Created with Sketch.
Up My Nursing Game
61 minutes | Oct 4, 2021
#21 Vancomycin and Oral Diabetic Agents
Listen in as I pick Victoria Arsenault's, PharmD, brain about two totally unrelated topics: vancomycin and oral diabetic agents. Learn more about emergency pharmacy at TILEmergencyPharmacist *TIL= Today I Learned* Residents & students of @ChillaPharmD posting the things they are learning on their emergency medicine pharmacy rotation.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.
48 minutes | Sep 6, 2021
#20 Neutropenic Fever
Neutropenic fever is a common hospital presentation for oncology patients. Dr. Darien Reed explains what neutropenic fever is, who is at risk for getting it, important assessment findings, and how we work these patients up.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.
58 minutes | Aug 2, 2021
#19 Interventional Radiology for Nurses
Dr. Amrit Hansra, interventional radiologist, gives an overview of imaging modalities as well as key nursing takeaways for common IR procedures such as G-tubes, biliary drains, and nephrostomy tubes.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).ObjectivesListeners will be able to describe the differences between the various modes of medical imaging, including their advantages, limitations and indicationsListeners will be able to explain the the differences between PEG tubes and G-tubes, including how each are inserted as well as important difference in nursing managementListeners will be able to identify tunneled v. non-tunneled catheters and where to apply pressure after catheter removal.Listeners will be able to describe what biliary drains are, when they are indicated, and how nurses can effectively manage them
55 minutes | Jul 5, 2021
#18 Critical Care Transport
Patients require transportation for many reasons: to an increased level of care, a decreased level of care, a procedure, or for imaging. Katherine Stradling, BSN, RN, CCRN, TCRN discusses the science of transport, what it's like in the ambulance, and what bedside nurses can do to facilitate safe transport.ObjectivesListeners will be able to describe the difference between basic life support (BLS) transfer vs. critical care transport (CCT)Listeners will be able to explain the physiologic demands placed on patients during transportListeners will be able to describe how the sending nurse can prepare the patient for safe transportBLS v. ALS v. CCTNote: Protocols differ by county and organizationBLS transport is for stable patients who will not require cardiac monitoring or medications during transport. It is typically a team of two or more EMTs. ALS transport includes a paramedic who can perform cardiac monitoring, chronic ventilators, and administer some medications. As Katherine explained, this set up is often unavailable, and thus patients who qualify for ALS transport often are transported by CCTCCT is a team including a critical care RN and two EMT. Their scope includes, but is not limited to cardiac monitoring, medication administration and titration, airway management. CCT is for patients who are not stable and will require intervention during transport.The Science of Patient TransportIncrease O2 demandIncrease ICPNauseaIncreased sympathetic responseVariable BP changesHow the sending nurse can help facilitate safe transportPre-medicate:this often means for pain and nauseaHave paperwork ready to goPull more meds than you think you need. Transportation is often delayed due to variable like traffic.Make room for the CCT crew to come in with their stretcherSpike hard-to-spike meds ahead of time (this is difficult to do on a bumpy ride!)Provide the receiving facility a complete and honest report. Make sure that they have all of the equipment the patient will need.Tip: If you're saying to yourself "the patient should be fine", just remember that the ambulance has finite supplies and team members. It's just the RN and EMTs out there on the road or in a helicopter, so give them more medications and supplies than you'd think and get your patient as stable as possible before they go.Relevant LinksHands to Hearts is a volunteer organization who believes that no one should die of treatable medical emergencies due to lack of education and resources. The organization helps build the first response system and offer life support courses in developing areas across rural Mexico.
64 minutes | Jun 7, 2021
#17 What Happens During Dialysis?
