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Nurse Mo wants you to ace nursing school!

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. This blog is so much more than a blog, there’s also a ton of FREE educational resources!

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 notes related to nursing school, printable reference sheets, study aids, goodies to buy, a link to my e-book and loads more.

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TBT: Microbiology is kicking my macro-booty

Screenshot 2015-05-20 09.05.35For Throwback Thursday, I am re-posting my nursing school blog entries. Each week I’ll post one entry from the “good ol’ days.” Travel back in time with me as we revisit the joy that is nursing school! Here you go!

I am lame…I haven’t posted in almost TWO MONTHS…which is really pathetic. I started school at the end of August (which only partially explains my lameness) and have been a complete whack-job ever since. I have class Monday-Thursday nights and the rest of the time I am trying to get my freelance business up and running, help Tom with his business, take care of the house and three cats + one child (oops, I mean + one husband), and maybe squeeze in time to shave my legs once in a while.

Microbiology is kicking my butt. It makes Chemistry look like a walk in the park…and I studied my butt off for my A in Chem. I have my first test tomorrow night, so we’ll see….but from where I stand it does not look so bueno. Not so bueno at all. I am hoping that the semester will get easier now that we have Microbial Metabolism behind us, but the chapters ahead (Recombinant DNA Technology, Microbial Genetics and other exciting topics) do not bode well. If anyone has taken Micro please let me know if it gets better!!!! I am mainly looking forward to the section of the book where we see what kinds of nasty disesase people get from bacteria and viruses…icky pictures and all!

My lab though, is FUN! It’s really neat to see what kinds of disgusting things grow from our cultures. Plus my lab partner is really nice and every day I thank GOD that I do not have Annoying Guy as my lab partner. Annoying Guy is this major science geek that smirks all the way through class and corrects the teacher’s pronunciation and every little thing under his breath (and sometimes out loud to the whole class). I had the joy and pleasure of sitting near him for the first three weeks until I had HAD IT! I soooo wanted to tell him off, but instead took the path of least resistance and just sat on the opposite side of the room….”Take that you science geek!”

In other news, I am no longer working in the office…did I post about that already? I got “released” from employee status back to my independent contractor status (another thing I am thankful for every day), and am now back to my insane self-employed-ness. The kittens all got exceptional homes, my hair is long enough to put in hot rollers and I am still as fat as ever. I’m working on it though…I promise I am going to get on a schedule and start taking my morning walks again. PROMISE!

I’ll also promise to try to not be so lame and to update my blog more regularly. At the very least I have to let you know how easy my Micro test is…ha! (originally posted 9/23/07)

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Good nurses ask for help

I had a “moment” at work the other day, and while it left me feeling flustered and a bit like a spaz, I think there’s a valuable lesson to be learned. I was taking care of a patient who had a whole host of problems…one of which was pretty severe heart failure. He needed a powerful inotropic medication that I’ve never given before so I was understandably a bit nervous. Luckily, I had this reference sheet available, but I still had a nagging feeling about it. The dosage was ordered as follows:

Give 50 mcg/kg as a bolus; then give maintenance dose of 0.375 ml/kg/min.

Pretty straightforward, right? So I pulled out the good ol’ dimensional analysis method and proceeded to figure out my loading dose. The problem is, I kept getting really weird answers that made NO SENSE. So rather than go with the really weird answer I kept getting, I asked another nurse to do the calculation. Low and behold she got a different answer than I did…so I called pharmacy and they got the same answer my friend did. What had I done wrong? Dimensional analysis works every time for every calculation, right? I am telling you this was bugging me to no end…and the fact that it was annoying me made me even more nervous about giving this particular medication to someone so very very sick.

After taking a few deep breaths I realized what I had done to cause my calculation to be off…it was my conversion factor…I had written it as 200 mcg in 100 ml, whereas it was 200 mcg in 1 ml (the whole bag was 100 ml). This was a huge reminder that a simple thing like a conversion factor can muck up your calculations, mess with your brain and leave you feeling like a frazzled mess. We ended up confirming the correct dosage and all was well, but the whole experience served as a reminder that a good nurse must ALWAYS ask questions, especially of him or herself. I have always said the nurse who never asks questions is the most dangerous nurse on the unit…so even if you are worried about swallowing your pride and asking for help…do it! Your patient deserves it, and you will probably learn something in the process. What did I learn? I learned to sloooow down, check ALL my numbers before doing my calculation, and to always have another nurse independently do the math as well. Next time, I hope to not feel like such a spaz (do people still say spaz? I’m a product of the 80s!).

