EP 214: How to Land Your First Nursing Job With Benjamin Baker

EP 214: How to Land Your First Nursing Job With Benjamin Baker

EP 214: How to Land Your First Nursing Job With Benjamin Baker

In this episode, we interview Ben Baker, a current ICU travel nurse, and new grad coach, about how to succeed in your first nursing job. We discuss new grad nurses’ challenges, how to thrive in your practice and best practices for resumes and interviews. We also touch on how healthcare facilities can better invest in and retain new nurses and the issue of “nurses eating their young.” Join us for an informative and engaging conversation!

It’s totally normal to feel both excited and nervous about starting your first shift as a Registered Nurse. Take a deep breath and remember you’ve worked hard to get here. To help ease any anxiety, take some time to prepare for success. You’ve got this! Join us for an informative and engaging conversation!

Questions for Our Guest

The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know.

    1. Can you give us a background about yourself and some of the experiences you’ve had throughout your career that bring you here today?
    2. What area(s) do you think new grad nurses struggle with?
    3. How do you cultivate resilience as a new grad – to see your “mess” as a “message”
    4. What are the best tips you can give to nurses getting ready for their interview? 
    5. What are the key things to remember when writing your nursing resume?
    6. How do you stand out as a new grad to get hired?
    7. How do you think healthcare facilities can better invest and retain new nurses coming into the workforce?
    8. How do we cancel the call light on nurses eating their young?

 

Ending Questions

Before we end the show, we have one last question we like to ask all our guests.

If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

 

Links: 

Coaching: www.nextlevelnurses.com

To watch the full episode:👇👇

https://youtu.be/1-j6kuNrbVg

 

 

EP 201: Lab Values to Know as a Nurse

EP 201: Lab Values to Know as a Nurse

Lab Values to Know as a Nurse

What are the lab values to know as a nurse? Lab values and what they show could mean so many things. They are used to determine the patient’s overall well-being and health and on nurses to base their care plan.

Different factors affect the patient’s lab values result, but the most common factors affecting it are the patient’s age, race, gender, medical history, and presence of any underlying conditions. Knowing and understanding lab values is essential in your nursing career.

There are different lab values to know as a nurse. In this episode, we will talk about all the different labs we look at in the hospital. We will go over their normal values, what they signify, and what can happen if they are out of their normal range.

This will be a good refresher episode for everyone who deals with labs and a great one for any nursing students because these are the labs you’ll need to know to pass some of your classes and the NCLEX.

Electrolytes

Potassium K+

  • Potassium is one of the most important minerals in the body. It helps regulate fluid balance, muscle contractions, and nerve signals. 
  • Normal level: 3.5-5 mEq/L
    • Hyperkalemia signs: heart arrhythmias, numbness, and tingling, breathing problems
    • Hypokalemia signs: muscle weakness, fatigue, heart arrhythmias
  • Clinical problem
    • Increased level: Acute renal failure, Crushed/burn injury, acidosis 
    • Decreased level: vomiting/diarrhea, dehydration, malnutrition, gastric suction, Diuretics 

Sodium Na+ 

  • Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance.
  • Normal level: 135-145 mEq/L
    • Hypernatremia signs: lethargy, myoclonic jerks, confusion, nystagmus, tachycardia
    • Hyponatremia  signs: nausea and vomiting, lethargy, seizure, neurological deficits
  • Clinical problem
    • Increased level: Dehydration, severe vomiting, diarrhea, Heart failure, hepatic failure, Cushing’s disease 
    • Decreased level: vomiting, diarrhea, gastric solution, D5W, SIADH,

Calcium Ca+ 

  • It is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium enables our blood to clot, our muscles to contract, and our heart to beat. About 99% of the calcium in our bodies is in our bones and teeth.
  • Normal level: 8.5 to 10.2 mg/dL
    • Hypercalcemia signs: bone pain, muscle weakness, excessive thirst, lethargy, nausea
    • Hypocalcemia signs: numbness and tingling in digits, muscle cramps, wheezing, fatigue
  • Clinical problem
    • Increased level: Hyperparathyroidism, malignant neoplasm of bone, lung, breast, kidney, multiple myeloma, and prolonged immobilization. 
    • Decreased level: Diarrhea, malabsorption of calcium, Hypoparathyroidism

Chloride CI- 

  • Chloride is one of the essential electrolytes in the blood. It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids.
  • Normal level: 95-105 mEq/L
    • Hyperchloremia signs: diarrhea, vomiting, fatigue, dry mucous membrane
    • Hypochloremia signs: diarrhea, vomiting, weakness, dehydration
  • Clinical problem
    • Increased level: Dehydration, hypernatremia, head injury, metabolic acidosis.  
    • Decreased level: Vomiting, gastric suction, diarrhea, hypokalemia. 

Magnesium Mg+

  • It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heartbeat steady, and helps bones remain strong. It also helps adjust blood glucose levels. It aids in the production of energy and protein.
  • Normal level: 1.5-2 mEq/L
    • Hypermagnesemia: diminished deep tendon reflexes, flushing, headache, nausea, drowsiness.
    • Hypomagnesemia: muscle weakness, twitches, or tremors; irritability, insomnia, drowsiness
  • Clinical problem
    • Increased level: Severe dehydration, renal failure, leukemia
    • Decreased level: Protein malnutrition, malabsorption, cirrhosis of the liver, alcoholism, hypokalemia

Phosphorus 

  • It is a mineral that makes up 1% of a person’s total body weight. It is the second most abundant mineral in the body. It is present in every cell of the body. Most of the phosphorus in the body is found in the bones and teeth.
  • Normal level: 2.5-4.5 mg/dl
    • Hyperphosphatemia signs: osteoporosis, cardiovascular disease
    • Hypophosphatemia signs: changes in mental state, bone pain/fragility, fatigue, weight loss, weakness
  • Clinical problem
    • Increased level: Renal failure, hypocalcemia, hypoparathyroidism 
    • Decreased level: starvation, hypercalcemia, hypomagnesemia, chronic alcoholism

Ammonia

  • Ammonia is a waste product made by your body during protein digestion.
  • Normal level: 15-50 μmol/L
    • Hyperammonemia signs: Lethargy (ETOH Pt), rapid or heavy breathing, Altered mental status 
  • Clinical problems
    • Increased level: Hepatic failure, High protein diet with liver failure, acidosis. 

