Medicación para los vómitos


Fuente: gettyimages
Patología frecuente en cualquier punto de consulta en la mayoría de los casos autolimitada y sin consecuencias. Sin embargo, al menos en mi experiencia, es en los puntos de atención urgente tanto en los PAC como en el hospital donde con más frecuencia usamos los antieméticos. Más que en las consultas de Atención Primaria. Probablemente sea debido a que las expectativas de los pacientes en cualquiera de las urgencias hacen mucha presión sobre nuestra decisión.
Por eso me ha llamado la atención este artículo reciente del que solo he leído el resumen pero con resultados interesantes, utilizan el ondansetron, la metoclopramida y el placebo y aunque los resultados tienden a ser mejores con los tratamientos activos, no hay diferencias estadísticamente significativas entre ellos. Esta es la traducción del resumen:
Las reducciones en la severidad de la náusea de esta población población fueron similares para 4 mg por vía intravenosa de ondansetrón, 20 mg de metoclopramida intravenosa y el placebo. Hubo una tendencia hacia una mayor reducción en las calificaciones de la EVA y a  un requerimiento menor de medicación de rescate en los grupos de fármacos antieméticos, pero la diferencias con el grupo de placebo no alcanzó significación. La mayoría de los pacientes en todos los grupos se mostraron satisfechos con el tratamiento.

Como tantas otras veces...menos puede ser más.

 

Medicación para los vómitos


Fuente: gettyimages
Patología frecuente en cualquier punto de consulta en la mayoría de los casos autolimitada y sin consecuencias. Sin embargo, al menos en mi experiencia, es en los puntos de atención urgente tanto en los PAC como en el hospital donde con más frecuencia usamos los antieméticos. Más que en las consultas de Atención Primaria. Probablemente sea debido a que las expectativas de los pacientes en cualquiera de las urgencias hacen mucha presión sobre nuestra decisión.
Por eso me ha llamado la atención este artículo reciente del que solo he leído el resumen pero con resultados interesantes, utilizan el ondansetron, la metoclopramida y el placebo y aunque los resultados tienden a ser mejores con los tratamientos activos, no hay diferencias estadísticamente significativas entre ellos. Esta es la traducción del resumen:
Las reducciones en la severidad de la náusea de esta población población fueron similares para 4 mg por vía intravenosa de ondansetrón, 20 mg de metoclopramida intravenosa y el placebo. Hubo una tendencia hacia una mayor reducción en las calificaciones de la EVA y a  un requerimiento menor de medicación de rescate en los grupos de fármacos antieméticos, pero la diferencias con el grupo de placebo no alcanzó significación. La mayoría de los pacientes en todos los grupos se mostraron satisfechos con el tratamiento.

Como tantas otras veces...menos puede ser más.

 

A few tips to help the new-graduate nurse flourish.

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One question I get asked a lot is for tips to help out new-graduate nurses or nurses just starting on a new ward. It can be a very stressful time.
Here is a (by no means exhaustive) scratch-list of tips to help the new nurse not just survive, but flourish.
As usual,  your own tips are welcome.

To do list.

Before starting:

Acquire any personal clinical equipment you might need. See below.

Contact your new unit manager to confirm starting date, initial roster etc. Ask if there is an unit specific information or educational materials that is available before you start.
Ask if you can have a quick 5min walk-through orientation before you start. This is very helpful just to get the ‘lay of the land’ and remove some of the fear of the unknown before your first shift.

First day:

Remember to breathe. Remember to smile.

You will be leaving an impression over your first few days. Rightly or wrongly you should take time with personal grooming and dress so as to give a presentation of professionalism. Personally, I really enjoy people who express a little individuality in their professional persona. But many others do not. Best to remove excessive jewellery piercings etc. At least until you have settled in to the unit.

Try to remember the names of key staff that you are introduced to (if you are anything like me you will fail dismally at this, so write them down in your notebook at earliest opportunity).

Introduce yourself to everybody you possibly can on your unit. From clinical educator to cleaner. You will feel silly doing this. But do it anyway.

Listen. Listen. Listen.

First week:

If you have been given any orientation materials for your new unit, try and read it all through at least once during the first week.

Take note of staff that are particularly supportive or helpful.
Now a few words about this:  Most wards will have a few staff that are NOT going to be particularly supportive or receptive to you. And some wards will have a few staff that are curmudgeonly, toxic, demanding and/or outright bullying.
As you interact with staff and begin working your way through the shifts it will not take long to figure it all out. But remember ,sometimes even the best role models will have off days, and sometimes they will be struggling with their own workloads and clinical issues.

Pace yourself. If you are feeling overwhelmed, take a moment to step back and look at what needs to be done. Always ask yourself: “what is THE next most important thing that I need to do?”.
Try not to multi-task too much (though this is easier said than done) or get distracted by low priority interruptions. Do one thing at a time and do it well.

Think about how you are thinking (this is known as meta-cognition) and if you are struggling THE most important thing to do is ask for help.
You may sometimes feel that you spend the whole shift asking questions and asking for help, but let me say that nurses who do this ALWAYS go on to perform more confidently and are looked upon more highly by colleagues than those who try to struggle-on not admitting their problems to others, or themselves.

