EP 223: Is Nursing Worth it

EP 223: Is Nursing Worth it

Is Nursing a Good Career Choice?

The short answer is yes for new nurses joining the field and current nurses. Nursing is still worth it and is a great career choice. It’s easy for us to look back and think, has nursing been the right choice? I’ll offer you some insight, everyone has those thoughts at some point in their career. Everyone eventually asks themselves the same question because the expectations don’t always meet the realities. What you thought you signed up for is there but with a lot of extras and long hard hours. No matter what field you enter you’re going to have to work hard to make something of it, there isn’t a perfect professional where you do everything you like. Nursing adds a very unique perspective to almost everything in life from relationships to finance. Below are some of the reasons I entered nursing and the benefits it brought me. 

Financial Benefits of Nursing

Nursing can bring you anywhere from $65,000 to $110,000 depending on state and experience. To be honest, that doesn’t seem like a lot but at the same time, it does. When you compare it to the median middle-class household income in the US is about $70,000, it is a very good career choice. The higher pay lies in staff nursing as it is in the highest demand and most abundant position. The most money in nursing is travel nursing but that requires moving around from place to place which is a little more stressful and harder. 

From a financial standpoint of you get your BSN or currently have it, you are in a good place in life. You are automatically positioned in the middle class right out of school and you have a really good cushion if you don’t make a series of bad choices. The financial beauty of nursing is you have a middle-class cushion, which means even if you don’t pursue anything else you will be well off but also if you do try something different and it doesn’t work out you can still fall back on nursing. 

Overtime and shift differentials

What’s really nice about nursing is that you get paid based on shifts and also hourly. Some jobs do have salaries but it doesn’t always equate to the time you put in. For nursing, the time you put in is the time you get paid for, you can view it as a pro or con but I see it as the best for nurses to get paid.

That being said, you can maximize your pay if you are ok with working the night or evening shift. It is a little rough but if you get used to it, you can make a couple hundred dollars more a week. Weekends are also paid more which is nice because you have to work every other. 

Overtime is always an option in nursing because in most places it it offered every day of the week This is nice because you can pick up whenever you want. If you want to make some more money you can pick up an extra day every month. In your typical job this would be hard because most have a 40hr week where it’s 9-5, but nurses have the luxury of 3×12 which makes for a long shift but also a longer week. You have about 4 days off, if you are complaining about money there is no reason you cannot pick up 1 or 2 days a month. 

One thing to watch out for is tax. You need to pay attention to how your income gets taxed because it might not be financially worth it to jump to the next tax bracket. Income tax levels can change every year so always keep an eye because it looks nice making more money but if a good chunk of that will be going to the taxman you’re better off spending time doing something else. As a nurse, you’re most likely going to get taxed at the 22% level and it would take you quite a bit of work to get to the 24% level and even more to get higher.

Job Security

Nursing is a healthcare field people will be getting sick forever. One financial benefit of this is that no matter where the economy goes no matter how many banks fail you will always have a job. No matter what happens you can always make an income. People will always be going to the hospital, people will always die, and people will always be born. In emergent times like we’ve seen over the last couple of years your job is in even higher demand. The unfortunate but positive thing is that nurses make more during emergencies. 

Career Advancement

There are a handful of administrator roles in nursing, nursing educator, assistant manager, and Clinical nurse specialist are just a few. They do require a graduate degree which has 2+ years of added school but it is worth it if you are trying to move up into a nurse leadership position. 

Nurse practitioners and Nurse anesthetists are also very popular fields to enter. They are the most-paid positions when it comes to being more hands-on in the clinical setting. With these careers, you are in over the $100,000 range when it comes to income. 

Going to school for an extra 2 to 3 years is worth it because it can bring you anywhere from $20,000 to$100,000 more a year. I understand this isn’t for everyone and it is completely fine if you just want to get your BSN. Regardless of what you choose, just having the BSN sets you up for success.