Be safe out there!


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Dosage Calculations Quiz

Last week I posted a tutorial on using dimensional analysis to solve any dosage calculation problem ever. As promised, here is a dosage calculations quiz that will put your knowledge to the test. Good luck and let me know what you think of having presentations on the website. If you like it, I’ll add more tutorials using a slide format. Good times! And be safe out there!

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Review: Compression Socks

If my first words about a pair of socks are “ohmygod,” then you know these are some awesome socks. I kept experiencing achy legs after my shift so I decided to break down and buy some compression socks. But, I didn’t want just any ol’ compression socks, I wanted stylish socks that would complement my boring navy blue uniform.

Compression socks

Super comfy socks!

Sockwell socks are amazing! They are made of a blend of materials, one of which is merino wool. I thought they would be too hot, but they are perfection! The socks provide a moderate level of compression (15-20 mmHg), which is great for nurses who stand/walk all day. Bonus…you can also wear them on an airplane or long car ride if you’re lucky enough to go on any fun trips anywhere!

One of the best things about these socks is that they are made with a little bit of spandex, so they stay in place all day…no saggy socks here!

The pattern I bought is the chevron, and I got them on Amazon for $25. Yes, much much more than I would normally pay for socks, but if it saves my legs and keeps me from getting nasty ol’ varicose veins then it’s money well spent. I initially thought they would be too bulky, but my shoes fit the same as they always do, and I never felt over-heated despite walking hither and yon for 12 hours.

And, maybe this was a coincidence, but I felt so good after my shift that I called a friend to meet up for a drink. I NEVER go out after work…I don’t even stop at the grocery on the way home. I typically head straight to the shower, then straight to the sofa. But, after a shift wearing my Sockwell socks, I had a couple o’ margaritas and some really tasty guac with a dear pal of mine. I can’t wait to wear them again!

Nurse Mo’s rating? 5 stars! Ask for a pair as a graduation gift!

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Dosage calculations the easy way!

dosage calculationsWhen it comes to doing nursing math, which is essentially figuring out dosage amounts, the absolute best, easiest and most foolproof way to do it is by using dimensional analysis. You may remember it from your chemistry class and loved it even then ;-). In this post I will show you how to use dimensional analysis to solve any dosage calculation, even the tricky weight-based ones.

Level 1 Dimensional Analysis: Piece of Cake
We’ll start at level 1….super easy ones to give you a feel for the technique. Ready? Your order reads:
Screenshot 2015-05-06 13.58.04In dimensional analysis, you always start with what’s ordered. In this case it’s 650 mg of acetaminophen. You will write this as a fraction, with 650 on top and 1 on the bottom like so: nursing math

Next, you need to know what dosage amounts your medication comes in. This is known as the conversion factor. In the case of good ol’ Tylenol, we check our blister pack and see that it’s 325 mg per tablet. The next step is to add the conversion factor also as a fraction. Since mg is at the top of our first fraction, it will go on the bottom of our next one so that they cancel each other out. Like so:
Screenshot 2015-05-06 13.53.08dimensional analysisAs we move forward into more complicated calculations, it will become more evident that you know when to stop conversions when you are left only with the information needed to give the dose. In this case, we want to know how many tablets to give the patient. Everything except for tablets is crossed out, so we know we are ready to do some math.

1) Multiply across the top: 650 x 1
2) Then divide across the bottom: ÷ 325.
What answer did you get?
Screenshot 2015-05-06 14.11.00

Let’s do one more easy one, then move on to something a little more difficult.
Screenshot 2015-05-06 14.14.35For this calculation, let’s assume midazolam comes in 5 mg tablets. I have no idea if it does, but we’re just practicing so it’s all good. Hopefully, you’ve set up your calculation like this:
Screenshot 2015-05-06 14.16.11Next, cross out the units that are the same…in this case it’s mg.
Screenshot 2015-05-06 14.16.26

We are no weft with X # of tablets to give our 1 patient. Voila! Now,  do your calculation!
dosage calculations

OK…you have the hang of that now? That’s a simple calculation with one conversion. What if you have multiple conversions?

