Introduction To ECG

 ECG has been for me a mystery and then I thought "Ok I need to decypher ECG language for the love of God" I've been watching videos, reading books, writing notes, and drawing. So I thought that another good way to memorize and share as educational purposes is writing a post about ECG. 

The ECG shows the electrical activity of the heart in the form of waves on a tiny orange squared striped paper. The orange stripes are divided into blocks of five tiny squares. On the horizontal represents time the measure of each tiny square as 0.04 seconds, thus a block of five is 0.20 seconds. So far so good, right? 

The vertical strips measure the amplitude in millimeter or mm or electrical voltage in millivolts or mv each tiny square is 0.1 mv, thus a block of 5 is 0.5 mv. 

The letters that make the ECG are P,Q,R,S,T,and U.

Before getting to know better each letter, important tips about placing the leads of each ECG pad is necessary for a good reading of the electrical waves. ECG devices come in 3, 4, 5, or 12 leads. Now let's talk about the 5 lead, mostly used and called telemetry you need to make sure you place each pad on the intercostal space between the bony ribs, never on bony areas or you won't be able to see the waves properly. If the skin is oily you can wipe it down or if it's too much hair shave the hair off .

White RA, right arm

Black LA, left arm

Brown C,chest

Green RL, right leg

Red LL, left leg 

Nmonic to help you remember the pads placement is:

 White (clouds or snow)  over Green ( tree or grass)

Black (smoke)  over Red (fire)

Brown (chocolate) close to the heart

P wave means to FIRE from SA (Sinus Atrial) node the impulse that generates a P wave with amplitude 2 to 3 mm high and time duration of 0.06 to 0.12 seconds.

PR interval is the tragetory of the impulse from the atria SA node through the AV (Artial Ventricular) to the bundle of His, and finally right and left bundle branches with duration is 0.12 to 0.20 seconds.

The QRS complex means ventricular depolarization or in other words the ventricules contract and creates a pulse. QRS amplitude is 5 to 30 mm high and duration 0.06 to 0.10 seconds.

The ST segment represents the end of ventricular depolarization ( contraction) and the beginning of ventricular recovery or in other words repolarization. This very place is also known as J point. Normal amplitude is 0.5 to 1.0 mm. If  ST segment is depressed, inverted 0.5 or more below the baseline may be myocardial ischemia or digoxin toxicity. If ST segment is elevated more than 1.0mm above the baseline might be myocardial injury.

T wave means ventricular recovery. Amplitude is 0.5 mm to 10 mm. If  the T wave is bumpy a P wave might be hidden in it. A tall T wave might be hyperkalemia, myocardial injure. Inverted T wave might be myocardial ischemia.

QT interval Prolonged QT might be a dangerous arrhythmia called Torsades de points. Short QT interval might be digoxin toxicity or hypercalcemia.

U wave if present represents the recovery of the Purkinje fibers.

The colors on this classic ECG is just a way to memorize, Fire as stimulation or depolarization, green as recovery or repolarization a plant in a vase to remember it's resting quietly. The purple looks like a tight dress to remember the ventricular contraction. The brown means just brown I couldn't think of something. Next post I'll try to improve the drawings as I'm planning on drawing the Arthytmias and their interpretation.

The wonderful sources of material for this post using the paraphrasing technique is a book called"ECG Interpretation Made Incredible Easy" Third edition Lippincott Williams & Wilkins. The pictures are from Dynamic Health and/or Healthstream, the use is for educational purposes only.

Workplace violence and bulling in nursing

Workplace violence and bullying is sometimes not clear to identify and at the same time this type of harassment happens frequently. Usually the victim happens to be new hires and the perpetrator is someone who has been doing this harm occasionally and has never been caught and reported. What is even possible is that the perpetrator does not realize it is harsh comments, gossip, a piece of information made up and not true, and this behavior is called UNCONSIOUS BIAS.

Unconsious bias is PREJUDICE which means a preconceived opinion that is not based on reason or actual experience (definition from Oxford languaged).

Workplace violence is not tolerated in big retail stores the same thing inside hospitals or healthcare facilities. All new hires and  all employees must go through mandatory training courses and must report this type of violent behavior to the open doors, and the theme for that is called "If you see something say something.

What are some of the situations that are considered violent?

"Intimidating or undermining employee by demeaning their work standards, not giving them credit, setting them up for failure and constantly reminding them of old mistakes" 

"Threatening employee personal self-steem and work status. Isolating employees from opportunities, information, and interaction with others" . Source: Google Search "What are the bully tactics at work?'

"Examples of bullying in the workplace:

Constantly criticising someone's work

Spreading malicious rumors about someone

Constantly putting someone down in meetings

Excluding someone from team-workload then everyone else  

Deliberately giving a heavier workload than everyone else

Excluding someone from team social events" Source: Google search

Gossip is related tp parrots, if has been dreams with those birds it is a sign someone might be gossiping about you. Look up spiritual meaning of dream with parrots. 