Dialysis isn't simply hooking up a patients to a machine for 3-4 hours. Veteran dialysis nurse, Jameisha Rogers RN, talks us through what happens during dialysis starting from reviewing orders to decannulation.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).What does dialysis do?Dialysis eliminates waste, corrects electrolyte deficiencies, and corrects fluid imbalances.Inpatient v Outpatient DialysisInpatientDialysis is often a part of a treatment plan for another medical issue, surgery or situationLabs are drawn for every dialysis timeOutpatientA patient’s labs may be drawn about 2-3x/monthFocuses more on the holistic care of the patient, including: Fluid statusElectrolyte balanceAnemiaMBD (mineral bone disease)VaccinationsCase managementDifferent Types of Dialysis AccessFistula: A surgical connection between a patient's own artery and vein. Considered the "gold standard" for dialysis access.Graft: Similar to the AV fistula, a graft is a surgical connection between a patient's vein and artery, however the connection is made with a synthetic tube.CVC: A central line that terminates right above the right atrium. Due to the risk of infection, this is mostly used as temporary dialysis access until a fistula or graft has matured. A trialysis catheter falls into this category: it is a short-term catheter that is both a power PICC and dialysis access.Blood Pressure During DialysisBP can increase or decrease based on the patient's baseline, what/when medications were taken prior to dialysis, and the dialysis machine settings.What is UF (ultrafiltration)?Ultrafiltration is the mechanism for which fluid is removed from the blood during dialysis. Ultrafiltration occurs when fluid passes across a semipermeable membrane (the dialyzer) to an area of lower pressure (the dialysate).A high UF volume means that a large volume of fluid will be removed from the patient. A high UF rate means that fluid will be removed from the patient quickly.Strategies to increase BP during dialysis?Decrease the UF rate (amount of fluid removed divided by the hours)ADD volumeMedication support such as albumin, midodrine, or vasopressersAnemia in ESRDThe kidneys play a primary role in RBC production by secreting the hormone erythropoietin. Patients will often receive exogenous Epogen, iron, and vit D to help stimulate RBC production on dialysis daysMiscellaneousQ: When should we be taking off dialysis dry dressing? A: Around 4 hours after dialysis has ended (don't leave until the next day)Q: Why are patients tired afterwards?A: We are doing in 3-4 hours what the body does 24 hours a day -- fluid balance, removing toxins, electrolyte replacement to name a few. The decrease in kidney function itself along with anemia and other comorbid issues contribute to fatigue.
53 minutes | May 24, 2021
#16 VTE Prophylaxis Demystified
Venous thromboembolism (VTE) prophylaxis is a core marker of healthcare excellence. Dr. Walter Cheng explains that almost every hospitalized patient is at an increased risk for developing a deep vein thrombosis (DVT) or pulmonary embolism (PE) and that nurses play a crucial role in preventing, assessing for, and educating our patients about VTE. Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).Virchow’s Triad Basis for understanding risk factors for DVT/PEBlood stasis, hypercoagulability, traumaWhen inpatient, immobility is common because patients are not moving and getting out of bed cannot circulate venous blood wellWhat are SCDs?Sequential compression devices are a venous thromboembolism prevention strategy that works to stimulate circulation in the lower extremities through inflation and deflation one at a time to simulate the pumping effect of walking.What are TED hose?TED hose stands for “thromboembolism deterrent” hose, and are used as compression stocking for the prevention of venous dilation and therefore prevention of clots, as noted below. They work by applying continuous pressure from the calf to the thigh, thereby compressing the veins and preventing venous stasis. Quick Anatomy RundownArterial Blood Flow: heart pumps blood and provides pressure to drive blood forwardVenous Blood Flow: PASSIVE → blood moves back is through muscle contractions of the legs and the arms. Immobility of the veins are not returning blood as efficiently as they should be Ex: Airplanes, sitting for a long timeHypercoagulabilityGenetic causes of hypercoagulability: inflammatory diseases, infections, cancer, rheumatologic diseases, organ failureRisk factors for VTEObesityPostoperative status and bed restHeart