Remember the basics. Nurses are seldom remembered for their knowledge of the thermodynamics of blood gas analysis, or their ability to recall every hospital policy and procedure verbatim. No, the best nurses are always remembered for their ability to provide consistent, quality basic (essential) nursing care.
Concentrate on this with your patients.

First month.

At some stage during the first month you may hit THE WALL.
Splat!
You may feel completely overwhelmed, underprepared, exhausted and useless. You are particularly likely to encounter the wall in high acuity areas but it can happen anywhere.
If you beginning to feel this way you need to talk to trusted senior staff and/or your unit manager.

After 28 years nursing I can assure you that nurses that really struggle at the beginning often become the best clinical nurses I have worked with.

By the end of your first month you should ask for a meeting with your manager or educator to discuss you progress and examine your needs and goals over the next few months.

Attitude.

You may move onto the ward busting at the seams with big ideas to improve care delivery, and a somewhat, er…. assertive impatience to make your way to positions of leadership and influence .
Conversely, you may feel totally overwhelmed and under-prepared to go out into the clinical world.
More than likely you will feel somewhere in the left-of-middle area in this spectrum.

The attitude that we are looking for in new graduate nurses is one of being a safe practitioner with clinical confidence, circumscribed by a beginners-mind and strong meta-cognative & self-reflective abilities.

You have now successfully completed your university studies. You have been found competent to practice as a registered nurse. You have learned the skills. You have accrued the knowledge. You have come a long way.

As I always say, there is only a very small percentage of people in our community who have the right parts knowledge, compassion, resilience and tenacity to do what it is you are now dedicating a fair chunk of your life to.
You are already awesome and you should acknowledge this and draw a certain confidence from it (In fact it will probably be many years yet before you really understand just how awesome you are).

In short, it is time. You are ready to begin your path.

But it will certainly be different to anything you have experienced before. No matter how much clinical time you have accrued. The depth of responsibility, the multitude of demands, and the palette of emotions in which you will be immersed once you take your first patient load is…….well it is exactly 4,354 end-to-end textbooks away from your experience thus far.

No matter, you will be amongst friends. And despite what you have heard about nurses “eating their young” there will be a large number of nurses willing to support and assist you.

In Zen, there is an important concept called Shoshin which can be translated as Beginner’s Mind.
Shunryu Suzuki, a famous Zen teacher once said:

In the beginner’s mind there are many possibilities, in the expert’s mind there are few.

In nursing, a beginners mind (or novice mind) might relate to having an attitude of openness, eagerness, flexibility and lack of preconceptions when engaging in patient care. Every nurse should have a beginners mind. Especially the experts.

One of the things I enjoy most about working with new graduate nurses is this open-minded, enthusiastic, flourishing that the best of them always seem to exude.

So. Small steps. Take time to dip into this profession. Percolate. Find the area that best stimulates your flourishing. Value the lessons that you will learn from more experienced staff. Seek out the good teachers, exemplary role models, and inspiring mentors. You will find them.

Equipment.

Shoes. Essentially (in order of importance) you will want shoes that are comfortable, provide protective support, are impermeable to fluids, have a non-slip sole and look professional.
Here is a whole page of nurses discussing their preferred brand of nursing shoes.

Stethoscope. This is NOT an ornament. It is a weapon against clinical calamity.
It is wise to invest in a decent stethoscope. However a word of advice, don’t buy one of those top-of-the-range digital super-stethoscopes (unless you are hearing impaired) because a) it tends to do the opposite of impress, and b) you will probably loose it, or break it way too quickly.

Notebook. Essential bit of equipment for capturing important information (see how I use my own notebook here), jotting down extension numbers or (if you are anything like me) the names of important staff that you will otherwise forget). Any cheap pocket sized notebook will do. But I like these Field Notes.

Pouch. Infection control issues aside, utility pouches seem to have become pretty popular with nurses these days. Around our own hospital the pick-pocket brand seems to be one of the most popular. They are cheep, lightweight, come with their own belt and easily carry pens, notebook, tape and even mobile phones.
They also sit quite flat & snug against the body so you don’t look like you are about to climb up an electricity pole and disconnect something important.
There are plenty of other varieties available.

Neuro-torch. Most nurses will find a neuro-torch essential as part of their clinical assessment kit. Some wards will provide them as ward stock. If not, you can purchase task specific neuro-torches (many include a chart of pupil sizes printed on their side) online.
Any cheap small pocket torch will suffice as long as its beam is not too bright.
Read: how to become a neuro-torch Jedi.

Pen. You will lose it.


Reference: Featured image via Nat


With the Scientific Endorsement of SEEIUC

Hola a tod@s, my dear friends:

Today is one of those days in which one has the satisfaction and honour to share good news with friends.

I am sharing the letter that I received yesterday from the President of the Spanish Society of Intensive Nursing and Coronary Units (SEEIUC), Rosa Jam:




This is a great reason to continue giving our best,  and that all you continue feeling as part of IC-HU Project.
Every day, Nurses and physicians working in the same awesome team as what we are, the professionals of the critical ill patient.

I will pay this round of beers!!.

Health and congrats for everybody!

Gabi