Nursing & Humor

Before I describe the different components involved in a vaccine, I want to address the so-called “bias” when it comes to the vaccine debate. The thing is, there is no “bias” from the medical side. There are facts that are back up by multiple studies, and then there are opinions that are based on fraudulent research done by a physician who has since lost his license.

And then there’s Jenny McCarthy, but we aren’t here to discuss people who offer their opinion on science when they probably don’t even know the difference between a virus and a bacteria.

So what is in a vaccine?

It really depends on the type of vaccine you’re talking about. The antigenic component varies based on whatever disease you’re trying to prevent. I’ll go into that further in a second, but I first want to focus on the “scary stuff” most people are worried about.

Thimerosal

Thimerosal is a preservative used to prevent bacterial and fungal growth. You know, critters that if injected into your child that would probably cause septicemia.  People get freaked out about thimerosal because it contains mercury. The funny thing is, thimerosal is only used in the flu vaccine. It has never been used in the MMR vaccine. It has also never been linked to any toxicity based on multiple studies.

Formaldehyde

Formaldehyde is used to inactivate viruses and detoxify bacterial toxins (like those in the tetanus vaccine.) A purification process is used to remove almost all formaldehyde in vaccines, although a very small amount will still remain. The amount of formaldehyde in vaccines is less than 200 parts per million (.02%) and several hundred times lower than the amount known to harm humans, even infants.  

Antibiotics

Sometimes very small amounts of antibiotic are added to a vaccine (ex. neomycin MMR) to prevent any bacterial growth in the vaccine. If a person is allergic to neomycin, they may end up having an allergic reaction. This is actually a significant (albeit rare) effect that needs to be monitored for.

Adjuvants

Adjuvants are added to vaccines to help increase the immune response to the antigen. None are known to be harmful.

I think the FDA has a really good page that answers most of your concerns as well: https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm

And lastly, there are the antigens of whatever disease you’re trying to prevent. So if you’re trying to prevent the flu, the vaccine will contain a killed influenza virus.

I want to end this long post by talking about a few diseases your son would be vaccinated against if you choose to vaccinate. I want you to make an informed decision on your own rather by ridiculing anyone for their misguided opinions on vaccine safety. Vaccines are, quite literally, the most significant medical advancement in all of human history, and I will show this by talking about the various diseases they prevent. I’m not going to discuss all of them because as I started doing this I realized it was going to take a long time to discuss every disease (and I have boards to study for), but I’ll try to highlight the important ones.

Hepatitis B

Hepatitis B, while usually not as big of a concern if you get it as an adult, is extremely detrimental to children. Adults usually clear the illness without any lasting effects. However, children (90% to be specific) are unable to clear the infection and ultimately develop chronic hepatitis. Chronic hepatitis leads to liver cirrhosis, cancer, and death. About 2000 people die a year due to hepatitis B related liver disease in the United States.  This has been in steep decline since we began vaccinating for hepatitis B, as seen from this graph.

MMR

This is the biggie that everyone thinks causes autism even though there is literally no link shown between vaccines and autism. You can google this and find thousands of articles showing no link while there are maybe three that show there is some sort of link. But that’s the thing about research. Just because research says something does NOT mean it is true. Not all research is good research. Some research uses small sample sizes (cough cough Wakefield.) Or the research has a bias and a desired result. There are many things that contribute to what constitutes “bad research” which is why I think everyone should be required to take an epidemiology course at some point in their life, but I digress. Let’s talk about measles and rubella specifically.

Measles is a funny one to me because everyone thinks it’s “just a rash.” This shows the ignorance of many people who really know nothing about the disease they are speaking of. Measles causes 130,000 deaths around the world annually. Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide. However, as more and more people stop vaccinating, we start to lose herd immunity. Measles is a biggie for herd immunity because it is so incredibly contagious. For context, Ebola generally infects 2-3 people that have been in contact with a diseased individual. Measles infects 12-18 people who have been in contact with an infected individual. An outbreak of measles is extremely difficult to control.

