Friday, April 25, 2014

Vital Signs

AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000372049.58200.da
In a short article in the American Journal of Nursing, Louise Rose, PhD, RN reminds us of the importance of monitoring vital signs.  "Abundant research," she says,  "indicates that vital signs aren't consistently assessed, recorded, or interpreted."  This is despite the fact that they are the best indicators of many complications or conditions, and offer clues to the reasons for deterioration of patients.  
Rose offers suggestions as to why vital signs may be pushed off as a menial task.  It is, after all, repetitive and time consuming.  In some cases, machines perform the task automatically; perhaps a nurse is not reviewing these reports.  On the other hand, less experienced medical professionals may deliver inaccurate results.  And, likely as any explanation (probably moreso) is that the nurse workload prevents them from taking and/or recording accurate vital signs.

So, how can and should this be addressed?  Isn't this fundamental?

I won't pretend to have the answer to this problem, but I do think it helps to be aware of the situation.  This is probably very indicative of the environment I will be entering.  If something this fundamental is being overlooked, what does that say about nurse morale and workload?  Or is it something else?

Thursday, April 24, 2014

Medical Spanish - Entry 5

ligadura de trompas - tubal ligation

"tenia usted ligadura de trompas?" - Did you have a tubal ligation?

Wednesday, April 23, 2014

Medical Spanish - Entry 4

parpadear - to blink
pestañar- to blink (this is what is used in Argentina.)

pestaña, por favor.
blink, please.

Tuesday, April 22, 2014

Feelin' Flighty

I have some research to do.  I have some studying to do.  I could learn some more medical Spanish. I could find a journal article or current even to read and reflect upon. But, my mind is so restless tonight, so, I'm gonna go with it.  What's bugging me?

Costa Rica is bugging me.
Last time this happened, it was some nonspecific European country. 

While I think it is absolutely important to serve my community here, and while I feel a calling to help in poorer areas, both domestically and abroad, I also think a year or two abroad in an interesting place would not only be fun, would not only be great for the children, but would also expose me to other ways of thinking that can help me think outside the box here. 

So, I'm starting to think about it.  My destination would necessarily be English- or Spanish-speaking.  And, I would need to be able to take my family.  How would Santi come along?  How would we find a place that worked for both of us? 

I read this, about teachers who "life swapped," and this about the feasibility and logistics of travel nursing with a family. 

Daydreaming: Costa Rica

I've started daydreaming about at least a visit to Costa Rica.  I've always wanted to go, and posts from an old friend living there keep it popping back into conscious thought. So, I'm going to dedicate time to researching this possibility.

I think, first and foremost, a visit is in order.  I may message the friend above in a few days.  The problem is always money, but by January, we should have saved enough to go.

I think it should be a family trip.  Said friend has a child.  I know that will make the trip a little more stressful, but I also think that we can enjoy this with the kids.
Then again, it makes me think we should wait until they are just a bit older. says to visit sometime between November and April.  We can't use vacation time this year, so it's perfect to wait until after the beginning of the year to do so.
Flights look to cost about $670/person, so about $2800.
I would think we would stay in hostels.  This one is owned by Argentines,

Wow.  I get a little bit into this and I already know that I cannot sacrifice going on the DR mission trip to do this.  So, maybe this is still on the roster, but not for 2015.

It's funny how many other things this brings up, though.  One sentence in a very touristy article resonated with me:
If you’re traveling with a good deal of luggage and not visiting any remote areas, it may be worth it to rent a car. 

When I said that I couldn't really put my finger on what goal I wanted to reach for this week, this sort of touches on it.  I want to not travel with a good deal of luggage, and I mean that literally and metaphorically.  I don't want my kids to be burdens; I want to be in a place that makes me ready to connect with them.  I don't want to be connected to my iphone; I want to be free of the burden of that.  I don't want to constantly worry.  I just want to enjoy. I don't want to have a garage full of stuff that needs to be gotten rid of.  I don't want to have a closet that looks like it threw up.  I don't want to worry about what people think.  I just want to be.

I think that's what Costa Rica symbolizes to me: freedom.


I'm not saying a visit is not in order.  I will still research about working there as a nurse.  But I think this daydream plan has shifted focus to how I can get ready to go to the DR next year.

Monday, April 21, 2014

What I'm Reading Today

How Public Health Advocates are Trying to reach Non-Vaccinators

The approaches described in the article are interesting, because the situation was actually the opposite for me.  While pregnant with my first son, I was unsure whether to vaccinate.  One of the factors in arranging a meeting with his pediatrician was whether the practice would allow us to skip vaccinations or modify the schedule.  This practice allows that, and is the only one in our area that I found that did.  When I went to meet with the pediatrician, I asked him about vaccinations.  He calmly explained with facts, and offered articles as support, why vaccinations are safe and why the risk from not vaccinating is much greater than from vaccinating.  His approach made sense to us, and we choose to vaccinate our children.  When we go to our check-up appointments, the vaccinations are a part of the appointment.  That is, if we were non-vaccinators, we would have to actively deny the vaccination. 

