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2.6. SN = Student nurse

Dear Student Nurse,

Today is the first clinical day of the rest of your life.

You're probably nervous; you might be scared. In fact, you're probably petrified. But remember: you have been prepared. You have practiced your skills, gotten items in your little white book checked off, received 90-100% on your math, and most of all, know how to stay safe to protect you and your patient(s).

You will make mistakes. You will forget things. You may be sentenced to Mandatory Skills Lab of Shame. You will linger in skills lab anyways, with or without sentencing, because you need to practice that urinary catheter insertion for the 50th time on the dismayed mannequin, or practice drawing up with a blunt needle every last drop of fake medicine in a leaky 1ml vial without getting bubbles, no flicking allowed. You may cry at some point (public meltdown in the computer lab; driving down G St.; secretly, at night)--this is normal. Common, even. Don't let things get to you; just do better ne…
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2.5. OT = Oxytocin

I. Oxytocin, sometimes called the love hormone, or the bonding hormone, is important right from the beginning of one's life. Released in large amounts during labor, it is responsible for uterine contraction, milk ejection, maternal behavior, and bonding. It is also related to arousal, orgasm, generosity, trust, healing, and other generally good things.   Above and below are crystallized, stained images of oxytocin, courtesy of a polarized light microscope. Everything, including intelligence, looks prettier crystallized, refracting all the colors of the rainbow.

II. Serotonin, a monoamine neurotransmitter, regulates mood, appetite, and sleep (also, gastrointestinal motility/activity, but nobody cares about that.) It also affects memory and learning. Many antidepressants act through increasing the availability of serotonin (in all its diverse, layered beauty, seen below,) at the synapses of the central nervous system.
III. Estradiol is an estrogen steroid hormone involved in the deve…

2.4. Evisceration = exiting of viscera

Sometimes a feeling of evisceration, of being gutted, emptied out from the inside, is not a metaphor.

The below scene is summarized from p. 269 of Ignatavicius & Workman's Medical-Surgical Nursing, 8th ed.

Readers who get queasy easily are advised to stop here. Here's a cute package of sterile gauze to look at instead : )
Those of you still here, it's still highly advised that you never Google Image the word, "evisceration."

After abdominal surgery, it is important to splint the incision site with a pillow to support the integrity of stitches/staples/sutures while coughing, sneezing, or laughing really hard, or things will cease being funny really fast.

It is possible for the insides to bust through sutures and spill outside, piling up on top of the abdomen, especially if the patient is already crashing and emergency chest compressions are taking place.

Should this occur, call for help (surgeon, rapid response team) immediately, but do not leave the patient a…

2.3 IV = Intravenous (therapy)

Things learned during IV insertion skills lab: Hydrate well so veins are plump and popping and unlikely to collapse or constrict and shrivel in fright, practically disappear. Disappearing won't stop someone from sticking the vein, will only increase the likelihood of the catheter needle missing its mark, poking all the way through the vessel, digging around, backing out, making more holes all the way up the dorsal metacarpal or cephalic veins.

Veins can be slippery, roll-y little buggers. Go too slow with the needle and the target vein will literally roll to the side from light pressure, some kind of magical, evolutionarily-fit way to evade thorns, pricks, and accidental bleeding-out. Unfortunately, blood vessels have not yet evolved to tell the difference between life-saving IV antibiotics and malicious pricks.

Slapping the vein to make it pop really hurts (especially if the instructor does it), more so than the needle poking around later, or the bruise that will soon form.

A &q…

2.2. MI = Myocardial infarction (heart attack)

If a patient says she feels like she is going to die, take her seriously. She might code before finishing a sentence about her cat. Heart patients in particular get premonitions, a sixth sense related to poor oxygen perfusion to the heart, a nagging sense of doom, as they repeat, "I just don't feel right."

Many women don't experience the typical symptoms of a heart attack (chest pain/pressure radiating to arms, irregular heart beat, shortness of breath). Instead, they report indigestion, pain between shoulders, an aching jaw, even a choking sensation. Also: fatigue, sleep disturbance, and dyspnea (labored breathing). The elderly may present with disorientation or acute confusion due to decreased blood flow to the brain, with no complaints about the organ in actual distress--the heart.
Not to be confused with the act of leaping off a cliff, into the sea, just for fun, an elevated ST segment on the electrocardiogram is referred to as "tombstoning," because th…

2.1. Neonate = newborn, 0-28 days

Babies are cool. They breathe 2-3 times faster than we do; their hearts beat 1.6 times faster. The head circumference, measured around the eyebrow and ears, is larger than chest circumference--lots of space needed for that cute, mammalian brain.

Check front and back soft spots where cranial bones will meet at 18 months and 6-8 weeks. Eyes clear, ears aligned, nares patent, palate intact, upper airway clear. Movement and extremities symmetrical, abdomen soft and round, umbilical cord with two arteries and one vein clamped, all nether parts and orifices in standard locations.

Babies, like superheroes, come equipped with all sorts of cool reflexes.

Rooting: stroke baby's cheek, and she turns towards the touch, mouth open, wanting milk.
Sucking: insert a gloved finger (or nipple) in her mouth, and baby sucks.

Palmer grasp: the pull-baby-up-using-only-two-fingers trick: give baby a finger in each palm, and she will grasp. Pull her up gently.
Moro: lowering baby, allowing her head to dr…

Pokémon = Pocket Monster

To the person who stole my five-year-old's favorite Snorlax rock: yours better be a make-a-wish-foundation type of situation to justify your theft, because not only have you made a five-year-old girl cry inconsolably, you have quite possibly permanently destroyed her faith in humanity. She no longer believes it safe to display her beloved rocks in front of her home, because people are terrible and steal little girls' rocks. Also, have you any idea how much work it is to replace a Snorlax rock?

The Japanese believe that everything has within it kami, a spiritual essence, the energy generating the thing. Kami is present in all things under the sun: trees, rocks, animals, and places.

The first step to creating a Snorlax rock is to find a rock that's big enough, and which passes the stand test (will it keel over on its own, or on a windy day?) Really look at the rock; feel its essence. Turn its weight over in your hands. Note its imperfections and decide if they are unacceptab…