disease> 40 years of ageLimb traumaCoagulation disordersPregnancyAdvanced neoplasmOral contraceptivesTips for explaining the need for SCDs, TED hose, and the Heparin/Lovenox A million cases of DVT and PE occur every year in this country. There is a real risk that this could happen to you. And unfortunately, with DVT, PE, it can be something from a very inconvenient swollen leg to a devastating and life- threatening pulmonary embolism.DVT prophylaxis with subcutaneous heparin or Lovenox, decreases that risk significantly (70-80%) and the SCDs also decrease that to some percentIf they develop a DVT or PE, they'll be stuck on like, oral anticoagulants from months, lowering their quality of life, prolonging hospitalizationAssessment findings of DVT/PEDVT: Asymmetry in the circumference of, of one limb versus the oppositePE: suddenly shorter breath and can happen very suddenly, pleuritic chest painDespite the classic signs, sometimes it can be subtle and hard to find DVT/PE, so we need to use lab tests such as: D-Dimer: looks at products of clotting (elevates in PE). If negative, likelihood of DVT is lowCT angiogramVentilation perfusion (VQ) scan
52 minutes | May 10, 2021
#15 The Nurse's Role in Early Mobility
Today, ICU patients seem to become sicker and more sedated. Sedation medications, such as Propofol, have become more accessible and can be hung up and left on a drip all day. Heidi Engel, PT, DPT argues that less sedation and more mobilization should be thought of as important as taking medications. In this episode, we discuss how nurses can play a crucial role in mobilizing our patients both in the ICU and on the floor.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).Benefits of Early Mobilization:Prevent pneumoniaPrevent blood clotsPrevent bowel obstructionsPrevent severe muscle wastingPrevent deliriumPrevent shoulder/back painPrevent calf weaknessDecrease length of hospital stayWhen to Initiate Mobility?48 hours is target for initiating mobility because it only takes 48 hrs to start developing diaphragm weaknessWe must advocate for our patients who develop anxiety regarding getting out of bedWhen a patient is hospitalized and constantly horizontal in a bed, it is associated as their safe spacePatients become terrified of leaving their comfort zoneNurse should anticipate the fears, anxieties and how much the patient has adapted to their bedStrategies for coaching patients through anxietyInform patient of session’s measurable goal: “today, we are going to walk out of the room into the hallway and sit at the bench by the window”Think of the patient as a whole, with questions such as: How frail are they?How many comorbidities do they have?How old are they?How much anxiety disorder?Do they have at baseline?How can we how can we recruit their family members to help cheer them on?Or do their family induce more anxiety? What are some chair and standing exercises RNs can lead with our patients while we’re in the room? Weight bering exercise to stretch heel cords to prevent calf wastingToe taps in chairAnkle Pumps Coughing and deep breathing/ incentive spirometer Squats and arm raises may be completed while standing and holding onto assistive device or chair,GOAL: We want to normalize activities and being out of bed as much as possible. Getting out of bed is imperative for maintaining mental and physical healthExample of Early Mobility Initiative SuccessInner Mountain Health in in Salt Lake City is an institution that is very aggressive about early mobilization. They have the longest running, most vigorous, mobility program in the country. Patients, ventilated or not, are out of bed and walking twice a day, while getting uninterrupted sleep throughout certain nightly hours. A very high percentage of their ICU patients are able to leave sooner and go straight home after their hospital stay. Here are articles that explain how an initiative encouraged early mobility for a shorter hospital stay.Last Notes:Mobility should not be viewed as just a PT project.It is an interprofessional, multidisciplinary, critical care project. It is always composed of TEAMWORK.The benefits early mobilization will involve improved core strength and returning to normal routines/independence
58 minutes | Apr 26, 2021
#14 Pregnant and Lactating Patients in Non-Obstetric Departments