Level 2 Dimensional Analysis: Multiple Conversions
Rather than deal with actual drugs, I’m just going to make them up from here on out…easier and more fun that way! So, your order reads:
Screenshot 2015-05-06 14.23.12You go to the med room and see that Smartella comes in vials that have 4 mg of drug per ml. How much Smartella do you need to draw up? Start with the order:
Dimensional analysisNext, look at your vial…you know you need to ultimately get to mg, so let’s convert mcg to mg in our next step:
Screenshot 2015-05-06 14.27.27Notice how mcg are set up to cancel each other out…let’s continue as we add the amounts our medication comes in (4mg/ml)
Screenshot 2015-05-06 14.29.43Let’s get to canceling our units:
Screenshot 2015-05-06 14.29.43(2)Now we do the math:
1) Multiply across the top: 2000 x 1 x 1
2) Divide across the bottom: ÷ 1000 ÷ 4
3) Press “=” on the calculator…what did you get?
Screenshot 2015-05-06 14.29.43(3)

Way to go! Let’s do one more…your order reads:
Screenshot 2015-05-06 14.36.34You check the vials of Awesome-Sauce and see they contain 1gm of drug in 10ml of solution. Because you yourself are taking Awesome-Sauce regularly,  you know how to do the calculation:
Screenshot 2015-05-06 14.41.02(3)Next you get to crossing things off that cancel each other out:
Screenshot 2015-05-06 14.38.54You’re just left with ml, which is exactly what you need to know. Now it’s time to do some math!
1) Multiply across the top: 60 x 1 x 10
2) Divide across the bottom: ÷ by 1000 ÷ by 1
Screenshot 2015-05-06 14.41.02(2)OK! You’ve got this! Let’s move on to something a little more difficult.

Level 3 Dimensional Analysis: Weight-based Calculations
You will do a LOT of weight-based calculations in pediatrics and a fair amount in the adult population. For this first calculation, let’s assume your patient is 4 kg….awwwww a little baby!
Screenshot 2015-05-06 14.49.20You will start with the dose as always, which is:
Screenshot 2015-05-06 14.53.01Notice what we did differently here? We didn’t put the 1.4 mg over a 1…we put it over KILOGRAMS, because your dose is 1.4 mg per kilogram. By the way, Brainzy comes in a 10ml vial that contains 100mg of the good stuff, so you’ll write out your calculation like this:
Screenshot 2015-05-06 14.53.06As you write out your conversions, notice that we have 4kg over 1baby…that’s because your particular patient is a 4kg baby. Next we cancel things out:
Screenshot 2015-05-06 14.53.32We are left with X number of ml for 1 baby…which is exactly what you need to know. No Brainzy for you…you’re already super smart!
Screenshot 2015-05-06 14.54.07

Sometimes your nursing professors will try to get all tricky on you and give you your patient’s weight in pounds, with the dosage in kilograms. No problem!

Nursing MathYour patient weighs 283 pounds and just had a BKA…you do NOT want him trying to get out of bed! You mosey on in to the  med room and see that CalmDown (the greatest invention EVER) comes in a dosage of 1 mg per 10 ml bag. You diligently set up your equation, including all the conversion factors you need to end up with X number of ml per patient:
Screenshot 2015-05-06 15.10.08Notice how we start with the order (2 mcg/kg) then convert the kg to pounds, then input our patient’s weight in pounds, then convert the mcg to mg, then add in the number of mg in a 10ml bag. Easy!

Now you cross things off…cancel out those matching units!
Screenshot 2015-05-06 15.11.04And you are left with X number of ml per angry patient…exactly what you need!

Now get to calculating!
1) Multiply across the top: 2 x 1 x 283 x 10
2) Divide across the bottom: ÷ 2.2 ÷ 1 ÷ 1000 ÷ 1
3) = ??
Screenshot 2015-05-06 15.11.53The next level of dimensional analysis is a bit more tricky…but you are amazing, so I’m not worried at all!