The best is to address with the perpetrator if he or she keeps saying these malicious comments he or she will be reported. 

Finally, I'm going to end this post by quoting some wise quotes by Florence Shinn:

"There is a supply for every demand".

"There is a place that you are to fill and no one else can fill, something you are to do which no one else can do". 

"The first start toward success is to be glad you are yourself"

"Every person is a golden link in the chain of my good"

"Gratitude is the law of increase and complaint is the law of decrease"

"What is really yours? The blessings you bring to yourself through your spoken or silent words, the things you see with your inner eye".

Forgive it, realiase it, and  move on, if that looks like a not very  welcoming enviornment, let it go. Something greater and much better is been prepared. 

What is malignant hyperthermia?

 Malignant hyperthermia is an emergency that needs to be recognized during the assessment and notifying the doctor and/or immediately stop surgery also stop the anesthesics agents and start treatment with Dantrolene 2.5mg/kg  

What are the signs and symptoms? The earlier symptom is a sudden increase of the CO2,  jaw rigidity, rise in skin temperature and rise in the core body temperature, acidosis (when arterial blood pH is lower than 7.35 nEq/L), increase in heart rate, cyanotic skin, mottled skin, intense diaphoresis.

How does Malignant Hyperthermia happen? It is an inherited muscle disturbance that unfolds a hypermetabolic cascade when the patient is exposed to triggering substances in certain inhalation anesthesic and depolarizing muscle sbstances or breaking down muscles, (aka rhabdomyolysis).so the combination of muscle rigidity, acidosis, and hyperthermia causes cell death. Muscle rigidity is caused by the calcium that escapes from the skeletal muscle cells, ATPase starts off metabolic activities, use up all available  O2. From these activities can occur internal bleeding, cardiac arrest, failure of vital organs such as the kidneys. Pre-operative assessment is important questioning the history of sudden death during surgery of a relative, is important to know the history of high temperature and dark urine(coca-cola color) after anesthesia procedures, including dental anesthesia. (this does not rule out a present crisis of malignant hyperthermia. There are tests available called caffeine halothane it's a contracture test, the classic signs and symptoms followed by exposure to the triggering anesthesic agents are the important clues.  While using Dandtolene avoid calcium channel blockers. Max titration dosage of Dantrolene is 10mg/kg.  Sodium bicarbonate is also used to treat acidosis. Another important plan of care is to monitor urine output, both color and volume.

#malignanthyperthermia #rhabdomyolysis  #anesthesiology #criticalcare  #Hyperkalemia

Sources: Wikipedia and HealthStream

What does it look like shadowing the nurse?

 Often times when applying for a job as a nurse it usually starts with shadowing the nurse during her/his day.

Shadowing means following the nurse being her shadow for 2 to 4 hours, or even for 12 hours just watching everything with no interference, no hands-on, just observe, unless he/she asks for help, please help, it feels amazing. All paperwork, kardexes, or notes you wrote down regarding the Pacient of his or her care must be thrown away at the end of the day in a proper place that's designed to shred into tiny pieces - the papers with sensitive information,  information like name, date of birth, lab results, and diagnostics. All information that is confidential, regarding HIPAA rules.

What is HIPAA? HIPPA means Health Insurance Portability and Accountability Act it is a law enacted in 1996 that protects the client's privacy, it's a law regarding healthcare, health plans, healthcare insurance, electronic signatures, electronic transactions, the client's health information, so HIPAA ensures the privacy of individual information.

Do you get paid for shadowing the nurse?  Sometimes yes, sometimes no. It is all very worth it, it's a lot of new information you will have the chance to learn, so it is always a very positive experience!

To get ready for the shadowing day, wake up a little earlier have breakfast first, and take your phone and a small thin wallet with you in your pocket, I recommend that because you're always ready to go anywhere including going on luch and buying your lunch at the cafeteria, the locker rooms are usually locked and it needs someone to open it for you to access your bags, having your items with you saves you time if you have only your essential belongings with you.

Good luck on your first day shadowing the nurse.

First Things First On Your Journey to Become a Nurse in The United States of America

 hi, freshly graduated nurses and international nurses!!!

Congratulations on your achievements passing nursing school!!!😻

Before anything else it is very important to check with the Board of Nursing of your State,  their Rules and Regulations, and their Nurse Practice Act. On this Blog I mention The Texas Board of Nursing which is pretty complete and the main idea works basically the same nationwide, except some candidate requirements can vary from one state to the other. 

To begin read the NURSE PRACTICE ACT (NPA) Sec. 301.251 License Required, this is very important and unless you hold a license you cannot wear a badge or clothes embroidery "RN", "LVN", "VN" or you also cannot practice or offer practice in nursing. 

Next, consider focusing on the following NPA Sec 301002(2)&(5) and Board Rules 217.11, 217.12,,224&225. For international graduates 217.4.