Uric acid 

  • It is a chemical created when the body breaks down substances called purines.
  • Purines are usually produced in the body and are also found in some foods and drinks.
  • Normal level 0.18-0.48 mmol/L
    • High signs: Joint pain, joint stiffness, redness, and swelling. 
  • Clinical problems
    • Increased level: Gout, alcoholism, severe eclampsia, renal failure

Creatinine

  • Creatinine is a waste product produced by muscles from the breakdown of a compound called creatine. It is removed from the body by the kidneys.
  • Normal level 0.8-1.3 mg/dL
    • High signs: Nausea, muscle cramps, vomiting, fatigue, HTN
  • Clinical problem
    • Increased level: Hypothyroidism, CKD, intense exercise, dehydration 
    • Decreased level: Renal impairment, hyperthyroidism, ALS

BUN 

  • BUN is the end product of protein metabolism and is excreted by the kidneys
  • Normal level 8-21 mg/dL
    • High signs: Frequent urination, itching, muscle cramps, fatigue. 
  • Clinical problem
    • Increased level: Dehydration, GI bleeding, prerenal failure, Acute MI, sepsis, shock
    • Decreased level:  Severe liver damage, overhydration, malnutrition

Specific Gravity

  • A urine-specific gravity test compares the density of urine to the density of water. This quick test can help determine how well your kidneys dilute your urine.
  • Normal level 1.010-1.030 
    • High signs: Dehydration, Diabetes, Proteinuria, SIADH
    • Low signs: Polydipsia, Diabetes Insipidus, Diuretics, early stages of CKD

LDH 

  • Lactic dehydrogenase (LDH) is an intracellular enzyme in nearly all metabolizing cells, with the highest concentration in the heart, skeletal muscle, liver, kidney, brain, and RBCs.
  • Normal level 50-150 U/L
    • Increased level: Acute MI, P.E, Sepsis, shock, CVA, sickle cell.

Hematology

RBC 

  • The reticulocyte count is an indicator of bone marrow activity
  • Normal level 4.5-5.0 million
    • Increased level: sickle cell, hemolytic anemia, leukemias 
    • Decreased level: Anemia, radiation therapy, post hemorrhage, cirrhosis of the liver (alcohol suppresses reticulocytes)

WBC 

  • White blood count, part of a complete blood count, is composed of 5 types of WBCs 
  • Normal level 5,000-10,000
    • Increased level: Acute infection, Inflammatory diseases (RA, gout), Tissue damage (acute MI, burns)
    • Decreased level: leukemias, immunosuppressive agents

Plt 

    • Platelets (thrombocytes) are essential elements in the blood that promote coagulation.
  • Normal level 200,000-400,000
    • Increased level: Polycythemia vera, trauma, acute blood loss, Metastatic carcinoma
    • Decreased level: Multiple myeloma, Anemias, Leukemias, liver disease, lupus, DIC, Cirrhosis 

Hgb 

  • Hemoglobin responsible for the transportation of oxygen
  • Normal level 
    • male 13-17 g/dL
    • female 12-15 g/dL
  • Increased level: Dehydration, polycythemia, COPD, HF, severe burns
  • Decreased level: Anemias, Hemorrhage, cirrhosis of the liver, Leukemias, Hodgkin’s disease, kidney disease

Hematocrit 

  • The hematocrit is a ratio of the volume of red blood cells to the volume of all these components, called whole blood. The value is expressed as a percentage or fraction.
  • Normal level Male 40%-52% Female 36%-47%
    • Increased level: Dehydration/hypovolemia, severe diarrhea, diabetic acidosis, burns.
    • Decreased level: Acute blood loss, anemias, RA, lupus, CKD, cirrhosis

PTT 

  • Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem or if your blood doesn’t clot properly.
  • Normal level 25-35 sec.  If on Heparin 1.5-2.5x normal
    • Increased level: Hemophilia, cirrhosis, vitamin k deficiency, Von Willebrand disease, DIC. 

PT 

  • Prothrombin Time. It is synthesized by the liver and is an inactive precursor in the clotting process.  
  • Normal level 11- 14 sec
    • Increased level: Liver disease, Clotting factor issues (Factor 2 deficiency), Heart failure, leukemias
    • Decreased level: Thrombophlebitis, MI, P.E 

INR 

  • The international normalized ratio (INR) is a laboratory measurement of how long it takes blood to form a clot. It is made to monitor patients receiving warfarin. 
  • Normal level 0.9-1.2 If on Coumadin 1.5 – 3

Reticulocytes

  • Reticulocytes are immature red blood cells (RBCs).
  • Normal range  0.5-1.5%

Neutrophils 

  • Are the most numerous circulating WBCs, respond mainly to inflammation & tissue injury.
  • Normal range 2-8 x 10^9/L

Bands 

  • Basophils increase during the healing process
  • Basophils are white blood cells that defend your body from allergens. Basophils release histamine
  • Normal Range < 1 x 10^9/L

Lymphocytes 

  • Increased during chronic and viral infections
  • Normal range 1-4 x 10^9/L

Monocytes 

  • The second line of defense. More extensive and more substantial than neutrophils can ingest large particles and debris.
  • Normal range 0.2-0.8 x 10^9/L

Eosinophils 

  • Increase during allergic and parasitic conditions 
  • Normal level < 0.5 x 10^9/L

