is, because of the low positions in the company and in the near future will experience job separation.
This made his father's shame to the family of a man if he cannot be a good father to his daughter.

But with the wise, steady and confident, the man to give understanding to the woman’s father, "Even if you work with a low position, or you do not work, and although my career destroyed, we will start from the bottom again, building businesses again. I'm sure it would work, because I love your daughter and your daughter loved me. And don’t be worried about the opinion of my family, because all wisdom is the lesson taught by my family to me. And I'm sure; someday your daughter will be proud of your decision now.

Heard a statement from a man who loved his daughter, the father thought for a moment and finally approved the request of these men.

Have you encountered a problem that may be similar to this? If not, surely every man experiencing problems in building a relationship with his girlfriend. What you should know is that it takes determination, serious in a relationship and maintains relationships.

When a problem comes, deal with the wise and show that you really love your lover.
If you don’t get a girlfriend until now, try to join with Russian Mail Order Brides, maybe your girlfriend to wait there.

SP Comp Exam

So I finished my standardized patient exam... the one at the end of the year where you have eight patients with blind scenarios, and you have to assess whats going on and perform whatever exams are necessary, etc.

What a shit show! Total chaos, lol.

I think everyone is done now... so I can write about it... hopefully :)

Surprisingly, I didn't get tired or stressed. It was kind of fun. Like Christmas. You don't know what's behind the door. I think I "handled" each one ok.. as in I could complete the assessments at the end no prob. The hard part was that if you left a room and needed more information, you were screwed. I definitely forgot to take pulses in the extremities on the cardio exam, and I didn't ask for a pelvic on a female patient with abdominal pain (obvious, I know... but she was in so much pain I decided to send her straight to imaging).

Blah. Whatev.

Princeton Review Best Value Colleges 2011

Swarthmore College is again the "Best Value Private College for 2011", according to the Princeton Review and USA Today. This is the third straight year in which the College has been recognized with this distinction. The Princeton Review selected its "Best Value" choices for 2011 based on surveys of administrators and students at more than 650 public and private colleges and universities. Schools

Saturday, February 26, 2011

to this blogs subscribers

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Martha Stewarts fat lip - its not a good thing

Poor Martha Stewart. Her dog jumped up and gave her a fat lip and a cut. What did Martha do? She called the police to give her a ride to the hospital. Apparently she couldn't drive herself or get someone to drive her. You know, I don't think the police would drive me to the hospital if I called them.

Another call Martha made was to someone else so they could have a plastic surgeon come to repair her laceration. I'm sure Martha went straight back, was seen right not pass go, do not collect $200. I don't think I would have got back that fast and an ordinary ER doc would have stitched me up.

This is the kind of stuff that drives ER nurses nuts. Some people are given VIP treatment. We will get a call periodically about so and so is coming in and they just want to LET US KNOW. Or someone will call one of our docs and tell them some "VIP" is coming and we are supposed to take them DIRECTLY BACK TO A ROOM.

Our thought: Every body should be treated the same. We don't like treating certain people special. ER is one of those places where everybody should be equal.

Nurse Marcie’s Island

Title: Nurse Marcie’s Island
Author: Arlene Hale
Publisher: Ace
Copyright: 1964
Illustrator: Bob Schinella
Review available

The signature on this cover (enlarged)

is similar to that of a known Bob Schinella work, the cover for A Nurse Called Hope (signature below).

Casino Nurse

Title: Casino Nurse
Author: Diana Douglas
Publisher: Signet
Copyright: 1974
Illustrator: G.H. Jones?

Lovely Rena Stafford had been taught as a student nurse never to become involved in the private lives of her patients. But she found it impossible not to get caught up in wealthy Madame Zeigler’s exciting, glamorours existence in Monte Carlo. Rena had never expected this strong bond to grow, nor did she expect the strange reaction of Madame Zeigler’s handsome nephew, Dr. Stephen Montrose, when she summoned him urgently to Monaco. When two of Madame Zeigler’s attractive friends from the casino, Mark Lassiter and Jean Auriol, began to vie for Rena’s affection, she was suprised—and strangely disturbed. But the biggest surprise of all was to discover she had fallen in love—with the very man who could only mean heartbreak.

The signature in the lower right corner of the above cover (enlarged)

is very similar to that of the illustrator of a book cover for “The Wanderers”:

Doctor’s Nurse

Title: Doctor’s Nurse
Author: Dorothy Worley
Publisher: Popular Library
Copyright: 1961
Illustrator: Lou Marchetti

His signature runs along her left shoulder.

Attractive Patricia Lloyd, R.N., had two problems—both of them doctors. Dr. Jeffrey Wayne was handsome, mature and mysteriously drawn to Patricia, beyond the call of duty. Dr. Bill Gregory was young, very much in love and intensely jealous. Caught between the two, Patricia found her personal emotions—and professional duty—in sudden and grave danger.

Night Call

Title: Night Call
Author: Adeline McElfresh
Publisher: Dell
Copyright: 1961
Illustrator: Robert Abbett

His signature runs down the back of her dress.

To Nurse Lyn Jennings, hurrying through Carter Memorial’s cool white corridors, emergencies were part of the life she had chosen—the challenging, exciting world of a hospital at night:
—in 212, a lonely, crying child, afraid to go to sleep without its mother—
—in the driveway, an ambulance shrieking to a halt after a race with death, bearing the victims of a highway collision—
—in the darkened supply room, storage place for drugs and narcotics, a mysterious figure moving toward a cabinet, no longer able to resist temptation.

Jane Arden Space Nurse

Title: Jane Arden Space Nurse
Author: Kathleen Harris
Publisher: Popular Library
Copyright: 1962
Illustrator: Lou Marchetti

His signature is in the lower right corner.

As Jane embarked upon the most exciting adventure of her career, she was forced to postpone her marriage to handsome Jeff Wallace. Jane had no way of foreseeing the personal crisis that would confront her as a “space nurse.” Nor could she have anticipated the lasting impact of the two attractive astronauts she met at Cape Canaveral. Fascinating Clyde McLaren, a strong candidate for the moon shot, was brilliant and quite friendly. —Or did he want more than friendship? And what of the dashing continental Lieutenant who made it clear that he was more than interested in her? —Just where did his interest lie?

Emergency Ward Nurse

Title: Emergency Ward Nurse
Author: Helen B. Castle
Publisher: Paperback Library
Copyright: 1963
Illustrator: Lou Marchetti

His signature is in the lower right corner.

