Abusing EMT Service

Hahah this Picture Says it ALL!!

Caffeine+Alcohol= DANGEROUS COMBINATION!!

There has been talk recently talk in the news about these drinks that contain high levels of alcohol with high levels of caffeine. These drinks are attracting college students nationwide. There has been many incidents where students have been hospitalized for alcohol poisoning. One of the very popular drinks is the drink named, Four Lokos. Four Lokos means Four crazies in Spanish. Many colleges in the area are now banning these drinks on campus. What is your take on it? Below I posted an article from MedPage Today.

FDA Cans Alcoholic Beverages that Contain Caffeine

By Kristina Fiore, Staff Writer, MedPage Today Published: November 17, 2010

The FDA has acted to effectively ban the sale of beverages that combine caffeine and alcohol, including Four Loko and Joose, by declaring that caffeine is an unsafe food additive for alcoholic beverages. The agency issued warning letters Wednesday to four makers of caffeinated alcoholic beverages, saying that addition of caffeine to their malt beverages is not "generally recognized as safe (GRAS)," the industry standard. "Several studies have shown that stimulants mask the intoxicating effects of alcohol," Joshua Sharfstein, MD, deputy FDA commissioner, told reporters. This can lead to overconsumption of the beverages and, subsequently, alcohol poisoning, he said. Most of the drinks contain 12% alcohol by volume and are sold in 24- to 32-oz cans. So, one can contains as much alcohol as four or five regular-sized beers. "Young, inexperienced drinkers may not realize just how impaired they are and drink to the point of alcohol poisoning," David Vladeck, director of the bureau of consumer protection at the Federal Trade Commission, said on the call. The four manufacturers include Four Loko maker Phusion Projects, Joose maker United Brands Company, Charge Beverages Corp., and New Century Brewing Co. Earlier today, Chicago-based Phusion Products, issued a statement saying it intended "to reformulate its products to remove caffeine, guarana, and taurine nationwide." "Going forward, Phusion will produce only non-caffeinated versions of Four Loko," the company said. Robert McKenna, attorney general of the state of Washington -- one of four states that has already taken action against the beverages -- said on the call that the company's move is a "cynical ploy." "It's like an employee who is about to get fired saying, I quit!" McKenna said. Several state attorneys launched their own investigations into the products in 2007 and subsequently brought the issue to the FDA's attention, he added. The Federal Trade Commission will also notify manufacturers that they're potentially marketing the products illegally, the FDA said, and that further action including seizure of the products, is possible under federal law. The FDA action follows a scientific review begun in November 2009 into the safety of the drinks. At that time, the agency sent letters to 30 manufacturers -- far more than the four that received warning letters today. Sharfstein said the agency's review is ongoing, and may lead to action against other products. There's been a spate of recent action on caffeinated alcoholic beverages. A handful of states -- including Oklahoma, Utah, Michigan, and Washington -- have banned Four Loko in the wake of a rash of hospitalizations, heart attacks, and death associated with its consumption. Just this week, the New York liquor authority and the state's largest beer distributors agreed to stop selling the drinks, according to a release from Sen. Charles Schumer (D-N.Y.), who announced the FDA's pending decision on Tuesday. And on Monday, Connecticut Attorney General and the state's senator-elect Richard Blumenthal sent a letter to FDA Commissioner Margaret Hamburg, MD, calling for the ban of the energy drinks. Two deaths may be associated with use of the drinks. An 18-year-old Long Island resident, Nicole Lynn Celestino, allegedly died in August of cardiac arrest after drinking four cans of Four Loko on top of a diet pill she had taken earlier in the day. And the family of 20-year-old Jason Keiran of Florida is suing the drink maker over claims that it caused him to behave so erratically that he shot himself. The FDA's warning letters request that the companies inform the agency in writing within 15 days of the specific steps that will be taken to remedy the violation and prevent its recurrence. If a company does not believe its products are in violation, it may present its reasoning and any supporting information as well.

Nurses’ Role in the Future of Health Care

This is an article that I found on the New York Times website in regards to the future of nurses role. Let me know what you think.

At the start of my surgical training, I helped to care for a middle-aged patient who was struggling to recuperate from a major operation on his aorta, the body’s central artery, and the blood vessels to his legs. As the days wore on, the surgeon in charge began consulting various experts until the once spare patient file became weighted down with the notes and suggestions of a whole roster of specialists.