Pregnant and breastfeeding patients aren't always hospitalized for obstetric reasons and can be placed throughout the hospital. Dr. Michelle Solone, OBGYN talks to us about how we can assess these patients, what to look out for, and how nurses can promote pumping and breastfeeding during a hospitalization.Common reasons for non-OBGYN related hospitalization for pregnant patients:Medical: Kidney Stones, Chemo, Pyelonephritis, Cardiac ConditionsSurgical: Cholecystitis, AppendicitisTraumaWhich floor does the Pregnant Patient receive care on?Less than 20 weeks → regular medical floor20 weeks & up → Labor & Delivery FloorSituational Examples: L&D Nurses don't interpret EKG's, which will influence which floor a patient can be assigned → CCU/ICUED for asthma exacerbation, traumasRespiratory Distress/IV Drip Monitoring →need ICU nurse with L&D Nurse present to monitor babyPhysiologic Differences of Pregnant PatientsIncreased Blood Volume which can lead to dilutional anemia (ex: Hct 34), due to plasma>RBCsIncreased Cardiac Output and decreased vascular resistance (↓BP) CPR: Left lateral decubitus positioning or Left Uterine displacement for CPR over 20 weeks →Have mom supine, and have a coworker push the uterus about 2 inches over to the Left side for circulation returnIncreased WBCsDecreased lung capacity, but increased tidal volume (RR should be same)Increased risk for VTE Nursing Interventions: SCD's, mobilization, sleep on left sideMedical Intervention: Lovenox, HeparinIncreased GFR →some medications may need adjustments/labsAssessment ABC's of PregnancyA. Amniotic FluidB. Bleeding (never normal, need OBGYN at bedside)C. Contractions/Abdominal PainD. DysuriaE. Edema (DVT or Pre-Eclampsia)F. Fetal MovementMedications and Imaging in PregnancyThere is a fear of giving moms pain medications, but most narcotics are safe in short term, such as with kidney stones. Chronic use would be of concern. Antibiotics such as Vancomycin and Ampicillin are very common for the treatment of infection in pregnant patientsImaging is safe Preference →ultrasound to avoid radiation, followed by MRI (no gadolinium) if neededCT (with or without contrast) is also safeCare of the Postpartum and Lactating PatientImportant: Advocate for breastfeeding and Pumping! Get a Pump in the room early on!Save ALL milk → DON'T DUMP Unnecessarily Label milk to later review with MD if safe for babyWhat meds are compatible with breastfeeding? Almost all medications are compatible with breastfeedingNotable exception: Codeine/Tramadol (such as Tylenol with Codeine)Regular Tylenol and Motrin safe for Postpartum PatientsPhysiological Changes in Postpartum Fluid Shifts: all blood from uterus rush and return back to heart → flash pulmonary edema, fluid overload within 24 hrs after deliveryPreeclampsia may present after deliveryAnemia →PP mom may need blood transfusions/iron
69 minutes | Apr 12, 2021
#13 Heart Failure Management: Diuretics and I&Os
Dr. Brandon Varr, an advanced heart failure and transplant cardiologist, provides insight into how heart failure is managed by diuretics and whether or not fluid restriction is important. Heart Failure (HF) RefresherHeart Failure (HF) simple means that the heart is not pumping enough blood to adequately supply organs.Body’s “Short Term Fix”: Kidneys sense that there is not enough blood → salt retention to expand fluid volume in bodyLong Term effect of above “Short Term Fix”: Fluid retention → congestion, breathing discomfort, edema TYPES OF DIURETICS (MAIN 4):Loop “Workhorse” or most commonly known diuretic known time and time again for their effectiveness and safetyFurosemide (Lasix) is the most commonly used loop diuretic in the hospital. Bumetanide (Bumex) is also used.Thiazide Adjunct (aka booster) therapy to loop diuretics in HF (ie augments the effects of loop diuretics when a loop diuretic is not producing the desired effects)Potassium Sparing (Aldosterone Antagonists)Another adjunct diuretic. Notably, as its name implies, does not lower serum potassium levelsPer Dr. Varr, this class of medication is often under-dosed or not given when could be beneficial to stabilize serum potassium levelsMost common: Spironolactone (Aldactone)OtherVasopressin inhibitorsReserved for patients who are experiencing significant hyponatremiaSGLT2 Inhibitors (-FLOZIN) Ex: Empagliflozin Per Dr. Varr: Upcoming blockbuster agent because it not only provides diuresis but also increases cardiac efficiencyAngiotensin Receptor Neprilysin Inhibitor (ARNI) Ex: EntrestoHolding ParametersHow much do diuretics influence BP?Concerned more with combo diuretic therapy with thiazideLoop and aldosterone antagonists with modest effectsWhen are we justified in holding on diuretics?Hypotension due to hypovolemiaHypotension with symptomsSevere electrolyte derangementsImportant