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Things Every Nursing Student Should Have: Part II, Palm Pilots and Programs

I left a cliffhanger of a post in Part I of this article. This section of the article will focus more on things to help you be successful and knowledgeable in your clinical skills as a student nurse, even if you do decide to go further for your master's or doctorate degree in nursing. Palm Pilots As I mentioned in the previous article, buying a palm pilot was the smartest thing that I ever did. Going on many websites, your head may swoon when thinking of all that you have to consider when buying a Palm Pilot. There are only three things that you need to worry about: price, compatibility, and memory. Price Most good palm pilots (PDAs) start at a range of $199 and can go as far as $499 or higher. I am not a rich person at all. The Palm Pilots (yes, plural...see below) I have bought took months for me to save up for. In my humble opinion, I would have to say that a PDA for $199-299 might be all that you need. Before you tsk, tsk me, there are several things working for you as a student nurse. The first is that you're a student, a poor, poor student who needs help financially. Most companies offer some kind of student discount if you order PDAs from their website like Skyscape and Epocrates. These two websites offer bundles in which you buy PDAs and medical programs together at a discounted price. There might be more sites out there, but these are the two big sites that I deal with when shopping for medical stuff for my PDA. Secondly, as I said in the last section of this article, you can always hit all of the relatives up for some palm pilot lovin' during Christmas/Hanukkah/birthday or whatever time. Compatibility I have had 4 Palm Pilots in my whole life. The first was lost by family members. Number two was tossed out due to the power button breaking...that was the Tungsten E, which I guess was on the list of many repairs and updates leading to Tungsten E2. The third was a Tungsten E2 that ran out of memory. Epocrates is a memory hog...more on this below. Currently I have a Palm TX, one of the few loves of my life. I only know Palm OS (operating system) as opposed to Windows Mobile. Most of the PDA programs that you're going to buy are going to be Palm OS compatible, so it can work on both a Mac or a PC. The PDAs that are only Windows Mobile compatible can only work with programs built for Windows, not for Macs. There are not many Windows only programs, so you're best bet is buying a PDA that is Palm OS compatible. Memory You want to have at least 32 megabytes of memory on the actual device. Palm's Tungsten E2 has this much memory and did very well for me. Most nurse practitioners (and nurses) who I have seen with a PDA have a Tungsten E2. If you choose to shower your palm with a good reference guide, medical dictionary, and drug book, then you will definitely need a memory card. A memory card with 1 gigabyte should be enough. I'm kind of obsessive about new and cool medical books available on PDAs, and I have a 1 gigabyte memory card. Be sure to know which major programs you would want to buy before buying a PDA. Some software requires a certain amount of memory to be on the actual PDA device, even if you have a huge amount of memory on your memory card. Programs Here's the fun part. The inner nerd in me loves nothing more than to break open a new PDA box or play with a new medical e-book found on the internet. You will find this to be true, too,or maybe I am a freak. Student Nurse Must Haves: 1. Epocrates Essentials Pros:
  • Keeps you up to date on current research (depending on how much you update Epocrates)
  • A 5-minute Clinical Consult in which you type in symptoms and it gives you the most likely diagnoses and treatment modalities
  • You can look up different labs and what they mean, different medical diagnoses/diseases, different drugs different medical math formulas i.e. body mass index, creatinine clearance, and pediatric maintenance fluids.
  • Epocrates = memory hog. Get a memory card to save you the trouble and heartache
  • It sometimes has trouble updating and gives you corrupt files. If you have a PDA with WiFi, like the Palm TX, then do the auto update wirelessly instead of using your hotsync cable. This will save you 5 months of constantly calling Epocrates tech support. You'll know exactly what all this mumbo-jumbo is when you actually have a PDA, I promise.
2. Taber's Cyclopedic Medical Dictionary Pros:
  • A full 2439 pages all wrapped up in 10966 kilobytes of memory.  It may sound like a lot of memory, but it's still not as much as Epocrates.
  • web access to the dictionary with illustrations.
  • No illustrations for the PDA version.
3. Lexi Comp Drugs International Pros:
  • In-depth description of tons of drugs...far better than Epocrates.
  • Many international drugs used in Canada and Europe listed.
  • Patient education and monitoring parameters are really spelled out well.
  • It is a bear to download and update. They are based in Hudson, OH, but their books are used all over. I'm really surprised that they haven't made their website more user-friendly.
Grad Nursing Student Must Haves: 1. Washington Manual Outpatient Medical Survival Guide 2. Washington Manual Internship Survival Guide These two books saved my life a few times when doing my clinical rotations. As student NP, you are basically treated as a resident because many people don't know what your training exactly is. This experience was bittersweet...maybe more sweet in hindsight, because I trained myself to not only think on an advance practice nurse's level, but also on medical level along with all of the residents and docs. Studying many sections of these two books also had prepared me for seeing common problems in all of my rotations that NPs and docs have to deal with all the time. I know it is the end of the school year for many and maybe soon to be the beginning of the school year for some. I get asked these questions all the time from classmates, so I figured if that many people wanted to know about PDAs and medical software, then there has to be hundreds more people out there who haven't even started nursing school, yet. I hope this article has helped you. If you have any questions, post them in the comments section below and I will try to answer or add additional parts to this article. Feedback is always greatly appreciated. Good luck in your future studies!