With more understanding, I know why it is so important that my children, and all children who are able to be vaccinated, are.  I still agree with the practice's approach of allowing non-vaccinated children, because those children, whose parents are making a bad decision, should also have a right to health care.  I wish our provider didn't have to be the one to provide it, because I did worry before my children were vaccinated, but I felt the quality of care we receive there was excellent, so I did not change providers.

Sunday, April 20, 2014

Saturday, April 19, 2014

TEAS Study Notes

Questions I am still finding answers to for studying TEAS - ongoing list compiled from various sources.  I delete them as I feel comfortable with them, and am adding more based on practice tests.  The original compilation is from a post on  Just google that site plus "how I studied for the TEAS V"

Reading - the first section

•Know which primary sources make sense for a given type of story

•Summarizing able to choose which is the best fit for a given story. [I can do this but want more practice]

•Understand what you can logically conclude from a story [I can do this but want more practice]

•Inference and what can be concluded from a given example [I can do this but want more practice]

•Decipher the meaning of a word based on its context in the sentence (mine were not as easy as the examples, so really think about this style of question.) [I can do this but want more practice]

•Choosing an appropriate title for a given paragraph (again, sounds easy, but I had to really think about this one because the answers are similar)

Math - the second section

(1) calculating percent increase/decrease
 (2) Work rate problem formula.

•Be able to list four numbers in the order requested. These numbers may include whole numbers, fractions, and decimals in any combination. Be VERY careful to order them as requested. (ex: greatest to least, least to greatest) [In the practice tests I keep doing it in opposite order!]

•Roman numerals.

•Familiarize yourself with interpreting information based on charts. (seems easy, but be sure you read headings and info on the charts, as there may be very important information)

•Know when you would use a bar chart/circle graph/histogram/scatter plot/line plot. Ex: if you want to show a change in something over time, you would use a line plot.

•Know the FOIL method

•Be very, very, very familiar with absolute value and how to solve equations that include absolute value.

Science - the third section

•Scientific reasoning

•The scientific method (know the steps, in order, and know examples of each step)

•Understand why an experiment is repeated

•Know the fundamentals of electronegativity

•Understand the various physical states of matter (gas, liquid, solid) and how a change in state might change pressure/volume/etc.

•Get a feel for the chemical properties of water, along with the specific values for it (such as specific heat/temp at which it freezes/boils/etc.)

•Understand what happens during serial dilution and what values result from it (these are very easy)

•Know the general concepts of natural selection and adaptation. Make sure you are able to distinguish between the two given an example.

•Know all of the factors that influence birth/fertility rates. Be able to decipher if the population will increase or decrease given an example.

•understand population growth/decline based on rates of emigration immigration/birth/death.

•Know your biological classifications from general to specific: Domain, Kingdom, Phylum...etc. Watch these questions, paying attention to whether they are asking for more specific or more general in the order.

•Know as much as you can possibly learn about Nucleic Acids/DNA/RNA. Know their make up, how they bond, the nitrogenous bases and how they pair, which are unique to DNA or RNA, and which are shared by both DNA/RNA, know which are purines and which are pyrimidines.

•Know what it happening in all of different stages of translation and transcription. Know where it happens.

•Know the parts of a cells in both eukaryotes and prokaryotes, and what those parts do. Know if they produce anything or if they are involved in an immune response...etc.

•Understand the makeup of the cell wall in both plant and animal cells.

•Always, always, always equate protein with amino acids (the building block of proteins)

•Understand what chloroplasts do and how they do it.

•Chromosomes, genes, and alleles...know what they are, how they relate to each other, and how they affect organisms.

•Cell differentiation - know what the meso/endo/ectoderm become.

•Mitosis/Meiosis - understand all phases (ex: G1, S, G2...)of each and what is happening in each. (I found videos useful in this...especially those from Khan Academy) Know what types of cells these happen to.

•Be sure you understand what a heterotroph and autotroph is and how they relate to each other in the life cycle.

•Review photosynthesis - review it again - then review it again. (the entire process) Know what it produces and how that product is used.

•Be very familiar with cellular respiration, why it happens and what is happening.

•Be able to read a codon chart and decipher the outcome from a given example (this question was more difficult than the basic charts I studies. make sure you study both basic and more advanced examples)

•Mutation vs. adaption

•Phenotype/Genotype - what are they and how are they related?

