Up My Nursing Game

Imagine being a nurse faced with a patient who has taken a fistful of someone else's medications, leading to a life-threatening allergic reaction. This was the reality Dave Dovell, a registered nurse and author, confronted in a fascinating case study he shares during this podcast episode. He takes listeners on a deep dive into the clinical presentation and management of anaphylaxis and offers insights into providing compassionate care. This powerful case study underscores the multifaceted challenges nurses face and the importance of prioritizing patient-centered care even in the most demanding situations. Mentioned in this episode: The New RN: A blog and more for new nurses and student nurses Brand New Nurse, by Dave Dovell Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

The emergency severity index, or ESI, is meant to swiftly triage patients based on urgency and resource needs. In this episode emergency nurse, Kevin MacFarlane, shares his techniques for determining ESI scores, from identifying true level one resuscitation cases to non-urgent level five medication refills. You'll gain a comprehensive understanding of how ESI goes beyond just categorizing medical emergencies to account for quality of life impacts. Kevin also offers a glimpse into the future role of AI in revolutionizing triage protocols - a must-listen for any nurse committed to providing the right care at the right time. Mentioned in this episode: The Art of Emergency Nursing Podcast How Not to Kill Your Patient Podcast Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

Sedation and delirium can derail even the strongest patient's recovery in the ICU - but spontaneous awakening trials (SATs) can empower nurses to get ahead of this vicious cycle. In this candid episode, I pick the brain of Kali Dayton, an ICU nurse practitioner fervent about early mobility. Kali pulls back the curtain on SATs, a tragically misunderstood intervention that involves stopping sedatives each day to reconnect with the patient. With a mix of hard data and bedside wisdom, Kali reveals SATs as a game-changer for bettering outcomes like delirium, ventilator days, and the chance of discharge to home. You'll hear practical tips on everything from managing agitated awakenings to recruiting family as awakening coaches. Whether you're routinely pawing through SAT policies or clueless about this critical care practice, this lively dialogue will upend assumptions about sedation and empower you to maximize your impact. Mentioned in this episode: RASS survey Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

Proper sedation management is critical for improving outcomes, yet studies show a widespread problem of inaccurate Richmond Agitation-Sedation Score (RASS) assessments by nurses. In this revealing episode, Kali Dayton DNP, shares her technique to accurately and objectively measure the RASS and why this matter for our patient's outcomes. Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

Ever wonder what goes on behind the operating room doors? In this episode, we pull back the curtain on the fascinating world of anesthesia and surgery. Certified Registered Nurse Anesthetists Tanner and Cole from the Core Anesthesia podcast provide an insider's look at the perioperative process, from pre-op preparation to the orchestrated induction of anesthesia to navigating complications post-op. With vivid detail and expert insights, they break down the physiology behind general anesthesia, reveal secrets of the OR, and equip nurses with knowledge to better support surgical patients. Whether you’re an ICU, ER, or floor nurse, you’ll gain invaluable perspective on the surgical experience.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com. Time Stamps [06:16] - Pre-operative process, pre-anesthesia clinic visits, elective versus emergent preparation [18:02] - Overview of the induction process to put a patient under general anesthesia. [27:24] - Anesthesia: gases versus IV [42:47] - Postoperative nausea and vomiting (PONV)[44:08] - Postoperative urinary retention (PO-UR)

We all know that staying in bed increases the risk of pressure injuries and DVTs. But the adverse effects of immobilization go far beyond those basics. In this eye-opening episode, Margaret Arnold, PT pulls back the curtain on the rapid and surprising physiological changes that occur when your patients are inactive. You’ll learn about the hidden dangers of immobility most nurses overlook, spanning metabolic, musculoskeletal, cardiopulmonary, and neurological systems. We’ll also equip you with practical tips to incorporate safe mobilization into your busy shift. This discussion will drastically change the way you view the vital importance of patient mobility.Check out Margaret's Early Mobility Conference this April 2024. I will be there!Learn more about the physiology of immobility with Margaret's webpage The Difference a Day Can Make: The Effects of Immobility.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

In this episode, Tim Madeira, cardiothoracic DNP,  provides an overview of the primary heart valve diseases. He expertly guides us through the complex physiological processes underlying conditions like stenosis and valve regurgitation arising from congenital abnormalities, calcifications, infective endocarditis, and trauma. In addition, Tim outlines the latest evidence-based standards in surgical, percutaneous and medical interventions that nurses find themselves managing in the hospital.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

Listen in as I chat with Philip Gonzalez, a critical care occupational therapist. He will help us de-mystify the philosophy of occupational therapy, discuss how nurses cane help their patients make the most of their therapy sessions, and introduce us to verticalization therapy.Discussed in episodeVerticalization therapy is a therapeutic approach using equipment, manual assistance, or other various technologies to gradually tilt a patient from supine to 90 degrees in a slow and controlled manner, traditionally accomplished without any hip flexion using tilt tables. Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services See the show notes at upmynursinggame.com.