Level 4 Dimensional Analysis: Weight Based Meds by Time
If you precept or do clinicals in critical care, you will notice that meds are often dosed mcg/kg/min…woah! That’s a lot of conversions! But with dimensional analysis it’s a walk in the ol’ park. Your order is:
Screenshot 2015-05-06 15.33.11You start with the order…which is to start your med at 2mcg/kg/minute. So let’s start there!
Screenshot 2015-05-06 15.35.45Next, think about what you want to get out of this calculation. Your pumps run on mls/hr so that’s what we want! You check out the bag of Squeezalot and see that it delivers 250 mg of drug in 250 ml. Ready? Let’ do this.
Screenshot 2015-05-06 15.35.59You’ve started with your order, then added your patient’s weight, then converted mcg to mg (since that’s what unit measurement our med comes in). Next we converted minutes to hours (since our pumps are configured to run on mls per hour) and lastly we have 250 mg of Squeezalot in one 250 ml bag. If you’re sure you’ve got yourself covered, let’s cancel out!
Screenshot 2015-05-06 15.37.32As you can see, we are left with ml/hr/patient…which is what we want! Now let’s do the mathulations:
1) Multiply across the top: 2 x 45 x 60 x 250
2) Divide across the bottom: ÷ 1 ÷ 1000 ÷ 1 ÷ 250
3) = ??
Screenshot 2015-05-06 15.37.38

One more tricky one and then you’ll be good to go! Your order is for a continuous infusion meant to keep intubated patients calm:Screenshot 2015-05-06 15.48.21You check the Copacetik IV bag and see that it provides 1000 mg in a 25o ml IV bag. Your patient weighs 180 kg and now you are ready to set up your equation. Hopefully it looks like this:
Screenshot 2015-05-06 15.50.43We’ve started with our dose of 3mcg/kg/min, then added in our patient’s weight, then converted mcg to mg, then converted minutes to hours, then added the information specific to Copacetik. What’s next? Cancel out those units!
Screenshot 2015-05-06 15.56.08Then it’s time to get down with yo bad self and math it out!
Screenshot 2015-05-06 15.50.201) Multiply across the top: 3 x 180 x 1 x 60 x 250
2) Divide across the bottom: ÷ 1 ÷ 1000 ÷ 1 ÷ 1000
3) = ??

See how wonderful, versatile and ultimately easy this method is? It works for any kind of calculation, any time, anywhere, on any patient. In these examples, I had you multiply and divide all numbers, including the numeral 1. Obviously, you don’t have to do include the 1’s, but if it helps you to remember every step, then it doesn’t hurt to include them.

Coming soon…a dosage calc quiz to test your brainy-ness!

Be safe out there!

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Mailbag Monday…NCLEX!

What do nursing students dread the most? Is it scary clinical professors? Skills check-offs? Their first encounter with a yeast-infested pannus? Nope! It’s NCLEX! A fellow nursing student named Julie writes in with this query:

I would love to hear your thoughts on NCLEX preparation: great review books, is it worth it to take a prep course (like Kaplan), any great practice question resources, any other helpful advice to aid in passing.

You have some great insight and I’d love to hear your thoughts on NCLEX!

First of all, you do not have to wait to start studying NCLEX-style questions. I started studying with NCLEX study books from Day 1 in good ol’ Med-Surg. I really loved the Mosby NCLEX books and used those a lot…mainly because they wrote great questions, they were organized by body system, AND they provided rationales for every correct and incorrect answer (sometimes knowing WHY something is wrong is just as important as knowing why the other answers are right!).

So, for example…while we were studying renal in Med-Surg, those are the questions I focused on with my NCLEX study books…as I got closer to graduation and my actual test date then I started taking practice tests that would throw all the body systems in together. Once I graduated, I obsessed about finding a job, learned snowboarding, and studied for about 6-8 weeks I think.

In the few days prior to the NCLEX, I did practice tests of at least 75 questions to prepare me for the length of the exam and just hoped I wouldn’t have to sit through all 265! The night before the exam, I did a few questions just to keep the ol’ grey cells limber. However, I did not study at all the morning of the exam as that goes against my principles of staying reeeelaaaxed on test day! I scheduled my test for early-ish in the day, ate a good breakfast, and went in with an open mind so the answers could just flow right on out of my head onto the computer screen. I don’t remember much about the actual exam, except that I felt like I was guessing A LOT. I also got a ton of those awful “select all that apply” questions…those are evil! I do remember that I cried all the way home, and got pulled over for talking (and crying) on my cell phone. The officer was very sweet and said, “I’m sure you passed”…. but he was also a jerk and still gave me a ticket! Whatever!! But he was right, I passed!