HBA1C 

  • The hemoglobin A1c test tells you your average blood sugar level over the past 2 to 3 months. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin.
  • Normal level <6.5%

Glucose 

  • Simple sugar is used as an energy source and is stored as glycogen in the liver and skeletal muscles.
  • Normal level 70-110 mg/dL
    • Increased level: DM, Diabetic acidosis, adrenal gland hyperfunction (Cushing’s) 
    • Decreased level: Hypoglycemia, malnutrition

Gastrointestinal

Bilirubin

  • Bilirubin is formed from the breakdown of hemoglobin by the reticuloendothelial system and is carried in the plasma to the liver. Bilirubin (unconjugated or indirect) is bound to serum albumin and transferred to the liver, which is conjugated to glucuronate by glucoronyl transferase. Conjugated (direct) bilirubin is excreted into the bile.
  • Normal level 
    • Direct Bilirubin 0-6 µmol/L 
    • Total Bilirubin 2-20 µmol/L
  • Increased level: Obstructive jaundice caused by stones, hepatitis, cirrhosis, liver cancer
  • Decreased level: Iron-deficiency anemia. 

Albumin 

  • Albumin is a protein made by your liver. Albumin helps keep fluid in your bloodstream so it doesn’t leak into other tissues. It also carries various substances throughout your body, including hormones, vitamins, and enzymes.
  • Normal level 35-50 g/L
    • Increased level: Dehydration, severe vomiting, severe diarrhea 
    • Decreased level: Cirrhosis of the liver, acute liver failure, severe burns, severe malnutrition, preeclampsia, renal disorders, prolonged immobilization. 

ALT/AST

  • ALT/AST is an enzyme found primarily in the liver cells and is effective in diagnosing hepatocellular destruction.
  • Normal level 5-30 U/L
  • Increased level: Acute (viral) hepatitis and liver necrosis (Drug or chemical toxicity).

Amylase 

  • Amylase is an enzyme derived from the pancreas, the salivary glands, and the liver. Its function is to change starch to sugar. 
  • Normal level: 30-125 U/L
  • Increased level: Acute pancreatitis, obstruction of the pancreatic duct, acute cholecystitis, diabetic acidosis, diabetes mellitus, renal failure. 

Lipase 

  • Lipase, an enzyme secreted by the pancreas, aids in digesting fats. Appears in the bloodstream following damage to the pancreas. 
  • Normal level: 10-150 U/L
  • Increased level: Acute and chronic pancreatitis, cancer of the pancreas, and obstructions. 

Hormones

Hydroxyprogesterone 

  • IHydroxyprogesterone is a hormone made by the adrenal glands, two glands on top of the kidneys. A 17-OHP test is used for Hydroxyprogesterone levels to help diagnose a rare genetic disorder called congenital adrenal hyperplasia.
  • Normal level: 0.2-1 mg/L

Adrenocorticotropic ACTH 

  • Adrenocorticotropic hormone (ACTH) is made in the pituitary gland. It is needed for your adrenal glands to work properly and help your body react to stress. ACTH stimulates the release of another hormone called cortisol from the adrenal gland’s cortex (outer part).
  • Normal level: 4.5-20 pmol/
  • Increased level: Addison’s disease, Stress, pituitary neoplasm, pregnancy. 
  • Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect the adrenal glands, a pair of walnut-sized organs above the kidneys. The adrenal glands produce essential hormones, including Cortisol, which regulates the body’s response to illness or stress.

TSH 

  • Thyroid-stimulating hormone is a pituitary hormone that stimulates the thyroid gland to produce thyroxine (T3), and triiodothyronine (T4)  which stimulates the metabolism of almost every tissue in the body.
  • Normal level: 0.5-5 mIU/L
  • Increased level: Hypothyroidism, acute thyroiditis, viral hepatitis, myasthenia gravis, preeclampsia
  • Decreased level: Hyperthyroidism

Thyroxine

  • Serum T4 levels are commonly used to measure thyroid hormone concentration and the function of the thyroid gland. 
  • So, if your T3 and T4 levels are too low, the pituitary gland will release more TSH. If they’re too high, the gland will release less TSH — but this give-and-take system only works if everything functions properly.
  • Normal level:
    • Free T3 0.2-0.5 ng/dL
    • Free T4 10-20 pmol/L
    • Total T4 4.9-11.7 mg/dL
    • Total T3 0.7-1.5 ng/dL
  • Increased level: Hyperthyroidism, acute thyroiditis, myasthenia gravis, preeclampsia
  • Decreased level: Hypothyroidism, Protein malnutrition.

Follicle-stimulating hormone 

  • FSH, a gonadotropic hormone produced and controlled by the pituitary gland, stimulates the growth and maturation of the ovarian follicle to produce estrogen in females and promote spermatogenesis in males. 
  • Normal level:
    • (FSH) 1-10 IU/L (M/F) 
    • 5-25 IU/L (ovulation) 
    • 30-110 IU/L (postmenopause)
  • Increased level: Gonadal failure such as menopause, Pituitary tumor, Turner’s syndrome, Klinefelter’s syndrome 
  • Decreased level: Neoplasms of the ovaries, testes, adrenal: polycystic ovarian disease, hypopituitarism; anorexia nervosa. 

Growth Hormone 

  • Human growth hormone (hGH), a hormone from the anterior pituitary gland, regulates the growth of bone and tissue. 
  • Normal level: (fasting) 0-5 ng/m
  • Increased level: Gigantism (children), Acromegaly (adults), major surgery. 
  • Decreased level: dwarfism in children, hypopituitarism

Progesterone 

  • It is secreted by the corpus luteum, a temporary endocrine gland that the female body produces after ovulation during the second half of the menstrual cycle.
  • Normal level 70-280 ng/dL
  • Increased level: Ovulation, pregnancy, ovarian cysts, tumors of the ovary or adrenal gland. 
  • Decreased level: Gonadal dysfunction, luteum deficiency, threatened abortion, placental failure.