The patient eventually recovered, thanks to the efforts of many. Nonetheless, one afternoon while walking around the wards with the senior surgeon, I couldn’t help but make a crack about the sheer heft of the patient’s chart; it was, after all, my job to carry it around while she visited with patients.
“Remember this for when you get out into the real world,” she said, taking the chart from me and letting it dip in a way that exaggerated its bulk. “When the ship seems to be going down, you’ve got to get all hands on deck.”
We might do well to remember that surgeon’s advice right now.
As we inch toward 2014, the year that the Patient Protection and Affordable Care Act, the centerpiece of the health care overhaul, takes effect, it has become increasingly clear that the ship known as our health care system is in the process of sinking. And it is not spiraling costs or an overreliance on technology that is weighing most heavily on the health care system, but the sheer volume of patients it must serve.
Currently overloaded with a rapidly aging patient population and their attendant complex medical problems, the system has yet to absorb the 32 million newly insured patients on the horizon. Moreover, over the next 10 years, a third of current physicians will retire, and the physician deficit will increase from just over 7,000 to almost 100,000, with shortages in all specialties, and not just primary care.
But like crew members frantically moving deck chairs, policy makers, medical center administrators, third-party payers and even doctors and patients have remained focused on one thing: the physicians. In all the discussions about adjusting the number of medical schools and training slots, rearranging physician payment schedules and reorganizing practice models, one group of providers has been conspicuously missing.
The nurses.
Nurses currently form the largest sector of health care providers, with more than three million currently registered; but few have led or even been involved in the formal policy discussions regarding the future care of patients. To address this discrepancy, the Institute of Medicine and the Robert Wood Johnson Foundation assembled a national panel of health care experts that has been meeting for the last two years to discuss the role of nurses in transforming the current health care system. Their final report was published last month with no less ambitious a title than “The Future of Nursing: Leading Change, Advancing Health.”
The report, it turns out, lives up to its name. Free of the kind of diatribes that usually creep into discussions about the roles of different health care providers, this report instead relies heavily on the evidence amassed over the last 50 years in clinical trials on the efficacy of nursing care. Weighing in at almost 600 pages, it offers several recommendations, including what amounts to a rebuke of the current piecemeal education of nurses and a debunking of the notion that physicians are the only ones who should lead (and be reimbursed for) any changes in the current health care system.
Leaders in nursing have welcomed the report. “I think it’s a good blueprint for the future,” said Catherine L. Gilliss, president of the American Academy of Nursing, who was not a member of the panel.
Part of that blueprint includes innovative nursing-led services like the Transitional Care Model program at the University of Pennsylvania in Philadelphia, where nurses are assigned to elderly hospitalized patients deemed to be at high risk for relapse. For up to three months after discharge, the nurse makes home visits, accompanies the patient to doctors’ offices and collaborates with the primary care physician and family caregivers. In early trials, the program has significantly decreased hospital readmissions and costs by as much as $5,000 per patient. But because not all third-party payers and institutions are willing to enroll patients in a nurse-directed program or pay for new nursing services, not all patients who are eligible for the special care can enroll because they won’t be reimbursed.
“What is fundamentally operating here is the culture of care,” said Mary D. Naylor, a principal investigator in the Transitional Care Model program and a professor of nursing at the University of Pennsylvania. “We don’t recognize how critically important it is to maximize the contributions of everyone.”
But the report was just as forceful in urging nurses to revamp the way they are educated, citing the decades-long struggle within the profession to define what exactly a nurse is. The term “registered nurse” can refer equally to graduates of two-year associate’s programs, four-year baccalaureate programs, and advanced master’s or doctorate programs. In addition to proposing the addition of postgraduate clinical training, or residency, programs, similar to what physicians currently go through, the panel recommended increasing the number of nurses with baccalaureate degrees to 80 percent from 50 percent and doubling the number of nurses with doctorate degrees over the next 10 years.
The expert panel is scheduled to convene again at the end of this month, this time to discuss implementing their recommendations. They will have their work cut out for them. Critics like the American Medical Association have charged that the report overlooks the extensive education and training of physicians and ignores the importance of physician-led teams in ensuring patient safety. In its official statement, the AMA warns that “with a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.”
Whatever the final outcome, leaders in the nursing community believe that the report is an important first step toward organizing nurses to better serve patients through the challenges of the next few decades.
“I don’t think any group has a lock on advocacy,” Dr. Gilliss said, “and I don’t believe that any one group is restricted from reaching out and being in the patient’s world, making home visits, doing a little something out of the ordinary.”
“There’s a need for many hands,” she added, “and this may be nursing’s shining moment.”

Alcohol-related emergency room visits skyrocket in New York: 74,000 in 2009

Heavy boozing has caused a shocking spike in drunken injuries and emergency room visits in New York, a troubling new study says.

Nearly 74,000 people wound up in hospitals in 2009 for alcohol-related reasons, compared with just 22,000 in 2003 - a jump of nearly 250%, said the city Health Department study, which was released yesterday.

"Excessive alcohol use in general is a serious problem," said Health Commissioner Thomas Farley. "The data suggest that the problem is getting worse."

Hard drinkers wind up in the ER for reasons ranging from alcohol poisoning to barroom fights and drunken spills.

While the majority of alcohol-related deaths in New York - 1,537 adults in 2008 - resulted from health problems, the study said, a solid proportion were caused by accidents, suicides and homicides.

The top boozing neighborhoods, with more than 4% of their overall emergency room visits linked to alcohol, are Greenwich Village, Murray Hill and Chelsea in Manhattan; Bay Ridge and Greenpoint in Brooklyn, and the northeastern stretches of Queens.

"A lot of bars have a lot of fights," noted John Connors, a 55-year-old transit worker slugging back Buds in Bay Ridge. "At one time there were 363 bars in this neighborhood - I know, I counted them."

Staten Island, central Brooklyn, the northeast Bronx and the Rockaways in Queens had the lowest number of alcohol-related hospital trips.

Among adult drinkers surveyed by the Health Department, 42% acknowledge binge drinking - defined as slugging back five or more drinks in a sitting. Eleven percent describe themselves as heavy drinkers.

"On a Monday afternoon you can end up with a full bar - look at this one," Connors said pointing to the more than 15 patrons bending elbows at Kelly's Tavern yesterday afternoon.

"I got here at about 2 p.m. and I'll be here until about 4 a.m."

Health officials said the data did not explain why the emergency room figures had shot up so much. Farley noted that the general thinking was that heavy drinkers were less likely to end up in the emergency room.

"This is not normally alcoholics, but moderate drinkers who had too much to drink," he said.

The pattern was similar for adults and underage drinkers.

For those younger than 21, the number of hospital visits shot up to 4,000 in 2009 from 1,000 in 2003, with the peaks seen in many of the same neighborhoods where adult alcohol-related visits rose.

The stats were released as the State Liquor Authority successfully pressured local beverage distributors to stop selling the controversial Four Loko caffeinated alcohol brew here.

lalpert@nydailynews.com


Read more: http://www.nydailynews.com/ny_local/2010/11/15/2010-11-15_alcoholrelated_emergency_room_visits_skyrocket_in_new_york_74000_in_2009.html#ixzz15TQiFGdD

My Audio Interview with Debbie

Debbies Interview

AAA.....and No I am Not Talking About the Car Club

For my clinical presentation for the semester I am doing a presentation on Abdominal Aortic Aneurysms. So I thought I would share some information with you. Let me know what you think. Are you at risk for a AAA?