Emergency duty was the very breath of life for young Nurse Merle Asquith. To countless men, women and children struck by illness and disaster she was a true angel of mercy. Merle threw herself into her work to forget her own unhappiness. When she met handsome, charming Intern Mike Jablonsky, he wanted only to love her and to offer her things she had never had. But Merle dared not return his love until she knew if she could entrust him with her secret...

Undercover Nurse

Title: Undercover Nurse
Author: Jane Converse
Publisher: Signet
Copyright: 1972
Illustrator: Allan Kass
Review available

This cover is included in the blog “Allan Kass Book Covers.”

Nurse Gail Arnold was young and beautiful and happy. Her work at the Narcotics Rehabilitation Center was interesting and rewarding. And her silent worship of handsome Dr. Bruce Cranston filled her heart with hopeful dreams. But her serene existence was in for a startling change. An unknown young woman, viciously beaten and near death from an overdose of heroin, was brought to the hospital. Gail, assigned to the case, now found herself working in heart-quickening closeness with the man she loved. Then menace marred the picture. For the new patient harbored a tormenting secret that was to spell deadly danger for Gail. It would lead her, innocent and unsuspecting, into the nightmare world of narcotics traffic where not only her dreams of love but also her very life would be threatened!

Night Nurse

Title: Night Nurse
Author: Rosamond Hunt
Publisher: Dell Candlelight
Copyright: 1962
Illustrator: Edrien King
Review available

Her signature is in the lower left corner.

Young and lovely Sheila Hayden had been planning to marry Kenny Jamison for as long as she could remember. But when Sheila became a night nurse at Mercer City Hospital, Kenny showed signs of growing resentment, and asked that she resign. Sheila, however, had fallen in love with her work. Moreover, a political campaign to smear the hospital made her presence vital to the pressured staff. Vehemently Sheila insisted that Kenny had no cause to be jealous of her job, or of the brilliant young Dr. Joel Alexander, who was so often at her side. It took a mysterious kidnapping and a new and vicious attack on the hospital’s good name to force the lovely nurse to face some painful truths—about Kenny, about Dr. Alexander, and about her own buffeted heart.

Nurse in Hollywood

Title: Nurse in Hollywood
Author: Jane Converse
Publisher: Signet
Copyright: 1965
Illustrator: Robert Abbett
Review available

His signature is seen above her left shoulder.

Her ash-blond hair. Her big brown eyes. Her pert figure. These were only frosting to her personality—a personality that was pure whistle bait. So what if Kitty Walters was a nursing student just three months short of graduating? So what if her idea of heaven was the symbol R.N. pinned on a starched white uniform? Phil Harlan wasn’t called “Boy Wonder” for nothing. He was dynamic, magnetic, charming, a glib Svengali whose record of convincing was 100 percent. Phil Harlan would have no trouble turning a dedicated would-be nurse into a determined Hollywood starlet. At least that’s what Phil Harlan thought …

Headline Nurse

Title: Headline Nurse
Author: Phyllis Ross
Publisher: Pocket Books
Copyright: 1965
Illustrator: Harry Bennett
Review available

His signature runs down her left sleeve.

“I’m a nurse! Not a woman!” She kept repeating the words to herself as she looked down at Pete’s broken body. His shirt was in rags, one trouser was ripped from ankle to knee, and there was a terrible gash on his forehead. She took out bandages and antiseptic and began to dress the wounds—all the time trying to forget that the battered man was the one she loved. The others in the clinic had turned their backs for a moment. She leaned down quickly and brushed her lips against his bruised cheek. “Oh, my darling,” she cried softly, “My poor darling.”

Beauty Contest Nurse

Title: Beauty Contest Nurse
Author: Diana Douglas
Publisher: Signet
Copyright: 1973
Illustrator: Allan Kass

When tawny-eyed nurse Maria MacKenzie sought to escape the routine and regimentation of the Veterans’ Hospital, she never expected anything like her job at a luxurious resort hotel in Acapulco. Assigned to the girls in the Miss All-America Beauty Contest, Maria soon discovered that her feminine attributes as a lovely young woman were more important than her nursing skill—especially with Dick Trevor, the attractive newspaperman covering the contest. Dr. Mitch Gilbert, her handsome, informal boss, was another surprise; as was Andrew Fisher, the powerful, red-headed doctor who was so mysteriously involved behind the scenes. One of these men would change the course of Maria’s life. Caught up in the heady excitement of her glamorous surroundings, could she trust her heart to make a wise choice…?

Night Nurse

Title: Night Nurse
Author: Fern Shepard
Publisher: Avon
Copyright: 1962
Illustrator: Victor Kalin

His signature is in the lower-right corner.

Nurse Kitty Casey’s personal concern for her young patient alienated the boy’s domineering mother who demanded Kitty’s removal from the case. While Doctor Tom Barbour understood Kitty’s feeling for the boy, he had no alternative but to order her reassignment. If she protested, it would mean dismissal from the hospital. But Tom Barbour had never met anyone quite like this spirited redhead. How different Kitty was from his own coldly self-centered fiancee. There was no denying the attraction Nurse Casey held for him, even as she challenged him in a dramatic clash of wills.

Nursing Care Plan (NCP) Inflammatory Bowel Disease (IBS)

Nursing diagnosis: Diarrhea related to Inflammation, irritation, or malabsorption of the bowel, Presence of toxins, Segmental narrowing of the lumen

Possibly evidenced by
Increased bowel sounds, peristalsis
Frequent, and often severe, watery stools (acute phase)
Changes in stool color
Abdominal pain; urgency, cramping

Desired Outcomes/Evaluation Criteria—Client Will
Bowel Elimination
Report reduction in frequency of stools and return to more normal stool consistency.
Identify and avoid contributing factors.

Nursing intervention with rationale:
1. Observe and record stool frequency, characteristics, amount, and precipitating factors.
Rationale: Helps differentiate individual disease and assesses severity of episode.

2. Promote bedrest and provide bedside commode.
Rationale: Rest decreases intestinal motility and reduces the metabolic rate when infection or hemorrhage is a complication. Urge to defecate may occur without warning and be uncontrollable, thus increasing risk of incontinence and falls if facilities are not close at hand.

3. Remove stool promptly. Provide room deodorizers.
Rationale: Reduces noxious odors to avoid undue client embarrassment.

4. Identify foods and fluids that precipitate diarrhea, such as raw vegetables and fruits, whole-grain cereals, condiments, carbonated drinks, and milk products.
Rationale: Avoiding intestinal irritants promotes intestinal rest.