Understanding Diltiazem is an important part of your cardiac skillset. It's indications range from blood pressure management, long term stable angina, to it's mainstay in the hospital setting: acute rate control of arrhythmias with rapid ventricular rates. This episode will cover Diltiazem's mechanism of action, its multiple indications for both acute and routine use, as well as important nursing considerations.Mentioned in the episode: ICU Advantage: Diltiazem (Cardizem) - CC Meds Strong Medicine by Dr. Eric Strong: Antiarrhytmics (Lesson 7 - How to Choose the Right Med and Classic Pitfalls) Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

In this episode, I'll give you the inside scoop on amiodarone so you can truly grasp why it is *the* most prescribed antiarrhythmic medication. We'll unpack its unique mechanism of action that makes it so effective, share a real-world case that shows amiodarone in action, as well as have a candid talk about its adverse effects. Join me to find out why after 40 years, this versatile antiarrhythmic still has a prime place in the hospital. The story of amiodarone is a fascinating one - and as nurses, we owe it to our patients to know it!Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. The key moments in this episode are:00:03:22 - Ventricular Tachycardia 00:05:00 - How Amiodarone Works 00:09:06 - Indications and Dosages 00:11:47 - Adverse Effects 

Do you want to enhance your understanding and effectively use atropine in the treatment of bradycardia? Starting with atropine's mechanism of action, we will explore its proper use for symptomatic bradycardia, including it's important contraindications.  We'll also cover some of atropine's other fascinating roles beyond the heart. You'll walk away with greater confidence in both the appropriate applications and limitations of atropine for bradycardia.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. The key moments in this episode are:02:07 - Mechanism of Action04:44 - Indications and Contraindications 07:45 - Other Uses of Atropine 09:32 - Real Patient Scenarios

Part one of our cardiac medication mini-series spotlights Milrinone. We'll unpack milrinone's mechanism of action, indications, and potential pitfalls. This high-value overview distills need-to-know details about milrinone for seasoned critical care nurses and students alike.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. The key moments in this episode are:2:00 - Mechanism of action of Milrinone 4:36 - Common conditions and indications for Milrinone 6:10 - Adverse effects and promising findings 

When I found myself struggling to communicate a patient's HIV status during a rapid response, it was a wake-up call that I needed to expand my knowledge. This podcast episodes delves deeper into HIV/AIDS than nursing school did, covering common hospital presentations, labs, medications, and opportunistic infections. By enhancing my own understanding, I hope to equip others to improve care for patients living with HIV/AIDS.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. The key moments in this episode are:00:02:33 - Overview of HIV/AIDS00:05:00 - Treatment of HIV00:09:15 - Opportunistic Infections 00:13:57 - Patient Education 

We often draw blood gasses looking for an ACIDosis, but what about when you discover an ALKAlosis? In this episode, I share a story of a patient with a history of CHF, admitted for diuresis. She was initially improving but becames lethargic and difficult to arouse. We were surprised when her VBG showed alkalosis instead acidosis. Guest Sarah Lorenzini from the Rapid Response RN podcast, helped me make sense of our finding. Listen in to learn about this rare acid base imbalance that can occur as a result of a very common intervention. Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. The key moments in this episode are:00:02:32 - Patient background and presentation00:15:14 - Causes of metabolic alkalosis 00:20:18 - Treatment of diuretic induced metabolic alkalosis, 00:27:12 - Diagnostic reasoning, antibiotic stewardship 

In nursing, we're taught certain conventions in school. But what happens when those practices don't match up with real-life situations? Join me as we delve into the controversial topics of administering medication one-by-one through feeding tubes, the presence of air bubbles in IV lines, and the appropriate size of IV catheters for blood transfusions. Get ready for a shocking revelations that might just leave you questioning what you thought you knew about nursing.  Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com. Timestamps:2:31 - Giving Medications through Feeding Tubes, 6:31 - Air Bubbles in IV Lines, 9:54 - Choosing IV Catheter Size for Blood Transfusions13:56 - Recap

Dive into the world of trauma nursing from the FAST exam, to the operating room and subsequent inpatient care. Michelle Dedeo, trauma and neuro clinical nurse specialist, explains key trauma concepts such as the trauma assessment, the triad of death, and massive transfusion protocols.Guest: Michelle Dedeo Michelle Dedeo is a clinical nurse specialist in the Seattle, WA area. Her work as a clinical nurse, clinical leader, and nurse educator have focused in trauma and neuro critical care. Brush up on neuroscience with Michelle's SCRN Prep Podcast Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

Have you ever wondered what float pool nursing is like? These nurses fill staffing gaps throughout various units in the hospital, meaning no two days are the same. Listen in as I discuss what float pool nursing is, it's pros and cons, and who would make an ideal float pool nurse. Whether you’re an experienced nurse looking for a change of pace or a nursing student who is intrigued by the idea of having a lot of variety, this episode on float pool nursing is for you! This is a collaboration with Nurse Mo from the Straight A Nursing Podcast.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

As nurses, we are trained to be on high alert for sepsis, but don't be fooled! This episode covers sepsis imposters: the sneaky diagnoses that present similarly to sepsis but could prove deadly if misdiagnosed. Follow along as Dawn Carpenter, DNP shares real-life case studies that will help you identify the subtle clues that could make the right diagnosis... and potentially save a life.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Have you noticed that your patients are being prescribed SGLT-2 inhibitors, even if they don't have diabetes?  If your patient asked, would you be able to explain why they are taking an SGLT-2 inhibitor?Listen in to learn about how this new and fascinating class of medication that was designed for diabetes is now being prescribed for heart failure, too.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

When fluid resuscitating hypotensive patients, how do you know when to continue with IV fluids and when to initiate vasopressors? In this episode, critical care teaching legend Nicole Kupchik, RN MSN CNS, shares evidence-based practices for determining the best course of action. Explore the significance of noninvasive measurements in assessing fluid responsiveness and learn how incorrect decisions can lead to adverse patient outcomes. Nicole Kupchik's latest book, The Critical Care Survival Guide, is a concise bedside reference book with easy-to-access resources for anyone working in critical care regardless of experience level.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Studies that support the use of balanced crystalloids in fluid resuscitation versus normal saline: Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis Lactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

For nurses who are looking to transition out of the bedside, the options may be confusing. From academia, to advanced practice and management, it’s crucial to find the right path before embarking on a long journey. In this episode, Sarah Wells, MSN RN from New Thing Nurse, lays out the multitude of options, their pros and cons, and their licensure requirements.Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

