hbthenp

01/23/2021

May have spoke too soon...

01/21/2021

12/08/2020

These are signs of anxiety. Don't ignore them.

Anyone else?

12/02/2020

Some nursing funnies for the night-shifters 😘🧛‍♀️🦉. @ Rexburg, Idaho

11/30/2020

🅱️🅿️ Blood pressure (BP) is an important vital sign that can tell your provider a lot. As simple as this reading seems there is actually a lot that goes into accurate assessment of BP. This post will go over some basic info!

💗 Expressed in 2️⃣ readings: Systolic (SBP) & Diastolic (DBP) SBP/DBP.

💗 SBP represents the pressure exerted on the arteries during systole (contraction) of the heart. First (Korotkoff) sound heard on manual read.

💗DBP represents the pressure exerted on the arteries during diastole (relaxation) of the heart. When Korotkoff sounds are no longer heard on manual read. A high DBP is generally more concerning 😟 as the heart is in diastole longer than systole. If the resting pressure is high this means more time spent at a high pressure.

💗 Average for adults is 120/80. Some run higher & some lower.

💗 Mean Arterial Pressure or "MAP" is an averaged amt of SBP & DBP calculated to reflect the pressure being exerted on the arteries at any given time.

💗 A cuff that is too LARGE for the diameter of a patient's arm are will show a falsely DECREASED 🅱️🅿️.

💗 A cuff that is too SMALL will result in a falsely INCREASED 🅱️🅿️. Always check check sizing if unsure of proper fit!

💗 Ideally conditions for a 🅱️🅿️ measurement is w/ feet flat on floor🦶, arm at level of the heart💪, NOT on same side as lymph nodes removed/mastectomy, haven't smoked or drank caffeine in the last 60mins.

⬆️ Pain, exercise, stress, shock (early sign), certain liver conditions can increase 🅱️🅿️

⬇️ Sleep, meditation, acute blood loss (late sign) dehydration, kidney injury can decrease 🅱️🅿️

👆 HYPERtension: JNC - 8 HTN Stages: >120/80 is PreHTN *see photo*

‼️Hypertensive crisis = >180 SBP or >120 DBP. Risk for aneurysm, cardiogenic shock, stroke & hemorrhage‼️

👇 HYPOtension =

11/27/2020

IPV = A pattern of assaultive & coercive behaviors that may include physical injury, psychological abuse, sexual assult, progressive social isolation, stalking deprivation, intimidatation, & threats. These acts are aimed at establishing control by one partner over the other.

This post is meant to provide awareness & basic overview of the topic.

🙅1/3 women 1/4 men physical violence.

🙅19.3 million women 5.1million men stalked in their lifetime.

🙅45.7% women were r***d by an intimate partner.

🙅72% of all murder-suicide involve intimate partners 94% of these victims are female.

🙅1/15 children witness IPV & 90% are eyewitnesses.

⬆️ The younger the age the higher the risk. Young women likely to disclose in writing, older women more often disclose face 2 face.

⬆️ Increased risk in minority groups & unmarried, exposure to IPV as a child, drug abuse,

⬆️ IPV risk increases significantly in pregnancy & postpartum period🤰.

‼️IPV can DRAMATICALLY impact maternal & neonatal health, & is often under-reported.

🥀DON'T: Pessure victims to leave the relationship.

🥀 DON'T: Use terms such as domestic abuse or IPV.

🥀 DON'T: Lie about confidentiality (legally, cases involving minors/weapons are mandatory reporting incidents).

🥀DON'T: Downplay or make light of a report of IPV.

🌹DO: Ask directly about specific abuse behaviors, believe & validate, affirm that no one deserves to be treated poorly, assure privacy of conversation (1 on 1), assess pt for safety.

🌹DO: Know your state's mandatory reporting laws. Be honest w/ patients about reporting requirements.

🌹DO: Provide community resources, assure support, & if possible create a safety plan.

👩‍⚕️👨‍⚕️US Preventative Task Force recommends screening for IPV is all women ages 14-46. Now recommendations exist for IPV screening in men. AMA recommends all pts routinely screened.

😖 Screening rates are poor in women's health and even more abysmal in family practice. Awareness of screening tools and practices are nessesscary for an increase in IPV recognition.