Watch the full episode

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

What’s in a Nurse’s Bag?: 6 Must-have Items

What’s in a Nurse’s Bag?: 6 Must-have Items

What’s in a Nurse’s Bag?: 6 Must-have Items

Ever wonder why nurses always carry a big bag with them? Whether a nurse or a nursing student, having a bag full of essentials is part of your everyday life to get through the shift successfully. But what items should be inside a nurse’s bag? 

Having these items ready in our bag is more of a need than a want! Of course, we love accessories, but with them comes practical use.

You’ll never know when an emergency arises, so it’s best to be ready than sorry! Here are the six items we love to keep in our nursing bag. 

1. Trusty stethoscope and blunt-tip scissors

Nurses cannot go without their stethoscopes [1]. Although sometimes they get mistaken for being “the doctor,” – this tool is just part of our daily routine.

Besides, it is always good to have your stethoscope to use on patients during your assessment, checking vital signs, or when your patient’s condition changes.

The blunt-tip scissors come in handy in emergencies when a wound dressing is needed. It helps cut medications or clothes during emergencies.

2. Medical kit for personal use

When studying as a nurse, a headache, tummy ache, or cold can occur anytime. The same goes when you are a nurse on duty. Long shifts can cause fatigue and a few aches and pains in between.

Having a personal pharmacy kit is essential. This kit usually contains vitamins, meds for headaches, some balms for aches and pains, meds for allergies, or anything needed for your shift.

You may also find some lotion, mouthwash, toothpaste, toothbrush, and other hygienic products that you use.

3. PENS, LOTS OF PENS

As a student nurse, I avidly collected colored pens for my notes [2]. I always had highlighters, pencils, erasers, liquid markers, etc. My pencil case is always full of them, and it looked like I had a stash of school supplies with me!

I’ve always thought it was just a thing I did, but I found out that my nurse friends did too. So, it is a nurse thing. Besides, these pens come in handy when taking notes or rewriting them in a way that you will understand.

Dry-erase markers are essential when correcting your patient’s information on whiteboards. 

4. Hand sanitizers or disinfectant alcohol

As a student nurse, I habitually carried a hand sanitizer wherever I went. I always prefer cleaning my hands with it even after I have washed them (to be extra clean).

So, even now, I still make sure that I have that in my bag. It is always a must to clean your hands before and after dealing with patients to minimize contact with germs, bacteria, or viruses.

5. Water bottles, candies, or snacks 

As a nurse, we are always on the go. Sometimes we forget to eat on time. Having snacks or candies in your bag can help spike your sugar levels when you are feeling low.

Of course, don’t forget your water bottle. HYDRATE. It is essential to hydrate at all times!

Our job needs our whole life force, so we must also care for ourselves. Having these in your bag will come in handy! 

6. Miscellaneous items

These could be your wallet, phone, car keys, extra socks (if needed), cologne, wet wipes, facial tissues, an iPad for your study notes, and many others. 

Now You Know What’s in a Nurse’s Bag! 

You see, we are prepared for anything! Our patients’ lives and the people around us matter. Having all these essentials with us helps deliver quality care to those in need.

Whether in a hospital setting or not, our hearts are ready to serve! 

Looking for more student resources? Check out these helpful links!

 

EP 140: Pulmonary Hypertension 101

EP 140: Pulmonary Hypertension 101

EP 140: Pulmonary Hypertension 101

Pulmonary hypertension is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart resulting in increased pulmonary vascular resistance and pulmonary arterial pressures [1].

Diagnosis

Pulmonary arterial hypertension is diagnosed with a right heart catheterization or Swan–Ganz catheter showing pulmonary arterial mean pressure greater than 25 mm Hg and not by echocardiogram.