Things Every Nursing Student Should Have…Even Through Grad School: Part I

I have stewed over this topic for several months as I am finishing up my second to last semester of my Family Nurse Practitioner (FNP) program. I do not consider myself an expert on this issue; however, there were several things that got me through nursing school that I could not survive without. The following stuff is mainly for an undergrad nursing student. Part II (coming soon) will be more for a nursing student in grad school. 1. A cheap watch that tells military time I am a cheap watch girl because, working with the pediatric population ( & going through 6 watches in 5 years), I have learned that it is not worth it to get an expensive watch. Also, the amount of lifting, moving, bending, carrying, etc. that a nurse (especially the average nursing student, since the nurses on the floors are happy to have students do the grunt work) does makes for a broken watch every 5 months or so. These watches are so cheap, $9.99 at Target. Military time watches saved my life. My husband always makes fun of me for having a military time watch, but it's truly a lifesaver. I never got used to adding or subtracting twelve hours to regular time. This watch made my life so much easier and my documentation much more accurate as a student and nurse. The first time I was truly grateful for having a military time watch was during my first job straight out of nursing school in the PICU (pediatric intensive care unit). It was during my first real code (code blue) ever and I was the recorder. When you watch ER or something, it amazes me that they never show the recorder who has to write down every single thing done to a patient during a code. 2. A good stethoscope I started out with a Prestige Medical sprague stethoscope. I remember an instructor telling us that we should buy a stethoscope with both a diaphragm and a bell in order to hear both high and low pitched sounds. This will be helpful for you distinguishing different breath sounds (rales, rhonchi, wheezing) and heart sounds (gallops, rubs, murmurs). I also (vaguely) remember being told that the shorter the tubing for the stethoscope, the better. This basically has to do with the physics of it all. You'll be able to hear the sound more clear the shorter the tubing is. My prestige stethoscope was a great starter. Once I was able to save up enough money, I got the a Littmann stethoscope. I made the upgrade to the Cardiology II because the difference in my ability to auscultate faint adventitious sounds of the body and checking NG (nasogastric) placement improved 20 times. Well, I was unable to actually measure the difference, but there was a definite difference. If you're the kind of student who feels that you need to have something like this early on (like now), hit those loved ones up, all of them at the same time. My Littmann is approximately 4 years old and still working very well. This is another very good investment for nursing school. 3. Comfortable nursing shoes I was never a trendy "croc" aficionado. Many hospitals don't even let you wear them. I'm a New Balance girl, myself. From working anywhere from 4 to 16-hour shifts, these babies keep you comfy. 4. Pocket protector filled with bandage scissors, many packets of rubbing alcohol, a permanent marker, a highlighter, and (at least) two 4-colored pens This is also something my husband makes fun of me about. It may seem nerdy, but it's going to save you the ink stains. Plus, it acts as a very handy storage area in your pocket. You'll learn to stuff unimaginable things in your pocket just to avoid an extra bag or trip. It's all about the multi-tasking. highlighter- Just highlight the important stuff for patient/family education. The patient is already overloaded. bandage scissors- I'm asked every single day for my scissors. rubbing alcohol- This is for a quick clean of almost any surface...also, those bandage scissors are going to end up in some pretty gross places permanent marker- Labeling meds/IV bags/anything really two 4-colored pens- You'll be surprised how much you might need red ink for taking off orders...depending on your institution. You'll learn that the piece of paper that you have all of your activities recorded for the day (tube feeds vs. PO meds vs. IV meds vs. I's & O's ) will need some color coding. This is pretty anal, but it helps map out your day. I've done this ever since junior high, and it has made me more organized in my thought process. You'll need at least two pens because us nurses are all filthy pen thieves. 