If you’re new to this blog…

WELCOME! Maybe you’re here because you’re starting nursing school, dreaming of nursing school or just getting ready to buckle down again for another semester. For all the newcomers, I thought it would be handy to give a brief overview of what you’ll find here…since this blog is SO MUCH more than a blog. Ready?

In this section of the blog you will see all the posts that I do periodically on a variety of nursey related topics, and it is always the first thing you’ll see on this page. But wait, there’s more!

At the top of the page, you see a menu bar with some headers…explore your heart out because this is where you’ll find all my notes from nursing school and some of my pre-reqs such as A&P, printable reference sheets, study aids, goodies to buy, a link to my e-book and loads more. So, this site is MUCH more than just a blog…it is your ultimate resource for kicking some nursing school bootay!

You will also occasionally (if you’re lucky) see a picture of the cat I stole from my neighbors. Well, “steal” might be too harsh a word. He sort of stole me…his name is Oliver and he loves nursing school!

Oliver says, "Dude, welcome to the best time of your life."

Oliver says, “Dude, welcome to the best time of your life.”

Have fun this semester, and be safe out there!

Posted in Organization | Tagged , | 4 Comments

ABGs….easy as 1 – 2 -3

I was chatting with some nursing students recently and asked what their most challenging subjects have been so far…someone piped in and said that ABGs were a real pain in the neck… and no wonder! Her professor had suggested they just try to memorize the values. Sorry, but that’s not going to do squat to help you analyze an ABG at the bedside of your critically ill patient in renal failure with COPD and pneumonia.

So, I thought it would be nice to do a little post about ABG analysis, mainly the tic-tac-toe method. Now I was going to link you to the original article, but it’s only available on EBSCO (or other subscription services) so if you have an EBSCO account through your school I highly recommend the article titled, ‘Turn ABGs into Child’s Play” by Doreen Mays and Eileen O’Connor.

Since this brilliant article was written, lots of folks have jumped on the tic-tac-toe bandwagon. If you google it, you’ll find videos and powerpoint slides galore. I haven’t gone and looked at them all, so I can’t tell you if they’re amazing or not. I do know the original article is amazing, so next time you’re at the library or logged in through your university’s site I highly recommend you read it. It will change your life ;-)

Of course, you know I’m not going to leave you hanging…so basically, it boils down to this. You know your normal ABG values, right? If not, then you do need to memorize that part and you need to know if the value is acidic, normal or basic/alkalotic. So, let’s review:

pH: 7.35 – 7.45 (lower than 7.35 is acidic, higher than 7.45 is basic)
CO2:  35-45 (lower than 35 is basic, higher than 45 is acidic)
Bicarb: 22-26 (lower than 22 is acidic, higher than 26 is basic)

The next thing you need to understand is that CO2 has to do with the lungs, and Bicarb has to do with the kidneys…so CO2 is respiratory related and Bicarb is metabolic related. Got it?

Ok, so now I’m going to get artsy…forgive me please! Let’s say you have a patient who has a bad pneumonia who suddenly isn’t looking so spiffy. You are super worried so you get an ABG. Your results show the following:

pH = 7.16; Bicarb = 24; CO2 = 59; O2 = 60. 

I can tell you right now that’s a pretty crudtastic ABG. Let’s figure out why it’s such bad news. Ready? The first thing you’re going to do is draw a tic-tac-toe grid, like this:

Step 1

Step 1

So, did you remember his crudtastic ABG results? Start with the pH…it’s 7.16. Is that acidic or alkalotic? Think about it for as sec and you’ll remember that a low pH is acidic. Good! Write “pH” under the acidic column like so:

Step 2

Step 2

The next value we’re going to look at is the Bicarb, which is 24. Is that acidotic or alkalotic? Think about it! Think carefully. Yes, it’s a trick question! That bicarb value is totally normal, so we’re going to write “Bicarb” (or you could write HCO3 if you wanted to be fancy) in the middle column like this:

Step 3

Step 3

Actually, you can look at Bicarb or CO2 after your pH, it doesn’t really matter…but this just happens to be how I set up my art show, so we’re doing it this way. Now let’s look at your CO2. It’s 59. Is this acidic or basic/alkalotic? Hmmm….high CO2 is acidotic, you say? Yes, you’re right! So, let’s write CO2 in the acid column just like this:

Step 4

Step 4

And then you step back and admire your tic-tac-toe board because guess what? You’ve got three-in-a-row…you win! 