5. Restart oral fluid intake gradually. Offer clear liquids hourly and avoid cold fluids.
Rationale: Provides colon rest by omitting or decreasing the stimulus of foods and fluids. Gradual resumption of liquids may prevent cramping and recurrence of diarrhea; however, cold fluids can increase intestinal motility.

6. Provide opportunity to vent frustrations related to disease process.
Rationale: Presence of disease with unknown cause that is difficult to cure and that may require surgical intervention can lead to stress reactions that may aggravate condition.

7. Observe for fever, tachycardia, lethargy, leukocytosis, decreased serum protein, anxiety, and prostration.
Rationale: May signify that toxic megacolon or perforation and peritonitis are imminent or have occurred, necessitating immediate medical intervention.

8. Administer medications, as indicated: Antidiarrheals, such as diphenoxylate (Lomotil), loperamide (Imodium), and anodyne suppositories
Rationale: Decreases GI motility or propulsion (peristalsis) and diminishes digestive secretions to relieve cramping and diarrhea. Note: Use with caution in UC because they may precipitate
toxic megacolon.

9. Anti-inflammatories, such as mesalamine (Pentasa, Asacol); mesalamine-containing drugs, for example, sulfasalazine (Azulfidine); and aminosalicylates, drugs that contain 5- aminosalicyclic acid (5-ASA), such as olsalazine (Dipentum) and balsalazide (Calazal)
Rationale: Most people with mild or moderate ulcerative colitis are treated first with the group of drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Clients who do not benefit from it or who cannot tolerate it may receive 5-ASA agents, which are given orally, through an enema, or in a suppository, depending on the location of the inflammation in the colon. This class of drugs is also used
in cases of relapse.

10. Steroids, such as adrenocorticotropic hormone (ACTH), hydrocortisone (Cortenema, Cortifoam), prednisolone (Delta-Cortef), and prednisone (Deltasone)
Rationale: Decreases acute inflammatory process. Steroid enemas (Cortenema) may be given in mild to moderate disease to aid absorption of the drug—possibly with atropine sulfate or belladonna suppository. Current research suggests an 8-week course of time-release steroids may effect remission in Crohn’s disease; however, steroids are contraindicated if intra-abdominal abscesses are suspected.

Nursing Care Plan (NCP) Gastrectomy | Risk for Imbalanced Nutrition: Less than Body Requirements

Nursing diagnosis: risk for imbalanced Nutrition: Less than Body Requirements

Risk factors may include
Restriction of fluids and food
Change in digestive process, absorption of nutrients

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Maintain stable weight and demonstrate progressive weight gain toward goal with normalization of laboratory values.
Be free of signs of malnutrition.

Nursing intervention with rationale:
1. Maintain patency of NG, OG, or NI tube when used. Be aware of feeding tube placement—enterostomal or jejunostomal. Notify physician if tube becomes dislodged.
Rationale: Intestinal tubes are inserted to provide rest for gastrointestinal (GI) tract during acute postoperative phase until return of normal GI function. These are attached to suction. Feeding tubes may be inserted at time of surgery or later and are used to provide enteral feedings once gut is functional. Note: Although several methods have been used to identify tube placement at the bedside, such as aspiration of gastric contents, measurement of trypsin, pH, and pepsin levels, abdominal radiographs may be necessary to confirm location of tube, and the physician/surgeon may need to reposition the tube endoscopically to prevent injury to the
operative area.

2. Note character and amount of gastric drainage.
Rationale: Drainage may be bloody for first few hours and then should clear or turn greenish gold. Continued or recurrent bleeding suggest complications and should be reported to physician.

3. Caution client to limit the intake of ice chips.
Rationale: Excessive intake of ice produces nausea and can wash out electrolytes via the NG tube.

4. Provide oral hygiene on a regular, frequent basis, including petroleum jelly for lips.
Rationale: Prevents discomfort of dry mouth and cracked lips caused by fluid restriction and the NG tube.

5. Auscultate for resumption of bowel sounds and note passage of flatus.
Rationale: Peristalsis can be expected to return about the third postoperative day, signaling readiness to resume oral intake.

6. Monitor tolerance to fluid and food intake when resumed, noting abdominal distention, reports of increased pain or cramping, and nausea and vomiting.
Rationale: Complications such as paralytic ileus, obstruction, delayed gastric emptying, or gastric dilation, may occur. Even if the above complications do not occur, “dumping syndrome” is a fairly common aftereffect of stomach surgery. Symptoms include bloating, nausea, weakness, sweating, and rapid heartbeat 30 to 60 minutes after a meal.

7. Note admission weight and compare with subsequent readings.
Rationale: Provides information about adequacy of dietary intake and determination of nutritional needs.

8. Collaborate with nutritional team and dietitian, as indicated.
Rationale: Aids in determining number of calories and types of nutrients for meeting client’s nutritional needs.

9. Administer intravenous (IV) fluids, parenteral or enteral nutrition, as indicated.
Rationale: Meets fluid and nutritional needs until oral intake can be resumed. Note: Early enteral feedings have been found to stimulate gut immunological function and can assist in maintaining gut structure and function. TPN is usually reserved for clients who are critically ill at the time of
surgery or those with total gastrectomy.

10. Monitor laboratory studies: hemoglobin/hematocrit (Hgb/Hct), electrolytes, and total protein and prealbumin.
Rationale: Indicators of fluid and nutritional needs and effectiveness of therapy. Detects developing complications.

Fear/Anxiety | Nursing Care Plan (NCP) for Upper GI Bleeding

Nursing diagnosis: Fear/Anxiety May be related to Change in health status, threat of death

Possibly evidenced by
Increased tension, restlessness, irritability, fearfulness
Trembling, tachycardia, diaphoresis
Lack of eye contact, focus on self
Verbalization of specific concern
Withdrawal, panic, or attack behavior

Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control
Discuss fears and concerns recognizing healthy versus unhealthy fears.
Verbalize appropriate range of feelings.
Appear relaxed and report anxiety is reduced to a manageable level.
Demonstrate problem-solving and effective use of resources.

Nursing intervention with rationale:
1. Monitor physiological responses, such as tachypnea, palpitations, dizziness, headache, tingling sensations, and behavioral cues, such as restlessness, irritability, lack of eye contact, and combativeness or attack behavior.
Rationale: May be indicative of the degree of fear client is experiencing— client may feel out of control of the situation or reach a state of panic. However, symptoms may also be related to
physical condition or shock state.