Prolactin 

  • It is a hormone produced by your pituitary gland, which sits at the bottom of the brain. Prolactin causes breasts to grow and develop and causes milk to be made after a baby is born. 
  • Normal level: < 14 ng/mL
  • Increased level: Pregnancy, breastfeeding, pituitary tumor, amenorrhea, hypothalamic disorder, endometriosis, chronic renal failure, Addison’s disease.
  • Decreased level: Postpartum pituitary infarction

Testosterone (male):  

  • Testosterone is the primary male sex hormone and an anabolic steroid. In male humans, testosterone plays a crucial role in developing male reproductive tissues such as the testes and prostate and promoting secondary sexual characteristics such as increased muscle and bone mass and body hair growth.
  • Normal level: 10-25 nmol/L
  • Increased level: Adrenal hyperplasia or tumor, polycystic ovaries in females
  • Decreased level: Testicular hypofunction, Klinefelter’s syndrome (primary hypogonadism), Alcoholism, hypopituitarism

Lipids

LDL 

  • LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
  • Normal level: 85-125 mg/dL
  • Saturated fat and cholesterol in your food make your blood cholesterol level rise.

HDL 

  • HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body to your liver. Your liver then removes the cholesterol from your body.
  • Normal level: 40-80 mg/dL

Triglycerides 

  • Triglycerides are a type of fat (lipid) found in your blood. When you eat, your body converts any calories it doesn’t need to use right away into triglycerides. The triglycerides are stored in your fat cells.
  • Normal level: 50-150 mg/dL
  • Increased level: Hyperlipoproteinemia, acute MI, Hypertension, cerebral thrombosis, hypothyroidism
  • Decreased level; Hyperthyroidism, hyperparathyroidism, and protein malnutrition.

Total chol 

  • A measure of the total amount of cholesterol in your blood. It includes low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.
  • Normal level: 3-5.5 mmol/L

Cardiac Markers

Creatine kinase

  • Creatine kinase is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. 
  • Normal level:  25-200 U/L
  • Increased level: exercise and inflammation of muscles, called myositis, and myopathies such as muscular dystrophy. Rhabdomyolysis.

Troponin 

  • Troponins are a group of proteins found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction—used for cardiac disease diagnosis of acute MI.
  • Normal level: 0-0.4 ng/mL
  • Increased level: MI, myocardial damage

C-reactive protein 

  • It is produced in the liver in response to tissue injury and inflammation. 
  • Normal level < 5 mg/L
  • Increased level: Chronic infections, cardiovascular and peripheral disease, acute MI, Stroke, inflammatory bowel disease, RA, Lupus, bacterial meningitis.

D-dimer 

  • D-dimer is a fibrin degradation product, a small protein fragment in the blood after a blood clot is degraded by fibrinolysis.
  • Normal level: < 500 ng/mL
  • Increased level: DIC, P.E, Thrombosis, COVID 

BNP

  • Brain Natriuretic peptide is a neurohormone secretion primarily in the cardiac ventricles and will increase in response to volume expansion and pressure overload.
  • Normal level:  < 100 pg/ml
  • Increased level: Heart failure, Left ventricular hypertrophy, myocarditis, AMI, Renal failure, prolonged systemic hypertension.

Tumor Markers 

Alpha-fetoprotein 

  • Serum alpha-fetoprotein (AFP), a screening test, is usually done between 16 and 20 weeks gestation to determine the probability of twins or to detect low birth weight or severe birth defects, such as neural-tube defects. 
  • Normal level: 0-44 ng/mL
  • Increased level: Cirrhosis of the liver, hepatitis, Spina bifida, Fetal death, fetal distress, Turner’s syndrome
  • Decreased level: Down’s syndrome, absence of pregnancy

HCG 

  • Human chorionic gonadotropin is a hormone produced by cells that surround a growing embryo, which eventually forms the placenta after implantation. The presence of hCG is detected in some pregnancy tests. Appears in the blood and urine 14-26 days after conception.
  • Normal level: <5 IU/I
  • Increased level: Pregnancy, Chorionepithelioma of pregnancy is a malignant tumor originating in connection with pregnancy. 
  • Decreased level: Nonpregnant, dead fetus, postpartum (3-4 days)

CA 19-9

  • Cancer Tumor Markers (CA 19-9) is a cancer antigen in diagnosing pancreatic, hepatobiliary, gastric, and colorectal cancer. 
  • Normal level: <40 U/mL
  • Decreased levels = Effective response to treatment, benign disease
    • There are also different tumor markers. You won’t need to know all of these, but we thought we should include them. 
    • CA 15-3: Metastatic breast cancer, ovarian, lung, pancreas, cirrhosis, colon cancer.
    • CA-27.29: Recurrence of breast cancer
    • CA 50: Gastrointestinal tumor, biliary tract tumors
    • CA 125: Ovarian breast cancer, uterine tumors, pancreas, breast, colon, lung, cirrhosis, pancreatitis.  

CEA 

  • Carcinoembryonic antigen (CEA) has been found in the gi epithelium of embryos and has been extracted from tumors in the adult gastrointestinal tract. 
  • Normal level: <4 ug/L
  • Increased level: GI tract (esophagus, stomach, small and large intestine, rectum cancer), leukemia, Ulcerative colitis. 

PAP 

  • Prostatic acid phosphatase (PAP) originates in the prostate and usually is present in small amounts in the blood. 
  • Normal level: 0-3 U/dL
  • Increased level: prostate cancer, testicular cancer, leukemia, and non-Hodgkin’s lymphoma.