•Punnet squares and calculating probability given an example. You will need to make sure you can set these up properly, which includes knowing the difference between heterozygous/homozygous/recessive/dominant and how they fit into the equation)

•Kinetic and potential energy. Make sure you can recognize an example of each. I suggest googling several examples so you can solidify the difference in your mind. My question was more difficult than the basic, but easy to understand because I had the concept down pat.

•The dreaded earth science question - is there one? Yes. And as covered in the manual, mine was about the sun. It was a concept not covered in the manual, but was easy nonetheless. There were no other earth science questions on my test. No rocks, clouds, water cycle...etc.

•Understand the purpose of a catalyst

•Know everything there is to know about the periodic table and the information you can get from it. Atomic number, atomic mass, how many protons/electrons/neutrons are in a given element. Know how the numbers relate to each other and how to decipher how many of each is in an element if given a specific number. (again, Khan Academy was a great resource on this). Also know the physical and chemical patters withing the table (what the rows mean, what the columns mean, which elements are more likely to have ionic/covalent bonds). Lastly, make sure you understand electron configuration.

•Be very familiar with valence electrons and why they are important

•Enzymes and vitamins - what do they do, where do they come from, why are they important.

•Understand pH balance/acid/base. Know what a given pH means (acidic or basic?) and understand what adding something to it may to to the pH (think about things that may raise or lower the pH of blood, for example)

•Understand bonds - ionic/covalent

•Understand hydrocarbons - saturated/unsaturated

•Make sure you remember how to balance a basic chemical equation (Khan Academy has an excellent video on this.

•Anatomy/Physiology as follows:

•Know the path of blood through the heart, including valves and whether the blood is oxygenated)

•Know the make up of the lungs and where oxygen exchange occurs

•Know the sections of the brain and what each is responsible for

•Tissue types, where you would find them, and what they do. Know several examples of each type of tissue.

•Digestive: follow bollus through the digestive system in its entirety. Know about peristalsis. Know about the digestive enzymes. Know where protein/carbs/fats are broken down. Know where the bulk of nutrients are absorbed. Know which division of the nervous system controls it.

•Know the functions of the liver, spleen and pancreas. Know which systems they belong to (and they may belong to more than one....hint)

•Know what the lymph system does and how it accomplishes it. Be mindful, also, of what it doesn't do. Just a suggestion.

•Be very familiar with the nervous system and its divisions. Know what each controls and the branches that make them up.

•Make sure you understand the structure/function of the kidney...well.

•Anatomical directions (super/inferior, proximal/distal...etc.) apply to an example.

•Know how the thyroid and parathyroid work together and what they do separately.

•Immune system - natural vs. artificial/active vs. passive. Recognize examples of each type. Also know the different cells involved and what they do.

English - the fourth and final section

•Recognize common possessive nouns.

•Pronoun/Antecedent agreement.

•Dialogue - correct punctuation and usage

•First/second/third person voice and recognizing which from a sentence or short story.

•Grammar usage for style/clarity

•Using sentence context to decipher the meaning of a word.

•Recognizing a simple vs. complex sentence

•Be able to identify a top and supporting sentence. Know the difference.

•Know the meaning of common prefixes/suffixes/roots (ex: uni, ous, endo...etc.)

•Rules of capitalization.

•Correct usage of commas, ellipses, semicolons, colons, hyphens, and parentheses.

•Correct usage of quotation marks and apostrophes.

•Go over a list of commonly misspelled words. You will have one on your test. if you get confused, look away from the word and write it down. If that doesn't help, write it in a sentence.

Thursday, April 17, 2014

TEAS Study Notes: Electronegativity, Covalent Bonds, Ionic Bonds

Electronegativity - the measure of attraction of an atom for the electrons in a chemical bond.

Note - electronegativity/ionization energy increases as we move up and to the right on the table.

Medical Spanish - entry 2

I had to go looking for new vocab today because the word of the day site didn't have anything new for this entire week.  Today I have two ways to say jaundice:


piel amarillenta

I will ask my in-laws about these terms tonight.  My thoughts are:

ictercia - probably pronounced ick-ter-CI-uh

piel amarillenta - piel means skin, and amarillo means yellow, so I'm wondering if amarillenta is yellowed. 

Monday, April 14, 2014


Oh, man, am I under the weather.  It's just a cold or something similar but it's rough.  I just want to crawl under something.  Preferably, a soft, warm blankie. 

I can't sleep because of the tickle in my throat.  The tickle, which subsides.  The tickle, which returns.  Returns at the godawfulest moments.  Like when I am 89.5% asleep.

I still want to write things.  I interviewed three nurses.  I have more to go.  I have a lot more to do.  But right now, I am barely functioning. 

So, I'm here.  Just not here.