AA Prevalence

• Approximately one in every 250 people over the age of 50 will die of a ruptured AAA
• AAA affects as many as eight percent of people over the age of 65
• Males are four times more likely to have AAA than females
• AAA is the 17th leading cause of death in the United States, accounting for more than 15,000 deaths each year.
• Those at highest risk are males over the age of 60 who have ever smoked and/or who have a history of atherosclerosis ("hardening of the arteries")
• 50 percent of patients with AAA who do not undergo treatment die of a rupture

Smoking is a Major Risk Factor for AAA and other Vascular Disease

• Those with a family history of AAA are at a higher risk (particularly if the relative with AAA was female)
• Smokers die four times more often from ruptured aneurysms than nonsmokers

AAA Symptoms

AAA is often called a "silent killer" because there are usually no obvious symptoms of the disease. Three out of four aneurysms show no symptoms at the time they are diagnosed. When symptoms are present, they may include:

• Abdominal pain (that may be constant or come and go)
• Pain in the lower back that may radiate to the buttocks, groin or legs
• The feeling of a "heartbeat" or pulse in the abdomen

Once the aneurysm bursts, symptoms include:

• Severe back or abdominal pain that begins suddenly
• Paleness
• Dry mouth/skin and excessive thirst
• Nausea and vomiting
• Signs of shock, such as shaking, dizziness, fainting, sweating, rapid heartbeat and sudden weakness

AAA Diagnosis

In some, but not all cases, AAA can be diagnosed by a physical examination in which the doctor feels the aneurysm as a soft mass in the abdomen (about the level of a belly button) that pulses with each heartbeat.

The most common test to diagnose AAA is ultrasound, a painless examination in which a device (a transducer) about the size of a computer mouse is passed over the abdomen. Sound waves are computerized to create "pictures" of the aorta and detect the presence of AAA. Other methods for determining the aneurysms' size are CT scan (computerized tomography), MRI (magnetic resonance imaging), and arteriogram (real time x-rays).

AAA Treatments

Currently, there are three treatment options for AAA:

Watchful waiting - Small AAA's (less than 5 centimeters or about 2 inches), which are not rapidly growing or causing symptoms, have a low incidence of rupture and often require no treatment other than "watchful waiting" under the guidance of a vascular disease specialist. This typically includes follow-up ultrasound exams at regular intervals to determine if the aneurysm has grown.

Surgical Repair - The most common treatment for a large, unruptured aneurysm is open surgical repair by a vascular surgeon. This procedure involves an incision from just below the breastbone to the top of the pubic bone. The surgeon then clamps off the aorta, cuts open the aneurysm and sews in a graft to act as a bridge for the blood flow. The blood flow then goes through the plastic graft and no longer allows the direct pulsation pressure of the blood to further expand the weak aorta wall.

Interventional Repair - This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient's artery. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows.

This is a less invasive method of placing a graft within the aneurysm to redirect blood flow and stop direct pressure from being exerted on the weak aortic wall. This relatively new method eliminates the need for a large abdominal incision. It also eliminates the need to clamp the aorta during the procedure. Clamping the aorta creates significant stress on the heart, and people with severe heart disease may not be able to tolerate this major surgery. Stent grafts are most commonly considered for patients at increased surgical risk due to age or other medical conditions.

The stent graft procedure is not for everyone, though. It is still a new technology and we don't yet have data to show that this will be a durable repair for long years. Thus, people with a life expectancy of 20 or more years may be counseled against this therapy. It is also a technology that is limited by size. The stent grafts are made in certain sizes, and the patient's anatomy must fit the graft, since grafts are not custom-built for each patient's anatomy.

Second Opinion

In order to determine if you are a candidate for the interventional radiology procedure, it's best to get a second opinion from an interventional radiologist. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.

A stent-graft is threaded into the blood vessel where the aneurysm is located. The stent graft is expanded like a spring to hold tightly against the wall of the blood vessel and cut off the blood supply to the aneurysm.

Efficacy and Patient Safety

Interventional repair is an effective treatment that can be performed safely, resulting in lower morbidity and lower mortality rates than those reported for open surgical repair.

Recovery Time

• Patients are often discharged the day after interventional repair, and typically do not require intensive care stay post-op
• Once discharged, most return to normal activity within 2 weeks compared to 6-8 weeks after surgical repair

Benefits of Interventional Repair

• No abdominal surgical incision
• No sutures, or sutures only at the groins
• Faster recovery, shorter time in the hospital
• No general anesthesia in some cases
• Less pain
• Reduced complications

Disadvantages of Interventional Repair

• Possible movement of the graft after treatment, with blood flow into the aneurysm and resumption of risk of growth/rupture of the aneurysm
• Probable life-time requirement for follow-up studies to be sure the stent graft is continuing to function

Interventional Radiologists are Vascular Disease Experts

Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are board-certified physicians with extensive training in vascular disease diagnosis, management and treatment. Their board certification includes both Vascular and Interventional Radiology and Diagnostic Radiology which are administered by the American Board of Radiology. This training marries state-of-the-art imaging and diagnostic expertise, coupled with clinical experience across all specialties and in-depth knowledge of the least invasive treatments.

Ipads in the ER

Okay, so I am  a huge Apple fan but I haven't jumped on the Ipad wagon yet. I am still waiting for a better Iphone 4 to come out so I can upgrade my phone. However, I think this is a great idea. However, I feel that we should also have a Plan B when technology fails.