  • Normal pulmonary artery pressure is 15-25/8-15
  • A normal mean pulmonary artery pressure: 10-20
  • Normal pulmonary artery wedge pressure: 6-12
  • A normal CVP: 2-6 
  • Normal CO: 4-8
  • A normal SVR: 700-1500

Causes

The typical heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through the heart, the lower right chamber (right ventricle). It then pumps blood to the lungs through a large blood vessel (pulmonary artery).
 
In the lungs, the blood releases carbon dioxide and picks up oxygen. The blood flows through vessels in the lungs (pulmonary arteries, capillaries, and veins). It then goes to the left side of the heart.
 
Changes in the cells that line the pulmonary arteries affect the wall of the arteries. They become stiff, swollen, and thick. These changes may slow down or block blood flow. It blocks the flow of blood through the lungs, causing pulmonary hypertension.
 
The right ventricle spends little time in isovolumic contraction or relaxation. As a result, is able to generate cardiac output with only a fifth of the energy demanded by the left ventricle (LV).
  • Left-sided heart failure can cause pulmonary hypertension.
  • Pulmonary hypertension can cause right-sided heart failure. 

Groups of Pulmonary Hypertension

This condition is divided into 5 groups by the World Health Organization

WHO group Etiology of pulmonary hypertension Mean pulmonary arterial wedge pressure Example causes
1 Pulmonary arterial hypertension Normal Idiopathic, hereditary, drug or toxin-induced, shunts related to congenital heart disease, connective tissue disease, portal hypertension, chronic hemolytic anemia, Collagen Vascular Diseases 
2 Pulmonary hypertension secondary to left heart disease Increased Valvular heart disease, systolic dysfunction, diastolic dysfunction, pericardial disease, congenital/acquired left heart inflow/outflow tract obstruction, congenital cardiomyopathies
3 Pulmonary hypertension secondary to lung disease Normal Chronic obstructive pulmonary disease, severe asthma, interstitial lung disease, sleep apnea, long term exposure to high altitude, congenital lung abnormalities
4 Chronic thromboembolic pulmonary hypertension (CTEPH) Normal Chronic pulmonary embolism
5 Pulmonary hypertension with unclear and/or multifactorial mechanisms Normal or increased Systemic diseases, sarcoidosis, vasculitis, hematological malignancies, chronic renal failure, metabolic disorders, lung tumors

 

Group 1: Pulmonary arterial hypertension (PAH)

Causes include:

  • Unknown cause (idiopathic pulmonary arterial hypertension)
  • Changes in a gene passed down through families (heritable pulmonary arterial hypertension)
  • Use of some prescription diet drugs or illegal drugs, such as meth
  • Heart problems present at birth (congenital heart disease)
  • Other conditions such as HIV infection, chronic liver disease (cirrhosis)
  • Collagen Vascular Diseases – Diseases such as R.A & Lupus. Inflammation is probably an important contributor to the development of pulmonary hypertension. Clustering of macrophages and T‐lymphocytes around vascular lesions has been reported in PPH and associated with this condition and has been linked to vascular remodeling [1].

Potential causes of PAH based on pathophysiology: Endothelial dysfunction, impaired vascular dilatation, alterations in the expression of NO, ET1 and serotonin, increased expression of inflammatory cytokines and chemokines, loss of endothelial caveolin-1, and disordered proteolysis of extracellular matrix contribute to the pathogenesis of PAH. 

Definition of Proteolysis – The breakdown of proteins or peptides into amino acids by the action of enzymes.

Group 2: Pulmonary hypertension caused by left-sided heart disease

Causes include:

  • Left-sided heart valve diseases such as a mitral valve or aortic valve disease
  • Failure of the lower left heart chamber (left ventricle)
    • In response to a massive increase in left-sided filling pressures, more specifically left atrial pressure

Group 3: Caused by lung disease

Causes include:

  • Chronic obstructive pulmonary disease (COPD)
  • Scarring of the tissue between the lung’s air sacs (pulmonary fibrosis)
  • Obstructive sleep apnea
  • Long-term exposure to high altitudes in people who may be at higher risk of pulmonary hypertension

Sleep apnea causes PAH due to left heart dysfunction with either preserved or diminished ejection fraction. The combination of hypoxic pulmonary vasoconstriction and pulmonary venous hypertension with abnormal production of mediators will result in vascular cell proliferation and aberrant vascular remodeling leading to pulmonary hypertension. 