In this episode,  Nurse Mo from the Straight A Nursing will delve into pancreatitis - its definition, causes, pathophysiology, and its impact on various systems of the body despite being categorized as a gastrointestinal condition. Additionally, we will discuss significant assessment findings, diagnostic procedures, and treatment options related to pancreatitis.Learn more about NTI, the American Association of Critical Care Nurses (AACN) premiere conference for progressive and critical care nurses on May 22-24, 2023: http://www.aacn.org/nti23Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

Tune your delirium radar and add some extra tools in your tool belt to get your delirious patient back on the rails.To help navigate us through the crazy train of delirium in the ED,  Kevin and Lisa from the How Not to Kill Your Patient podcast have joined me to discuss delirium assessment, risk factors, prevention, and treatment. It is part of a week-long Nurses' Podcrawl in which nurse podcasters including: Walking Home from the ICU Cup of Nurses Good Nurse Bad Nurse FreshRN The Rapid Response RN Learn more about NTI, the American Association of Critical Care Nurses (AACN) premiere conference for progressive and critical care nurses on May 22-24, 2023: http://www.aacn.org/nti23Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

When I created a podcast episode with Kali Dayton, an ICU nurse practitioner and passionate advocate for preventing delirium, I never expected it to have such a profound impact on my nursing practice. To raise awareness about this issue, a group of nurse podcasters will participate in a PodCrawl starting on Monday, April 17th. I've decided to re-release the episode with Kali in preparation for this event, as her insights on promoting early mobility in ICUs are invaluable. Whether you've listened to it before or not, be sure to tune in for a mind-blowing perspective on delirium prevention.

On this episode, I will share with you the secret sauce of a prolific nursing career. It touches education, evidence-based practice, staying up to date, networking, and "recharging your batteries". This episode is about nursing conferences,  like the American Association of Critical Care Nurses' premier conference, NTI, should be a pillar of every nurse's career.By the end of this episode, you will know how to make the most of nursing conferences in general, and specifically for NTI. You will also get a sneak peek into some of the fascinating sessions on tap for NTI 2023.Learn more about NTI 2023Guests: Sarah Wells, RN MSN CNL can be reached at [email protected] DiCenzo-CrotalloConnect with the AACN!IG: @exceptionalnursesFB: @aacnfaceTwitter: @AACNme

In this second of a two part series, Dr. Mohammed Soliman, MD, PhD, MBA speaks with us about the landscape of psychiatric medications, a discussion is geared towards hospitals nurses who work in non-psychiatric units such as medical-surgical floors, ICUs, or emergency departments. This episode will cover antipsychotic and mood stabilizing medications as well as when to request a psychiatric consult.Learn more about NTI, the American Association of Critical Care Nurses (AACN) premiere conference for progressive and critical care nurses on May 22-24, 2023: http://www.aacn.org/nti23Listen to Dr. Soliman's podcast, Thrive! Learning from the Best.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

In this first of a two part series, Dr. Mohammed Soliman, MD, PhD, MBA speaks with us about the landscape of psychiatric medications, a discussion is geared towards hospitals nurses who work in non-psychiatric units such as medical-surgical floors, ICUs, or emergency departments.Listen to Dr. Soliman's podcast, Thrive! Learning from the Best.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

Have you ever wondered what happens to your patients who you discharge home on hospice? What medications do they receive to promote comfort? What does the dying process actually look like?Listen in as Nurse Allie @nurseallie anwers all the questions we have about hospice care.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

Have you always wanted to go on an ambulance ride?  Here is the chance to get a sneak peak at what happens to our patients who are brought in by ambulance. Listen in as Mike Linares from Simple Nursing thoughtfully (and humorously!) recounts stories from his time as an EMT.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.See the show notes at upmynursinggame.com.

Dr. Eric Strong, internal medicine physician, faculty professor and YouTuber Strong Medicine, reviews the three categories of cardiomyopathy including their etiology, physiology, treatment, and what nurses need to look out for in patients with the disease. Dr. Strong will also explain why the term “cardiomyopathy” is surprisingly misleading and misunderstood by nurses and clinicians alike.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Listen in as I share a case of vasovagal syncope with rapid response guru, Sarah Lorenzini from the Rapid Response RN Podcast, in which my patient had a syncopal episode while on telemetry. We discuss what the telemetry strip looked like, why atropine might not have been the best intervention for this patient and some of the treatment options for bradycardia.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

In this episode, I will share with you what I have considered to be my biggest ah-ha moments from the last 2.5 years of hosting this podcast — those that have influenced my practice on just about a daily basis.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Kidney transplant is, by far, the most common type of transplant procedure performed and therefore the most commonly seen in clinical practice. Dr. Silas Norman, MD, transplant nephrologist, discusses pertinent topics for clinical nurses such as the pre-transplant work-up, post-transplant medications, and potential pitfalls when caring for transplant recipients.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Hostility, uncooperativeness and impulsivity: acute agitation can be one of the most stressful aspects of a nurses job. With forty years of nursing experience, Dee Henderson, RN, MSN, joins us to discuss how both pharmacologic and non-pharmacologic interventions can be used to de-escalate the crisis cycle.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Here is the definitive episode about ostomies for the bedside nurse. From comparing  and ileal conduit v. ileostomy v. colostomy to coaching your patient on what to expect in life with an ostomy, Sarah Baumgart MSN, APRN, CWOCN, answers many of the questions nurses have about their patients with ostomies.Up your nursing assessment with Eko Stethoscopes. Get noise cancelling, 40x amplification and murmur detection. Use the promo code GAME to get $50 off your order.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Time is brain. Rapid response nurse, Sarah Lorenzini, is frequently working against the clock to get patients with stroke symptoms to CT and ultimately receiving definitive care. We will discuss what nurses can do to help facilitate fast interventions including tPA, thrombectomy, ventriculostomies, stroke center designation and post-CVA complications.Up your nursing assessment with Eko Stethoscopes. Get noise cancelling, 40x amplification and murmur detection. Use the promo code GAME to get $50 off your order.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Ketamine seems to be the new "it" drug. Victoria Arsenault, PharmD,  returns to the podcast to discuss how Ketamine's dissociative properties can be used as an analgesic, anesthetic, and antidepressant.Up your nursing assessment with Eko Stethoscopes. Get noise cancelling, 40x amplification and murmur detection. Use the promo code GAME to get $50 off your order.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Emergency departments in rural areas work in austere conditions that often require critically ill patients to transfer to larger hospitals that can provide a higher level of care. Kent Herbert, emergency physician, discusses what resources are available at rural hospitals and the process for transferring patients to higher levels of care.Up your nursing assessment with Eko Stethoscopes. Get noise cancelling, 40x amplification and murmur detection. Use the promo code GAME to get $50 off your order.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

