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For those who have been struggling with staying se For those who have been struggling with staying serious about COVID, wearing a mask, limiting gatherings, then this is for you. I’ve seen this trending, and it’s to show awareness of how COVID has affected so many people. 
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I’ve talked to lots of my coworkers, and we can all agree that it’s hard for people to believe in something unless they have been affected by it. The goal of this post is to visually represent everyone that has been affected by this virus.
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Post the hearts that relate to you:
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❤️ Lost a loved one or friend to COVID.
🧡 Know someone who has lost a loved one or friend to COVID. 
💛 Have taken care of a patient with COVID.
💚 Have personally suffered from COVID. 
💙 Have a loved one or friend who has suffered from COVID.
💜 Have been an essential worker on the frontlines of this pandemic.
🤍 Have had a loved one, friend, or personally lost a job due to COVID. 
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Here’s mine: 🧡💛💙💜🤍
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What’s yours? Comment below and share, or repost to see how your followers have been impacted too. 💕
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#frontliners #frontliners #nurseonduty #crnaschool #srna #srnalife #anesthesiaschool #nurseanesthesia #nursingschoolprobs #wearfigs #awesomehumans #frontlineheroes #frontlines #frontlineworker #essentialworker #covidicu #nursesofig #nursesareheroes
Santa Klogs are comin’ to town 🎅🏼 Comment Santa Klogs are comin’ to town 🎅🏼

Comment if you’re working > 8 hours/day?

> 3 shifts a week?

> You’ve developed back problems from working bedside?

Haven’t worn Klogs in a few years and definitely forgot how comfortable they are. Perfect for these COVID days - wipeable, anti-microbial, non-slip. These shoes are great for all of you awesome healthcare providers working long hours and need the extra arch support for better posture. @zappos offers 365-day returns on these shoes and tons of other styles too 👟👠👢

Check out my latest blog post for the full review!

#sponsored #zappos #zapposxklogs #klogsfootwear #walkwithus @zappos @klogsfootwear
💙🚨CODE BLUE 🚨💙
Do you remember your H’s & T’s?

🚨A PEA Arrest stands for Pulseless Electrical Activity. If the patient is on a monitor, you can see electrical activity on their EKG. But, if you feel for a pulse they’re pulseless. This can sometimes last a couple of minutes before they flatline. 

🚨This is really important to catch early. If I know my patient is circling the drain and I’m expecting a code... my fingers are feeling for a pulse nonstop, even if I see a normal EKG on the monitor. You want to catch them in cardiac arrest ASAP for the best outcome, and start compressions the second you lose a pulse, not wait for the monitor to show you. 

🚨Even if you’re not in the ICU with a monitor, if your patient codes it is still so important to run through possible causes of the code. These are your H’s & T’s!

🚨Codes are chaos, we all know this. It’s so easy to let the adrenaline kick in and be the first to grab the meds or start compressions. OBVI this is important but don’t get too caught up in the process that you forget to assess what caused the code in the first place. You can do compressions on an acidotic patient all night long, and they’re not gonna come back unless you treat the cause of that acidosis (push an amp of bicarb, treat the K etc). 

🚨It’s extremely important for the code team to communicate. Be the one to shout out possible causes and run through them with others. All of the interventions listed in this diagram can be life saving ✨