Rubella does not generally cause as severe of disease in children. However, the problem with rubella is what it can do to a fetus. Congenital rubella syndrome (caused when a pregnant mother contracts the disease) can result in microcephaly, congenital cataracts, deafness, and heart defects. Since we have started vaccinating, the cases of congenital rubella have basically been eradicated from the US (see figure below.) CRS= Congenital Rubella Syndrome

I have included multiple links throughout this if you want to click to learn more, and I’ve provided more sources below: 

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

https://www.cdc.gov/hepatitis/statistics/

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html

https://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-thimerosal-color-office.pdf

I’m on cardiology right now, and yesterday the fellow taught us some basics for interpreting EKGs. The trick is the have a thorough algorithm and do it every time so you don’t miss anything.

Disclaimer: Obviously this is just a cursory intro so folks won’t look like complete fools like me- who, when asked to interpret an EKG, went into a cold sweat and said, “Well, it looks like the heart is beating.” Attendings do NOT like that.

INTRO

This is what a normal lead II EKG one beat reading should look like. TAKE NOTE LITERALLY EVERYONE STOP CALLING YOUR SQUIGGLY LINES HEARTBEATS IT IS WRONG GAAAHHHH.

Normal EKG.

What the various leads are monitoring.

1. Rhythm: Sinus or not- aka, is the SA node talking to the AV node correctly? Check in leads V1 and II- if there is a P wave before every QRS you have sinus rhythm. If this is not the case, you do not have sinus rhythm! A whole discussion on things messing up sinus rhythm will come when I have a better grip on it myself.

2. Rate: How fast is the heart beating- aka, how fast are the ventricles depolarizing? So EKGs are little tiny boxes in bigger boxes, right? There are several methods for calculating rate using the boxes, but the one that works for my brain is to count the big boxes between R’s and divide that by 300. So, 1 big box between R = 300/1 = 300 bpm. 2 big boxes between R= 300/2= 150 bpm. And so on.

In general, any heart rate above 100 is tachycardia, and any heart rate below 60 is bradycardia. These values may vary (ex: SIRS criteria counts heart rate above 90 as tachy). Normal heart rate is around 75 (exceptions include athletes- look up athletic heart syndrome)

3. QRS Complex: Wide or narrow- aka, is the Bundle of His bossing the ventricles around? Basically, a nice narrow QRS complex generally indicates the bundle of His is intact and operating how it is supposed to. A wide QRS complex indicates something is awry with the Bundle of His- could be an organic pathology, could be a medication side effect (ex: antiarrythmics, TCAs, quinidine, to name a few), could be an electrolyte imbalance (ex: hyperkalemia), could be other things.

4. Axis: Is the heart depolarizing the way it should- aka right shoulder to left nipple. I, personally, am still sorting out the axis system, and it’s hard to do in this format. The first, most basic place to start is checking if lead I and aVF are POSITIVE, meaning their QRS complexes go ABOVE the isoelectric line. If that is the case, you are probably ok axis-wise.

Essentially, lead I’s vector goes from left to right, and aVF’s vector goes from head to toe. So the average of those vectors is the general path of depolarization of the heart. You want the axis to be between -30 and +90.  So, if aVF is positive, but lead I is negative (the QRS is below the isoelectric line) that means it is going from left to right instead and would be classified as a right shift. Likewise, if lead I is positive, but aVF is negative, that means it is going down to up and would be classified as a left shift. There is soooo much more to axis interpretation, this is just a starting point.

5. Intervals: Again with the conduction system, it’s, like, totally important that it obeys all the rules every time. PR= <.2 seconds, or one big box QRS= <.12 seconds, or 3 small boxes QT= < ½ the RR interval

6. ST segment changes: checking for CAD- aka, is the myocardium getting enough blood/oxygen?  Since the folks in the South seem to consider butter a food group and know that if it can’t be fried it’s not worth eating, CAD is a huuuuuuuuge issue here. When blood supply to the myocardium is compromised, there will usually be characteristic EKG changes. Note- not every episode of angina/MI will have EKG changes though! - Inferior leads –> right coronary artery. - lateral leads –> circumflex artery - anteroseptal leads –> left anterior descending. Disclaimer: does not apply to everyone all the time, some folks have variant coronary anatomy.