Much as consumers have loved Apple’s iPad since it hit the market in April, busy physicians have been prominent among its early professional adopters. John D. Halamka, Chief Information Officer at Beth Israel Deaconess Medical Center in Boston (BIDMC), bought one as soon as they came out and blogged about their usefulness in daily rounds.
“The Emergency Department is the perfect place for an iPad because all our ED workflows are web-based, wireless and iPad compatible,” he told me. “Since June, I’ve seen increasing numbers of clinicians use the iPad because of its light weight, its battery life, and the easy of keeping it clean.” The last is no small factor, when you consider how cluttered and grimy the standard hospital workstation can become.
Clinical web based applications that physicians normally had to access via the workstation can now be accessed from the patient’s bedside. According to Halamka’s colleague Larry Nathanson, “The EKGs look better onscreen than on paper,” he wrote in a guest post for Halamka’s blog in April. “It was great having all of the clinical information right at the bedside to discuss with the patient. The only problem was that the increase in efficiency was offset by the patients and family who wanted to gawk at it.”
Doctors in the ER are on their feet for hours at a time, which is exhausting. Having a tool that is light, and more importantly lasts for 10 hours without a recharge, is what has helped transform more than a few ERs around the country. Extra bedside time with the patient is no small thing in these days when doctors are already overworked. But when you add in the quick updates to records and notes a doctor can make on the fly when the nurse grabs him or her in between floors, the increase in efficiency is significant.
Web-based electronic health records and other existing clinical software that can be accessed via the iPad’s Safari browser are the most useful applications. But as you would expect there are also apps being developed especially for MD iPad users. “The most popular application is the medication reference tool ePocrates,” according to Halamka, which works on both iPhones and iPads. Also, Nuance Dragon Dictation voice recognition software, which was developed for the iPod and iPad, is something clinicians find very valuable as well.
But BIDMC at least is not limiting itself to just what’s available from app developers. According to Halamka, “Our programmers are planning to build a few iPad native applications that enrich the user experience over the standard web browser access to our electronic health records.”

CRNAs: We'll Be Watching

Since I know I have a lot of friends who want to be CRNAs i have posted some information and a PSA announcement that might be useful.

Nurse anesthetists have been providing anesthesia care to patients in the United States for nearly 150 years. 
The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 32 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2009 Practice Profile Survey. 
CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.
According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.* 
CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.
As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.
CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.
Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Nurses first provided anesthesia to wounded soldiers during the Civil War.
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.
In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 15 states have opted out of the federal supervision requirement, most recently California (July 2009). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so. 
Nationally, the average 2009 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (62 percent lower when adjusted for inflation). 
Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.
More than 40,000 of the nation’s 44,000 nurse anesthetists (including CRNAs and student nurse anesthetists) are members of the AANA (or, greater than 90 percent). Approximately 41 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole.  
Education and experience required to become a CRNA include:

• A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
• A current license as a registered nurse.
• At least one year of experience as a registered nurse in an acute care setting.
• Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program. As of April 2010 there were 108 nurse anesthesia programs in the United States utilizing more than 1,700 approved clinical sites. These programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.
• Pass the national certification examination following graduation.

In order to be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

Breastfeeding PSA

I choose this PSA because I feel that breastfeeding is the single best thing that a mother can do for their child. Plus its FREE!!!

Liver Cirrhosis

This week in class we are learning about liver cirrhosis. One of the number one causes of liver cirrhosis is alcohol abuse. After reading about it and watching the video below, I think I am going to stick to non-alcoholic drinks.

The liver weighs about 3 pounds and is the largest solid organ in the body. It performs many important functions, such as:

• Manufacturing blood proteins that aid in clotting, oxygen transport, and immune system function.
• Storing excess nutrients and returning some of the nutrients to the bloodstream.
• Manufacturing bile, a substance needed to help digest food.
• Helping the body store sugar (glucose) in the form of glycogen.
• Ridding the body of harmful substances in the bloodstream, including drugs and alcohol.
• Breaking down saturated fat and producing cholesterol.

Alcohol MySpace Comments & Myspace Comments

Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

According to the National Institutes of Health, cirrhosis is the 12th leading cause of death by disease.

What Causes Cirrhosis of the Liver?

Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver in the U.S., but anything that damages the liver can cause cirrhosis, including:

• Fatty liver associated with obesity and diabetes.
• Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare).
• Blockage of the bile duct, which carries bile formed in the liver to the intestines where it helps in the digestion of fats. In babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.
• Repeated bouts of heart failure with fluid backing up into the liver.
• Certain inherited diseases such as:
  • Cystic fibrosis.
  • Glycogen storage diseases, in which the body is unable to process glycogen, a form of sugar that is converted to glucose and serves as a source of energy for the body.
  • Alpha 1 antitrypsin deficiency, an absence of a specific enzyme in the liver.
  • Diseases caused by abnormal liver function, such as hemochromatosis, a condition in which excessive iron is absorbed and deposited into the liver and other organs, and Wilson's disease, caused by the abnormal storage of copper in the liver.

Although less likely, other causes of cirrhosis include reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infections.

Do People Who Drink A Lot of Alcohol Always Get Cirrhosis of the Liver?

Most people who drink large amounts of alcohol harm their livers in some way; but not all of these people get cirrhosis of the liver. Women who are heavy drinkers are at higher risk than men. People who have hepatitis B or hepatitis C are more likely to suffer liver damage from alcohol.

Emergency Nurses as Advocates

Nurses are the patient's advocate. But when a nurse disagrees with a doctor, how far should they go on behalf of their patient? Where do you draw the line? This is a recent article from the New York Times. 

A recent conversation with a physician at my hospital was laced with tension about the different roles of doctors and nurses.

“When you get down to it,” he told me, “Patients come to me for care, Theresa, not you.”

Both of us were called away before we could talk more, but his words have been ringing in my head ever since.

Jeff Swensen for The New York TimesTheresa Brown, R.N.

I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.

As I puzzled over our brief but heated exchange, I thought back to the events leading up to the conversation.

It all began after the doctor read a story I had written about a leukemia patient in his 70s. The doctor had not been involved in the case, but he was troubled by my role in it. Due to the patient’s existing health problems, I was concerned that giving him chemotherapy would cause more harm than good.

During the course of the treatment, the patient complained in agony, telling me “I can’t take it,” and I relayed his misgivings to the patient’s care team. A more aggressive lament from the patient — “What the hell are you doing to me?” — also got communicated to the team. I was the patient’s nurse and his advocate, and I worried that it was not ethical to subject him to more chemotherapy when he was clearly having a hard time with the treatment. The chemo we had given him before this latest round had already sent him into permanent renal failure and caused congestive heart failure.

Other members of the team shared these concerns, but the man’s doctor did not. He checked in with the patient to see if he wanted to continue treatment. After some gentle prodding by the doctor (“You want to keep going, right? Right?”), the patient agreed.