 

PSA 

  • Prostate-specific antigen (PSA) is always present in low concentrations in the blood of adult males.
  • Normal level: <4 ug/L
  • Increased level: Prostate cancer

Vitamins 

Folate 

  • Folate is one of the B vitamins needed to make red and white blood cells in the bone marrow, convert carbohydrates into energy, and produce DNA and RNA.
  • Normal level: 7-36 nmol/L
  • Increased level: Pernicious anemia (is a deficiency in red blood cells caused by lack of vitamin B12)
  • Decreased level: Folic acid anemia, vitamin b6 deficiency anemia, malnutrition, malabsorption syndrome (small intestine), pregnancy, liver disease.

Vitamin A 

  • It is a Fat-soluble vitamin absorbed from the intestine in the presence of lipase and bile. Vitamin A moves to the liver and is then stored in the body as retinol.
  • Vitamin A is vital for normal vision, the immune system, reproduction, and growth and development.
  • Normal level: 30-65 µg/dL
  • Increased level: Hypervitaminosis, Chronic kidney disease
  • Decreased level: Night blindness, liver, intestinal, or pancreatic disease, chronic infections, cystic fibrosis, protein malnutrition, malabsorption, celiac disease

Vitamin B6

  • Vitamin B6, also known as pyridoxine, is a water-soluble vitamin your body needs for several functions. It’s significant to protein, fat, and carbohydrate metabolism and the creation of red blood cells and neurotransmitters.
  • Normal level: 5-30 ng/mL
  • Decreased level: Malnutrition, chronic alcoholism, gestational diabetes, pregnancy, lactation, small bowel inflammatory disease, renal failure.

Vitamin B12 

  • Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia.
  • Normal level: 130-700 ng/L
  • Decreased level: Pernicious anemia, malabsorption syndrome, liver diseases, hypothyroidism (myxedema), pancreatic insufficiency, Crohn’s disease.
  • Increased level: Acute hepatitis, leukemia.

Vitamin C 

  • Ascorbic acid is a water-soluble vitamin important for forming collagen and certain amino acids for wound healing and withstanding stress, injury, and infection. 
  • Normal level: 0.4-1.5 mg/dL
  • Decreased levels: Scurvy, malabsorption, pregnancy, cancer, and severe burns. 

Vitamin D

  • Vitamin D is a fat-soluble vitamin occurring from exposure to the ultraviolet rays of sunlight and is absorbed in the presence of bile and stored in the liver. Vitamin D helps regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth, and muscles healthy. 
  • Normal level:  5-75 ng/mL
  • Decreased level: Malabsorption, cirrhosis of the liver, rickets, osteomalacia, hypoparathyroidism, celiac disease, inflammatory bowel disease

Miscellaneous

Rheumatoid Factor

  • RF factor is a screening test used to detect antibodies (Igm, IgG, or Ig)
  • Normal level:  <25 IU/ml
  • Increased level: Rheumatoid arthritis, lupus, tuberculosis, leukemia

ESR 

  • An erythrocyte sedimentation rate (ESR) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle in unclotted blood in millimeters per hour. 
  • It can show if you have inflammation in your body.
  • Normal level: >2 mm/h
  • Increased level: RA, rheumatic fever, AMI, Hodgkin’s disease, multiple myeloma, bacterial endocarditis, gout, hepatitis
  • Decreased level: Polycythemia vera, heart failure, sickle-cell anemias, factor V deficiency

ACE 

  • The ACE test measures the level of angiotensin-converting enzyme (ACE) in the blood.
  • Normal level: 20-50 µmol/L
  • Increased level: Sarcoidosis, Diabetes Mellitus, hypothyroidism, Respiratory distress syndrome
  • Decreased level: Therapy for sarcoidosis, diabetes mellitus, hypothyroidism

Lead

  • Found in lead-based paint, unglazed pottery, batteries, leaded gasoline
  • Normal level: < 25 IU/ml 
  • Higher levels can damage the kidneys and nervous system.

Refresh your memory and relearn the lab values by watching the full episode here 👇👇👇

TIMESTAMPS:

00:00 Introduction
01:21 About the episode
02:35 Electrolytes Potassium K+
Sodium Na+
Calcium Ca+
Chloride CI-
Magnesium Mg+
Phosphorus
Ammonia Uric acid
Creatinine
BUN
Specific Gravity
Lactic Dehydrogenase (LDH)
17:02 Hematology
RBC
WBC
Platelets (thrombocytes)
Hemoglobin (Hgb)
Hematocrit
Partial thromboplastin time (PTT)
Prothrombin Time (PT)
International Normalised Ratio (INR)
Reticulocytes
Neutrophils Bands
Lymphocytes
Monocytes
Eosinophils
HBA1C
Glucose
27:25 Gastrointestinal
Bilirubin
Albumin
ALT/AST
Amylase Lipase
30:40 Hormones
Hydroxyprogesterone
Adrenocorticotropic ACTH
Thyroid-Stimulating Hormone (TSH)
Thyroxine Follicle-Stimulating Hormone (FSH)
Human Growth Hormone (hGH)
Progesterone
Prolactin
Testosterone
36:57 Lipids Low-Density Lipoproteins (LDL)
High-Density Lipoproteins (HDL)
Triglycerides Total Cholesterol
39:11 Cardiac Markers
Creatine kinase
Troponin
C-Reactive Protein
D-Dimer
Brain Natriuretic Peptide (BNP)
41:56 Tumor Markers
Alpha-Fetoprotein (AFP)
CA 19-9 Carcinoembryonic Antigen (CEA)
Prostatic Acid Phosphatase (PAP)
Prostate-Specific Antigen (PSA)
44:15 Vitamins
Folate
Vitamin A
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D
48:12 Miscellaneous
Rheumatoid Factor (RF)
Erythrocyte Sedimentation Rate (ESR)
Angiotensin-Converting Enzyme (ACE)
Lead

EP 167: Should You Start in a CVICU as a New Grad?