So the EKG changes to look for must be seen in two contiguous leads, aka, two inferior leads or two lateral leads. - Ischemia (low oxygen) = ST depression or T wave inversion (EXCEPT T wave inversions are ok in leads V1 and aVR)

- Injury = ST elevation

- Old infarct/dead myocardium = pathologic Q waves. Basically that first negative vector (aka, the Q of the QRS complex) should never be bigger than one tiny box.

And, that, friends, is a basic algorithm for reading EKGs! There is a lot more, but if you follow these steps every time, you will look like a rock star on wards. Good luck!

In 1986, nurse Sandra Clarke could not stay with a patient who asked her to stay. When she returned, the patient had died alone. In 2001, she was key in starting No One Dies Alone, a program where volunteers sit with terminal patients who have no one else. The program is now world-wide. source

Sepsis

Blood cultures

ABG - check lactate

Urine output

IV antibiotics

IV fluids

High flow oxygen

Remember 3 investigations and then 3 treatments.

PLEASE RE-BLOG

I don’t normally say that? but everyone is talking (shaming people) about how the Congressional elections are SO IMPORTANT - but nobody is educating folks on how to go about it.

How To Insert A Chest Tube (Adult)

HEARTBEATS!!

The pause is to allow the atria to fully empty into the ventricle.

Heartbeat on an ECG trace

P Interval (Ventricular Diastole)

Atria and ventricles are relaxed

blood is flowing into the atria from the veins. 

Atrial pressure increases above that of the ventricle, AV valves open allowing blood to flow into the ventricle

P Wave (Atrial Systole) P-Q

Signal transduction from SA to AV nodes. 

SA node fires 

Atria contract causing atrial systole 

which forces all blood into the ventricles

emptying the atria.

Q Interval (End of Ventricular Diastole)

Depolarisation of interventricular (IV) septum 

AV valves remain open - all remaining blood squeezed into the ventricles. 

impulse from the SA node reaches the AV node 

which spreads the signal throughout the walls of the ventricles via bundles of His and Purkinje fibres

R peak is the end of ventricular diastole and the start of systole.

R Interval (Ventricular Systole)

Ventricular contraction

All blood is now within the ventricles

so pressure is higher than in the atria - AV valves close

ventricles start to contract although pressure is not yet high enough to open the SL (semilunar) valves

ST Segment (Ventricular Systole)

Ventricular contraction

Pressure increases until it equals Aortic pressure,

SL valves open

blood is ejected into the Aorta (and pulmonary artery) as ventricles contract

At this time the atria are in diastole and filling with blood returning from the veins.

plateau in ventricular arterial pressure

T Wave (Ventricular Diastole)

T= moment of Ventricular repolarisation immediately before ventricular relaxation

Ventricles relax

ventricular pressure is once again less than the aortic pressure 

If R is far from P then you have a First Degree.

Longer, Longer, Longer DROP! Then you have a Wenkebach.

If some P’s just don’t get through, then you have a Mobitz II. 

Hi all! Grace here.

I am not yet studying Anatomy and probably won’t until next year, but I decided to look up sources relating to Anatomy and gather them here for future reference! I will be adding more to it as I find more. If you are currently studying Anatomy or already have, please let me know if there were sources you are using/did use that were/are helpful so I can add them! :)

Nurse Journal

Human Body Images

Gross Anatomy

E-Skeleton

Human Anatomy

Introduction to the Human Body

Digestive System: The Inside Story

Body Parts Game

The Immune System

Human Anatomy Learning Modules

The Respiratory System

Anatomy of the Eye

Digestive Disorders and Anatomy

Anatomy Flashcards

Human Anatomy and Physiology

Blood Type Lesson Plan

Introduction to Human Genetics

Anatomy of the Human Brain

Heart Anatomy

Anatomy of the Lungs

NYU Virtual Microscope

Muscle Quizzes

Parts of the Brain

Dermatology Glossary

Interactive Body Games

Anatomical Images

The Bone Box

Muscles of the Body

Anatomy and Physiology Course 

Human Body Maps

The Digestive System

Interactive Case Studies

Online Biology Book

Radiographic Anatomy 

Body Guide: Skin

Immunity Guide

Anatomy Self-Test

it’s your worst nightmare: you have tons of work to do and yet, you can’t seem to get it done. you’re tired and you’re sick of working so hard. don’t let a burnout stop you! here are some tips for avoiding and getting over a burnout. you can do this! (:

** first things first.. what is a burnout? **

burnout |ˈbərnˌout| noun

physical or mental collapse caused by overwork or stress: high levels of professionalism that may result in burnout | you’ll suffer a burnout.

burnouts happen to everyone now and then and the most important thing for you to know is that it’s okay!! *gasp* yes, it’s actually okay to feel like you need to stop once in a while. you’re only human. basically, it’s when you just can’t seem to focus on your work anymore or you really really need a break.

however, note that there’s a difference between procrastination and burnouts. procrastination is when you keep doing other stuff instead of your work. burnouts are when you keep doing your work and never do other stuff. (i suppose burnouts can lead to procrastination, but there is a difference!)

** preventing them **

NUMBER ONE TIP FOR PREVENTING BURN OUTS is to not overwork yourself!! this is so important!! you should not be pulling all nighters every other day to study!! you should not be cancelling doctors appointments or meetings with friends to study! go out there and have some fun, care about your health, do your thing! even if you don’t have anything else to do, instead of just doing more work, find something else that’s fun and requires little effort. in fact, do that fun stuff while you study! make studying and work not a task or chore, but something you enjoy and doesn’t stress you out.

fun games to play during study breaks

drift : you’re a cat and you’re jumping over balloons. super simple to learn and really fun to play!!

tea : by the same person who created drift, there are two mice and you’re collecting sugar cubes for tea! so cute ohmygoodnesss

2048 : i’m sure you know what this is but use your keys to slide the tiles around and try to get the 2048 tile!

tetris : classic game of tetris. i like this one because it keeps your brain moving fast, but you’re still taking a (much-needed) break, which is great!

flower reaction : you’re a flower and when you click, your flower (and the flowers around your flower) grow bigger, and your goal is to time your first flower so that you’ll have the largest chain reaction. watching the flowers get bigger is really calming for me!

flow : interesting little game where you’re basically a mouth and a body, and you eat other teeny organisms.

if you play some cute little games every now and then while you study, your grade will be fine. don’t worry <3

another thing you can do instead of playing a game is to go to a relaxing website or look at motivational quotes. my absolute favorite is the 90 second relaxation exercise because it’s so quick but it definitely helps!! it’s super calming and *be sure to turn your sound on because the music is lovely*

more stuff to help you relax + get motivated during breaks

the quiet place : go to the quiet place if you need to take a step back and just relax for a little bit.

easewave : pretty background and a motivational quote every day! you can also go to the navigation and click “browse quotes” if you want to see more. you can also get it as a chrome extension in case you don’t want to go to the website.

tonematrix : click on the squares to make different sounds! plus you can make really cute patterns and such.

webchemy : basically makes symmetrical art, it’s really neat if you just need to frantically click at the screen and make something that looks cool!

relax.li : pick an option and look at a video + listen to some nice audio to relax! my favorite is the cat (;

sometimes instead of staying at your computer screen, maybe it’s better to step away for a little bit. go for a quick run, or walk, or even just a stretch. go outside (unless it’s raining. you still can, of course, but bring an umbrella, silly!) and take a breath of fresh air!

stuff to do outside!

99 free things to do outside : exactly what it sounds like. 99 things you can do outside of your house for free.