I didn’t take any Kaplan courses, but when I looked into them they seemed really expensive to me…my thoughts are that if you are having trouble with NCLEX-style questions when you graduate your school hasn’t done a very good job of preparing you for the inevitable. Most schools will utilize NCLEX-style questions on all your exams, and also require you to complete exit exams each semester such as ATI or HESI.

So there, you have it…my NCLEX advice and tearful experience. Hope yours is better!

Has anyone taken a Kaplan course? Care to share your experience?

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C’s get degrees!

C Nursing StudentOne of the things that sends me over the edge is when I hear someone happily exclaim, “C’s get degrees!” in reference to their nursing school education. While it is factual and true, it is such a fundamentally wrong attitude that I shake my head every single time I hear it…and also hope the student who says it never works on my unit nor is ever my nurse.

Now don’t get me wrong. There is absolutely nothing wrong with brushing yourself off after a poor performance and getting right back up on that horse.

I’ve known plenty of smart-as-a-whip students who earned a C on a test or even in an entire course and still went on to become wonderful nurses. Maybe they had test anxiety and didn’t test well, maybe a migraine made an appearance, maybe their dog died that morning…the list of things that can muck up your grades is endless. Regardless, they didn’t have the cavalier attitude of one who aims to just be a C nursing student, and that makes all the difference. Everyone has an off day, or even an off week. Some people even have entire semesters when they’re not at the top of their game…life happens and you can’t always plan it out in advance. But the point is, earning a poor grade despite your best intentions and earning a poor grade out of laziness (and then bragging about it) are two entirely different things. Which nurse would you rather have taking care of your family member? The nurse who studied their tail off for the exam and had an “off day” is going to be far more prepared than the nurse who didn’t study at all, because (say it with me) “C’s get degrees!!”

I have always said that “Straight A Nursing Student” isn’t as much about making a 4.0 throughout your program as it is about learning the material and taking excellent care of your patients (and yourself!). And yes, I have sat through countless arguments about how “C” students make better nurses because they are more caring and better at clinical and how “A” students are great at earning the grade, but lack the know-how to excel in clinical. To me, this is just a bunch of poorly-performing students chiding away at those who have put in the time and effort while they sit back with their 2.0 knowing they’ll get their degree regardless. And when you take into account that a C is the lowest grade one can attain in nursing school and still pass, you have to realize that in most cases, a C is very close to failing…I can’t imagine being comfortable with that, especially knowing that someday I would be responsible for people’s LIVES. Let that sink in. Nurses hold people’s LIVES IN THEIR HANDS. What we do or don’t do during a shift can make the difference between life and death. Now, how hard are you going to study for your next exam?

As to who does better in clinical situations, I am not one to say that C students can’t do fantastic in clinical and that “book-smart” students can’t flail when it comes to actual patient care…but to generalize so broadly is just plain wrong. I have even seen people making the argument that students who perform poorly in the classroom make great nurses because they infuse their care with the human touch. In my humble opinion, you don’t need to go to school for five years to learn how to be nice and caring to people. You need to go to school for five years to understand pathophysiology, pharmacology, electrolytes, homeostasis, microbiology, the Krebs cycle, cardiac electrophysiology, hemodynamics, biochemistry, assessment, and so on and so forth.

As we come to what is the end of the semester for many of you, don’t focus so much on what grade you earned, but how you got there. Ask yourself “What did I learn? How will I use this information to take care of patients? What do I still need to learn? How can I apply this knowledge to what I already know to understand the big picture?” By reflecting on these important questions, it doesn’t matter what grade you receive…you WILL be a thoughtful, conscientious and caring nurse. Yes, C’s get degrees, so if you work hard and still get a C on that test or in that course, I am immensely proud of you. But please don’t sit back knowing you can just “get by” without studying. Your future patients are counting on you.

And guess what? A’s and B’s get degrees, too (and in a tough job market, they also get the job).

As always, be safe out there!


