Author: C. Aseysalinas

This is a picture my brother took on the night of December 4th, 2017. It’s a picture of us and all of our neighbors evacuating from our homes in the path of the Thomas Fire in the pitch blackness.

In the dark we gathered up everything valuable to us. Our cats, dogs, birth certificates. And then we waited in the road for the traffic to start moving.

We watched in the side view mirror as the fire climbed over the back of the ridge and down into our neighborhood. It took over an hour to drive half a mile.

But we were ready. We had flashlights and headlamps to see in spite of the power outage. We had cat carriers and dog leashes ready to go. We had gallons of water to drink in spite of the boil-water advisory.

I guess where I am going with this is that we have always had a disaster plan, and it saved us. And I think its a lesson that I can take with me into critical care nursing. Yes its stressful, but I plan on being prepared.

And for the record my family and I are all fine. We were allowed back into our house 2 weeks later.

This semester has been a heavy one for me. Every one of my courses has at least one writing assignment due every week. At first I though, great! This will make me a better writer! Nope, not even close. It has made me a cloistered, joyless hermit.

So after having three papers due in three consecutive days, I stepped away from the computer on Friday and didn’t open it again until Sunday. I simply couldn’t bear to be in front of the cursed machine. This was a good move. Instead of being a zombified nursing student with a thousand yard stare, I was a person. I had a name, thoughts, feelings, the works. It felt great to be back and with improved mental health.

But it was kind of a mistake for my academic health. I forgot that I had two other assignments due that week. I worked on them both today even though they are late (this is one of them :/). Oh well. Some things fall through the cracks, but this ship will sail on. I can’t wait until I can disconnect again sometime in December. Until then

 

Osteoporosis is a degenerative disease marked by the deterioration, weakening, and loss of bone. It is important to assess dietary and exercise habits, health history, lab values, and diagnostic tests.

In regards to dietary needs, the recommended daily intake of 1,000 mg of calcium maintains adult bone mass, and 800 IU of vitamin D maintains bone health in people over 50 years old. Physical activity stimulates bone formation, so sedentary lifestyles are a red flag.

Lab values are important, because elevated parathyroid hormone, thyroid hormone, and cortisol all cause bone resorption. Growth hormone stimulates bone growth and estrogen and  testosterone stimulate bone formation. Diagnostically speaking, X-RAY tests are the main way to determine bone density.

And finally, a thorough health history that asks about any past bone fractures, loss of height, and posture changes are important in assessing bone health.

No limitations to mobility. In fact, weight bearing activity is encouraged to promote bone mineralization

D/C teaching would include dietary recommendations to increase calcium and vitamin D intake through dairy, egg yolks, and fortified foods, and increasing weight bearing exercise as tolerated.

References

Hinkle, J.L. & Cheever, K. H. (2014). Brunner & Suddarth’s Textbook of     Medical-Surgical Nursing (13th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

by Jane Shon, JB Dones, Kenny Dadacay, Edwin Rios, and Casey Salinas

What (Pathophysiology): Self digestion of the pancreas from proteolytic enzymes such as trypsin and inflammatory proteins.

Who (Population): Affects all people but more often people with cholelithiasis, alcohol abuse, and cystic fibrosis. Mortality increases with advanced age. 

Where (Systems Affected): The pancreas is destroyed, including the islet cells that make insulin, leading to diabetes mellitus.

When (Presentation): Signs and symptoms include elevated amylase and lipase laboratory findings, knife-like epigastric pain that radiates to the back, pain in the right upper quadrant, pain that is more severe after meals, abdominal distension, nausea, vomiting, fever, respiratory distress, hypoxia, and confusion.

Why (Risk Factors): Alcohol increases the secretion of insoluble pancreatic proteins which lead to obstruction of the pancreatic ducts. Genetic mutations in the genes that regulate pancreatic enzyme secretion, also contribute to the disease.

 

References

Hinkle, J.L. & Cheever, K. H. (2013). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

Sodium phosphate is a drug that is typically used as a laxative or bowel prep. That sounds pretty innocuous, but The National Kidney Foundation begs to differ.

Oral sodium phosphate can cause acute renal injury because phosphate crystals can accumulate in the kidney and cause a loss of function. In 2009 the FDA recommended that manufacturers add a black box warning to drug packaging. Sodium phosphate is available over the counter and a stronger version is available by prescription.

 

“Oral Sodium Phosphate Safety Alerts.” National Kidney Foundation. https://www.kidney.org/atoz/content/oralsodium

 

There are six electrolytes: sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphorus.

The easiest to understand is sodium. Water follows sodium. Boom. Done.

The one that always escapes me is phosphorus. It’s not talked about as much so I never remember what role this electrolyte plays. So I looked it up, and it’s complicated.

According to the Skyscape app, normal serum level is 1.7-2.6 mEq/L (2.5-4.5 mg/dL). It is integral to the health of teeth and bones, is important for nerve and muscle activity, part of the metabolism of carbs, proteins, and fats, and aids in acid-base balance. It is regulated by parathyroid hormone. Hypophosphatemia is mainly caused by diet and GI issues, or drug, hormone, or cellular changes. It can lead to dysrhytmias, heart failure, shock, seizure, and coma. Hyperphosphatemia is rare but can occur with renal insufficiency.

I liked thinking about this comparison between my favorite and least favorite electrolytes. It kept me from skipping over something I didn’t really understand, and made me curious enough to go over the information for my own satisfaction.