A patient's nutrition status is often an afterthought for nurses. Clinical nurse specialist, Janice Powers, PhD, RN explains how nutrition improves patient outcomes and reviews evidence based enteral feeding practices in hopes that nurses will play a more central role in facilitating adequate nutrition for our patients.Up your nursing assessment with Eko Stethoscopes. Get noise cancelling, 40x amplification and murmur detection. Use the promo code GAME to get $50 off your order.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Healthcare has a complex and convoluted relationship with marijuana. Marijuana is a "schedule 1" substance, meaning it has a high potential for abuse and no accepted medical use, yet a synthetic version of it is FDA approved as an appetite stimulant. Dr. Thomas, hospitalist, discusses the relevant historical and political context of the drug, as well as its pharmacology, cannabinoid hyperemesis syndrome, and some communication techniques for discussing drug use with patients.Join the podcast! Learn more about the podcast production internship and apply here.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Acute respiratory distress syndrome (ARDS) has a stubbornly high mortality rate with current estimates at about 40%. Critical care veteran Kathleen Vollman, MSN, RN, CCNS lays the foundation of ARDS starting with pathophysiology followed by the “8 Ps” of evidence-based supportive care and summary of long-term prognosis.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Check out Kathleen Vollman's consulting business Advancing Nursing.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Status epilepticus (SE) is a neurologic emergency much like an MI is a cardiac emergency and should be treated as such.⁠ From EEGs to medications, Mary Kay Bader MSN, RN talks us through both convulsive and non-convulsive SE.⁠Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (0.75).See the show notes at upmynursinggame.com.

Signs of clinical deterioration often start appearing hours before an adverse event or arrest. As nurses, we are in the unique position to be able to identify and act on early warning signs. Nurse Alice, from the Ask Nurse Alice podcast, talks about early signs and symptoms of clinical deterioration and how the Modified Early Warning Score (MEWS) can be implemented.Please take my listener survey to help me improve the podcast: https://forms.gle/YdufbTZZoRELxZSG8Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Nicole Kupchik's online course The ABCs of ABGs and Capnography is referenced in this episode.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (0.75).See the show notes at upmynursinggame.com.

Oxycontin, drug-seeking behavior, co-addiction. Who better to talk us through the current opioid crisis with two former law enforcement officers and emergency nurses turned nurse practitioners? Join us for this memorable discussion with Ben and Tom from Just Some Podcast for Advanced Practitioners.Please take my listener survey to help me improve the podcast: https://forms.gle/YdufbTZZoRELxZSG8Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

What is it *really* like in the ED and why do emergency nurses often feel like they are at odds with the rest of the hospital? Kevin McFarlane from The Art of Emergency Nursing paints a picture of the ED while addressing important topics like frequent flyers, hand-off reports, and admit holds.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

We all know BLS and even ACLS like the back of our hands so now it's time to understand *why*. Why are VF and VT under the arrest algorithms? Why epi? Why are survival rates so low, even in the hospital?Former paramedic and current BLS and ACLS instructor, Al Gook, answers some basic yet honest questions we all have about cardiac arrest and what we can do to improve our stubbornly low survival rates.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Managing blood pressure for dialysis patient can be complicated. Nephrologists Dr. Daniel Weiner and Dr. Bourne Auguste address intradialytic hypertension and hypotension while giving a huge shout out to the dark horse of nephrology: peritoneal dialysis. This episode is a part of NephMadness: a nephrology educational initiative that is modeled after the college basketball tournament but with nephrology concepts. It is a noncommercial learning initiative that leverages the tools of social media to teach about the latest and greatest breakthroughs in the field of nephrology.Participants in the PodCrawl:The Curbsiders : An Internal Medicine Podcast…for the Internist. This episode will focus on the Cardiorenal Syndrome. Listen on Apple or Spotify.The Drs. Washington: The Drs. Washington are three sister physicians  will discuss social and physical determinants of health as well as governmental and institutional initiatives that affect health inequities in nephrology. Listen on Apple or Spotify. The Cribsiders: On this pediatric podcast, go deep into Neonatal AKI. Listen on Apple or Spotify. Best Science (BS) Medicine: The Best Science Medicine podcast  discusses the tricky issue of albuminuria – who to monitor, what to monitor, and who to treat. Listen on Apple or Spotify. Freely Filtered: On this nephrology podcast, the filtrate discuss comparative animal physiology (specifically nephrology). This time around they are discussing giraffe and whale kidneys. Listen on Apple or Spotify. Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Tina Vinsant, RN, host of the podcast Good Nurse Bad Nurse, joins us for a run through of all the major vasoactive agents given in the hospital. We minimized the jargon and maximized on practical cases, so join us for a memorable discussion of this fundamental subject.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