Bibliography suggestions:

Saunders Comprehensive Review for the NCLEX-RN examination by Linda Anne Silvestrin &Angela E. Silvrstre, Evolve edition.

Clinical Nursing Skills Basic to Advanced Skills by SMITH, DUEL, MARTIN, Pearson edition.

Medical Surgical Nursing by LeMone, Burke, Bauldoff, Gubrud. VOLUME 1&2 Pearson edition.

Prioritization, Delegation, and Assignment, Practice Exercises for the NCLEX Examination by LaCharity, Kumagai, Bartz. Elsevier 

Kaplan NCLEX PREParation is an excellent online course, usually 6 months duration that is interactive and you prepare for the test with videos, flashcards, you can also download the book, and the classes are recorded and online classes you participate live. 

For the Elsevier books if you buy them new you have a scratch code that allows you more resources. Thriftsbook has good prices on used books if you're on a budget.

Good study, good luck, and God bless you always.

Update on this new blogger name

 Hi there,

I just changed this blog name from Saude Brasil e Enfermagem to Nurse Health Writer

I'm testing with this new post to see if the blog address will keep the previous blog address name or if it will change as well, so I'm posting this post with the new name and I'll check that later.

The reason why I changed the name and language is because English is my first language now and most of the books I read are in English. I also live in the United States of America, so I thought about sharing my current status experiences.

I wasn't sure about the name, considering that most of my posts are health-related and I also graduated from Nursing School in Brazil and I'm currently reviewing nursing content such as MedSurg contents, including ECG interpretation, Laboratory ABG interpretation, and other topics I plan on writing more about these type of topics and add some experiences I have.   

I hope you enjoy reading the Blog and I'm preparing some very good topics for the next posts.  

I'll catch you later, bye

Brazilian or International graduated nurse to apply for the United States Nursing Process.

 Graduated nurses outside the United States can apply for a license in the USA

One important thing to remember is if a nurse has worked several years in his/her country with a license in Brazil (the board of Nursing there is called COREN) or in another country, in the USA one must apply for a license first and until there a nurse is not allowed yet to be called a Registered Nurse or practice nursing in this country, he or she must go through the process. I'll explain below. Practicing nursing without a license is considered a crime, this is a law for all graduated nurses, graduated in the USA or outside the USA. Read the rules and regulations from the Texas Board of Nursing it's available for download.

First contact CGFNS and create an account. Follow the steps, then pay the fee for professional CES.

Just fill in the secondary education, or high school education, then fill in the nursing school, usually it is a bachelor's of 4 years-long nursing education. Please do not add any extra education (Specialization, Master's degree, a Doctorate degree education). Those extras are not necessary for initial licensure. Besides if you enter it will take longer to erase as you might need to call customer service to erase it for you, calling from outside the USA can be a little expensive. To send e-mails and including diplomas or paperwork use the FIREFOX browser. CGFNS will send you your order to be completed by your nursing school, another for your secondary education, and another for your board or license department. You must sign them before mail or e-mail them. Contact your Nursing School and your professional translator to prepare the paperwork,  these must be sent directly to CGFNS. Contact your board of nursing from your Country, In Brazil COREN, again your professional translator with the board will prepare the paperwork and send it directly to CGFNS.

Decide which board of Nursing in the USA you will apply. There are 50 in total. All of them accept the Professional CES from CGFNS. Most states require English Proficiency. TOEFL must be presential not home edition, minimum of 83 points, with a minimum of 26 in the speaking part. IELTS Minimal of 6.5 overall and 7 on the speaking part. Board of Nursing decided, pay the fee for licensure by examination.

Once the Board Of Nursing of Your choice is decided your CES from CGFNS will be sent electronically to the board. 

Decide what English Proficiency you like best and apply for the academic exam. Prepare for the test. Both tests have the reading and comprehension, Listening, and finally Writing (which has two essays first assay has a minimun of 150 words and another essay with a minimun of 300 words.

When all the paperwork is appoved and when you have passed the Engligh exams your Professional CES will be expedited. Now when you recieve your ATT authorization to test you can book your NCLEX RN exam with Pearson Vue, it's a fee of about $200.00 You can choose the closest test center to your home, I know In Sao Paulo, SP, Brazil there's one.

To prepare for the NCLEX I highly reccommed preparing with KAPLAN NCLEX PREP you choose the best program and you will be very well prepared. 

Make sure you are practicing nursing in your country while wait for the process, some boards of Nursing require recent experience, less than 4 years before the test date, the process can take a few years if you fail the tests which is OK, just keep positive learn from the mistakes improve the weak  area and pass the next test.

I hope this helps in your process and I wish you the best of luck and before I go, here are some of the websites

htts://www.cgfns.org

htts://www.bon.texas.gov

htts://www.ets.org>toefl

ielts.org

ncsbn 

htts://home.pearsonvue.com