Tic-Tac-Toe!

Tic-Tac-Toe!

Because your three-in-a-row is in the acidic column, you know you’re dealing with an ACIDOSIS. Now, is it respiratory or is it metabolic? Easy. Respiratory acid/base is determined by the CO2, while metabolic acid/base is determined by the Bicarb. So which one is in your column? The CO2, right? That means, this is a RESPIRATORY ACIDOSIS. 

The next question you’re going to ask yourself is, “Self, is this compensated, partially compensated or uncompensated respiratory acidosis?” Well, self, it’s a good thing you’re so smart because that’s an easy one for you, too. To determine compensation, we look at the pH first. Is it abnormal? Yes…so we are definitely not compensated. Now we look at the Bicarb…the only number we have left (except for O2, which we’ll get to in a minute). The Bicarb is normal…so what does this mean? This means the kidneys have not yet had a chance to kick in and start buffering that acid. If they had, the Bicarb would be high. But in this case, it’s totally normal, which means your poor patient has some acidic blood coursing through his little ol’ system and his dumb ol’ kidneys haven’t done a darn thing about it. So in this case we have UNCOMPENSATED RESPIRATORY ACIDOSIS. 

Now we’re going to take note of his O2 and his clinical presentation (which is as crudtastic as his ABG). This dude needs to be intubated RIGHT AWAY!!! Get the team in there now (and what supplies do you want to have handy? Hmm? We’ll save that for another post.) Want to do another one? Of course you do!

Let’s say you’ve got a patient who’s on a vent, zonked out on paralytics and breathing at a set rate of 16. He’s suspected of taking an overdose of antacids, thinking they were ecstasy pills. So, he’s not the brightest bulb in the pack…welcome to nursing. So, anyway his ABG results are such:

pH = 7.56; Bicarb = 32; CO2 = 37; O2 = 90

So, first draw your tic-tac-toe grid. I’ll wait. Now, let’s look at our pH. Is it acidotic or alkalotic? It’s alkalotic, so let’s write it in:

So far so good!

So far so good!

Your next value is the Bicarb of 32. Where does that go? Yep! You got it…his Bicarb is high so he’s alkalotic. 

It's getting easier, huh?

It’s getting easier, huh?

Even though you have tic-tac-toe already, you still need to analyze the CO2 to see if we’re compensated or not. So, his CO2 is 37. Where’s that go?

You're rocking it!

You’re rocking it!

So, what do you think? You have a tic-tac-toe with the Bicarb matching up with the pH…so you have a METABOLIC ALKALOSIS. Is it compensated or not? Have the lungs adjusted CO2 to balance things out? Nope. So it’s UNCOMPENSATED METABOLIC ALKALOSIS. Since he’s on paralytics his body isn’t going to breathe at a rate to naturally compensate for the alkalosis…so we need to make those vent adjustments ourselves and turn his rate down…maybe to around 12 or so. We’ll keep an eye on his CO2 and O2 as well…but most folks tolerate a rate of 12 just fine.

So now go watch a few YouTube videos. Let this sink in and then we’ll tackle compensated and partially compensated acid/base disorders. Then we’ll tackle mixed acid/base disorders. Then you’ll be even more amazing than you are right now. 

Be safe out there!

Posted in Diseases & Conditions, Tips & Tricks | Tagged , , | Leave a comment

Save your neck with a bookstand!