#acls #codeblue #icunursing #futurecrna #nursingeducation #criticalcarenurse #nursingschoolprobs #srnalife #srnaproblems #srnatocrna
HOW TO REMEMBER DRUG CLASSES BY SUFFIX 💊 ⠀⠀ HOW TO REMEMBER DRUG CLASSES BY SUFFIX 💊
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🩸Anticoagulant: -arin
ex. heparin, warfarin
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🤧Antihistamine: -ine
ex. diphenhydramine (Benadryl), loratadine (Claritin)
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🤢Antiemetic: -azine
ex. promethazine (Phenergan)
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💥Antiulcer: -tidine
ex. famotidine (Pepcid), ranitidine (Zantac)
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✖️Proton Pump Inhibitors (✖️gastric acid): -prazole
ex. lansoprozole (Prevacid), omeprazole (Prilosec)
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🦠Antiviral: -vir
ex. acyclovir
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🧫 Antibiotics:
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Aminoglycoside: -mycin
ex. vancomycin
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Fluoroquinolones: -floxaxin
ex. ciprofloxacin
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Tetracyclines: -cycline
ex. doxycycline, tetracycline
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😞Antidepressants/Anti-anxiety
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Tricyclic: -triptyline
ex. amitiptyline (Elavil)
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SSRIs: -pram/-ine
ex. citalopram (Celexa), ecitalopram (Lexapro)
 fluoxetine (Prozac), sertraline (Zoloft)
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🗃 SAVE for reference & SHARE with your friends!
Feeling very thankful this year. 🦃 ⁣ I am tha Feeling very thankful this year. 🦃
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I am thankful for all of you here. Not only for following along my crazy journey, but for all you have done this year on the frontlines. We couldn’t have gotten through this year without eachother. Through the literal sweat, blood, and so many tears that were shed from COVID-19. 
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We needed eachother this year, and I am so grateful:
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For the people who physically worked together to manually prone so many
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For the respiratory therapists working tirelessly, changing vent settings and pulling ABGs nonstop.
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For the doctors who kept up on the evolution of an ever-changing virus, to make sure care was the most up to date.
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For the students who had to keep so mentally strong to adapt to a different way of learning, and still so eager so they too, can be on the frontlines 
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For those of you who had to hold the phone bedside, as family members said goodbye to their loved one for the last time over FaceTime. 
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And then having to go home and still be a support to your families. 
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Like everyone has said, this Thanksgiving is in fact different. While lots of us get to be incredibly thankful to be alive and celebrate our blessings, there are a lot of you wondering why a loved one has been taken from you this year, and this thanksgiving is really hard. 
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If you have lost someone special this year, drop their name below, so everyone who sees this post can pause and send you lots of positive energy for your difficult holiday 💘
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I wish you all a very happy Thanksgiving. Be safe, and keep on smiling the best you can 😌🍁
HOW TO BE THAT NURSE THAT EVERYONE WANTS REPORT FR HOW TO BE THAT NURSE THAT EVERYONE WANTS REPORT FROM 📋🩺👩🏻‍⚕️
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• Be PREPARED. Don’t be that nurse that’s scrambling in a panic when you see the next shift walking in - because YOU didn’t have time management. Obvi this is putting those crazy shifts aside, but if it’s a typical patient assignment, get your shift together (see what I did there 😜).
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•Your rooms better be spotless & ready for the next nurse. This includes:
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•Grabbing supplies for the day/nightshift nurse and put them in the room. 
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•If there’s a foley empty it, chart it right at end of your shift. While you’re giving report it will start on the hour, & you can tell them whatever’s in there now is theirs to chart for this hour. 
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•Making sure their medications are available. If needing to come from pharmacy, that can take time to request & receive.
