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Week 17. HS = Hour of Sleep

HS, hour of sleep, aka bedtime--a beautiful word to hardworking, sleep-deprived people all around the world. The primary function of sleep is unclear, though it clearly contributes to physiological and psychological restoration. Humans spend a full third of their lives in slumber.

Circadian rhythms regulated by sleep are cyclical, as are sleep cycles. Rapid-eye-movement periods bring the most vivid and curious dreams, including lucid ones. If one recognizes a discrepancy or missing logic in one's surroundings and realizes this is a dream, one becomes suddenly lucid, holding the potential to control an entire dream world, along with the people in it.

When sleep goes wrong, insomnias (difficulty sleeping), hypersomnias (e.g. narcolepsy), and parasomnias (e.g. sleepwalking) occur.

A sedative at a low dose becomes a hypnotic at high dose. Sometimes a paradoxical response occurs; instead of feeling sedated, one develops insomnia, euphoria, anxiety, or rage.

Benzos: Diazepam, Lorazepam,…
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Week 16. LPAT = Leveled Physical Assessment Tool

Approach a patient during the head-to-toe physical assessment with no preconceptions, no assumptions, no judgement. Also, with kindness, patience, and respect.
Please allow me to take your temperature, pulse, respiration, blood pressure, and O2 saturation. What is your pain level on a scale of 0-10? How did you sleep last night?

What is your full name? Do you know where you are and what brought you here? What time/day is it?
If you don't mind, I will check your head for lumps and bumps and run gloved fingers through your hair. I see your eyebrows, nice lashes, the whites of your eyes a bit bloodshot. My, what big eyes you have. Do you wear contacts or need glasses? Can you hear this? How about this? Sniff for me through one nostril, then the other. Thank you. Please open up wide so I can see your tongue, mucous membranes, and teeth/dentures. Swallow for me. Say something. Okay, no aphasia, but I'm going to pretend you didn't just say that.
You're breathing a little har…

Week 15. TOD = Time of Death

Dear Mom,  Some nights I still dream of you and in the dream you’re alive (and I’ve forgotten you’re not); we’re arguing about something mundane and I’m angry at you. I wake up and want to return to the dream, because I’d rather argue with you alive than think fondly of you six feet under. I’m thankful for the time we had together, how you’ve helped me grow through a bit of a journey, and as a former psychology major I’m sure you’ll appreciate that Murdock’s The Heroine’s Journey presents a convenient psychosocial model. 1. Shift from Feminine to Masculine: Family have told me when I was little I was glued to your skirt, something hard to imagine because as far back as I remember we never touched or were affectionate. (None of us were affectionate, but it was no secret Dad was my favorite.) 2. The Road of Trials: I’m sorry for rebelling, for not becoming the concert violinist you’d wanted for a daughter. I wish you had believed me and protected me when I told you I was threatened and a…

Week 14. Rx = prescription

Rx, Latin: recipe, to take, prescription.

Below are three archetypal pharmacology test questions for your reading pleasure (yeah!), so that you might also experience the exquisite pain that is the biweekly proctored pharm exam.

Type I. The Lab-Values-From-Hell Question.
A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105° F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer:
a. iodine-131 (131I).
b. propylthiouracil (PTU).
c. intravenous levothyroxine.
d. methimazole (Tapazole).
Answer: These are actually all great things that might help this patient experiencing a thyroid storm, but this being the ER, pick the drug that will act the fastest, which is PTU.

Type II. The "Which Patient Will Die First?" Question. The nurse working on a high acuity medical-surgical unit is…

Week 13. DM = Diabetes Mellitus

Diabetes, Greek, to pass; mellitus, Latin, honeyed or sweet.

In 1552 B.C., Egyptian physician Hesy-Ra noticed that ants were attracted to the urine of those with a mysterious disease that also caused emaciation.

150 AD, Greek physician Arateus described the illness as, "the melting down of flesh and limbs into urine."

Today we know diabetes as a disorder of carbohydrate metabolism--the body cannot utilize and store sugars effectively. Characteristic symptoms include the three polys: polyuria, polydipsia, and polyphagia (lots of pissing, drinking, eating). Long term, poor management of the illness can lead to cardiovascular disease, blindness, kidney disease, and amputations.

Diabetes (type II) is also a disease of civilization; modern technology led to surplus calories compacted into innocuous servings, less physical activity, and obesity rates resulting from both increased energy intake and lack of energy expenditure.

A diabetic can be spotted from a singular, extended hand…

Week 12. pH= power of hydrogen

The K├╝bler-Ross stages of grief provide a perfect model to comprehend blood pH (among other things). Denial, neutral, pH 7.35-7.45: One feels neither acidic or alkaline, somewhat ambivalent, almost okay. Also, maybe this was all just a misunderstanding, a nightmare, a midautumn night's dream. Just wake up, and all that transpired will poof, and one can carry on like before.

Anger, acidosis, pH 6.90-7.35: One's so metabolically upset one's lungs are hyperventilating, or so busy yelling & arguing one forgets to breathe and kidneys are dropping sodium bicarb like crazy. Blame, frustration, accusation. Do not keep sliding left down that slippery slope, because acidosis means denaturalization of one's proteins--past the tipping point one plummets all the way to uncertain death.

Bargaining, neutral, pH 7.35-7.45: One tries to make a deal, make the most of things, strike a bargain with supernatural entities, dead ancestors, former partners, the universe. I'll do anythin…

Week 11. CN = charge nurse

Here's a day in the life of a charge nurse, framed within the structure of the monomyth, or the hero’s journey (saving Murdock's The Heroine's Journey for another time).


The Ordinary World: The charge nurse, an intelligent, independent and capable professional, enjoys a quiet night’s sleep in her warm bed on a late October night, the windows cracked just so, allowing the chill of winter to creep in and crisp the air in her bedroom.

The Call to Adventure: After working the day before, she had accidentally left her pager on, and as a consequence she is abruptly woken up by it before the skies were beginning to brighten, with a request for her to come in to the hospital and help manage the floor from 7am to 7pm.

(Near) Refusal of the Call: The nurse hesitates. Having worked yesterday, she knows there are several transfers, shortage in coverage due to multiple admissions and an RN calling in sick, two one-on-one safety sitters required, therefore fewer CNAs on the floor...not a f…