So I am in full back-to-school shopping mode…my favorite time of year! In a previous post you may have noticed me singing the praises of my wooden book stand. Well, guess what? It’s so nice I bought it twice!Screen Shot 2014-08-10 at 8.06.32 AM

Actually, I loaned my original to my sister-in-law for her adventure through nursing school and now that I’m going back for my MSN, I found myself in need of something to make it easier on my neck with all the reading I’ll be doing. So…with that said, I loved this book stand! It’s only downside is the price ($35) which admittedly does seem a little high, but when I compared it to other book stands, it seems to be the most sturdy and the little clips make it easy to turn pages and then clamp them down again. Considering how much I used it the first go around, I’d probably still buy it even if it were priced higher…did I mention I loved it?

Here it is, if you want to click through to Amazon and check it out!

 

Posted in Organization | Tagged | 2 Comments

The dreaded rolling backpack!

I know, I know…rolling backpacks have a reputation as dorky, but if you’ve been reading this website (or my book), then you know I wholeheartedly endorse choosing function over fashion. BUT WAIT! Now that I’ve found this bag, I don’t have to!

The cutest rolling bag ever!

The cutest rolling bag ever!

Screen Shot 2014-08-09 at 9.15.24 AM

Plenty of room for a laptop and all your supplies!

So, be super fashionable AND functional this semester…the bag is available at Amazon (my favorite online retailer EVER!) for just $57.99 with free shipping! For a bag of this quality, that’s a steal! Here’s the link!

Posted in Organization, Supplies | Tagged , | 1 Comment

The Academic Planner is HERE!!!

The Straight A Academic Planner is here!!! And a full day ahead of schedule…thanks to a lot of coffee and a husband who works at a fire station and wasn’t here to distract me with his cuteness.

This is a full-size printable planner with monthly and weekly views plus a load of unique touches that will help make your busy life run like clockwork:

-12-month-at-a-glance with space for you to write down a new good habit you’d like to develop each month (drink more water, take your vitamins, meditate, brush the cat!)
-nursey facts across the top of each weekly spread…that’s right…104 factoids you WILL use at some point in school (and also on the job!)
-a space to keep track of assignments each week so you never miss a deadline again
-a designated “TODO” list area, a separate list for school and home
-a space to plan or log meals and exercise plus boxes to check off your water consumption, fruit & veggie consumption (aim for 9 a day!), and a special orange box to check off when you do something each day that brings you joy (call a friend, go for a walk, relax in the tub, meet a buddy for coffee, sing a song…whatever!)
-vertical Monday-Friday with faintly lined columns so  you can write super neatly
-large space for Saturday-Sunday since that’s when you catch up on studying and “me time”
-project pages to help you keep those “fun” group projects on track
-blank note pages for writing down ideas, directions to your study partner’s house, names for the dog you’re going to get when you graduate…whatever your heart desires!
-the calendar starts each month, so choose when you want to start (currently August and September starts are available).

To purchase, just visit my Etsy store by clicking here!

I hope to have a “guy version” for Jan 15, as well as a half-size version at some point. Hope you love it as much as I do!!

Keep track of every task, assignment and to-do. Be a list-making fool!

Keep track of every task, assignment and to-do. Be a list-making fool!

Please take care of yourself!

Please take care of yourself!

I wish I'd had this when I was in nursing school

I wish I’d had this when I was in nursing school

Posted in Organization, Supplies | Tagged , , | 6 Comments

FREE e-book thru 8/6!

Amazon is running a promotion on The Nursing School Thrive Guide, so it will be FREE for download through August 6th! If you are a brand-new student or even if you’ve already started your program, the Thrive Guide is chock-full of tips about every single aspect of nursing school. From getting organized, to studying and writing care plans…it’s all there!

Just go to this link at Amazon and bam! It’s yours!

And if you would please leave an honest Amazon review, that would help me TONS!

Be safe out there!

Nurse Mo

P.S. Tell your friends ;-)

Posted in Study Aids, Tips & Tricks | Tagged | 3 Comments

Sneak peak at the straight A academic planner!

The planner-to-end-all academic planners is now officially in the beta-testing stage…can’t wait to get the kinks worked out of this baby and in your hot little hands! Here’s a look at how to use the weekly spread…more to come soon!

Can  you say "uber-organized nursing student?"

Can you say “uber-organized nursing student?”

Posted in Organization, Supplies | Tagged , | 12 Comments