Take-AwaysThink critically as to WHY your patient is here in the hospital. For example, a decompensated HF patient is in the hospital to lose weight, salt, and take aggressive diuretics to help them feel better. If a patient is hypotensive, look at their meds and think about which medication to hold (usually NOT the diuretic). Consider adjusting BP meds before holding a diuretic.Nurses should hold other BP meds before holding diuretics if patient is hospitalized for fluid overloadFluid RestrictionsThink about patient’s quality of life and patient happiness when it comes to fluid restriction. Drinking tap water (1800 – 2200 ccs) will not be hugely impactful on HF management, but can be for their quality of life.Keeping people on fluid restrictions as they are nearing their dry weight can lead to adverse effects → low BP, dehydration, worsening kidney function I&Os v. Os & WeightI think that strict intakes are just complete waste of time, from a general telemetry floor level patient who’s getting Lasix BID and responding. What I’m more concerned with is how much urine came out that day, what was their weight yesterday and what was their weight today on the same scale standing up in the morning? Those are the most useful things to me is their overall urine output for the day and how much weight they’ve gained or lost.Dr. Brandon VarrMore useful: Overall output for day and daily weights
67 minutes | Mar 29, 2021
#12 Hospital Care of Homeless Patients
OverviewPatients experiencing homelessness can add extra layers of complexities to emergency or inpatient care. Dr. Joe Mega provides some much needed perspective about the needs of our patients experiencing homelessness and how healthcare professionals can care for them more effectively.BelongingsHomeless patients are often concerned about their belongings being stolen due to theft or abatementIf a patients is concerned about their belongings, ask if there is someone they can call to look after them OR find out if there are any services that can check on the patient’s belongings while they are hospitalizedPetsPets are often like family members to the homeless and there is a hesitancy to be separated from themIf this is a concern for your patient, look to see if your local animal shelter can keep the animal while your patient is hospitalizedSubstance AbuseWhen people are in the throes of addiction, this is often their #1 priority and they live in fear of experiencing withdrawalMake sure that you are addressing your patients substance abuse concerns by asking questions like “When did you last drink/use and how can I help keep you comfortable?”Opioid withdrawal can be treated with buprenorphine (Suboxone)Alcohol withdrawal can be treated with benzodiazepines, gabapentin, phenobarbital, etc. Check out Episode 6: Acute alcohol intoxication and withdrawal syndrome for more info.Methamphetamine-induced agitation can be treated with benzodiazepines and antipsychotics such as mirtazapine or risperidone.IF YOUR PATIENT IS BECOMING UNCOMFORTABLE DUE TO WITHDRAWAL SYMPTOMS AND WANTS TO LEAVE THE HOSPITALAsk questions like these:“I want to help keep you in the hospital. How do you think we can do that?”“How much do you usually drink a day and how does how you’re feeling now compare to past withdrawals?”“When was your last drink?” or “when did you last use?”Present the situation to the physician in a constructive way such as “I’m worried that the patient might leave, because they’re starting to feel unwell. What do you think about giving them something to help prevent withdrawal such as x, y, and z”FoodIt’s important to put it in the context of how easy it is, for someone with resources in home to access food, and then compare it to a person who doesn’t have a home. Just opening a refrigerator and getting access to some to what they want to eat is, is not a convenience that most people have.Be Trauma AwareThe homeless have often experienced extreme trauma and horrible experiences that either contributed to their homelessness or resulted from it.It’s important to be “trauma informed” and consider reframing your mindset from “What is wrong the patient” to “What happened to the patient?”Give-away: Tribe RN BadgeGuru Set 2.0To win a free set of Tribe RN’s BadgeGuru Set 2.0, simply enter your email address on the homepage to start receiving email notifications when new episodes come out.Visit tribe-rn.com to check out these badge cards or other cool nursing items like pen lights, stethoscope cases, etc.You can also join the supportive Tribe RN Facebook Community.