You are in for a treat as Dr. Joel Topf, aka @kidney_boy, gives us the low down on hyponatremia. Dr. Topf discusses this condition in a way that is helpful for nurses by reviewing clinical concepts without getting into unneeded nitty gritty.Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Propofol and Ativan are a nurses best friend, right? WRONG. Kali Dayton, RN, DNP from the podcast Walking Home from the ICU challenges us to rethink delirium in a way that not only produce better patient outcomes but substantially decrease the nurses workload in the long run.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Jami Fregeau, RN walks through rapid responses that nurses can (for the most part) manage independently. Hold on to your seat as we discuss equipment malfunctions and how to be prepared for when it happens to your patient.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com

From post-operative to acute illness, managing pain in the hospital is both an art and a science. As the lead advanced practitioner on an Acute Pain Team, Jason Low, RN, NP discusses important clinical concepts such as the multi modal approach, acute on chronic pain, as well as some cultural considerations when discussing pain management with our patients.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com

What do you do when you notice that your patient has obstructive sleep apnea (OSA)? Hospitalist James Thomas MD PhD, discusses what OSA is, risk factors, its relationship with heart disease, and how to navigate management of OSA in the hospital setting.Click here to obtain one FREE hour of continuing education credit (1.00) from VCU Health.Buy tickets (virtual and in-person) for the upcoming Nurses PodCon in Nashville, TN on Nov. 20, 2021 here.

Listen in as I pick Victoria Arsenault's, PharmD, brain about two totally unrelated topics: vancomycin and oral diabetic agents. Learn more about emergency pharmacy at TILEmergencyPharmacist   *TIL= Today I Learned* Residents & students of @ChillaPharmD  posting the things they are learning on their emergency medicine pharmacy rotation.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Neutropenic fever is a common hospital presentation for oncology patients. Dr. Darien Reed explains what neutropenic fever is, who is at risk for getting it, important assessment findings, and how we work these patients up.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).See the show notes at upmynursinggame.com.

Dr. Amrit Hansra, interventional radiologist, gives an overview of imaging modalities as well as key nursing takeaways for common IR procedures such as G-tubes, biliary drains, and nephrostomy tubes.Use the promo code UMNG10 to get 10% off your order from Stoggles.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00). Objectives Listeners will be able to describe the differences between the various modes of medical imaging, including their advantages, limitations and indications Listeners will be able to explain the the differences between PEG tubes and G-tubes, including how each are inserted as well as important difference in nursing management Listeners will be able to identify tunneled v. non-tunneled catheters and where to apply pressure after catheter removal. Listeners will be able to describe what biliary drains are, when they are indicated, and how nurses can effectively manage them

Patients require transportation for many reasons: to an increased level of care, a decreased level of care, a procedure, or for imaging. Katherine Stradling, BSN, RN, CCRN, TCRN discusses the science of transport, what it's like in the ambulance, and what bedside nurses can do to facilitate safe transport. Objectives Listeners will be able to describe the difference between basic life support (BLS) transfer vs. critical care transport (CCT) Listeners will be able to explain the physiologic demands placed on patients during transport Listeners will be able to describe how the sending nurse can prepare the patient for safe transport BLS v. ALS v. CCT Note: Protocols differ by county and organization BLS transport is for stable patients who will not require cardiac monitoring or medications during transport. It is typically a team of two or more EMTs.  ALS transport includes a paramedic who can perform cardiac monitoring, chronic ventilators, and administer some medications. As Katherine explained, this set up is often unavailable, and thus patients who qualify for ALS transport often are transported by CCT CCT is a team including a critical care RN and two EMT. Their scope includes, but is not limited to cardiac monitoring, medication administration and titration, airway management. CCT is for patients who are not stable and will require intervention during transport. The Science of Patient Transport Increase O2 demand Increase ICP Nausea Increased sympathetic response Variable BP changes How the sending nurse can help facilitate safe transport Pre-medicate:this often means for pain and nausea Have paperwork ready to go Pull more meds than you think you need. Transportation is often delayed due to variable like traffic. Make room for the CCT crew to come in with their stretcher Spike hard-to-spike meds ahead of time (this is difficult to do on a bumpy ride!) Provide the receiving facility a complete and honest report. Make sure that they have all of the equipment the patient will need. Tip: If you're saying to yourself "the patient should be fine", just remember that the ambulance has finite supplies and team members. It's just the RN and EMTs out there on the road or in a helicopter, so give them more medications and supplies than you'd think and get your patient as stable as possible before they go. Relevant Links Hands to Hearts is a volunteer organization who believes that no one should die of treatable medical emergencies due to lack of education and resources. The organization helps build the first response system and offer life support courses in developing areas across rural Mexico. 