Pulmonary vascular remodeling in COPD is the main cause of the increase in pulmonary artery pressure and is thought to result from the combined effects of hypoxia, inflammation, and loss of capillaries in severe emphysema.

Group 4: Caused by chronic blood clots

Causes include:

  • Chronic blood clots in the lungs (pulmonary emboli)
  • Other clotting disorders

Group 5: Pulmonary hypertension triggered by other health conditions

Causes include:

  • Blood disorders, including polycythemia vera and essential thrombocythemia
  • Inflammatory disorders such as sarcoidosis and vasculitis
  • Metabolic disorders, including glycogen storage disease
  • Kidney disease
  • Tumors pressing against pulmonary arteries

Signs:

  • Heart sounds: Loud P2 (Closing of the Pulmonic value, Murmur of tricuspid regurgitation
  • The liver will be pulsatile
  • EKG – Right Ventricular Deviation (RVH)
    • Lead 2 peaked P-wave
    •  V1 – Large V wave and maybe an RBBB
  • Echo – This device would measure the change of pressure “Velocity” Measuring the absolute pressure of the Right atrium and the right ventricle. Would also measure the Size of the Right Atrium and Ventricle. 

Complications

Potential complications of pulmonary hypertension include:

  • Right-sided heart enlargement and heart failure (cor pulmonale). In cor pulmonale, the heart’s right ventricle becomes enlarged and has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries.
    • As a result, the heart walls thicken and the right ventricle expands to increase the amount of blood it can hold. But these changes create more strain on the heart, and eventually, the right ventricle fails.
  • Blood clots. Having this kind of hypertension increases the risk of blood clots in the small arteries in the lungs.
  • Arrhythmia can cause irregular heartbeats (arrhythmias), which can lead to a pounding heartbeat (palpitations), dizziness, or fainting. Certain arrhythmias can be life-threatening.
  • Bleeding in the lungs can lead to life-threatening bleeding of the lungs and coughing up blood (hemoptysis).

Pathophysiology of PAH and RVF 

  • In order to reduce wall tension caused by the increased afterload of PHTN, hypertrophy of the right ventricle occurs. As a result, coronary flow no longer occurs in diastole despite the increased demand of the hypertrophied right ventricle. 
  • The right ventricle spends more time in isovolumic contraction and relaxation to overcome increased pulmonary pressures, reducing right heart output and greater energy demand.
  • RV hypertrophy also interferes with the normal motion of the tricuspid valve and increases pulmonary pressures resulting in tricuspid regurgitation. The growth of the right ventricle also impedes the function of the LV as the interventricular septum bulges into the LV. 
  • These changes in the right ventricle all reduce cardiac output, decrease coronary flow to the RV, and causes ischemic damage. Finally, this hypertrophy of the right ventricle, accompanied by ischemic damage, eventually leads to ventricular dilatation and total right heart failure.

Fun Fact:

Patients with PHTN are at risk for developing sepsis. Patients with low cardiac output may poorly perfuse the bowel, leading to a leaky endothelial barrier that allows bacteria and their toxins to invade, which can result in sepsis.

The effects of sepsis on patients with PHTN can be devastating. Sepsis-induced drops in systemic vascular resistance (SVR) can severely compromise patients with reduced cardiac output from PHTN. 

Sepsis has been shown to cause pulmonary vasoconstriction and dysfunction and produce cytokines that reduce right heart contractility.

Clinically, sepsis was found to be a leading cause of patient mortality in the ICU for patients with PHTN exacerbations [2].