2. Encourage verbalization of concerns. Assist client in expressing feelings by active listening.
Rationale: Establishes a therapeutic relationship. Assists client in dealing with feelings, and provides opportunity to clarify misconceptions.

3. Acknowledge that this is a fearful situation and that others have expressed similar fears.
Rationale: When client is expressing own fear, the validation that these feelings are normal can help client to feel less isolated.

4. Provide accurate, concrete information about what is being done, including sensations to expect and usual procedures undertaken.
Rationale: Involves client in plan of care and decreases unnecessary anxiety about unknowns.

5. Provide a calm, restful environment.
Rationale: Removing client from outside stressors promotes relaxation and may enhance coping skills.

6. Encourage significant other (SO) to stay with client, as able. Respond to call signal promptly. Use touch and eye contact, as appropriate.
Rationale: Helps reduce fear of going through a frightening experience alone.

7. Provide opportunity for SO to express feelings and concerns. Encourage SO to project positive, realistic attitude.
Rationale: Helps SO to deal with own anxiety and fears that can be transmitted to client. Promotes a supportive attitude that can facilitate recovery.

8. Demonstrate and encourage relaxation techniques such as visualization, deep-breathing exercises, and guided imagery.
Rationale: Learning ways to relax can be helpful in reducing fear and anxiety. Because client with GI bleeding may be a person who has difficulty relaxing, learning these skills can be important to recovery and prevention of recurrence.

9. Help client identify and initiate positive coping behaviors used successfully in the past.
Rationale: Successful behaviors can be fostered in dealing with current fear, enhancing client’s sense of self-control and providing reassurance.

10. Encourage and support client in evaluation of lifestyle.
Rationale: Changes may be necessary to avoid recurrence of ulcer condition.

University of Chicago - Rankings

The University of Chicago (UChicago) is a top ranked private coeducational research university located in Chicago, Illinois, USA. It is classified by the Carnegie Foundation for the Advancement of Teaching as an institution with "very high research activity".

UChicago has a number of Graduate Professional Schools: Divinity School; Booth School of Business; Law School; Pritzker School of Medicine

Friday, February 25, 2011

SEEKING -Registered Physical Therapist (RPT) (morgan hill, USA)

SEEKING: -Registered Physical Therapist (RPT)

Relocate to beautiful weather and warm climates!
Active Life Rehab invites you to become one of our valued team members. Join the Active Life Rehab team and start your journey toward success! Our compassionate and professional therapist rank Active Life Rehab, Inc. one of the leading rehabilitation companies in California. We take pride in having low staff turnover. Lead and owned by an RPT, Active Life Rehab strives to provide an environment where therapists relate well to one another and are given the support they need to grow professionally.
An EMPLOYER, not a staffing company

Active Life Rehab offers:
* Sign on Bonus! $$$ Available
* Management Opportunities;
-become a Director of Rehab!
* Flexible Hours; full-time/part-time
* Referral bonus program
* Relocation Assistance Available
* H-1B Visa Sponsorship

Apply for this position NOW!
For a complete listing of openings, visit our website at:
Email your resume with cover letter with available start date and salary desired to:

Active Life Rehab has a network of facilities throughout California in the counties of:

take care

Six More Days

Until I am done with classes. For the REST OF MY LIFE!!! I mean, assuming I pass 2nd year that is. I really can't believe it. Two more years of rotations, then residency, then... the big doctor life. Weird.

20 lashes with a tourniquet

What is a nurses priority in a hospital? Giving great patient care right? Wrong. To me, these days, it feels like documentation is the most important part of my job. The emphasis now in the hospital is have you filled in all the blanks on the computer that you need to in order to be compliant with JCAHO, Medicare, etc. Have you documented location, quality, aggravating factors, level of pain? After giving pain meds did you revital and redo level of pain 30 minutes after? Did you do discharged/admission vital signs? Did you reconcile all meds and record last time the med was taken? Did you fill in all of the many blanks around conscious sedation? Did you do the proper trauma charting so that statistics can be gathered? Screen for MRSA, VRE, TB. Did you screen the patient for potential abuse, suicidal thoughts? And these are just a few.

I spend the majority of my time doing documentation these days, crossing t's, dotting i's, filling in the myriad of blanks that need to be filled in. My documentation is tracked and if I don't do it right, I am given a note. A naughty nurse note. If it happens again I am placed in the staff time out chair in the middle of the ER. A third time? 20 lashes with a tourniquet.

o if you wonder why the nurse doesn't come in your room that often it is because she is out there documenting all the things that are required.

Vellore Christian Medical College Nursing Admission 2011

2. BSc in (Nsg): Candidates should have a pass with 45% aggregate in English, Physics, Chemistry and Biology (Botany and Zoology).

3. BOT: Candidates should have a pass in English, Physics, Chemistry and Biology

4. BPT: Same as above

5. BSc MLT: Same as above

6. Bsc optometry: Same as above


1. Dip in Nursing: (10+2) Plus two or its equivalent examination securing pass with aggregate 40% marks. Single men or women only; age between 17 & 22 years by 30 Sept 2011.

2. Dip in Radiodiagnosis (MRT): (10+2 level) English, Physics, Biology or Botany/Zoology; age 17 years by 15 July

3. Dip in Radiotherapy (MRT): (10+2 level) English & Science subjects including Physics; age 17 years by 15 July

4. Dip in Anaesthesia Technology: (10+2 level) English, Physics, Chemistry & Biology

5. Dip in Hand & Leprosy Physiotherapy: (10+2 level) English, Physics, Chemistry & Biology

6. Dip in Optometry: 40% in (10+2) or its equivalent with English, Physics, Chemistry & Biology

7. Dip in Critical Care Therapy: (10+2 level) English, Physics, Chemistry & Biology

8. Dip in Prosthetics & Orthotics: (10+2 level) English, Physics & Biology or Mathematics

9. Dip in Hearing Language & Speech: (10+2 level) English, Physics, Chemistry & Biology with minimum of 50% in each subject
Application form

Keeping Your Baby Close After Birth

Written by Laura Schuerwegen

I could write about a million benefits of keeping your child close after birth, but I'll leave that up to the experts and stretch your imagination a little.

Imagine that you are an unborn child. You have been floating happily in lukewarm liquid for nine months now, you experienced taste through it. You felt vibrations and heard your mother speak, and you heard other, more muffled noises too. You sensed your mother's touch through the womb that hugs you. You have been really comfortable.

But right now, that womb, which is all you have know for all eternity, is getting a little tighter, you have little space left and it is getting harder to move. You may have engaged, you may not., anyway, you are ready for some change.