EP 167: Should You Start in a CVICU as a New Grad?

Should You Start in a CVICU as a New Grad?

Start in a CVICU as a new grad? Why not! One of the exciting areas to start working as a nurse is in the Cardiac ICU. The cardiovascular Intensive Care Unit or CVICU is a hospital ward that caters to and cares for patients with ischemic heart disease and other severe heart conditions. 

Patients who suffered a heart attack and need close monitoring are also placed in this unit. The same goes for patients recovering from heart surgery and with other severe conditions like cardiomyopathy, arrhythmia, heart infection, or unstable angina. 

Most patients in the CVICU often have various complications such as respiratory failure and renal failure. Therefore, medical staff who work at CVICU are required to have the ability to practice systemic intensive care.

In this episode, we introduce you to one of our followers, James Hatano. James is a New grad nurse in the Cardiac ICU at a Trauma 1 hospital in Cleveland, Ohio.

He is also a certified CrossFit coach and a baseball coach. Today we will talk about his new grad experience as a Cardiac ICU nurse. So if you are interested to start in a CVICU as a new grad, this episode is for you. 

QUESTIONS FOR GUESTS:

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  1. Your BSN is your second degree, you also have a degree in exercise physiology. What made you decide on exercise physiology and then what made you transition into nursing?
    • Are there some aspects of exercise physiology that have helped you in nursing school, being a nurse, and/or with life in general? 
    • How did you survive nursing school? What do you think was the key? Time management, good schedule, etc…?
  2. Was the Cardiac ICU something you wanted to get into right off the bat? 
    • Why did you choose the Cardiac ICU? Do you fit the typical cardiac ICU stereotype? (craziest lives but neatest lines, control, OCD)
  3. Biggest difference between nursing school and the ICU?
    • What’s something you wished you knew going into school?
    • What did you struggle with most in school? What do you struggle with most now?
    • Tips for nurses trying to join the ICU.
  4. Nursing is stressful, we can agree that it is never going to change. No matter if there are appropriate ratios and great morale, working with patients that are very sick you’re always going to have that stress on your shoulders.
    • What do you do to help balance that stress, do you have any issue with not leaving it at work and bringing it home with you?
  5. You’re big into fitness you’re even one of the top 50 fittest nurses in the world, how has that helped you through life?
    • How has fitness played a role in your life and how has it helped you with nursing?
    • How has your exercise changed over time?
  6. The drive podcast by Peter Attia, what got you into it and why do you enjoy it, what do they talk about?
  7. Chop wood, carry water book, would you recommend that book, why and/or to whom?

ENDING QUESTIONS:

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

You can find James on Instagram @jameshatano to know more about CVICU nursing.

You can also watch the full episode here 👇

TIME STAMPS:

00:00 Intro
00:45 Episode Introduction
01:33 About the guest
03:29 James Hatano and nursing
06:46 How does nursing school impact life
09:57 Transitioning out of nursing school
12:17 Life lessons you learned from being a CVICU nurse
13:51 Struggles as a new grad
20:03 Balancing Work and Life
22:15 Managing time
25:03 Managing relationship
30:32 How is it working with a female dominant profession
33:44 What would you like to improve in the healthcare system
37:00 A thing that you always have
39:47 The person outside nursing
43:52 Personal interests
46:34 Who would you want to have the one last cup of coffee?

EP 163: Tips To Help You Survive Floating as a Nurse

EP 163: Tips To Help You Survive Floating as a Nurse

Tips To Help You Survive Floating as a Nurse

Survive floating as a nurse? It’s possible! You may have heard the term “floating” from nurses one way or another. While this term seems new, it has been used by many nurses in the unit before. So what is it? 

The term floating is used for a registered nurse who fills the short-staffed unit. They are also sometimes called float pool nurses and can be seen working in any area of a health care facility.

A floating nurse is the “reassignment of staff from one nursing unit to another, based upon the patient census and acuities.” They are an essential part of the healthcare staff and help to ensure that all areas are adequately staffed. 

Hospitals consider this a positive solution for saving money through resource utilization. It continues to be a staffing practice in health care facilities throughout the country. If you happen to be a floating nurse, this episode is for you. 

Today we will talk about how to survive floating as a nurse. It’s another day in the office when you walk into your unit, and you look at the assignment sheet and discover you have been assigned to float to another department.

How you respond to this news can make or break the assignment.

How to Survive Floating as a Nurse

Not every nurse needs to float but there are many hospital positions that you can enter that allow you to float. Most of the time, floating nurses pay well. It is also a good reason why many nurses join the float pool. It is even better if you are a travel nurse.

Floating is challenging to get used to. Sometimes, a little bit impossible. It is because many nurses are unfamiliar with how things work in different units. The new environment can also be overwhelming.

But the good news is that many nurses thrive in this position, no matter where they are.

In some cases, nurses choose to float because they like the idea of helping out units that need nurses the most.

1. Remain Calm

Why are you taking me off my unit? The first thing when you realize you’re floating usually your mood changes but don’t feel like to world is ending.

Positivity and confidence are the keys. Go to the floating unit with a positive attitude to be welcoming to the new unit.

It makes such a difference when you ground yourself in positivity. Knowing no matter what happens, this shift will end, and I will provide great patient care. This attitude will also set the mood for how your shift will go.

A lot of times floating nurses face unfamiliarity. This unfamiliarity may result in losing their confidence. Don’t forget you studied for over 4 years + to get your degree.

Being in the position you’re in today, or the number of years of experience you have under your belt.

Start that positive self-talk with yourself. Remember, as a nurse you know what you have to do to take care of your patients. You’re good enough to be in the position that you’re in. Keeping calm and gathering your thoughts before working can also help.

2. Ask questions/learn the unit preferences

The best way to figure out the unit protocols or fit in is by asking what they do and why. After the huddle, go introduce yourself to the charge nurse. 