5. Mosby's Drug Guide This book was a good starter for me. It has all the info that you will need for when your instructor grills you. The language is easy to understand. The part of the book that I really like (I'm sure it's even better now because I only have the 4th edition from 2002) were the pictures of how to give different kinds of injections. It also gave pictures of different common drugs used in the general population. This is helpful for that those cute little old people taking 15 different kinds of medications per day, don't know what they're for, but can tell you the color of the pill. 6. A PDA Know these initials and know them well. PDA stands for personal digital assistant (for those who always wondered, but felt too dumb to ask), otherwise known as a palm pilot. In nursing school, one thing I hated was carrying around 5 different books to get me through clinicals. After biting the $200 bullet, I got hip to my first palm pilot. The greatest thing about these little devices is that you can carry 10 or more different medical books all on this little device. One thing you may be thinking is, "I can't afford this. She's out of her mind." Believe me, I couldn't afford it, either; however, it has proven to be the best investment (besides becoming a nurse) that I have made for myself financially and medically. This is what you can do. Again, tell all of your family members...I mean all of them, to not get you anything else for your birthday/Christmas except a palm pilot. You will have a vast array of knowledge at your fingertips, your backaches will go away, and people in the hospital (doctors, nurses, patients) will be impressed. Plus, every palm pilot comes with some kind of built-in calculator (another nursing school must), calendar to schedule appointments/meetings, and an address book to help you manage your hectic life. See Part II of this post (will be posted soon) on what to look for when buying a palm pilot and programs/books to put on it. 7. The knowledge that things will get better and that you will overcome this. I didn't want to have to be all preachy, but I wanted to include this because I think it's important. The decision to become a nurse is a very important one. You will hold people's lives in your hands, literally. The pressure between nursing school, your job to make ends meet, possibly kids/family can all seem like it's just too much...not to mention all the blood, vomit, mucous, urine, and poop that you're going to have to put up with. There is something to be said about those nurses that tend to eat their young. It seems like they use you as their own little "fresh blood" punching bag. Someone probably did the same thing to him/her in nursing school or his/her first job, so they feel like they need to pass on the tradition. I don't believe is this bs. This is part of the reason that there is such a shortage, because even some nurses can't appreciate each other and stop the cycle of hate. You need to take it upon yourself to kill that person with kindness and do your job 150%. If you are still thinking of quitting nursing school/nursing in general, speak to a nurse who has been around the block a few times (not sexually) and that truly loves what he/she does. You may not find many nurses that like where they work, but you should find nurses that love what they do. No nurse should be in this profession that is burned out and/or hates what he/she does. When a person comes to this point, this is when they should leave nursing, even if there is a shortage. It's just not fair to the patients. Coming Soon: Things Every Nursing Student Should Have...Even Through Grad School: Part II---palm pilots, programs, books, and websites. Oh My!

Why should you care that all the bees are dying?