And so it happens, you start to feel hugged ever more tightly by that uterus, your home. Irregular at first, and short, but after a while, these sensations get more intense. Something is about to happen! You feel slightly pressed downward with every contraction. You are excited. You feel how your mother feels and you hear her voice, maybe she's a little frightened, should you be? Maybe she's excited too, and happy, so you feel happy too.

Let's just assume you are all well and she is indeed happy and excited to meet you - after all, she did wait nine months for this moment. Let's assume that this engaging thing and the contractions work well.

So you feel it's time to put in some effort of your own, after all, your mommy - who you have felt and heard and tasted all this time, but have yet to meet - is putting in so much effort.
So you twist and wriggle and turn. You feel really squeezed. Your head is a little sore, you feel like you can't take much of this for too long.

And then it happens...

[[[ I am sorry to take you out of the imaginative trip for a moment, but I just want to show you two possible scenarios and you pick the one you would like to have as the second half of this story ]]]

The pressure on your head is relieved and you feel a rush of - what is this, it's fresh, cold even, and it smells so different - air on your face. A big human pulls you out rather rudely and holds you upside down. There are all these things around, and so many people and noises and smells and everything happens so quickly and you don't see well, but the light stings your eyes.

"Hey, why are they cutting off my lifeline? I like that, I played with it all this time! Don't take it away!"

You are being pulled away from the one smell and feel you knew to again another entirely different setting. They prick you and it hurts and they rub you down and put stuff in your eyes, it stings even more than the light! You are starting to feel very desperate, very helpless. Maybe this wasn't as exciting as you though it would be. Frankly, you wish you were back in that warm - albeit tight - uterus. You start to cry - "Hey what's this noise, it's loud and it hurts my ears, wait... it's me!" - you are kind of freaking out.

Someone else puts you on a cold metal thingy and starts measuring you. By this time you are tired and desperate.

But then they bring you over to the one creature you know. She looks kind of desperate too. And she's cold and tired, just as you are.

You want to look, you want to taste and smell. But you're still a little freaked out, scared, and very very tired. Will they come and take you away again?

The pressure on your head is finally gone and you are in a lukewarm environment, just as you were in utero, but vast and less tasty, though it does taste and smells the same, just less pronounced. You open your eyes and see a beautiful face radiating love. You feel two strong but tired hands on your back.
 They pull you up - "Hey what is this? This smells great! I want to have a taste of this!!!" - and put you at the breast.

While you enjoy this liquid gold, you dare another glance. "Wow, mommy is really beautiful and look at how happy she is!"

You hear an emotion filled mutter, and look to the side. You've heard that voice before, but a lot more muffled. Hey, look at that, that's a totally different face than mommy's! A hand that belongs with the second face caresses your back and the face speaks gentle words to you, ever so softly. Mommy hums, and cries tears of joy.

"It was all worth it!" you think, as you doze off into a wonderful little slumber.

[[[ Take your time to wake up out of that soft dreamless sleep ]]]

Which one would you pick?

Laura Schuerwegen aka Mamapoekie is a Belgian mother, wife and writer who lives in Sub-Saharan Africa. Find her thought on birthing, parenting and living on Authentic Parenting

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Kansas State University Profile

Kansas State University (K-State) is one of the nation’s top colleges, renowned for the excellence of its faculty and programs.

Kansas State University  has the following Colleges: Arts and sciences; engineering; business administration; education; agriculture; human ecology; architecture, planning, and design; technology and aviation (K-State at Salina); and veterinary medicine.


Thursday, February 24, 2011


Alrighty, so I'm back after a long hiatus of studying hahaha. So go check out my newest video on youtube if you haven't done so already called "Mid semester update" to catch up on what I've been doing this semester.  Clinical has been super fun as always and this past week I was able to go to Endoscopy...for those of you who don't know what it is when there is a camera and it it inserted into your mouth or your anus and the Dr can check out your colon or GI tract and see if anything is out of the ordinary. Lots of fun. So I went down to endoscopy and observed and to be totally was honest was incredibly bored with that I saw. I DO NOT want to be a RN in endoscopy. Although their job there is important it seems very repetitive and could potentially get boring...I'm still loving the idea of working in emerg and just found out today that I AM ABLE to my preceptorship in emerg!! :D This excites me a great deal because just like I felt that nursing was my calling I feel that emerg is my calling. It's nice every now and then to be reminded why I went into this career field because it reignites my passion and drive for nursing. love it. This is such a grammatically poor entry but whatever....That's all for now I think...I'll let you guys know when something new comes up :) Good bye boys and girls!

home james!

I wonder if other states have this service: cab rides for those on medical assistance. Everyday in our ER there is literally a line up of people under age 30 calling to get a cab ride home from the hospital. Now mind you these are not disabled people. These are able bodied young adults who are eligible for MA.

They get on the phone and wait for 15 or 20 minutes for someone to come on the line. Usually we have to verify that they were really there. Then they sit there and wait for the cab. I am amazed at the time people will spend setting this up. They could have walked home before it was all complete.

If you are a working person who makes too much for medical assistance, sorry you are going to have to take a bus, get a ride or walk. You are chopped liver. I was telling a co worker that we should open a medical limousine service for those on medical assistance. All we would do is transport those on medicaid around in style. No doubt we could get a big fat contract with the state..

Perhaps the government could stop this kind of stuff to reduce the deficit. What a country.

The Future of Muslim-Christian Relationships in the Middle East

The College of Nursing and the Center for Arab and Islamic Studies invite the campus community to hear Dr. Abdulrahman al-Salimi’s lecture “The Future of Muslim-Christian Relationships in the Middle East” on Tuesday, March 22nd at 4:00 p.m. in the Driscoll Hall Auditorium. Dr. al-Salimi is chief editor of al-Tasamoh (Tolerance) Journal, Ministry of Endowments & Religious Affairs, Sultanate of Oman.

Risk for Shock | Nursing Care Plan for Gastrointestinal (GI) Bleeding

Nursing diagnosis: risk for Shock

Risk factors may include

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Circulation Status
Maintain and improve tissue perfusion as evidenced by stabilized vital signs, warm skin, palpable peripheral pulses, ABGs within client norms, and adequate urine output.

Nursing intervention with rationale:
1. Investigate changes in level of consciousness and reports of dizziness or headache.
Rationale: Changes may reflect inadequate cerebral perfusion as a result of reduced arterial blood pressure. Note: Changes in sensorium may also reflect elevated ammonia levels or hepatic
encephalopathy in client with liver disease.