I recounted that story with great sadness, as it had been agonizing to watch my patient suffer through treatments that I believed he would not have chosen had he known the harm they could cause and the unlikeliness of being cured.

He eventually was admitted to hospice and died, but only after the chemo had left him with unstoppable and painful bleeding in his bladder, robbing him of a more peaceful and more comfortable end to his life.

The doctor colleague who cornered me at the nursing station was particularly unhappy with my aggressive objection to the patient’s care plan. This doctor felt strongly that for cancer patients, end-of-life decisions should ultimately be the responsibility of the physician in charge of his or her care. That physician, he argued, is in the best position to offer advice about care decisions because he knows the patient’s full history. Floor nurses, he said, usually only see a snapshot of the patient near the end of a long journey.

I understood his point, but I also felt he was too quickly dismissing the observations of oncology nurses, who intimately confront the suffering sometimes caused by well intentioned treatment.

And that’s when the conversation became tense.

Obviously, doctors and nurses have different roles in the hospital. Our training is different, and so are our responsibilities. It’s also true that patients choose their doctor and only end up with a particular nurse through the luck of the draw. But when a doctor and a nurse disagree over patient care, should the doctor always prevail?

Many of the nurses I know could share their own, dramatic stories of rescuing patients or catching frightening errors by other health care workers, including doctors. In fact, the same day the doctor cornered me at the nursing station, I had caught a potentially risky medication prescribing error by a doctor in training. I took my care question to a clinical pharmacist and the attending physician to insure that my patient was given the right treatment. Nurses don’t have the power to make certain types of care decisions, but they do have the power -– and the responsibility — to go up the ladder until they are satisfied that good decisions are being made.

Nursing care is also an important factor in a patient’s recovery. Several studies now show a strong association between nurse staffing levels and rates of patient complications like pneumonia or internal bleeding during a hospital stay. Patients in hospitals with high nurse staffing ratios get better sooner and have shorter hospital stays. Many doctors will tell you that it’s nursing care, not physician care, that makes the biggest impact on a patient’s recovery.

So is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship? I don’t think so. Physicians have the ultimate responsibility for treatment decisions, but because nurses spend so much more time with hospital patients than doctors do, we have a unique view of how the patient is really doing. And at times, patients present very different faces to nurses and to doctors — complaining to a nurse in a way they never would to a doctor.

And while my physician colleague said that nurses only see a snapshot, that picture is often one the doctor does not see.

Later, I had another chance to talk to the doctor who raised this issue in the first place. I told him that I was planning to write about our discussion of the role of doctors and nurses. “Yes,’’ he said. “We never got to finish our conversation.”

So we finished it. He shared difficulties he’d had with nurses criticizing treatment decisions when they had only known the patient for a few hours. I nodded. Then I said that physicians can have blinders on, too, and he nodded as well.

In the end he said, “The point is, it needs to be a conversation.” And we both agreed on that.

But when in doubt, I will err on the side of aggressive advocacy for my patients. Nurses have a professional obligation to make sure that patients receive the best care possible and to insure that all care given in hospitals is safe. For better or for worse, patients who come into our hospital are the responsibility of the nurses, even if the patient has been admitted by a doctor of her own choosing. A good nurse will share his or her opinions with the medical staff — sometimes loudly — because that’s part of our job, even if we ruffle a few feathers in the process.

Bone Marrow Drive

My Capstone group and I are in the process of organizing a bone marrow drive on Bloomfield College in the Spring. In the mean time here is some information about a local bone marrow drive at Jersey City University, in Jersey City, New Jersey. I will be there, hope to see you there.

Since tissue types are inherited, patients in need of a bone marrow transplant are most likely to match with someone from the same ethnic background. Currently, minority groups are underrepresented in the donor registry. As a result, is it is much harder for anyone from a minority background with leukemia or other blood disease to find a donor match. "It's sad that African-Americans are severely under-represented, comprising only 7% of the national registry's of 6 million donors.

Get Swabbed, New Jersey City University!

Date: 

Tue Nov 2, 2010

- Jersey City, NJ

Every year, more than 10,000 men, women, and children could benefit from a bone marrow transplant. Sadly, 6 out of 10 patients will not find a matching donor that could save their lives. The students at New Jersey City University want to beat these odds.
Get Swabbed, New Jersey City University!
Tuesday, November 2nd
11:00am - 5:00pm
Multipurpose Room A, Gilligan Student Union
40% of DKMS Americas donors were registered between the ages of 18-22. That’s why it is so important to get as many college students registered as possible. The more students who register as bone marrow donors, the better the chances for patients in need!!

Email kelly@dkmsamericas.org for more information.

Stroke Awarness

I know Stroke Awareness Month is not until May but I found this pretty cool video that I think will be helpful to anyone who has no idea what to do when they suspect someone is having a stroke.

Nursing Quote of the week

Haha, I think this is soooo true!


Be nice to your kids. They'll choose your nursing home.
Anonymous

How to become a Pediatric Nurse?

I think that Pediatric nursing is a difficult field to work in. Children have a way to tug on people's heartstrings. I am certain that I will not make a good pediatric nurse. Pediatric nurses must be very patient and be able to see things from a perspective of a child at the same being able to educate and reassure already nervous parents. I hope that when my son gets sick that I will receive care from a nurse that truly loves her job. I posted this article I found on www.degreefinder.com. Check it out!!

Pediatrics is an important field of medicine that deals with providing medical care to infants, children, and adolescents. Pediatric nurses are specially trained registered nurses that provide preventative and acute care to pediatric patients in a variety of healthcare settings.

What does a pediatric nurse do?

Pediatric nurses specialize in providing care to a variety of pediatric patients ranging in ages from birth to 18 years old. They provide primary care such as routine examinations and developmental screenings, treatment of childhood illnesses, administration of immunizations, school physicals, and guidance regarding common health concerns. They also provide acute and specialty care including caring for children who are critically or chronically ill, ordering medications, performing therapeutic treatments, interpreting test results, and performing thorough physical examinations. Pediatric nurses also develop treatment plans and discuss options with family members and caregivers. They provide education and support to families and document the progress of their patients.