Tell her you’re floating from another floor. If possible, ask if she can show you around the important thing you need to know about the unit. 

Remember, don’t hesitate or be afraid to ask questions. You have the whole shift to do that. Ask as many questions as you can so you are familiar with how the unit works.

  • Where is the medication room?
  • Do you have access to the pyxis?
  • Where is the supply room?
  • Are there standard charting or orders for this unit?
  • Where is the equipment room?
  • Where is the nutrition room?

Unit Routines

  • There might be different standing orders or charting protocol
  • Rhythm strips, pt weights
  • Specific handoff reports?
  • Specific medications to be signed off?
  • Accuchecks in the morning, are you covering the insulin

3. Speak up

No one knows if you don’t know something or if you’re struggling. Like any relationship, communication is key. If you’re having a busy shift because you spent a lot of time getting yourself familiar with the unit, speak up.

Make your needs known. Most of the time, everyone is helpful. 

When floating from the ICU: you can’t do everything for every patient

  • This isn’t the ICU, you can’t do everything
  • Importance of time management
  • Give recommendations but ultimately its the physician’s call

This is All a Learning Experience

In our younger nursing days, we prayed not to get floated. We still, to this day, prefer to work in our home unit, but we have a positive outlook when it comes down to floating. Being challenged is a good thing. New experiences are what create growth.

Don’t be stuck in your own bubble because you hinder your growth. 

You, too can survive being a floating nurse. Here’s what you need to know 👇

TIME STAMPS:

00:00 Intro
00:44 Plugs
01:55 Episode Introduction
03:41 Tip #1: Remain Calm
07:39 Tip #2: Ask Questions
09:13 Things to ask: Where is the medication and nutrition room?
11:03 Things to ask: Where are the supply room and the equipment room?
17:47 Tip #3: Speak up
22:44 Tip #4: This is All a Learning Experience
25:08 Shadowing other nurses to learn
27:34 Sometimes Floating is not always good times

How Dental Health Affects Overall Health

How Dental Health Affects Overall Health

How Dental Health Affects Overall Health

In this episode, we would like to talk about dental health. Many people don’t know that dental health provides valuable information on someone’s overall health.

Today we know that most chronic illnesses are not down to coincidence, bad luck, or bad genes. Instead, they are the result of constant, silent inflammation in the body and the resulting chronic stress. This kind of inflammation often occurs in the mouth.

It can be found hiding in the tips of inflamed tooth roots, gingival pockets, around implants, in dead teeth, or in the cavities that are left behind whenever a tooth has to be removed.

Although research is constantly revealing new relationships between teeth and the body, doctors and dentists work in two different spheres, our medical care system is structured such that we can’t see the forest for the trees.

Importance of Dental Health

Looking inside someone’s mouth gives clues to their overall health. Did you know that many problems can stem from poor oral health? Good oral health gives a person the ability to speak, smile, smell, taste, touch, chew, swallow, and impacts facial expressions to show feelings and emotions.

Just like in other parts of the body, the mouth houses a lot of beneficial bacteria. But remember that the mouth is the initial entry point into the rest of your body and sometimes these bacteria make a home elsewhere where they can cause damage.  Proper oral hygiene keeps these bacteria in stable conditions.

What Contributes to Poor Dental Health

Untreated tooth decay. More than 1 in 4 (26%) adults in the United States have untreated tooth decay. Gum disease. Nearly half (46%) of all adults aged 30 years or older show signs of gum disease; severe gum disease affects about 9% of adults [1].

The main factors that cause oral health are:

  • Poor hygiene
  • Diet high in sugar
    • Sugar changes the acidity in your mouth.
      • There are 2 bacteria, streptococcus mutants, and streptococcus sobrinus. These bacteria feed on sugar and create plaque on your teeth. When you get your teeth cleaned your dentist removes this plaque. If left unchecked this plaque will eat away at your enamel.
      • Sugar also attracts bacteria that eat away at your gums and cause gingivitis and gum disease [2].
  • Alcohol use
    • Alcohol drinks are usually high in sugar like beer, liquor, and mixed drinks. This leads to the breakdown of enamel, long-term tooth decay, and gum disease.
    • Alcohol also decreases the amount of natural saliva that acts as a natural antibacterial agent. 
    • Depending on what alcohol you consume it can stain your teeth. 
    • Normal Saliva PH: 6.2-7.6
  • Smoking 
    • Smoking weakens your body’s infection fighters (your immune system). This makes it harder to fight off a gum infection. Once you have gum damage, smoking also makes it harder for your gums to heal.
      • You have twice the risk for gum disease compared with a nonsmoker.
      • The more cigarettes you smoke, the greater your risk for gum disease.
      • The longer you smoke, the greater your risk for gum disease.
      • Treatments for gum disease may not work as well for people who smoke.

Prevention

  • Proper oral hygiene
  • A well-balanced diet low in free sugars and high in fruit and vegetables, and water as the main drink;
  • Stopping the use of all forms of tobacco, including chewing
  • Reducing alcohol consumption
  • encouraging the use of protective equipment when doing sports.

What Conditions are Linked to Oral Health

Your oral health might contribute to various diseases and conditions, including:

Endocarditis

This infection of the inner lining of your heart chambers or valves (endocardium) typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to certain areas in your heart.

  • The study looked at 94 participants where participant’s portal hygiene, gingivitis, and periodontitis statuses were evaluated. 
  • The authors found that oral hygiene and gingival disease indexes were associated significantly with IE-related bacteremia after toothbrushing.
  • Participants with a mean plaque and calculus scores of 2 or greater were at a 3.78- and 4.43-fold increased risk of developing bacteremia, respectively.
  • The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in the risk of developing bacteremia [3]. 