2. Investigate reports of chest pain. Note location, quality, duration, and what relieves pain.
Rationale: May reflect cardiac ischemia related to decreased perfusion. Note: Impaired oxygenation status resulting from blood loss can bring on myocardial infarction (MI) in client with cardiac disease.

3. Auscultate apical pulse. Monitor cardiac rate and rhythm, if continuous electrocardiogram (ECG) available and indicated.
Rationale: Dysrhythmias and ischemic changes can occur as a result of hypotension, hypoxia, acidosis, electrolyte imbalance, or cooling near the heart if cold saline lavage is used to control bleeding.

4. Assess skin for coolness; pallor; diaphoresis; delayed capillary refill; and weak, thready peripheral pulses.
Rationale: Vasoconstriction is a sympathetic response to lowered circulating volume and may occur as a side effect of vasopressin administration.

5. Note urinary output and specific gravity. Insert Foley catheter to accurately measure urine, as indicated.
Rationale: Decreased systemic perfusion may cause kidney ischemia and failure, manifested by decreased urine output. Acute tubular necrosis (ATN) may develop if hypovolemic state is

6. Note reports of abdominal pain, especially sudden, severe pain or pain radiating to shoulder.
Rationale: Pain caused by gastric ulcer is often relieved after acute bleeding because of buffering effects of blood. Continued severe or sudden pain may reflect ischemia due to vasoconstrictive
therapy, bleeding into biliary tract (hematobilia), or perforation with onset of peritonitis.

7. Observe skin for pallor and redness. Massage gently with lotion. Change position frequently.
Rationale: Compromised peripheral circulation increases risk of skin breakdown as demonstrated by redness over bony prominence that does not blanch when digital pressure applied.

8. Monitor ABGs and pulse oximetry.
Rationale: Identifies hypoxemia and effectiveness of and need for therapy.

9. Provide supplemental oxygen, if indicated.
Rationale: Treats hypoxemia and lactic acidosis during acute bleed.

10. Administer IV fluids, as indicated.
Rationale: Maintains circulating volume and perfusion. A guideline for fluid replacement is 3 mL of fluid for each 1 mL of blood lost.

Risk for Bleeding | Nursing Care Plan for Upper Gastrointestinal (GI) Bleeding

Nursing diagnosis: risk for Bleeding related to Active fluid volume loss—hemorrhage

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Blood Loss Severity
Be free of signs of bleeding in GI aspirate or stools, with stabilization of Hgb and Hct.
Demonstrate improved fluid balance as evidenced by individually adequate urinary output with normal specific gravity, stable vital signs, moist mucous membranes, good skin turgor, and prompt capillary refill.

Nursing intervention with rationale:
1. Note color and characteristics of vomitus, nasogastric (NG) tube drainage, and stools.
Rationale: The first step in managing bleeding is to determine its location. Bright red blood that does not clear signals recent or acute arterial bleeding, perhaps caused by gastric ulceration; dark red blood may be old blood that has been retained in intestine or venous bleeding from varices. Coffee-ground appearance is suggestive of partially digested blood from slowly oozing area. Undigested food indicates obstruction or gastric tumor. In a rapid upper GI bleed, stool color may be red or maroon because of rapid transit time through the GI tract.

2. Monitor vital signs; compare with client’s normal and previous readings. Take blood pressure (BP) in lying, sitting, and standing positions when possible.
Rationale: Changes in BP and pulse may be used for rough estimate of blood loss; BP less than 90 mm Hg and pulse greater than 110 suggest a 25% decrease in volume, or approximately 1,000 mL. Postural hypotension reflects a decrease in circulating volume. Note: Heart rate may not rise above normal until up to 30% of total blood volume is lost.

3. Note client’s individual physiological response to bleeding, such as changes in mentation, weakness, restlessness, anxiety, pallor, diaphoresis, tachypnea, and temperature elevation.
Rationale: Symptomatology is useful in gauging severity and length of bleeding episode. Worsening of symptoms may reflect continued bleeding, inadequate fluid replacement, and shock.

4. Measure central venous pressure (CVP) if available.
Rationale: Reflects circulating volume and cardiac response to bleeding and fluid replacement. CVP values between 5 and 20 cm H2O usually reflect adequate volume.

5. Monitor intake and output (I&O) and correlate with weight changes. Measure blood and fluid losses via emesis, gastric suction or lavage, and stools.
Rationale: Provides guidelines for fluid replacement.

6. Keep accurate record of subtotals of solutions and blood products during replacement therapy.
Rationale: Potential exists for overtransfusion of fluids, especially when volume expanders are given before blood transfusions.

7. Maintain bedrest; prevent vomiting and straining at stool. Schedule activities to provide undisturbed rest periods. Eliminate noxious stimuli.
Rationale: Activity and vomiting increases intra-abdominal pressure and can predispose to further bleeding.

8. Elevate head of bed during antacid gavage.
Rationale: Prevents gastric reflux and aspiration of antacids, which can cause serious pulmonary complications.

9. Note signs of renewed bleeding after cessation of initial bleed.
Rationale: Increased abdominal fullness and distention, nausea or renewed vomiting, and bloody diarrhea may indicate return of bleeding.

10. Observe for secondary bleeding from nose or gums, oozing from puncture sites, or appearance of ecchymotic areas following minimal trauma.
Rationale: Loss of or inadequate replacement of clotting factors may precipitate development of DIC.

Impaired Urinary Elimination | Nursing Care Plan for Multiple Sclerosis

Nursing diagnosis: impaired Urinary Elimination related to Neuromuscular impairment, such as spinal cord lesions, neurogenic bladder

Possibly evidenced by
Incontinence, nocturia, frequency
Retention with overflow
Recurrent UTIs

Desired Outcomes/Evaluation Criteria—Client Will
Urinary Continence
Verbalize understanding of condition.
Demonstrate behaviors and techniques to prevent or minimize infection.
Empty bladder completely and regularly, voluntarily or by catheter, as appropriate.
Be free of urine leakage between voiding.

Nursing intervention with rationale:
1. Note reports of urinary frequency, urgency, burning, incontinence, nocturia, and size and force of urinary stream.
Rationale: Urinary habits indicate kidney and bladder function and possible UTI. Bladder fullness after voiding indicates inadequate emptying or retention and requires further evaluation and intervention. Palpate bladder after voiding.

2. Review drug regimen, including prescribed, OTC, and street drug use.
Rationale: A number of medications, including some antispasmodics, antidepressants, and opioid analgesics; OTC medications with anticholinergic or alpha-agonist properties; or recreational
drugs such as cannabis, may interfere with bladder emptying.

