I’ve always been of the opinion that healthcare workers should “walk the walk” before they “talk the talk”. What I really mean is that if you, as a healthcare worker, is going to give health advice to a patient, you should be healthy yourself. That is something that’s been in my head for years, but has really hit home since starting my journey to become a Nurse Practitioner.

On a personal note, I worked very hard to lose 40 pounds after finishing undergrad and moving from Chicago to Phoenix. 100% of that work was done by diet and exercise, so I know it can be done… and I also know how hard it is and that’s something that I can use to empathize with my patients while I recommend the same to them. Over the last few years (while getting too comfortable in my relationship), I managed to gain about half of that weight back. And, over the last 3 months, I’ve worked to lose half of that weight I’d gained back. If you’ve been following along with the math here, you’ll see that I’m still 10 pounds over my goal weight (but 30 pounds under my heaviest weight). This struggle is a reminder that we’re all human – it’s hard to keep healthy when your diet and exercise routine turns to crap in times of stress or lack of focus.

But, to me, it’s all worth it to be healthy. I want to be healthy first and foremost for myself, but also for my future patients. I want to be someone that people can turn to and trust that I am giving sound advice for a healthy lifestyle. My in-hospital example of a non-trustworthy healthcare provider is the nurse who comes in reeking of cigarette smoke, who councils his/her patient against the dangers of smoking… just hard to take that advice seriously.

I can’t believe that it’s been 2.5 months since I’ve posted on Nursing Influence. Although, since I have grad school (my FNP program) to blame, I don’t quite feel as bad. :-P

I’ve been spending this gorgeous 70-degree January weekend inside studying fluid, electrolyte, & pH balance. I can definitely say that I’m getting quite a bit done. But, as I was reading I came across the most interesting fact of the week and wanted to share it here!

BNP (brain naturetic peptide) is one of the reasons why people feel the need to urinate after getting in the pool. The increased pressure on the body drives more fluid into systemic circulation which leads to a slight increase in preload. In response to the increased preload, the ventricle secretes BNP, which has a natriuretic effect and leads to an increase in urine production.

Who knew?!?! :)

I just started a new class in my NP program – Ethics, Policy, & Finance. So far, I’m totally loving it. I’ve always loved aspects of business (which is why I took extra classes in undergrad to get a minor in business), but it’s even more interesting hearing about aspects of business that specifically relate to the field of nursing. Our first section is focused on health policy and changes in healthcare through the last 100 years.

Excited :) I’m sure there will be more posts to come on these topics

(my last course was nursing research which was very uninteresting as far as blog posts go)

I heard about the proposed ban earlier this summer and while I can’t say I was shocked (it is San Fran, after all), I was annoyed. I can see their side of the issue… babies unwillingly having a piece of their skin cut off. But where do we draw the line? There are a lot of things that occur within medicine that aren’t pleasant… immunizations, IVs. If I were a boy, I would hope that my parents would have gotten me circumcised when I was an infant. I know that my grandpa was circumcised when he was 19 years old due to an infection… I bet he wished he had it done when he was too young to remember it.

Circumcision is not just a cosmetic procedure. Boys/men who have been circumcised have a lower incidence of bladder infections, reduced incidence of balanitis (inflammation of foreskin/head of penis), reduction in spread of HPV to women during intercourse, as well as improved body image and ease of male hygiene.

(CNN) — California Gov. Jerry Brown signed into law Sunday a bill that prevents local governments from banning the practice of male circumcision.

The legislation comes in response to an effort this summer by a San Francisco Bay Area advocacy group opposed to the practice to get a measure proposing a citywide ban added to the November 8 city ballot.

In July, a Superior Court judge ordered the proposed measure removed from the ballot, saying that male circumcision is “a widely practiced medical procedure” and that medical services are left to the regulation of the state, not individual cities.

The legislation signed Sunday, which takes effect immediately, prohibits governments at the local or county level from “restricting the practice of male circumcision” and “declares that the laws affecting male circumcision must have uniform application throughout the state.”

Our cath lab shared leadership (shared governance) team decided that we’d like to help our hospital staff better understand what goes on in the cardiac catheterization lab which will lead to better patient education and care. So, we have broken the cath lab procedures into 3 basic categories: diagnostic, interventional, and EP studies/device implants. We will be putting on 3 different presentations to cover these topics.

Last week, we started with our first of the presentations (on diagnostic caths). We used one of our cath labs and set up a “sterile” tray, brought in a mannequin, and turned on our equipment. We presented 30-minute mock caths, where we talked about topics like pre-procedural prep, sterile fields, coronary anatomy, and closure devices. We had about 60 staff members come through the lab in just a few hours and received positive feedback from the staff who attended.

I’m honestly really proud of what our team put together – I think programs like these do nothing but help the staff to care for our patients.

One thing that’s been hard for me while working in the cath lab is the lack of education I’m able to give to my patients. I love educating. I really think that patient education is a highlight of what nurses can do to make a difference in the lives of their patients.