🛠️Different screening tools:

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/prevention.html

11/14/2020

Fear will only hold you back. You can do anything you set your mind to. Courage isn't for the fearless. It's for the fearful who press forward regardless. Don't be afraid to fail or what others may think. This is how you learn. Try new things and don't stop pushing yourself. 💪😖😰😌🖤💯✊

11/14/2020

🔥TORCH Infections: Herpes Simplex Virus (HSV)

📍 Although HSV is considered treatable it IS NOT curable. Some medications may help to decrease⬇️ outbreak symptoms. Those infected will experience outbreaks throughout their lifetime 😖.

📍ACOG estimates that 1️⃣ in 5️⃣ women are infected with HSV. Vertical transmission is most common in women with active herpetic lesions at the time of vaginal delivery.

📍It can also be spread post-natals by kisses 💋 and hands ✋of those infected w/active lesions.

📍 Mothers who contract HSV during pregnancy are at the highest risk of congenital infection👶.

📍Current standards recommend delivering babies whose mother have active infection via C-section🔪

📍Anti-virals💊 (ie. Valcyclovir, Acyclovir) can be started at approx 36wks until birth to suppress an outbreak & allow for vaginal delivery.

📍Although data supports routine HSV testing in pregnancy, not many providers do. This is thought to be due to the lack of CDC recommendations for management of HSV in pregnancy🤰. Additionally, USPSTF recommends against routine🚫 screening in asymptomatic pregnancy women.

📍Initial symptoms in neonates can be delayed up to 6️⃣wks. Most commonly seen in the fist 2️⃣wks.

📍Babies w/congenital HSV can experience central nervous system damage, severe liver dysfunction, rash, bleeding disorder, respiratory distress, seizures, damage to the eyes, and sepsis-like illness.

📍 Congenital HSV infection is potentially life-threatening & can cause permanent nerve damage in infants. Prevention is key 🗝️. Anti-virals can reduce symptoms but are not a cure😟.

📍Be sure to tell your provider 🥼about any STIs prior to pregnancy as well as reporting suspicious lesions, decrease ⬇️ the # of sexual partners in pregnancy & prior to, take meds💊 as prescribed.

📍 Condoms can reduce the spread from one partner to another but do not eliminate the risk.

@ Rexburg, Idaho

11/12/2020

Don't be afraid of what might happen. Do your best, work hard, and the rest will sort itself out.

11/11/2020

There are 3️⃣ medications that are recommended for your baby 👶 within two hours of birth = 2 intramuscular (IM) shots & eye ointment lovingly referred to as "eyes & thighs":

1) Vitamin K 💉 - Given as an IM injection to prevent vitamin K deficiency bleeding (VKDB) aka: hemorrhagic disease of the newborn. Vit. K is essential for clotting. As adults, it is produced by the bacteria 🦠in our gut & it is then absorbed through our intestines. However, newborns have a sterile gut.This single intramuscular injection is given to baby at delivery to prevent a potentially deadly ☠️ hemorrhage 🩸🩸 while baby develops the microbiome nessesscary to provide them w/ endogenous Vit.K. Single IM injection has shown to prevent VKDB better than oral dosing over 12 weeks.

❗If you skip any of them, my advice is DON'T skip this one.

2) Erythromycin - Is an antibiotic ointment administred into baby's eyes given to prevent gonococcal conjunctivitis (infection of the eye). Neisseria gonorrhoea is a bacteria 🦠 that is easily passed to mother's during in*******se. Maternal infection w/ this bacteria can be silent🤫, meaning mom's can be infected and show no symptoms😦. Vaginal delivery can cause infection in the newborn👶. Erythromycin is given to prevent colonization in eye which can result in corneal ulcerations & ultimately vision loss. This is a safe🦺, cheap💲, and effective preventative measure.

3) Hepatitis B Vaccine (1st in the series) - Given IM w/in 24hrs of delivery. Hepatitis B is a virus that is transmitted through direct-contact with infected blood. Therefore, this infection can be passed from mother to baby during delivery. HepB infection in a newborn can severely impact the already immature liver function & can result in death 😥. Universally recommended regardless of maternal HepB status. It is recommended that babies born to HepB + mother's receive vaccination & HBIG antibodies (preferably w/in 12hrs).

Discuss concerns/questions w/ your doctor. They are there to guide you, but you have the ultimate say. Know the risks & OWN the decisions.

Happy Birthing! 🤗

11/10/2020

The reality is we are all flowers🌷🌸🌹🌺🌻🌼🏵️. Don't allow other's opinions of you determine your worth🥀.