101 things to do outside : also includes a cute little coloring page, though this is probably more for little kids there’s definitely still stuff you can do!

go for a walk with your friends/family and have a big discussion on something you can all talk about!

take a camera and just snap photos of things you find beautiful. it could be a mother and her child, some flowers, the sky, someone crying… i don’t know, whatever floats your boat~

bring a journal and just sit under a tree and write for a little bit. a diary entry, a song, a story you’ve been working on (that rhymes omg), it doesn’t matter!! but.. do not write your essay under that tree, okay? write something else!

relive your childhood and play tag. seriously just play something you used to play and haven’t played in a while because you will feel wonderfully nostalgic + exercise is great and makes you happy!

window shopping can be really fun if you need to get your mind off things. or just go to a shop and try half the store on and don’t get anything. y’know 0:-)

go to an arts store or something and buy things for diys or your bullet journal (washi tape yessss) or some art project you want to start and spend some time working on artsy fartsy stuff!!

lie in the grass with a book and read. or sleep.

11 fun things to do on a rainy day : if it’s raining, that doesn’t always mean “hit the books”. here’s stuff you can do (not outside, i guess) when it’s rainy.

if you really have to study for something and you don’t have time to spare but you’re worried about a burn out, there are still some things you can do to help!

set a schedule : make a solid, never-changing-regardless-of-circumstance, study schedule. leave plenty of room for breaks. studying non-stop WON’T help you, but if you have a set schedule that you’re used to and you know works for you, use it.

study in new places : this may not work for everyone but sometimes the best way to prevent a burn out is to make sure you feel like you’re not always doing the same thing! switch it up with study spaces – study outside, go to the library, stay at your desk, etc. – but try to make sure you’re not getting distracted!

break it down : break everything down into smaller tasks that are easier to accomplish! instead of “finish final project”, make it “finish outline” “finish design” “type it up” etc. so that you don’t feel too daunted. also, if you’re like me and you feel a great sense of accomplishment + motivation when you check things off a to-do list, making more manageable tasks will be like many bursts of motivation!

experiment : like with the new study spaces, maybe try new techniques! have you never ever used flashcards before? try those out (especially for vocab!) studying for history and you think you should make a timeline, even if you’ve never made one before? go for it!

talk to other people : it might help to teach what you’re learning to someone else. it’ll help you remember it better and that way, you actually understand the material. i would recommend “teaching” to someone who has already learnt everything so that if you make a mistake they can correct you!

make it right for you : lots of great studyblrs post gorgeous pictures of their studying. but that’s not how everyone needs to study, and we know that! if you don’t study well by taking pretty notes, and instead you like hearing recordings of your lectures, that’s great too! get yourself in your own study zone, not anyone else’s.

** bonus – some other posts that talk about studying tips and self care that you should take a peek at!! **

6 things people don’t always tell you about studying : great if you need help getting over procrastination

all the self care : some nice self care stuff like what to do on a bad day or beating stress and anxiety!

10 rules of good and bad studying : this is so immensely helpful!!

how to get motivated / stop procrastinating : short but sweet

motivation : best post for motivation i’ve found!! like honestly if you are unmotivated click here and i assure you waves of motivation will pour over you!

** getting over a burnout **

first of all, stop comparing yourself to other people. this might not help you, but for me, when i get burned out it’s because i’m trying hard to prove everyone wrong and my competitiveness is just messing everything up. focus on yourself instead of other people. so what if they got a better grade than you on that test, what matters is that you got a better grade than what you got last time!! it’s so stereotypical but you really just need to ignore what everyone else is doing and just go for it.

if you’re having a huge burnout i would suggest to sleep a lot. go to sleep thinking about things you’re grateful for, things that make you happy, things that relax you, etc. and take lots of nice, long, hot showers. wear comfy clothes. drink lots of tea/coffee/hot chocolate/your preference. just get yourself in a more comfortable zone, you feel?

sometimes you might be burned out for one subject but not the other. your mindset should not be “oh, i can’t do this anymore, guess i’ll devote my energy and soul to that subject instead!” learn from your mistakes! you can still study that other subject but remember to balance your time out. maybe by studying your other subject you’ll regain motivation to study the original one, and that’s great! but if you’re just burning out more and more, take. a. break.

talk to someone about it!! other people may have experienced the same and have super valuable + great advice for you, especially if they know you well. i’m a person on the internet who you’ve probably never met, i don’t know what works best for you! if you talk to people who are close to you about it, maybe they can spark an idea in your head.

woohoo, that’s it for now ^^ this is my second masterpost (ohmygoodness that sounds so cool hearing it now) and i really hope it helps you!! also, i’d like to thank you for all the nice comments and support i got on my first masterpost ♥ i honestly never expected you guys to like the idea so much! thanks again and have a looovely day (also coming up : more on online schools, study playlists!)