3. Institute bladder training program or timed voiding, as appropriate.
Rationale: Bladder training program helps restore bladder functioning and reduces incontinence and bladder infection.

4. Encourage adequate fluid intake, avoiding caffeine and use of aspartame and limiting intake during late evening and at bedtime. Recommend use of cranberry juice and vitamin C.
Rationale: Sufficient hydration promotes urinary output and aids in preventing infection. Note: When client is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug, reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., NutraSweet), may cause bladder irritation leading to bladder dysfunction.

5. Promote continued mobility.
Rationale: Continued mobility promotes bladder emptying, thus decreases risk of developing UTI.

6. Recommend good hand-washing and perineal care.
Rationale: Perineal care reduces skin irritation and risk of ascending infection.

7. Encourage client to observe for sediment, blood in urine, foul odor, fever, or unexplained increase in MS symptoms, such as spasticity and dysarthria.
Rationale: Urinary symptoms indicate infection that requires further evaluation and prompt treatment.

8. Refer to urinary continence specialist, as indicated.
Rationale: The continence specialist helps develop individual plan of care to meet client’s specific needs using the latest techniques and continence products.

9. Administer medications, as indicated, such as Tolterodine (Detrol), oxybutynin (Ditropan), propantheline (Pro-Banthine), hyoscyamine sulfate (Cytospaz-M), flavoxate (Urispaz).
Rationale: These medications reduce bladder spasticity and associated urinary symptoms of frequency, urgency, incontinence, and nocturia.

10. Teach self-catheterization. Instruct in use and care of indwelling catheter.
Rationale: Self-catheterization helps maintain client autonomy and encourages self-care. Indwelling catheter may be required, depending on client’s abilities and degree of urinary problem.

Top Medical Schools in Norway

List of top medical schools in Norway:

University of Bergen
- The Faculty of Medicine and Dentistry is one of the six faculties at the University of Bergen. It covers a broad spectrum of research fields in clinical medicine, biomedicine and health sciences.
- The University of Bergen has earned the reputation of being Norway's most international university.
- University of Bergen is ranked in

Dialysis RN (BC Fraser Valley, canada)

Select Medical is actively recruiting Dialysis RNs who can take on a longer assignment of 3 months to one year for the greater Vancouver region.

Earn up to $45 hourly, working day shift only. This could be a part-time or full-time position. Current experience of at least one year, and a Canadian RN license are mandatory.

If you or your colleagues have ever thought about travel nursing - now is the time! Contact us today to take advantage of this opportunity.

1) Complete our online application form at or
2) Call us toll free at 1-877-525-3870 or
3) Email us at

take care

Infirmier(ère) auxiliaire, clinique exécutive (métro McGill) Canada

Infirmier(ère) auxiliaire, clinique exécutive

Permanent, temps partiel, 20 heures/semaines
Horaire de jour : lundi au vendredi (7h00 à 12h00)

Montréal (centre-ville)

Le titulaire du poste devra prodiguer les soins et traitements infirmiers et médicaux en fonction de l’ordonnance et des protocoles en vigueur. Il devra collaborer avec la coordonnatrice afin d’assurer un niveau de service élevé et sans attente pour les clients.

Principales fonctions :
• Effectuer des prélèvements sanguins et autres analyses ;
• Effectuer entre autre les tests ou traitements suivants : spirométrie, tonométrie, ortho-rater, audiogramme, installation de MAPA;
• Voir à l’entretien des salles de technique afin d’assurer le bon fonctionnement des opérations et de l’équipement :
• Vérifier l'inventaire et procéder aux commandes du matériel requis;
• Effectuer toutes autres tâches connexes

• Détenir un DEP en Santé, assistance et soins infirmiers
• Être membre de l’OIIAQ
• Posséder 1 à 2 ans d’expérience pertinente à titre d’infirmier(ère) auxiliaire
• Bilinguisme essentiel (parlé et écrit)
• Intérêt pour le service à la clientèle et un environnement de travail corporatif
• Bon jugement professionnel
• Assiduité, autonomie, ponctualité, discrétion, entregent
• Présentation et attitude professionnelles


Nous remercions tous les candidats de leur intérêt, cependant, nous ne communiquerons qu’avec les personnes sélectionnées pour une entrevue. Veuillez noter que l’emploi du masculin a pour seul but d’alléger le texte.

Déterminé à maintenir son engagement en matière d'équité en emploi, Medisys encourage les candidatures des 4 groupes désignés tels qu'identifiés dans la Loi sur l'Équité en matière d'Emploi. En vertu de la politique d'accommodation de Medisys, toute forme d'accommodation sera fournie pour l'ensemble du processus d'embauche. Les candidats sont tenus de faire connaître leurs besoins à l'avance.

have a great weekend

Wednesday, February 23, 2011

News Headlines

Midwife Amy Medwin (left) was recently arrested.
  • Georgia law could give death penalty for miscarriage Feb. 23, 2011 "There's a new bill on the block that may have reached the apex (I hope) of woman-hating craziness. Georgia State Rep. Bobby Franklin—who last year proposed making rape and domestic violence "victims" into "accusers"—has introduced a 10-page bill that would criminalize miscarriages and make abortion in Georgia completely illegal. Both miscarriages and abortions would be potentially punishable by death: any "prenatal murder" in the words of the bill, including "human involvement" in a miscarriage, would be a felony and carry a penalty of life in prison or death."
  • The "Skeptical OB" speaks on how natural childbirth educators are lying to pregnant women Feb. 23, 2011 (warning, this article is pretty intense) "...natural childbirth is not simply a specific set of choices; it's a philosophy that idealizes a specific set of choices and makes value judgments about women who choose differently. Moreover, it is a philosophy that rests on specific empirical claims; claims that are disingenuous, untrue, or occasionally outright lies."
  • Incarcerated woman dies from an ectopic pregnancy Feb. 22, 2011 "A pregnant Marion County jail inmate died from internal bleeding caused by an abnormal pregnancy, police said Tuesday. But Amber Redden's family wants to know why she wasn't taken to a hospital before she died."
  • FDA issues severe warning on pre-term labor drug 'Terbutaline' Feb. 18, 2011 "The drug is FDA-approved to prevent and treat symptoms associated with asthma, bronchitis and emphysema, and was being used for off-label obstetric purposes, including treating preterm labor. There is no evidence that using Terbutaline improves infant outcomes, and carries risk of serious adverse effects, including maternal death."
  • 61-year-old surrogate grandmother gives birth to her grandson Feb. 15, 2011 "A Chicago woman gave birth to her first grandson last week. Kristine Casey, 61, served as a surrogate for her daughter, Sara Connell, 35, who had tried unsuccessfully for years to have a baby. When Finnean Lee Connell arrived via cesarean section, Casey became the oldest woman in Chicago's recorded history to give birth."
  • Sudan focuses on high maternal mortality rate Feb. 10, 2011 "The United Nations humanitarian office in South Sudan's capital, Juba, says that 1 in 7 women who become pregnant “will probably die from pregnancy-related causes.”'
  • UK Midwifery Training Numbers Fall Feb. 8, 2011 "The number of midwifery training places is dropping despite the Prime Minister's promise to recruit 3,000 more midwives, research has suggested."
  • Moms fight hospital over photography ban Feb. 3, 2011 "Spurred by a hospital policy not allowing any photography or video until five minutes after birth, an online petition has hundreds of people expressing outrage that a hospital would prevent parents from recording such a moment that could never be recaptured."