Dialysis isn't simply hooking up a patients to a machine for 3-4 hours. Veteran dialysis nurse, Jameisha Rogers RN, talks us through what happens during dialysis starting from reviewing orders to decannulation.Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00). What does dialysis do? Dialysis eliminates waste, corrects electrolyte deficiencies, and corrects fluid imbalances. Inpatient v Outpatient Dialysis Inpatient Dialysis is often a part of a treatment plan for another medical issue, surgery or situation Labs are drawn for every dialysis time Outpatient A patient’s labs may be drawn about 2-3x/month Focuses more on the holistic care of the patient, including:  Fluid status Electrolyte balance Anemia MBD (mineral bone disease) Vaccinations Case management Different Types of Dialysis Access Fistula: A surgical connection between a patient's own artery and vein.  Considered the "gold standard" for dialysis access. Graft: Similar to the AV fistula, a graft is a surgical connection between a patient's vein and artery, however the connection is made with a synthetic tube. CVC: A central line that terminates right above the right atrium. Due to the risk of infection, this is mostly used as temporary dialysis access until a fistula or graft has matured. A trialysis catheter falls into this category: it is a short-term catheter that is both a power PICC and dialysis access. Blood Pressure During Dialysis BP can increase or decrease based on the patient's baseline, what/when medications were taken prior to dialysis, and the dialysis machine settings. What is UF (ultrafiltration)? Ultrafiltration is the mechanism for which fluid is removed from the blood during dialysis. Ultrafiltration occurs when fluid passes across a semipermeable membrane (the dialyzer) to an area of lower pressure (the dialysate). A high UF volume means that a large volume of fluid will be removed from the patient. A high UF rate means that fluid will be removed from the patient quickly. Strategies to increase BP during dialysis? Decrease the UF rate (amount of fluid removed divided by the hours) ADD volume Medication support such as albumin, midodrine, or vasopressers Anemia in ESRD The kidneys play a primary role in RBC production by secreting the hormone erythropoietin. Patients will often receive exogenous Epogen, iron, and vit D to help stimulate RBC production on dialysis days Miscellaneous Q: When should we be taking off dialysis dry dressing?  A: Around 4 hours after dialysis has ended (don't leave until the next day) Q: Why are patients tired afterwards? A: We are doing in 3-4 hours what the body does 24 hours a day -- fluid balance, removing toxins, electrolyte replacement to name a few.  The decrease in kidney function itself along with anemia and other comorbid issues contribute to fatigue.    

Venous thromboembolism (VTE) prophylaxis is a core marker of healthcare excellence. Dr. Walter Cheng explains that almost every hospitalized patient is at an increased risk for developing a deep vein thrombosis (DVT) or pulmonary embolism (PE) and that nurses play a crucial role in preventing, assessing for, and educating our patients about VTE.  Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00). Virchow’s Triad  Basis for understanding risk factors for DVT/PE Blood stasis, hypercoagulability, trauma When inpatient, immobility is common because patients are not moving and getting out of bed cannot circulate venous blood well What are SCDs? Sequential compression devices are a venous thromboembolism prevention strategy that works to stimulate circulation in the lower extremities through inflation and deflation one at a time to simulate the pumping effect of walking. What are TED hose? TED hose stands for “thromboembolism deterrent” hose, and are used as compression stocking for the prevention of venous dilation and therefore prevention of clots, as noted below. They work by applying continuous pressure from the calf to the thigh, thereby compressing the veins and preventing venous stasis.  Quick Anatomy Rundown Arterial Blood Flow: heart pumps blood and provides pressure to drive blood forward Venous Blood Flow: PASSIVE → blood moves back is through muscle contractions of the legs and the arms.  Immobility of the veins are not returning blood as efficiently as they should be Ex: Airplanes, sitting for a long time Hypercoagulability Genetic causes of hypercoagulability: inflammatory diseases, infections, cancer, rheumatologic diseases, organ failure Risk factors for VTE Obesity Postoperative status and bed rest Heart disease > 40 years of age Limb trauma Coagulation disorders Pregnancy Advanced neoplasm Oral contraceptives Tips for explaining the need for SCDs, TED hose, and the Heparin/Lovenox  A million cases of DVT and PE occur every year in this country. There is a real risk that this could happen to you. And unfortunately, with DVT, PE, it can be something from a very inconvenient swollen leg to a devastating and life- threatening pulmonary embolism. DVT prophylaxis with subcutaneous heparin or Lovenox, decreases that risk significantly (70-80%) and the SCDs also decrease that to some percent If they develop a DVT or PE, they'll be stuck on like, oral anticoagulants from months, lowering their quality of life, prolonging hospitalization Assessment findings of DVT/PE DVT: Asymmetry in the circumference of, of one limb versus the opposite PE: suddenly shorter breath and can happen very suddenly, pleuritic chest pain Despite the classic signs, sometimes it can be subtle and hard to find DVT/PE, so we need to use lab tests such as:  D-Dimer: looks at products of clotting (elevates in PE). If negative, likelihood of DVT is low CT angiogram Ventilation perfusion (VQ) scan 

Today, ICU patients seem to become sicker and more sedated. Sedation medications, such as Propofol, have become more accessible and can be hung up and left on a drip all day. Heidi Engel, PT, DPT argues that less sedation and more mobilization should be thought of as important as taking medications. In this episode, we discuss how nurses can play a crucial role in mobilizing our patients both in the ICU and on the floor. Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00). Benefits of Early Mobilization: Prevent pneumonia Prevent blood clots Prevent bowel obstructions Prevent severe muscle wasting Prevent delirium Prevent shoulder/back pain Prevent calf weakness Decrease length of hospital stay When to Initiate Mobility? 48 hours is target for initiating mobility because it only takes 48 hrs to start developing diaphragm weakness We must advocate for our patients who develop anxiety regarding getting out of bed When a patient is hospitalized and constantly horizontal in a bed, it is associated as their safe space Patients become terrified of leaving their comfort zone Nurse should anticipate the fears, anxieties and how much the patient has adapted to their bed Strategies for coaching patients through anxiety Inform patient of session’s measurable goal: “today, we are going to walk out of the room into the hallway and sit at the bench by the window” Think of the patient as a whole, with questions such as:  How frail are they? How many comorbidities do they have? How old are they? How much anxiety disorder? Do they have at baseline? How can we how can we recruit their family members to help cheer them on? Or do their family induce more anxiety?  What are some chair and standing exercises RNs can lead with our patients while we’re in the room?  Weight bering exercise to stretch heel cords to prevent calf wasting Toe taps in chair Ankle Pumps  Coughing and deep breathing/ incentive spirometer  Squats and arm raises may be completed while standing and holding onto assistive device or chair, GOAL: We want to normalize activities and being out of bed as much as possible. Getting out of bed is imperative for maintaining mental and physical health Example of Early Mobility Initiative Success Inner Mountain Health in in Salt Lake City is an institution that is very aggressive about early mobilization. They have the longest running, most vigorous, mobility program in the country. Patients, ventilated or not, are out of bed and walking twice a day, while getting uninterrupted sleep throughout certain nightly hours. A very high percentage of their ICU patients are able to leave sooner and go straight home after their hospital stay. Here are articles that explain how an initiative encouraged early mobility for a shorter hospital stay. Last Notes: Mobility should not be viewed as just a PT project. It is an interprofessional, multidisciplinary, critical care project. It is always composed of TEAMWORK. The benefits early mobilization will involve improved core strength and returning to normal routines/independence