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Mailbag Monday…motivation is key

Oh boy, do I know the challenges our friend R is having. Here’s what she has to say about motivation:

I found your blog in the early summer and wait around like a crack addict for a new post. :) Right now I am in the midst of 1st semester pre health (term Canadian’s use i/o TEAS for American’s I think). In any case, I am having the absolute hardest time finding motivation. The 1st 2 weeks of classes were difficult as I have been in the work force for a while but my job was not my passion.

In any case, I was hoping you could write a piece on how you stay motivated thru the tough school times? I don’t think you really do though as you are a rock star student and seem to love every minute of it. But still, if you can.

Ok, enjoy your day.

Motivation is one of the HARDEST things to maintain while in nursing school. Well, that and a clean house…haha. As for staying motivated, I absolutely thrived on being a good student, but there were times when I was completely and mind-numbingly exhausted. What kept me going was the dedication I felt for my future patients AND my fellow students. Even in nursing school I offered up my notes, shared my flashcards, published my recorded audio quizzes…all in the spirit of helping my classmates succeed. I was lucky in that I didn’t have to work, didn’t have any children to care for and basically could dedicate all my time to school. Many of my compadres had plenty of other responsibilities outside school and my little bitty heart just went out to them…nursing is a TEAM SPORT, ya’ll! You’ll figure that out soon enough once you’re working (provided you work on a good unit…not all are blessed with the team spirit I am so lucky to enjoy at my workplace).

So, at the risk of rambling here, I suppose the biggest motivation would be to determine WHY you are putting yourself through this endeavor. Is it to help others? Let those future patients of yours be your motivation. Is it to get a good, steady job so you can support your family? Look at the faces of those dear to you as your motivation. Is it to rock the heck out of a pair of Koi scrub pants? You get the idea 😉

How do you stay motivated?

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Mixed up about mixed gas?

If you are in a critical care clinical rotation, or new to the ICU, you may hear the term “mixed gas” thrown around here and there. What is a mixed gas, why do you measure it, and what does it tell us about your patient?

“Mixed gas” is shorthand for an SVO2 measurement or “mixed venous gas,” which looks at the oxygen saturation levels of blood obtained from the pulmonary artery. However, not every ICU uses PA catheters regularly, but never fear…you can still get some usable data by using blood from the superior vena cava. Note that when the blood is drawn from a central line placed in the superior vena cava vs the PA catheter, the measurement is referred to as an ScVO2. In the ICU where I work, we don’t use PA catheters much , so our mixed gasses are typically taken from the superior vena cava and are used to obtain information related to severe sepsis and septic shock. Unless you are working in a cardiac-surgery ICU, your mixed gas measurements will most likely be done as ScVO2 and related to sepsis and/or shock, so that’s what we’ll focus on here.

To obtain your mixed gas or ScVO2, you’re going to draw a VBG or venous blood gas. It’s a lot like an ABG, only it’s blood from the vein. One of the nifty things about a VBG is that it can also give you some other really valuable information such as the blood pH and carbon dioxide levels. As a quick aside, if you need to know your patient’s pH and you’re not able to obtain an ABG (maybe they’re on max vasopressors and their arteries are all clamped down), you can grab a VBG off your central line and voila…pH for everyone!

So, what does a mixed gas tell us? Basically, it tells us about oxygen consumption and delivery throughout the body, and thus provides a way to detect global tissue hypoxia. As blood comes out of the heart, all freshly oxygenated, it loses oxygen as it flows throughout the circuit delivering oxygen to the cells. In a normal, healthy, hemodynamically-stable patient, the body uses about 25-30% of the oxygen in the blood as it travels from the left ventricle through systemic circulation and back to the right side of the heart. So, in our “normal” patient, the ScVO2 will measure 65 to 80%. With the ScVO2, this is one instance where we’re not trying to shoot for 100%…if that were the case, it would indicate that the body is not picking up any oxygen as the blood makes its way around the circuit (which would be very bad for your patient indeed) so that’s why the range is from 65-80%.