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•If they’re on a critical drip (pressors, etc) have a backup bag in the room ready to hang. You’re about to get a major eye roll if the nurse you’re giving report to walks in to start their shift, the pressor bag runs dry, patient gets hypotensive, & there’s no backup bag in the room. Just, no. 
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•If they’re on sedation and you see it running low before report, grab the extra bottle of propofol etc. Again, eye roll comin’ for ya if you’re giving report and your patient starts waking up. You interrupt report to go in the room and up your sedation. Then your sedation runs dry, so you have to go get a new bottle/syringe, double-nurse verify it like no.
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• Wiping down the counters, clean up clutter. If there’s patient-specific hygiene products in there, go grab a wash basin & organize it all in one spot. If there’s wound dressing supplies stocked in there, again, put it in a separate basin. I can’t stand lined up clutter. 
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What do you guys do to prepare your room? I ran out of space 😅
WHAT SHOULD BE HELD FOR SURGERY? 😷 ⠀⠀⠀⠀ WHAT SHOULD BE HELD FOR SURGERY? 😷
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🩸Anticoagulants
-Plavix & Coumadin d/c 5-7 days before
-Low molecular weight heparin 💉 d/c 12 hrs before
-IV heparin d/c 6 hours before
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🧄 3 G’s
-Garlic, Ginkgo, & Ginseng ⬆️ bleeding risk. D/c a week before
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🍬 Oral hypoglycemics
-All you need is a long-acting hypoglycemic to cause life-threatening hypoglycemia in the OR, which can go unrecognized under anesthesia. These patients will be managed via insulin drip to be more carefully titrated & blood sugars checked every hour. 
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💧Diuretics 
-The patient will have already been NPO for some time, we don’t want to make them even more dehydrated for possible hemodynamic instability.
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DO NOT HOLD:
🫀 Beta Blockers
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-You’re probably thinking well, I wouldn’t want to give a BB before surgery, & drop their HR/BP. But for patients on a daily BB, it is especially important for them to take their medication to prevent possible MI or even acute heart failure in the OR. Why? 
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Their body’s beta receptors are “up-regulated.” 
AKA: their body is “used to” the drug being in their system regularly. When this happens longer term, their receptors are not as... receptive? 😉 This is the reason why people have to “up their dose” when they’ve been on the same med for awhile. So if you were to abruptly stop a beta blocker.. you wouldn’t be blocking those sympathetic beta receptors. You could have a HUGE “fight or flight” response. 👎🏼 That, combined with painful surgery and a tube in your throat, puts the pt at extreme risk for heart attack. These patients were already susceptible to MI at baseline...that’s why they were on a beta blocker 😬
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💊 Patients on opioids should continue to take them. By holding them for chronic users, think about how much harder pain mgmt will be post-op. ☹️
A simple explanation of the mechanics of breathing A simple explanation of the mechanics of breathing 🌬
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In a healthy person, our drive to breathe is based off of the amount of carbon dioxide in our blood. We have these lil things called chemoreceptors that sit in the carotid artery. 
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These chemoreceptors are basically takin’ ABGs nonstop, and constantly taking those samples of blood to titrate breathing to effect. 🩸
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An increase in carbon dioxide is sensed by the chemoreceptors, and they tell the body to take a breath. Remember that taking a breath in means exhaling a breath out. That breath out is exhaling the Co2 that came from gas exchange at the alveoli (swappin’ oxygen from the air for the “waste” in our body) that was building up. 🗑
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But why is Co2 “waste” and where does that even come from? Obvi we need oxygen to live but why is that? The body uses the oxygen we breathe in to actually break down the sugar(carbs) we eat. 🍞 Say whaaaat? Ya. Breaking down that sugar = energy that we need to basically exist. So. When that sugar is broken down by oxygen, Co2 is produced. 
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High levels of this waste product leads to a million different problems as you know. Some side effects include respiratory acidosis, tachycardia, dizziness, seizures, and loss of consciousness ☠️
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Phew! Now take a deep breath and let me know if this was helpful! 😃
I was told by my clinical instructor that I wouldn I was told by my clinical instructor that I wouldn’t make it in the ICU as a new grad. 