Interventions

  • Pulmonary vasodilators are used to reduce RV afterload by reducing pulmonary arterial pressures. Vasodilators are effective at reducing RV afterloads, such as IV Prostanoids, Inhaled Nitric oxide cause improvements in cardiac output and oxygenation.
    • Outpatient we can use Sildenafil to cause an increase in nitric oxide that will vasodilate.
  • Inotropes, such as Dobutamine and Milrinone are used to maintain cardiac output in the presence of cardiogenic shock from right heart failure due to this hypertension.
  • Pressure support medications, such as norepinephrine and vasopressin, should be used to maintain systemic blood pressure as well as right coronary artery perfusion of the right ventricle.
  • We also can Diuresis these patients to reduce the pressure of fluid overload on a failing right ventricle.
  • Intubation of patients with PHTN and RVF should be avoided as sedatives can depress cardiac function and lower SVR, and increased transpulmonary pressures can further lower CO.
  • For patients with end-stage PAH and RVF refractory to optimized medical treatment, lung transplantation with bridging via extracorporeal life support should be considered.
  • Anticoagulation was found beneficial in groups 1 and 4 based on autopsies that there are a lot of blood clots.
  • For stage 4 PAH, like we saw during COVID, we refer to a drug called Epoprostenol. Stimulates the Prostacyclin receptor (agonists) and causes Vasodilation.  

TIMESTAMPS:

0:00 Cup of Nurses Intro
0:54 Sponsor Ads
1:32 Cup of Nurses Introduction
3:23 Pulmonary Hypertension
6:16 Pulmonary Arterial Hypertension Diagnosis
10:25 Groups of pulmonary hypertension
10:38 Pulmonary arterial hypertension Causes
11:58 Pulmonary hypertension secondary to left heart disease
12:36 Pulmonary hypertension secondary to lung disease
16:20 Pulmonary hypertension caused by chronic blood clots
19:18 Pulmonary hypertension triggered by other health conditions
19:54 Signs of Pulmonary Hypertension
22:44 Complications of Pulmonary Hypertension
25:38 Fun Facts

Ep 98: Becoming a CRNA with Dr. Jason Bolt

Ep 98: Becoming a CRNA with Dr. Jason Bolt

Becoming a CRNA with Dr. Jason Bolt

In this episode, we introduce you to our guest, Dr. Jason Bolt, DNP & CRNA. Not only is Jason a nurse anesthesiologist he also has a YT channel called BoltCRNA, where he offers mentorship and a behind-the-scenes look at the life of a CRNA. Follow him on Instagram at @BoltCRNA.

Questions for Our Guest

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

  • Let’s get a little background about yourself; why made you choose to become a CRNA?
  • How is CRNA school? How do you become one?
  • Can you run through your typical work day? What does this job entail?
  • What are the most challenging aspects of your job, and how do you manage them?
  • Before becoming a CRNA, what type of nursing did you do?
  • It seems like you are entering the education field; what made you want to start a YT channel and offer CRNA education?
  • Future advice for anyone trying to become a certified registered nurse anesthetist?
  • How did/does it feel to work in a female-dominant profession?
  • What do you enjoy doing on your time off? Has covid changed that, and how are you coping?

Learn how you can be a Certified Registered Nurse Anesthetist like Dr. Bolt here 👇👇👇

TIMESTAMPS:

00:00 – Intro
01:12 – Who is Dr. Bolt?
02:12 – How is school finishing up?
04:49 – Are you still able to work?
05:55 – School
07:49 – Type of Clinicals
09:56 – Day-to-day activities
13:04 – Autonomy of a CRNA
16:50 – Stress in anesthesia
21:47 – Monitoring
23:00 – Favorite Cases
25:12 – Work Schedule
27:19 – Culture of the Operating Room
33:02 – Free time
35:23 – Words of wisdom
37:57 – Nursing School
40:11 – Covid Impact
42:12 – Working as a nurse in 2020