Recently it has come to my attention that all of the nations bees are seriously threatened. Iaren't bees cute? know, it's hard to believe that it would be a big deal, and in fact, no one has really made a big stink about it yet. But it's important. Why, you might ask? Well, even if you didn't ask, you should probably read on since this topic definitely affects everyone, even if you don't like honey or bees. Most people know that bees are responsible for honey and bee stings but what you may not know is that they are a much more important member of the agricultural community. Bees, especially honey bees, are responsible for the pollination of flowers (you might be saying duh, here but follow me on this one, please), and said pollination causes plants to actually bear fruits as the method of their reproduction. And said fruits are important for not only human nutrition, but also for that of most of the animals we raise as pets and most of the animals that we eat. This topic came to my attention from my grandfather, an almost retired farmer. He brought it up to my mother in this manner. Grandpa: "Hey, The Fidge (that's me, btw) is a biologist, right?" Mom: "you know she is" G: "Well, can she tell me why the lady down the road's bees are almost all dead?" M: "Really? They are almost all dead? Why?" G: " Well, if we knew, we wouldn't be asking The Fidge, would we? Of her 20 hives, only two of them are still alive. All of the other hives are dead. And the other guy down the road, he had 125 hives and now only maybe twenty of them are still alive. They asked me if I knew what was happening, and I said I would ask the Fidge." So, this has become a job for me. Although I am just using the internet to research it, I do plan on calling a visit on these beekeepers to talk to them about their practices, but in the meantime I will fill you in on what the vast spaces of the interweb have to say about this little bee apocalypse. First of all, officials are calling this epidemic Colony Collapse Disorder, or CCD for short. (I just would like to point out that everything needs an acronym.) This used to be called Fall Dwindle Disease (FDD) but it was changed b/c it was noticed that this is not due to seasonality, nor can it be ruled to just being a disease. Actually, most experts are baffled to what exactly CCD is. Basically, they can't narrow it down to what is really killing all the bees. For example, according to the Penn State College of Agricultural Sciences news release on the topic: "Preliminary work has identified several likely factors that could be causing or contributing to CCD," says Dennis van Engelsdorp, acting state apiarist with the Pennsylvania Department of Agriculture. "Among them are mites and associated diseases, some unknown pathogenic disease and pesticide contamination or poisoning." That helps narrow it down, doesn't it? So, basically we can't really rule out anything at this point. We don't know what is killing the bees, and we can't decide what it could be, either. Most of the information I am using in my research comes from the Mid-Atlantic Apiculture Research and Extension Consortium Web site. In the hives that were researched by MAAREC there was evidence of vampire mites, a small parasite that lives off the "blood" of adult bees, viral infection, stress due to constant relocation of hives for crop pollination, intestinal amoebas, fungal infection, stunted learning and development due to industry chemicals (pesticides, fungicides, herbicides), and on and on. You get the point. We have not been able to narrow CCD down to any particular thing, which makes it incredibly difficult to treat the problem. The drastic amount of bees found dead over such a short period of time is what is so scary about the whole thing. A small bee apocalypse, the few surviving bees are all very young adults from what most beekeepers can see. I mean, as I pointed out, the two local cases above have lost an incredible amount of bees from their original numbers, and this is the case all around the country. The rate at which these bees are dying is alarming, especially since we cannot narrow the cause of their mortality down to anything specific. According to Jean-Louis Santini of AFP, "Bee numbers on parts of the east coast and in Texas have fallen by more than 70 percent, while California has seen colonies drop by 30 to 60 percent. It is normal for hives to see populations fall by some 20 percent during the winter, but the sharp loss of bees is causing concern, especially as domestic US bee colonies have been steadily decreasing since 1980." Well, either way, I have not really helped to narrow it down, but I hope you have learned something. Maybe this summer when food is really expensive you will know why, since most of the food we eat comes from the pollination efforts of bees, with only a few crops such as corn and wheat being wind pollinated. And just so you know, this is not something just limited to specific areas. This is affecting not only the US, but parts of Europe as well. This is a big deal, and no one seems to know anything about it. I figured I would end this article with a quote from Albert Einstein. "If the bee disappeared off the surface of the globe then man would only have four years of life left. No more bees, no more pollination, no more plants, no more animals, no more man," This may seem a little extremist, but it does bring the point home.

Who Cares About the iPod, Where is the Apple Glucose Meter?