Working in a procedural area, it’s not breaking news that we don’t get to spend much time with our patients (while they’re awake anyways). When we roll patients into the cath lab, they are usually nervous, so I focus on small talk to take their mind off of the procedure or do some pre-procedural education about what to expect at the start of the procedure (deciding between the two is based on a quick judgement about how the patient is feeling as I first meet them in their room before the cath). Then, they’re sedated for the procedure…

After the cath, they are usually groggy which leads to short term memory issues (they can barely remember that we told them the procedure was over, let alone information about which artery has blockage). If the patient’s post-sedation state of mind isn’t the issue, the patient has often gotten news they might not have been expecting, such as needed open heart surgery or receiving stents, which cause the patient to focus on those facts and limits their ability to take in other information.

So, that’s been one of my issues. I would love to educate patients on the importance of taking their Aspirin and Plavix, or the importance of risk factor modification based on the results of the cath. I miss having that opportunity.

During a recent on-call shift, we were called in to cath a 38 year old female who was having a heart attack. She has a significant medical history of high blood pressure, smoking, diabetes, and obesity as well as noncompliance of medication. Her cath showed a stumped off LAD (completely blocked coronary artery) and partial blockage in her other two arteries. When asked, she admitted that she often had trouble paying for her medications. There is an obscene amount of education that this patient needs: importance of taking her plavix, financial resources for medications, smoking cessation, importance of diabetes control (her glucose was 360), and the effect that smoking, obesity, and noncompliance with blood pressure/diabetic medications have on the arteries in the body.

But, after opening up her LAD with a stent, we took her to the ICU for recovery. Chances are that I’ll never see her again or know what happens in her life.

This is my motivation for becoming a nurse practitioner… continuity of care.

After posting my x-rays from before and after my foot surgery in my last post, I came upon this article in the local news… and this guy’s xray is WAY cooler than mine. Check out the full post on AZ Central’s website.

I had my one-week post op appointment and received all good news. Doc says that I’m healing well and that he is happy with the lack of swelling in my foot. He says it’s because I’ve been such an awesome patient and have been keeping my foot elevated most of the day. :) Honestly, I’m kinda proud of myself too… I’m not good at laying on the couch for most of the day, but it’s been a priority to take care of my foot this week. It has definitely helped that I’ve had so much school work to do and my 11″ Macbook Air sits so nicely on my lap while I’m on the couch. :)

If you haven’t already guessed, above are my pre and post-op x-rays. My doc was nice enough to burn them to a disc for me so I could share with my friends :) In the pre-op picture, you can see how that bone jets out on the lateral side; in the post-op picture, you can see my new hardware (the screws) and how nicely aligned that joint is now.

Well, my surgery was a success… bunion removed. I went into the hospital about 2 hours before my scheduled start time, had my vitals taken, peed in a cup, got poked in the arm with an 18gauge needle, etc, etc.

Everyone at the hospital was really nice – it seemed like they weren’t very busy that day. Lots of staff coming in the pre-op bay asking if my nurse needed any help. Two different CRNAs came in to do my pre-op H&P. What can I say? I’m one popular patient. Chad, the CRNA that did my anesthesia works with a former co-worker of mine, so we were swapping funny stories about him as he was slipping me some versed. I remember rolling into the OR, scooting over to the operating table, and Chad telling me “this is just some oxygen”…. yeah, right. I don’t remember a darn thing after that mask :)

I guess it took me about an hour to regain consciousness after they brought me into the PACU. The doc went out in the waiting room and showed Chuck the x-rays they took in the OR and apparently everything looked really good. We stopped and grabbed some grub on the way home, but I passed out before I even finished eating.

I slept most of the day yesterday (the day of my surgery) but my foot was still numb from the local. This morning, I woke up, put on my walking boot, and about passed out from the pain as I was trying to limp into the bathroom. Not a fun way to start the day. I successfully made it to the couch with an ice pack and some narcotics. The day has gone much better ever since I’ve kept myself on a schedule with the pain pills… I’ve even made some progress on a quilt I’ve been working on. :)

T-minus 5 days until I go under the knife… as a patient. Eeeeeek!

I have a tailor bunion on my left foot that’s been painful ever since I ran the Ragnar Relay in February (a 200-mile team relay). At first, I tried resting my foot for a few weeks… then tried running again… still painful. So, I rested for two months – two whole months!!! Then, found it was still painful as I tried running… darnit! So I made an appointment with my podiatrist to get his take on the situation. I’ve already had surgery to correct the tailor bunion on my right foot, so I knew exactly what I was getting myself into.

Consultation appointments, a pre-op appointment, pre-op labs, Xrays & a MRI have all been completed and it’s finally time. I’m really not nervous about the surgery – the thought of anesthesia, needles, scalpels, or blood doesn’t frighten me in any way. But, what does scare me is the thought of something going wrong during the surgery and hurting my foot – I’m not old enough to have a bum foot for the rest of my life. The thought of being in a walking boot for the next 4-6 weeks gives me a bit of anxiety as well. That’s 4-6 weeks out of work as well as 4-6 weeks away from cardiovascular exercise (hoping I get the all clear to ride a stationary bike at the gym in a few weeks).

Wish me luck!