the ER patients creed

What a winter. There has been snow on the ground since November. Some of it melted earlier this month but was replaced sunday and monday with another 14 inches. Whoopee. Of course I had to work Monday. Even though I live in a state where this goes on every winter, lots of people call in to say that they can't make it in to work. I don't have that option, living in the city and only about 10 minutes away.

You would think that people, especially those from the neighborhood who walk to the hospital, would stay home unless they were having a true emergency. Au contraire mon ami. They make it there with there silly complaints. THey remind me of the postman.


Perhaps that should be engraved somewhere. I mean really would you tromp through the snow, spend a couple of hours in the waiting room, for a cold? Of course you wouldn't because you are normal and you have a life.

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Top MBA in Real Estate

Top universities offering MBA programs with a Real Estate Focus:

Baruch College/CUNY (Zicklin School of Business)
- It offers the MBA degree in Real Estate. Electives include valuation and market analysis, capital markets, real estate law and transactions, urban economics, and investment analysis and strategies.
- Baruch’s full-time MBA program was ranked 65th on a list of Top 100 business

In praise of haun-knitted fitba

THE Tartan Army has its critics - particularly amongst the ranks of my media colleagues in "the Lap Top Loyal", or as I prefer to call them "the A Team": those put-upon souls, the lead football writers of our national newspapers, with their soul-destroying round of - Murray Park, Lennoxtown then Hampden Park for press conferences, with weekends spent chronicling the games involving the Old Firm and just the occasional midweek trip to Europe with the big two or Scotland for light relief.

Theirs is indeed, a long, hard slog; and as the bean counters' influence grows ever-greater within newspaper and broadcasting back offices, they can no longer flex their imagination with outlandish expenses claims. Gone are the days when the late, great Ian "Dan" Archer could blighly take the hovercraft from Dover to Calais to enjoy a particularly fine French lunch, whilst supposedly covering the Open Golf at Royal St George's.

Then, there is the sheer tedium of covering the SPL. For every brief potential Camelot moment from Hearts or Dundee United or Aberdeen downing one or other to the Big Two, there will be a crushing riposte as the twin axis of evil grinds it metaphorical jackboot down on the throat of Scottish football.

No wonder we often yearn for a Scottish game without the tedium of the same two clubs winning everything. No wonder the ranks of the Tartan Army are awash with provincials who would never see foreign cuisine (other than Indian, Chinese or the odd pizza) with their clubs.

What a paradise it would be, if THEY would simply bugger-off and join the rest of the greedy, money-obsessed clubs in the English Premiership.

Well there is such a paradise, it's called the SFL.

OK, the football is sometimes crap, the surroundings are at best Edwardian, but more-likely to recall the dark satanic mills of Victorian times, but it's competitive.

You are far more likely to see upsets and shocks in the three SFL divisions than in the SPL. The SFL clubs don't go in for badge-kissing foreign mercenaries; and while many of the "top" players in the SFL failed with the Old Firm or the usual also-rans in the SPL; and at the lower level many of the players are on a Saturday, augmenting the meagre wages they earn Monday to Friday: because, by paying too-much attention to football and not enough to education while at school, they under-achieved in life, just as in football.

Yes, they lack flair and skill - but they try, and God loves a trier.

The SFL may be crap, but it's Scottish crap and long may it continue. Sure there are failings, many of the directors are simply glorified fans, more concerned with nanging-on in senior football than driving the game forward. But, many of the genuine greats of Scottish football emerged from these wee clubs - John White at Alloa, Wembley Wizards Jimmy McMullan and Alex James at Partick Thistle and Raith Rovers, Billy Steel and Jimmy Cowan from Morton - umpteen Rangers greats from Airdrie.

If the SPL is a league of supermarkets - 24-hour mega-stores in East and South West Glasgow, large branches elsewhere - there are still good experiences to be enjoyed in the corner shops of the SFL. At least the element of surprise still lurks there - the same two clubs don't win everything.

Tuesday, February 22, 2011

5 People, You Don’t Dating Him

Many people who say that falling in love is not indiscriminate. Falling in love makes people lose their common sense and logic. Sometimes there is also a saying, that love is blind.

When you choose a date that is wrong, can make it all apart, careers and life. There are also many people who rose from a sense of remorse difficult because of their broken love.

In order for you not to experience such things. Consider to avoid the 5 people who do not you dating the following:

1. Friends work together
Going out with friends work together will make us more closely monitored by bosses. At the time of declining performance, we also will be used as a scapegoat. If it breaks? Well, it's doomsday, so ingredients chat and gossip materials. Other than that? Each day you should still see your ex.

2. Runaway
When you are just 1-month break, you say you've found a couple back. Avoid deciding quickly, because your own feelings have not recovered. Never force. You will continue to compare him with your ex! Give your heart and mind to come back ready to undergo a serious relationship.

3. Friends of Your Ex
You have a partner, and you know a few friends. When you break up, don’t try to build relationship with your friends of your Ex. Since you will face new problems.

4. One person at a time
In one year you have alternated as many as 12 persons were friends dating. This means that 1 person in a month. Would not you need to prepare your thoughts and feelings to determine which ones really love you and you feel happy with him?

5. People who had encountered
You've met with that person. Do not quickly fall in love; it takes a process to get to know the person. The extent to which, he likes you. Although you like him, and he likes you. Let he underwent the role. Let him be the first to express his feelings.

You want to try something different, join the Mail Order Brides. Hope you find something different and find a suitable partner there.