A few months ago I was looking at blood sugar meters and cholesterol testers for family members.  I have had my blood tested for various things throughout my life and I've seen the standard drugstore-issue glucose monitors in action, so I had a very basic idea of what I was looking for.  But I wasn't exactly an expert, so I went online. Now one of the benefits of living in the Internet age is that if you need to learn about any technological device, from MP3 players to video cards to application servers, you can quickly and easily find out all about it online.  Making a major purchase?  Some skillful Googling will lead you to novice-level tutorials, product comparisons, recommendations from normal users, and jargon-laden details from experts. Unless you want to buy a glucose meter.  I found virtually nothing except for short blurbs on retailers' sites.  I even had a hard time finding product info from manufacturers! The worst thing is, I was wasting my time.  Even if there had been a ton of info out there, comparisons, anecdotes, reviews, etc., it would have been no use.  Because as far as I can tell, all blood glucose monitors are complicated, confusing devices that are difficult to use.  Diabetics are supposed to test their blood every day, but the testers are temperamental, require expensive consumables, and can fail without always alerting you to the error. You have to line up drops of liquid on a tiny little target.  Make sure you cover the whole target, or the results will be off.  Make sure you don't go outside the target, or you'll screw up everything.  Oh, maybe you need to recalibrate.  Did you check how old the strips are? I was really, really surprised about this.  Actually, it was a mix of surprise and anger - why should anyone have to put up with such frustration for something that is so important? Why would a confusing interface make me so angry?  I couldn't really put my finger on it (bad pun) until now.  I just read an article at Techcrunch, "Apple iPod vs. the Insulin Pump."  Apparently a blog that covers Diabetes that has posted an open letter to Steve Jobs of Apple:

We are, of course, deeply grateful to the medical device industry for keeping us alive.  Where would we be without them?  But while they’re still struggling with shrinking complex technologies down to a scale where we can attach them, hard-wired, to our bodies, design kinda becomes an afterthought.

This is where the world needs your help, Steve.
This is precisely what is needed.  Now, it doesn't have to be Steve Jobs or even Jonathan Ive, the guys who designed the iPod.  Any designer with some insight and a proven track record of making usable devices could probably improve these medical devices immeasurably.  Millions of people's lives could be made easier if someone married modern medical technology with user-centered design. So add me to the list of people asking the questions in this letter, Steve (few people realize that Steve Jobs reads Unsought Input daily and hangs on our every word).