If your mixed gas is less than 65%, be concerned about:

  • Decreased oxygen delivery (anemia, blood loss/hemorrhage, hypoxia, hypovolemia, heart failure)
  • Increased oxygen consumption (pain, fever, shivering, agitation, respiratory failure, or increased metabolic demand)

If your mixed gas is > 80%, be concerned about:

  • Increased oxygen delivery (high FiO2, increased cardiac output, hypervolemia, blood transfusions)
  • Decreased oxygen consumption (sedation, pain meds, hypothermia, mechanical ventilation)
  • Decreased oxygen extraction (shunting in sepsis, cell lysiss.

So, what are you going to do about it, Super Nurse? It depends on what is causing the mixed gas to be off. Give blood, give fluids, give oxygen, relieve pain, etc..  In the case of a septic patient, if your ScVO2 is too low despite fluids and vasopressors (less than 70% according to the Surviving Sepsis Guidelines), you’re going to add an inotropic agent such as dobutamine which will increase cardiac output. You also want to increase oxygen carrying capacity, so if your hematocrit is below 30%, you’ll be giving one or two units of PRBCs. Of course, there are other reasons your patient’s mixed gas could be outside normal parameters, so always try to determine what is causing it in the first place.

This has been a very basic introduction to mixed venous gas and is certainly enough to get you through your ICU clinical orientation, but if you are interested in the topic there is a wealth of information out there that is continually being updated as new knowledge is obtained.

I hope you found this helpful, and be safe out there!

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Psychopharmacology the easy way

psychopharmacologyPsychopharmacology is possibly the most interesting subset of pharmacology simply because the conditions these meds treat are absolutely fascinating. But the problem is, there are a ton of them…and keeping them straight can be difficult! Never fear, Nurse Mo is here! I’ve compiled a few tidbits for keeping those psych meds all straightened out in your fabulous brain.

Step 1: Have a general understanding of the conditions each med treats. This will take you beyond memorization to actual understanding. When you understand information, it has a tendency to move into long-term memory rather than jump out of your skull as soon as you hit “submit” on your exam.

Step 2: Learn about each type of medication as a group…study the atypical antidepressants together, the traditional antidepressants together and so on and so forth. The reason for this is that drugs of a particular class will share some common characteristics.

Step 3: Make up goofy mnemonics and acronyms to help you remember which drugs go into which class. For example, the mnemonic I used to help me remember the atypical antipsychotics was “All Good Zoos Save Rare Cats.” This equated to Abilify, Geodon, Zyprexa, Seroquel, Risperdal and Clozapine (Case in point, I am writing this post 5 years after I made up this mnemonic and I could recite 4 of the 6 off the top of my head. 5 years!!! Not bad!)

Step 4: Learn the side effects that are associated with each class of drug. My method involved making up ridiculous stories that I actually recited to myself (quietly, to myself!) during the exams. For example, here is one for the traditional antidepressants. The underlined and bolded words are the key words in the story. Try not to make fun of me.

A very traditional man became depressed when his dog B.C.* ran away. He ran through the neighborhood, and worked up quite a sweat. His heart raced, and as he searched for his dog, he realized that for the first time in years he wasn’t thinking about sex. This realization stopped him dead in his tracks, and his heart slowed. As he stood there, mouth dry and muscles twitching from the exertion, he saw B.C. trying to urinate on a fat lady’s lawn. He ran to his dog and scooped him up, dizzy with happiness. He danced around the yard with graceful rhythm, until he stepped in a pile of dog poo. “BC”, he exclaimed. “I thought you were constipated!” He flailed around the yard trying to get the poo off his shoe as the fat lady watched from her window. She was convinced the traditional man who was flailing about on the lawn was having a seizure or a stroke. (*B.C. = blood cell)

So, from this silly little scenario you can see that the traditional antidepressants (also known as tricyclic antidepressants) cause some pretty unpleasant side effects:

  • Decrease in white and red blood cell production
  • Sweating
  • Tachycardia or Bradycardia
  • Low libido
  • Dry mouth
  • Twitching muscles
  • Difficulty urinating
  • Weight gain
  • Dizziness
  • Altered heart rhythm leading to QT prolongation
  • Constipation
  • Seizures
  • Stroke
  • …and there are probably others as we learn more about these drugs!

For my Mental Health Nursing course I made up goofy stories for all the drug classes, which you can find here. But, if you have the time I encourage you to make your own as you’ll be able to remember them that much more readily when the time comes.

Good luck and be safe out there!

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