What kind of training does a pediatric nurse need?

Pediatric nurses must complete an approved registered nursing program and a specialization in pediatrics. Nursing programs provide extensive classroom instruction and supervised clinical experience. Pediatric nursing courses usually include human growth and development, family centered care, health promotion and maintenance, childhood disorders and diseases, physiology of children and adolescents, and psychosocial and behavioral health of children.
All states require pediatric nurses to be licensed. Licensing requirements include graduating from an approved nursing program and passing a national licensing examination called the NCLEX-RN. Many pediatric nurses also take the examination to become a Certified Pediatric Nurse (CPN) administered by the Pediatric Nursing Certification Board (PNCB). Continuing education is required to maintain licensure and pediatric nurses frequently complete continuing education courses and attend conferences, workshops, and seminars.

What are the prospects for a career as a pediatric nurse?

Employment of all registered nurses is expected to grow much faster than average for all professions, increasing 23% from 2006 to 2016 (1). Technological advances and the increase in pediatric patients will drive job growth.
Job prospects are expected to be excellent especially for pediatric nurses with at least a bachelor degree and extensive experience. Many job openings will also arise from the need to replace pediatric nurses that retire, transfer, or leave the field for other reasons.

How much do pediatric nurses make?

As of October 2009, pediatric nurses with less than 1 year experience earn average annual salaries between $42,253 and $51,395. Those with 1 to 4 years experience earn average annual salaries between $38,322 and $63,918 (2).
A career as a pediatric nurse is an excellent choice for individuals interested in providing nursing care to infants, children, and adolescents. Pediatric nurses must be compassionate, sympathetic, caring, detail-oriented, and open-minded. They must have excellent communication and interpersonal skills and be able to carefully explain conditions in ways the patient and the family can understand. Good stress management, emotional stability, and ability to comfort patients and families are also essential.

Now what? The next step is easy!

Take the first step today and request free information from our selected top online nursing and healthcare schools, or simply use the form below to find the program that is right for you!

Here is a video I found on youtube.com on how to perform a physical assessment on a school age child. Hope it helps anyone.

How to become an ICU Nurse....

Ok, so this week I did my intensive care rotation at the MICU at St. Josephs Hospital in Paterson. Words cannot describe my experience. All I can say was that it was AWESOME!! So, I found the following article on eHow.com. I hope you find it useful.

Complete the degree requirements for a RN or BSN at an accredited academic institution. If you are thinking about an online degree or distance-learning program, it is critical that you verify the program's accreditation status before you start your classes.

Pass the licensing exam in your state after you've finished the required coursework. Contact your state board of nursing for any additional requirements.

Listen attentively during rounds. The ICU nurse will have extensive interaction with doctors as they perform daily rounds and will be inundated with patient care information. When in doubt, ask a resident for help in clarifying a doctor's orders 

Get used to dealing with uncertainty. When a new patient arrives in the ICU, her condition is often bad and getting worse. Even if one problem is obvious, there may be several more hidden complications making the condition even worse. Never expect that you have all the information you need at hand.

Haha, pretty cute T-shirt

Study prescription drugs. Because patients in ICU are often in excruciating pain and are susceptible to infections of various kinds, they may be given several different drugs at once. You need to know how each medication works and be aware of any potentially dangerous interactions.

Learn the workings of ICU machines. A nurse working in the ICU must be familiar with some of the most advanced medical technology available today, including EKG machines, defibrillators and ventilators.

Apply for a full-time ICU nurse position with the hospital at which you made your rounds. Many times, a hospital is more likely to promote a recent graduate who has worked on the grounds before.

Stay up-to-date on the latest developments in ICU technology by joining the Society of Trauma Nurses (see Resources below).

Past Nursing Quotes of the Week

Week 1
Nursing would be a dream job if there were no doctors.~ Gerhard Kocher

Nursing Quote of the Week

Wow, I found the following quote to be true in so many ways. One of my new favorites. I now want to know the name of the Hispanic janitor that always in the library cleaning.


During my second year of nursing school our professor gave us a quiz.  I breezed through the questions until I read the last one:  "What is the first name of the woman who cleans the school?"  Surely this was a joke.  I had seen the cleaning woman several times, but how would I know her name?  I handed in my paper, leaving the last question blank.  Before the class ended, one student asked if the last question would count toward our grade.  "Absolutely," the professor said.  "In your careers, you will meet many people.  All are significant.  They deserve your attention and care, even if all you do is smile and say hello."  I've never forgotten that lesson.  I also learned her name was Dorothy.  ~Joann C. Jones

2010 Nurses Convocation Sets the Tone for the Year

Seniors Steal the Spotlight

Bloomfield College is located in Bloomfield, NJ.

The Frances M. McLaughlin Division of Nursing formally opened the academic year with the convocation exercises. Attended by sophomore, junior, and senior nursing students; faculty, and alumni, the event served to set the tone for the year with words of encouragement and advice about becoming a nurse.

Vice President Marion Terenzio related a personal tale of recently needing medical care and the compassion of the nurses who were in her attendance. She said that due to her nurses becoming part of her medical team, she was able to concentrate on her own healing with trust. She encouraged the future nurses to develop caring as well as learning to care for their patients.

Dr. Neddie Serra, chair of the division, told the students that, while the program is not “a piece of cake,” the faculty members are there to support their journeys. “We are here to help you become successful,” she related. With that, Dr. Serra introduced Brunna Coutinho ’09 and said that Ms. Coutinho is proof that there is success waiting for them. Ms. Coutinho is currently a medical/surgical nurse at the Palisades Medical Center. She was twice the recipient of the Nurses Alumni Scholarship award, which is given to a junior and a senior student with the highest GPA in nursing subjects.

Edwina “Win” Zengerle N’52, president of the Frances M. McLaughlin Alumni Association read from the Jewish scriptures and the Christian scriptures. To everything there is a season was the reading from Ecclesiastes and Faith, hope, and love was the reading from I Corinthians. These two readings are traditional for the convocation ceremony.