How to Fat Smash and Become an Ultramarathon Man, Pt. 2

Had a weigh in for the competition recently and I’m down 30 lbs. total. 30 lbs in two months and I haven’t done anything unhealthy to lose it. I’m getting positive comments on my weight daily. Chuck and I finally got to run his neighborhood again this weekend and challenge the monster hill of doom. End result: 5 ½ miles and one conquered hill. At the risk of going all Tony Robbins, I want to share how I’ve been able to achieve all of this in such a short time. I was completely and utterly disgusted with myself but now I’m confident that someday I’ll be able to achieve my goals. So read on, and see how you too can achieve what I have. Give yourself multiple pieces of motivation. If you read my last post, my weight loss kicked off with a bet. A sizable chunk of money ($180) was waiting for the winner. And that money was great motivation to start. But once the contest was over, what then? I wanted to make a serious life change. Short term goals might get you moving, but changing the way I ate in the long term meant I needed long term motivation. My first motivation was running a marathon. I knew I couldn’t get in that much shape during the three short months of the challenge. I also knew that in order to run a marathon, I had to get down to where carrying my weight wouldn’t be too huge a burden on my legs. My second motivation was to get more, ahem, “attention� from my wife. My wife is into tall, skinny, gay guys out of Japanese comics. I fit in only one of those categories, the least I could do is fit into two. Just to be clear, the two categories are tall and skinny. My third motivation is this tight knit turtleneck sweater that I’d look bad ass in if I didn’t have a gut. There will be pain, but it won’t last. Biggest and best thing I did was cut soda out of my diet. A bottle of soda is two servings, and you run some 180-260 calories per serving. One soda is a meal! All I used to drink was soda. And beer. Mmmmmm… beer. Anyway, stopping the soda intake meant stopping the caffeine intake. Which meant withdrawal. Which meant three solid days of splitting headaches. But doing it that way was better than the alternatve. One of my fellow competitiors slowly weaned himself off of Mountain Dew, and put himself through two weeks of mild headaches. I’m a get over it and get going kind of guy. The other pain was the hunger. This too will pass. The American Obesity diet plan is all about big portions that you don’t need. Your primitive survival instincts always want to pack on fat because you don’t know if your tribe will be able to find a berry patch or hunt down a wildebeest tomorrow. So when you cut your calorie intake below what you burn in an average day (which is the only way to lose weight), your body starts to look to replenish its fat stores. Don’t give in. It takes about ten days to get used to the smaller portions. You have to break down to rebuild. I didn’t realize I was on the Fat Smash Diet until I browsed through the book three weeks in. Much to my surprise, I was following the same program they do on Celebrity Fit Club. Fat Smash is a diet in the scientific sense… you don’t go on it and then off it, you make it your diet for life. Much better then destroying your kidneys on Atkins, or starving yourself on the new fad diet and then gaining it back when your done. To start off I cut my calories way down, ate pretty much purely healthy stuff. Total fruits and vegetables, no red meat. Did I get rid of carbs? NO! Carbs are energy. I hate this low carb culture we’ve created. It’s bullshit. I ate subway A LOT. That bread has a lot of carbs. Here I am, 30 pounds later. I ate 1000-1200 calories a day for about two weeks. Spark People, a free diet website was a huge help during that time period. I really suggest you give them a shot. The amount of calories is not good long term, but I had no intention of staying there. It was a purging. I was so used to consuming 1000 calorie meals, that just to cut some food here or there would never work. But using that as a base got me used to portion control, and when I slowly built up to a safe 1600-1800 I felt like I was endulging myself. I am dead serious here about YOU MUST WORK UP TO A HEALTHY INTAKE. It actually helps you lose weight. When you stay at that low a level, your body goes into starvation defense, kills your energy level, and throws on as much fat as it can because it thinks it needs to keep you alive. Water is your best friend. Remember how I stopped drinking soda. Well I started drinking water. Non stop. And I used to hate water. I also used to have the driest, most cracked skin in the worl. Now girls ask me how much I moisturizer I use to get my baby botttom smoothness. Water is awesome on so many levels. It has 0 calories. It is is vital for metabolizing fat into energy… in other words, the more you drink, the more fat you burn off. It keeps your skin healthy. It cools you down. You MUST drink at least 8 cups a day. Do better. Drink 10. Make that 12. Yes, you will pee every hour on the hour. Make it a game. If you don’t pee clear, you didn’t drink enough water. If you’re thirsty, you aren’t drinking enough water. I got up in the middle of that last sentence to drink more water. On a side note, drink tap water. Don’t fall for the bottled water is cleaner scam. The water coming out of your tap is monitored by local, state, and federal organizations. It has all sorts of rules. Bottled water falls under a loophole that considers it on the same level of soda and does not have the same stringent codes. So in the best case, they filled it out of the same tap you did, and only ripped you off by charging you $2.00 for a plastic bottle that cost them half a cent. In the worse case you are drinking spring water that was downstream from where the bears crap… and the bears have dysentery. Eat a breakfast of Champions I never ate breakfast. I had diarrhea about three times a week. Coincidence? Not really. Eating a high fiber breakfast every day is great on so many levels. Every morning I pour Post Raisin Bran into a measuring cup. Pour said cup into a bowl. Fill measuring cup halfway with soy milk (8th Continent or Silk). Pour said cup into bowl. Voila. This plus eating takes me five minutes and destroys my old “I don’t have time for breakfast argument�. I love Raisin Bran. The fiber does two things. First,it jump starts my metabolism. Second, it keeps me regular. I haven’t been regular for years… probably since my Mom stopped making me eat breakfast. Total caloric intake at breakfast: under 300. Several times a week I throw in a banana and make it 350. So that just about covers my diet. Next time I’ll discuss my exercise plan. Good Luck!