Pregnant and breastfeeding patients aren't always hospitalized for obstetric reasons and can be placed throughout the hospital. Dr. Michelle Solone, OBGYN talks to us about how we can assess these patients, what to look out for, and how nurses can promote pumping and breastfeeding during a hospitalization. Common reasons for non-OBGYN related hospitalization for pregnant patients: Medical: Kidney Stones, Chemo, Pyelonephritis, Cardiac Conditions Surgical: Cholecystitis, Appendicitis Trauma Which floor does the Pregnant Patient receive care on? Less than 20 weeks → regular medical floor 20 weeks & up → Labor & Delivery Floor Situational Examples:   L&D Nurses don't interpret EKG's, which will influence which floor a patient can be assigned → CCU/ICU ED for asthma exacerbation, traumas Respiratory Distress/IV Drip Monitoring →need ICU nurse with L&D Nurse present to monitor baby Physiologic Differences of Pregnant Patients Increased Blood Volume which can lead to dilutional anemia (ex: Hct 34), due to plasma>RBCs Increased Cardiac Output and decreased vascular resistance (↓BP)  CPR: Left lateral decubitus positioning or Left Uterine displacement for CPR over 20 weeks →Have mom supine, and have a coworker push the uterus about 2 inches over to the Left side for circulation return Increased WBCs Decreased lung capacity, but increased tidal volume (RR should be same) Increased risk for VTE  Nursing Interventions: SCD's, mobilization, sleep on left side Medical Intervention: Lovenox, Heparin Increased GFR →some medications may need adjustments/labs Assessment ABC's of Pregnancy A. Amniotic Fluid B. Bleeding (never normal, need OBGYN at bedside) C. Contractions/Abdominal Pain D. Dysuria E. Edema (DVT or Pre-Eclampsia) F. Fetal Movement Medications and Imaging in Pregnancy There is a fear of giving moms pain medications, but most narcotics are safe in short term, such as with kidney stones. Chronic use would be of concern.  Antibiotics such as Vancomycin and Ampicillin are very common for the treatment of infection in pregnant patients Imaging is safe  Preference →ultrasound to avoid radiation, followed by MRI (no gadolinium) if needed CT (with or without contrast) is also safe Care of the Postpartum and Lactating Patient Important: Advocate for breastfeeding and Pumping!  Get a Pump in the room early on! Save ALL milk → DON'T DUMP Unnecessarily Label milk to later review with MD if safe for baby What meds are compatible with breastfeeding?  Almost all medications are compatible with breastfeedingNotable exception: Codeine/Tramadol (such as Tylenol with Codeine) Regular Tylenol and Motrin safe for Postpartum Patients Physiological Changes in Postpartum  Fluid Shifts: all blood from uterus rush and return back to heart → flash pulmonary edema, fluid overload within 24 hrs after delivery Preeclampsia may present after delivery Anemia →PP mom may need blood transfusions/iron

Dr. Brandon Varr, an advanced heart failure and transplant cardiologist, provides insight into how heart failure is managed by diuretics and whether or not fluid restriction is important.  Heart Failure (HF) Refresher Heart Failure (HF) simple means that the heart is not pumping enough blood to adequately supply organs. Body’s “Short Term Fix”: Kidneys sense that there is not enough blood → salt retention to expand fluid volume in body Long Term effect of above “Short Term Fix”: Fluid retention → congestion, breathing discomfort, edema  TYPES OF DIURETICS (MAIN 4): Loop  “Workhorse” or most commonly known diuretic known time and time again for their effectiveness and safety Furosemide (Lasix) is the most commonly used loop diuretic in the hospital. Bumetanide (Bumex) is also used. Thiazide Adjunct (aka booster) therapy to loop diuretics in HF (ie augments the effects of loop diuretics when a loop diuretic is not producing the desired effects) Potassium Sparing (Aldosterone Antagonists) Another adjunct diuretic. Notably, as its name implies, does not lower serum potassium levels Per Dr. Varr, this class of medication is often under-dosed or not given when could be beneficial to stabilize serum potassium levels Most common: Spironolactone (Aldactone) Other Vasopressin inhibitorsReserved for patients who are experiencing significant hyponatremia SGLT2 Inhibitors  (-FLOZIN) Ex: Empagliflozin  Per Dr. Varr: Upcoming blockbuster agent because it not only provides diuresis but also increases cardiac efficiency Angiotensin Receptor Neprilysin Inhibitor (ARNI) Ex: Entresto Holding Parameters How much do diuretics influence BP? Concerned more with combo diuretic therapy with thiazide Loop and aldosterone antagonists with modest effects When are we justified in holding on diuretics? Hypotension due to hypovolemia Hypotension with symptoms Severe electrolyte derangements Important Take-Aways Think critically as to WHY your patient is here in the hospital. For example, a decompensated HF patient is in the hospital to lose weight, salt, and take aggressive diuretics to help them feel better.  If a patient is hypotensive, look at their meds and think about which medication to hold (usually NOT the diuretic). Consider adjusting BP meds before holding a diuretic. Nurses should hold other BP meds before holding diuretics if patient is hospitalized for fluid overload Fluid Restrictions Think about patient’s quality of life and patient happiness when it comes to fluid restriction.  Drinking tap water (1800 – 2200 ccs) will not be hugely impactful on HF management, but can be for their quality of life. Keeping people on fluid restrictions as they are nearing their dry weight can lead to adverse effects → low BP, dehydration, worsening kidney function  I&Os v. Os & Weight I think that strict intakes are just complete waste of time, from a general telemetry floor level patient who’s getting Lasix BID and responding. What I’m more concerned with is how much urine came out that day, what was their weight yesterday and what was their weight today on the same scale standing up in the morning? Those are the most useful things to me is their overall urine output for the day and how much weight they’ve gained or lost.Dr. Brandon VarrMore useful: Overall output for day and daily weights