Jigna Patel, senior,speaks with the Nursing community.

Jigna Patel, senior nursing student and president of the Bloomfield College Student Nurses Association spoke eloquently about empathy and the need for students to develop this very important trait in order to succeed in their chosen profession. She welcomed all students to the BCSNA and had words of encouragement for each class. To the sophomores she advised that they become close to their classmates and welcomed them as full nursing students. The junior year, she noted, is the toughest and she told them to work hard, study harder and develop real teamwork skills. To the senior class, she said “We’ve been through it all. We started out as strangers and become family.”

With that, Ms. Patel and her BCSNA board members introduced a Family Feud game with representatives from each class and a faculty member on Team A and Team B. They had to answer questions concerning nursing skills. Team B won by one point with the question “What do nursing students drink in class?”

Stephenia Manalo,junior, and Myko Lallgas,senior at Bloomfield Collge

The sophomore and junior class were all presented with a $10 gift card, courtesy of Scrubadoo.com, makers of nursing uniforms. Scrubadoo.com donated 130 cards to be distributed.

Mrs. Zengerle then presented the Alumni Scholarships to junior Richard Moody and senior Ashley Leandre. Both Moody and Leandre held the highest GPA in nursing subjects.

The morning was completed with a discussion and presentation by Nathan Walts from the Assessment Technologies Institute, who showed the students how to use the website that prepares them for the NCLEX exams (state tests required for nurses to practice after graduation).

Then it was back to class.

 This article can be found at www.bloomfield.edu

Nursing Quote of the Week....

Nursing would be a dream job if there were no doctors.  ~Gerhard Kocher

How to Become a Cardiac Nurse?

Ok, anyone that knows me can tell you how much I hate cardiac. I REALLY HATE IT! I find it so boring and I feel like its the same stuff over and over again. However, I realized some people might be interested in this field (blah!!) so here are some steps one can follow in order to become a Cardiac Nurse.


Cardiac Nurses work with patients suffering from heart-related ailments, such as heart disease, congestive heart failure or angina. Cardiac Nurses must complete a Nursing program and pass a national licensing exam.

Step 1: Research Cardiac Nursing Careers and Education Requirements

Cardiac Nurses aid patients suffering from heart disease and assist in the rehabilitation of patients who have undergone heart surgery. They may assist with surgeries, procedures or other interventions, and they provide education on management and prevention of heart disease or related conditions. Cardiac Nurses are registered nurses who have completed a Nursing program, the national licensing exam and additional training in cardiac care.

Step 2: Apply to a Nursing Program

Students who wish to pursue a Cardiac Nursing career can choose to earn an associate's degree, a bachelor's degree or a diploma through a hospital program. Diploma programs are becoming less common and students are increasingly advised to pursue a Bachelor of Science in Nursing degree. Upon completion of a nursing program, students take the National Council Licensure Examination for Registered Nurses to become licensed registered nurses, RNs.

Step 3: Gain Additional Training In Cardiac Nursing

Since cardiac nursing is a specialty area, Cardiac Nurses generally require additional training. Most employers require Cardiac Nurses to have Basic Life Support and Advanced Cardiac Life Support certification. To become certified as Cardiac Nurses, RNs also need a specified amount of clinical practice and continuing education hours. Various universities and organizations may provide training opportunities, including the American College of Cardiovascular Nurses, www.accn.net.

Step 4: Obtain Certification as a Cardiac Nurse

The American Nurse Credentialing Center (ANCC), www.nursecredentialing.org, provides certification in cardiac rehabilitation nursing and cardiac vascular nursing. Certification requirements include holding an active RN license, two years of experience as an RN and a minimum number of clinical and continuing education hours. According to the ANCC, certification could lead to career advancement and higher pay. The American Board of Cardiovascular Medicine, www.cvncertify.org, is another certifying agency for Cardiac Nurses.

Step 5: Consider Career Advancement

Many Cardiac Nurses continue their education and become clinical nurse specialists in the area of cardiac nursing. Clinical nurse specialists are an advanced practice specialty, which usually requires a Master of Science in Nursing degree. The U.S. Bureau of Labor Statistics, www.bls.gov, predicts that advance practice nurses will be in increasing demand over the next decade.

How to Become an ER Nurse....

I have always found the Emergeny Room one of my favorite places to be as a kid (yes, weird I know). But for some reason that I cannot explain I just love the hustle and bustle of the ER. ER nurses have to be quick on their feet, have sharp minds and be able to stand their ground. I listed below some steps someone who is interested in becoming an ER nurse should follow as a guide.


Locate a hospital with a preceptor program. Working in the ER is a different environment than other areas of the hospital and takes additional skills. Even with nursing experience being assigned to a preceptor will help you make the transition to ER work. Call hospitals and speak to the nursing director to inquire about a preceptor program.

Get certified in advanced cardiac life support and pediatric advanced life support. These two certifications give an emergency room nurse special skills and knowledge to treat adults and children who are in respiratory or cardiac arrest. Both certifications require attending a class and passing a written and practical exam. Most hospitals offer classes.

Take the exam to become a Certified Emergency Room Nurse. Although it may not be a requirement to get hired in an ER, it may set you apart from other potential employees. Obtain an application for the exam from the Board of Certification for Emergency Nursing.
Join the American Association of Critical Care Nurses. This organization can provide information on jobs and continuing education classes.

Learn to work effectively as part of a team. ER nurses work very closely with other members of the health care team such as doctors, respiratory therapists, lab tech and social workers. Because situations are stressful and fast paced emotions can run high, ER nurses need to be calm, efficient and work as part of a team.

Find ways to reduce stress. ER nurses deal with life and death situations daily. Burnout is high. Find ways to cope with the stress such as exercise, hobbies and spending time with friends.

Funny Nursing Jokes

This is just a couple of Nursing jokes and pics that I came across that I thought were pretty funny. Enjoy!