Just some things I’ve learned that when I share some people don’t seem to know yet! 

CATCH DUPLICATES. Catch them and then return them to prof willow. You can do this by clicking on the pokemon’s stats, scrolling down and hitting transfer. You get pokecandy for this which you can use to evolve/power up your original! 

Make sure you compare and contrast CPs of your duplicates. One pikachu might be 10cp and the other 56cp. Keep the higher one, transfer the other. 

That being said DONT waste your time evolving/powering your pokemon just yet. You might work hard to power your eevee to 100cp only to catch one at 150cp the next day. WAIT. In fact, I started only powering up my highest evolved pokemon. (ninetails, fearow, etc)

Pokestops refresh every 5 minutes. You can visit them for an unlimited amount of time. I live right on top of one and check back in whenever I remember to. 

Leveling up will give you LURES, INCENSE AND INCUBATORS. So don’t think you NEED to buy these from the shop. 

If your wary about spending money for coins, you can GET COINS by having pokemon in gyms. This is the ‘defender bonus’ Theres a shield icon in the shop section that you can refresh every 21 hours. You can have up to 10 pokemon in 10 diff gyms for a total of 100 pokecoins and 5000 stardust a day.(10 Pokecoins and 500 stardust per pokemon)

Your gym alliance makes it so that ANY GYM you fight of your own alliance, your pokemon WILL NOT FAINT.  Their hp will reduce to 1 and they will need healing, but they won’t faint. You also gain gym prestige this way which helps strengthen your alliance territory. Any rival gyms however will faint your pokemon and they will need a REVIVE to keep being used. You can also transform them into candy at this point if you are a heartless monster. :( 

A gym has a max of 3 pokemon traners/defenders. If you find a gym of your alliance with only 1 or 2 pokemon in it, you can ADD YOUR POKEMON WITHOUT FIGHTING YOUR FELLOW TEAM. Just drop a pokemon in there and keep walking! Free defender bonus. (Do this by clicking the bottom left icon of ‘add pokemon’)

More than one trainer can fight one gym leader at a time. Getting a friend to fight with you is the best way to beat the gym!! You attack at the same time.

ITS NOT TURN BASED ATTACKS. Its real time! Click once for a basic attack, swipe to dodge, and hold down a click for a SPECIAL ATTACK!

My best method is not to dodge at all but just click forever. So long as I have a bigger CP I usually win lol. 

Do NOT put your best pokemon into a gym. Your second or third only. You cannot recall your pokemon once its in a gym and you will need it to fight other gyms.  (they get returned to you after they are beaten)

Everyone gets one free incubator that lasts forever. Any extras you find or receive from leveling up only last 3 hatches before breaking.

TRACKING POKEMON! Sparkling grass doesn’t guarantee a pokemon showing up. The ‘nearby’ tab is the actual tracker. The highest on the list is the closest. Selecting a pokemon in it will make the tracker pulse when you get nearer to it. 3 footsteps away mean THREE RINGS away (or more). 2 footsteps means TWO RINGS, one footstep means one ring and NO RINGS MEANS YOU CAN CLICK ON THAT POKEMON AND IT WILL APPEAR IN 10 SECONDS.

Battery saver mode, found in settings, works as follows: Once clicked on, if you drop your phone to your side as you walk, with the top of your phone facing the ground, the screen will dim so only the pokemon logo shows. It still tracks your steps for your eggs and it will vibrate and beep when a pokemon shows up. As soon as you lift your phone to your face (right side up) the screen will appear again as normal!

The higher level you get, the more rare pokemon you come across.