Cardiovascular Disease

 Although the connection is not fully understood, some research suggests that heart disease, clogged arteries, and stroke might be linked to the inflammation and infections that oral bacteria can cause.

There are a few theories on why this can occur, according to Harvard: 

  • The bacteria that infect the gums and cause gingivitis and periodontitis also travel to blood vessels elsewhere in the body where they cause blood vessel inflammation and damage; tiny blood clots, heart attack, and stroke may follow.
  • Supporting this idea is the finding of remnants of oral bacteria within atherosclerotic blood vessels far from the mouth.
  • Rather than bacteria causing the problem, it’s the body’s immune response – inflammation – that sets off a cascade of vascular damage throughout the body, including the heart and brain.
  • There may be no direct connection between gum disease and cardiovascular disease; the reason they may occur together is that there is a 3rd factor (such as smoking) that’s a risk factor for both conditions.
  • Other potential “confounders” include poor access to healthcare and lack of exercise – perhaps people without health insurance or who don’t take good care of their overall health are more likely to have poor oral health and heart disease [4].

Pregnancy and birth complications

Periodontitis has been linked to premature birth and low birth weight.

  • Nearly 60 to 75% of pregnant women have gingivitis, an early stage of periodontal disease that occurs when the gums become red and swollen from inflammation that may be aggravated by changing hormones during pregnancy.
  • If gingivitis is not treated, the bone that supports the teeth can be lost, and the gums can become infected. Teeth with little bone support can become loose and may eventually have to be extracted.
  • Periodontitis has also been associated with poor pregnancy outcomes, including preterm birth and low birth weight. However, how periodontitis may lead to adverse pregnancy outcomes is not yet fully understood [5].
  • One systematic review looked at periodontal status looked at 22 totaling about 17,00 subjects and concluded that “The present systematic review reported a low but existing association between periodontitis and adverse pregnancy outcomes.” [6].

Pneumonia

Certain bacteria in your mouth can be pulled into your lungs, causing pneumonia and other respiratory diseases.

  • A study looked at over 122,000 participants with no history of pneumonia with a median age of 52.4.
  • The mean systolic blood pressure and fasting glucose were 125.5 mmHg and 96.7 mg/dL. While 49.6% of participants had periodontal disease, 2.7% and 6.0% had five or more dental caries and missing teeth, respectively. 
  • According to the self-reported questionnaires, 45.0% of participants brushed their teeth three times or more per day, and 26.0% replied having professional dental cleaning at least once per year.

It concluded that:

The risk of pneumonia was higher in groups with more dental caries and missing teeth. In contrast, the risk of pneumonia was lower in the frequent tooth brushing group and the regular professional dental cleaning group. 

  • There was no significant difference in the risk of pneumonia between groups with and without periodontal disease. 
  • A number of dental caries and missing teeth, and the frequency of tooth brushing and professional dental cleaning, were associated with the incidence of pneumonia. 
  • The risk of pneumonia was significantly higher in the group with a higher number of dental caries and the group with more missing teeth. 
  • Risks of pneumonia decreased significantly in the frequent tooth brushing group and the regular professional dental cleaning group [7].

Fluoride: Is it the best means of fighting tooth decay?

Fluoride is considered an essential part of dental care. Almost all toothpaste contains it. Roughly 73.0% of the U.S. population with public water access in 2018 received water fortified with fluoride. In Germany, however, no fluoride is added to drinking water—and yet rates of tooth decay have dropped.

Fluoride can store and lock calcium and other minerals in tooth enamel, which sounds like a beautiful, helpful attribute. But just like many things, it also comes with unwanted side effects.

There are ongoing studies linking fluoride to chromosomal changes, bone cancer, and impairments to intelligence, while many other studies declare its innocence of these allegations.

The concept of holistic dentistry is based on avoiding overburdening the body with artificial substances as far as possible. If we eat well and get all the nutrients we need, there is no need for additional fluoride. Saliva’s job is to store minerals in teeth. That is its natural function, and it does not require extra fluoride to get the job done.

Tough Foods Make You Tougher 

Chewing food is easier to digest. But did you know that adequately chewing our food can protect us from infections? Researchers recently discovered this when they took a closer look at what is known as Th17 cells in our mouths.

These cells are part of the immune system and can ward off harmful bacteria to our health while leaving friendly bacteria in peace.

Furthermore, Th17 cells form in the mouth, so the more we chew, the more cells are produced. In addition to this, eating foods with a more rigid consistency, or simply chewing well, ensures a better immune defense in the mouth.

Good Dental Hygiene Practices

Taking care of your oral health may take a lot of effort. However, if you add them to your daily routine and practice them daily, it will not feel like a chore but more of a natural habit. Here’s how you can practice good dental hygiene:

  1. Brush your teeth twice a day
  2. Use mouthwash daily
  3. Floss daily
  4. Drink more water
  5. Eat more crunch fruits and vegetables
  6. See your dentist twice a year

Watch the full episode on this by clicking here:

TIME STAMPS:

0:00 Introduction
1:00 Sponsor Ads
2:15 Cup of Nurses Introduction
4:04 Episode Introduction
6:36 Importance of Dental Health
10:44 Statistics About Gum Disease
13:28 What Contributes To Poor Dental Health
13:39 Sugar changes the acidity in your mouth!
15:42 How Alcohol Affects Dental Health
18:08 How Smoking Affects Dental Health
21:59 How to Prevent Poor Dental Health
22:45 Conditions Linked to Bad Oral Health: Endocarditis
23:23 Study About People with Endocarditis
25:13 Conditions Linked to Bad Oral Health: Cardiovascular Disease
28:24 Conditions Linked to Bad Oral Health: Pregnancy & Birth Complications
31:51 Conditions Linked to Bad Oral Health: Pneumonia
37:36 Fluoride: The best means of fighting tooth decay?
44:13 Tough Foods Make You Tougher