49 minutes | Mar 15, 2021
#11 Safe Swallowing and Aspiration Pneumonia
Faiman Chow MS, SLP provides insight into safe swallowing practices, good oral care, the risk factors for aspiration pneumonia, and the use of artificial nutrition in advanced dementia.
69 minutes | Mar 1, 2021
#10 The COVID Episode: Where Are We Now?
We're a year into the pandemic and, as a nurse, I'm curious: what are the best practices for treating COVID in the hospital? I sat down with a returning guest, Dr. Cyrus Shariat, an intensivist, and asked him about COVID pathophysiology, management of respiratory failure, medications, and risk of thromboembolism.
42 minutes | Feb 22, 2021
#9 Atrial Fibrillation Management and a Peak Inside the Cath Lab
Dr. Megan Coylewright, interventional cardiologist, and Danielle Durfey, cath lab RN, sit down with me to talk about atrial fibrillation (AF) management including rate v. rhythm control, anticoagulants, the Watchman™ device, and give us a peak inside life in the cath lab.
37 minutes | Feb 7, 2021
#8 Difficult Foley Insertion and CAUTI Prevention
Dr. Matthew Truong, urologist, shares some pearls for difficult foley insertion, what CAUTI is, what it is not, and how to prevent it.
53 minutes | Jan 17, 2021
#7 Palliative Care: Goals of Care Discussion
Palliative care nurse, Michelle Hedding, and I talk about what palliative care is and how nurses can advocate for it for our patients. We also discuss the contemporary issue of communicating with family members during this COVID era of visitor restrictions.
40 minutes | Jan 3, 2021
#6 Acute alcohol intoxication and withdrawal syndrome
Intoxicated patients in ED and alcohol withdrawal syndrome -- Dr. Natalie Htet and I bust some myths about caring for drunk patients in emergency as well as dive into the complexities of alcohol withdrawal.
37 minutes | Dec 6, 2020
#5 Chronic diseases and conditions related to alcohol use
Ataxia, GI bleeds, ascites, jaundice... patient's with long term, heavy alcohol consumption can have head-to-toe problems. Dr. Natalie Htet, emergency physician and intensivist, and I go over the expected assessment findings of the ETOH patient, what to look out for, and long-term management of alcoholic cirrhosis.
54 minutes | Nov 1, 2020
#4 Potassium Replacement and Inpatient Hypertension
Dr. Ronald Matuszak, hospitalist, and I discuss the ins and outs of potassium replacement and uncover that potassium replacement protocols are not often indicated. We also discuss the overtreatment of inpatient hypertension and how doctors and nurses can safely, if at all, lower a patient's blood pressure in a hospital setting.
43 minutes | Oct 4, 2020
#3 Rapid Sequence Intubation
For this episode I interviewed Dr. Cyrus Shariat, who is an intensivist, about rapid sequence intubation (RSI). We talked about what happens during RSI and, specifically, how nurses can help facilitate this high stakes procedure.
59 minutes | Sep 6, 2020
#2 Wound Nursing: Ostomies, Leaking Wound Vacs, Pressure Injuries
For this episode, I speak with Brittany Hoang, NP CWON, about common wound nursing pitfalls including admitting a patient with wounds, wound vac trouble shooting, ostomy care, and wounds related to oxygen administration and COVID-19.
Terms of Service
Do Not Sell My Personal Information
© Stitcher 2021