Top ten reasons to become a nurse:
Pays better then fast food, though the hours aren't as good.
Fashionable shoes and sexy white uniforms.
Needles: "Tis better to give then receive"
Reassure your patients that all bleeding stops...eventually.
Expose yourself to rare, exciting and new diseases.
Interesting aromas.
Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
Do enough charting to navigate around the world.
Celebrate all the holidays with your friends- at work.
Take comfort that most of your patients survive no matter what you do to them.




You know you're a nurse if...


You believe every patient needs TLC: Thorazine, Lorazepam and Compazine.
You would like to meet the inventor of the call light in a dark alley one night.
You believe not all patients are annoying ... some are unconscious.
Your sense of humor seems to get more "warped" each year.
You know the phone numbers of every late night food delivery place in town by heart.
You can only tell time with a 24 hour clock.
Almost everything can seem humorous ... eventually.
When asked, "What color is the patient's diarrhea?", you show them your shoes.
Every time you walk, you make a rattling noise because of all the scissors and clamps in your pockets.
You can tell the pharmacist more about the medicines he is dispensing than he can.
You carry "spare" meds in your pocket rather than wait for pharmacy to deliver.
You refuse to watch ER because it's too much like the real thing and triggers "flash backs."
You check the caller ID when the phone rings on your day off to see if someone from the hospital is trying to call to ask you to work.
You've been telling stories in a restaurant and had someone at another table throw up.
You notice that you use more four letter words now than before you became a nurse.
Every time someone asks you for a pen, you can find at least three of them on you.
You can intubate your friends at parties.
You don't get excited about blood loss ... unless it's your own.
You live by the motto, "To be right is only half the battle, to convince the physician is more difficult."
You've basted your Thanksgiving turkey with a Toomey syringe.
You've told a confused patient your name was that of your coworker and to HOLLER if they need help.
Eating microwave popcorn out a clean bedpan is perfectly natural.
Your bladder can expand to the same size as a Winnebago's water tank.
When checking the level of orientation of a patient, you aren't sure of the answer.
You find yourself checking out other customer's arm veins in grocery waiting lines.
You can sleep soundly at the hospital cafeteria table during dinner break, sitting up and not be embarrassed when you wake up.
You avoid unhealthy looking shoppers in the mall for fear that they'll drop near you and you'll have to do CPR on your day off.
You've sworn you're going to have "NO CODE" tattooed on your chest.







 

3 Nurses and a Wish
A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarfs and wearing large polished stoned jewlery.


"I am 'Gina the Great'," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses could think otherwise.


The nurses quickly aurgued among themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first. "I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone.
The floor nurse went next."I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me coccoa and doughnuts." With a puff of smoke, she too was gone.


"Now, what is the last wish?" asked the lady.


The charge nurse said," I want those two back on the floor at the end of the lunch break."





 Two doctors were in a hospital hallway one day complaining about Nurse Nancy.
" She's incredibly mixed up," said one doctor. "She does everything absolutely backwards.
Just last week, I told her to give a patient 2 milligrams of morphine every 10 hours.
She gave him 10 milligrams every 2 hours. He damn near died on us!"
The second doctor said, "That's nothing.
Earlier this week, I told her to give a patient an enema every 24 hours.
She tries to give him 24 enemas in one hour! The guy damn near exploded!"
Suddenly, they hear this blood-curdling scream from down the hall.
" Oh my God!" said the first doctor, "I just realized I told Nurse Nancy to prick Mr. Smith's boil!"


A man goes to visit his 85-year-old grandpa in hospital.
" How are you grandpa? he asks.
"Feeling fine," says the old man.


"What's the food like?"


"Terrific, wonderful menus."


"And the nursing?"


"Just couldn't be better. These young nurses really take care of you."


"What about sleeping? Do you sleep OK?"


"No problem, nine hours solid every night. At 10 o'clock they bring me a cup of hot chocolate and a Viagra tablet ... and that's it. I go out like a light."


The grandson is puzzled and a little alarmed by this, so rushes off to question the Sister in charge. "What are you people doing," he says,
" I'm told you're giving an 85-year-old Viagra on a daily basis. Surely that can't be true?"


"Oh, yes," replies the Sister. "Every night at 10 o'clock we give him a cup of hot chocolate and a Viagra tablet. It works
wonderfully well. The chocolate makes him sleep, and the Viagra stops him from rolling out of bed

 

A new nurse listened while the doctor was yelling, "Typhoid! Tetanus! Measles!"
The new nurse asked another nurse, "Why is he doing that?"
The other nurse replied, "Oh, he just likes to call the shots around here."




Three nurses died & went to heaven where they were met at the Pearly Gates by St. Peter. To the first, he asked, "What did you do on Earth and why should you go to heaven?" "I was a nurse in an inner city hospital," she replied. "I worked to bring healing and peace to the poor suffering city children." "Very noble," said St. Peter. "You may enter." And in through the gates she went.
To the next, he asked the same question, "So what did you do on Earth?" "I was a nurse at a missionary hospital in Africa," she replied. "For many years, I worked with a skeleton crew of doctors and nurses who tried to reach out to as many peoples and tribes with a hand of healing and with a message of God's love." "How touching," said St. Peter. "You too may enter." And in she went.He then came to the last nurse, to whom he asked, "So, what did you do back on Earth?" After some hesitation, she explained, "I was just a nurse at an H.M.O." St. Peter pondered this for a moment, and then said, "Okay, you may enter also." "Whew!" said the nurse. "For a moment there, I thought you weren't going to let me in." " Oh, you can come in," said St. Peter, "but you can only stay for three days..."


What did the nurse say when she found a rectal thermometer in her pocket? " Some asshole has my pen!"
What's the difference between an oral thermometer and a rectal thermometer?
The taste.
Why did the nurse always insist on using the rectal thermometer to obtain temperatures? She was taught in nursing school to always look for her patient's best side.
How can you tell who is the head nurse of a facility?
She's the one with dirty knees.
They found a naked dead body of a nurse washed up on the shore today.
How did they know it was a nurse?
She had an empty stomach, a full bladder, and her butt was chewed out.