OverviewPatients experiencing homelessness can add extra layers of complexities to emergency or inpatient care. Dr. Joe Mega provides some much needed perspective about the needs of our patients experiencing homelessness and how healthcare professionals can care for them more effectively.Belongings Homeless patients are often concerned about their belongings being stolen due to theft or abatement If a patients is concerned about their belongings, ask if there is someone they can call to look after them OR find out if there are any services that can check on the patient’s belongings while they are hospitalized Pets Pets are often like family members to the homeless and there is a hesitancy to be separated from them If this is a concern for your patient, look to see if your local animal shelter can keep the animal while your patient is hospitalized Substance Abuse When people are in the throes of addiction, this is often their #1 priority and they live in fear of experiencing withdrawal Make sure that you are addressing your patients substance abuse concerns by asking questions like “When did you last drink/use and how can I help keep you comfortable?” Opioid withdrawal can be treated with buprenorphine (Suboxone) Alcohol withdrawal can be treated with benzodiazepines, gabapentin, phenobarbital, etc. Check out Episode 6: Acute alcohol intoxication and withdrawal syndrome for more info. Methamphetamine-induced agitation can be treated with benzodiazepines and antipsychotics such as mirtazapine or risperidone. IF YOUR PATIENT IS BECOMING UNCOMFORTABLE DUE TO WITHDRAWAL SYMPTOMS AND WANTS TO LEAVE THE HOSPITALAsk questions like these: “I want to help keep you in the hospital. How do you think we can do that?” “How much do you usually drink a day and how does how you’re feeling now compare to past withdrawals?” “When was your last drink?” or “when did you last use?” Present the situation to the physician in a constructive way such as “I’m worried that the patient might leave, because they’re starting to feel unwell. What do you think about giving them something to help prevent withdrawal such as x, y, and z” FoodIt’s important to put it in the context of how easy it is, for someone with resources in home to access food, and then compare it to a person who doesn’t have a home. Just opening a refrigerator and getting access to some to what they want to eat is, is not a convenience that most people have. Be Trauma AwareThe homeless have often experienced extreme trauma and horrible experiences that either contributed to their homelessness or resulted from it. It’s important to be “trauma informed” and consider reframing your mindset from “What is wrong the patient” to “What happened to the patient?” Give-away: Tribe RN BadgeGuru Set 2.0To win a free set of Tribe RN’s BadgeGuru Set 2.0, simply enter your email address on the homepage to start receiving email notifications when new episodes come out. Visit tribe-rn.com to check out these badge cards or other cool nursing items like pen lights, stethoscope cases, etc. You can also join the supportive Tribe RN Facebook Community.

Faiman Chow MS, SLP provides insight into safe swallowing practices, good oral care, the risk factors for aspiration pneumonia, and the use of artificial nutrition in advanced dementia.

We're a year into the pandemic and, as a nurse, I'm curious: what are the best practices for treating COVID in the hospital? I sat down with a returning guest, Dr. Cyrus Shariat, an intensivist, and asked him about COVID pathophysiology, management of respiratory failure, medications, and risk of thromboembolism. 

Dr. Megan Coylewright, interventional cardiologist, and Danielle Durfey, cath lab RN, sit down with me to talk about atrial fibrillation (AF) management including rate v. rhythm control, anticoagulants, the Watchman™ device, and give us a peak inside life in the cath lab.

Dr. Matthew Truong, urologist, shares some pearls for difficult foley insertion, what CAUTI is, what it is not, and how to prevent it.

Palliative care nurse, Michelle Hedding, and I talk about what palliative care is and how nurses can advocate for it for our patients. We also discuss the contemporary issue of communicating with family members during this COVID era of visitor restrictions.

Intoxicated patients in ED and alcohol withdrawal syndrome -- Dr. Natalie Htet and I bust some myths about caring for drunk patients in emergency as well as dive into the complexities of alcohol withdrawal.

Ataxia, GI bleeds, ascites, jaundice... patient's with long term, heavy alcohol consumption can have head-to-toe problems. Dr. Natalie Htet, emergency physician and intensivist, and I go over the expected assessment findings of the ETOH patient, what to look out for, and long-term management of alcoholic cirrhosis.

Dr. Ronald Matuszak , hospitalist, and I discuss the ins and outs of potassium replacement and uncover that potassium replacement protocols are not often indicated. We also discuss the overtreatment of inpatient hypertension and how doctors and nurses can safely, if at all, lower a patient's blood pressure in a hospital setting.

For this episode I interviewed Dr. Cyrus Shariat, who is an intensivist, about rapid sequence intubation (RSI).  We talked about what happens during RSI and, specifically, how nurses can help facilitate this high stakes procedure.

For this episode, I speak with Brittany Hoang, NP CWON, about common wound nursing pitfalls including admitting a patient with wounds, wound vac trouble shooting, ostomy care, and wounds related to oxygen administration and COVID-19.

General surgeon, Dr. Colin Bohannan, and I discuss topics related to nasogastric tubes (NGT): small bowels obstructions (SBO), Salem Sumps, why NGTs are crucial for healing, as well as some tips and tricks to keep NGTs working.