I ended up getting hired before I graduated. I was one of 3, out of over 800 applicants. 

When I was applying to take the NCLEX, my ATT (approval to test) date was delayed due to my school submitting it late. I had landed my dream job, and I couldn’t start if I didn’t get my license in time. I emailed the assistant dean asking if there was anything I could do. She replied with, “maybe this job wasn’t meant for you.” 

Her and I had been bumping heads since I began the program. She didn’t like me. I challenged her, and I stood up to her when everyone else was too afraid to. My nursing program was one of a punitive environment - my teachers had their years of experience. Now it was our turn to be mentally broken down like they were as a new nurse. It was a breeding ground for future nurse bullies - I opposed it, and I opposed her. 

So I ended up being able to test in time (no help from her btw), I passed, and began my new grad ICU job. 

Years later, on the same unit, I saw her visiting her mom who had just had surgery. She saw me standing in the hallway. And I smiled at her, said nothing, and I walked away. 

Don’t EVER let anyone tell you that you can’t.
Never realized how Italian I was until someone rec Never realized how Italian I was until someone recorded my hand gestures 😂 teach with enthusiasm right? 🤓🇮🇹
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Sassy Anesthesia

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Nursing

My First Code Blue

March 26, 2018March 26, 2018

Code Blue. The two most anxiety-provoking words to any nurse. When you’re a new nurse, the thought of your patient coding is always a lingering fear. When’s it going to happen to me..? Will I freeze? What if they don’t make it?

If you think your patient is headed towards a Code Blue, keep investigating. The take-home is, YOU know your patient best. Trust your instincts FIRST, and then take other’s opinions second in regards to your patient. I learned this very well after my first code blue, which goes as follows.

It was 4 months after I got off orientation. Brand new little me struggling to stay afloat in the ICU. I don’t remember exactly what my patient was in for since this was years ago, but I believe he had gone for possible stent placement that day. He was an older guy, and they weren’t able to stent him. They compared his coronaries to concrete. He was stable when I came on, and I’m doing my little assessment while the family was in the room talking.

I overheard them saying how they didn’t believe the doctors when they said he was doing okay. The family knew something was wrong. To me, the patient appeared stable. Vitals in check, good mobility and strength, and was talking with his family. Alert. I told the family he was doing well (regret number one), and that he may just need some blood pressure medicine if his blood pressure were to drop.

The family left and as I expected, his blood pressure did drop. I called the doctor and we started levo. Problem solved.

Around midnight, he started complaining of pain. He didn’t speak english, but was pointing to his chest. I had someone translate and ask him if he was having chest pain. He shook his head yes. Okay crap that’s not good. But we have emergency standing orders so I’m good right? I know this. He needs a stat EKG and my girl MONA. But as a new grad, I went to talk to my resource nurse first about my plan.

She asked me why I would want to order an EKG. Um, what? “He’s complaining of chest pain…”

“Well what does he rate his pain 0-10?”

“Uh, i didn’t ask that, he doesn’t speak any English.”

I mean come on… he’s complaining of chest pain… whether the guys a pansy or Iron Man, if someone mentions chest pain it’s a concern. But being new, I went with her opinion that he didn’t need one at that moment. Regret number two.

Now it’s around 0530, my shift is almost over. The dude’s been okay throughout the night. Then he gets his morning X-Ray and one lung is completely whited out. Uh. So I call the doctor right away to let him know. He’s says he’s on his way into work and he’ll see the patient first. Then my patient starts getting kinda sweaty and restless (hello hypoxia). This guy does not look good. He had wiggled his way down in the bed so I asked another nurse to help me boost. The nurse was like, “they don’t look good.” I said “I know.” This was another missed opportunity for a nurse to intervene.

It’s past six, and I’m getting really nervous at this point. This guy might code. Ok what do I do. I check where the code pedal is on the bed. Got it. I ask him again if he’s having chest pain and he says yes. The dayshift nurse has arrived. At this point I’m done, I order the stat EKG myself and go to grab morphine. I tell the oncoming nurse that this guy is gonna code. I’m pretty sure that’s what this looks like at this point. I see the resource nurse on her way out. I looked at her and was like, “my patient’s tanking!” She said, “does this mean I have to stay and help you?” Uh YEAH. I have no idea what I’m doing. I had never felt so helpless. Why is no one doing anything?

I go to grab the morphine. While I’m in the med room I hear the code bell go off. Oh God it’s happening. The dayshift nurse comes running in my direction to the supply room, “there’s no ambu bag in the room!” Nice Marissa. I’ll never forget to check for that at the beginning of my shift ever again. Regret number three.

I run into the room and somehow I knew where I needed to be. I had practiced this. I became the med nurse in the code and things were going well for me. The code lasted and lasted. All I could think during was I’ve been trying to tell people, I tried. Should I have done more? I don’t even know what’s happening. Why did this happen again?

We call it. My patient was gone. The crowd of people in the room disappear as fast as they had arrived. And now I have to go give report on my other patient. The doctor who was on his way in shows up.

Just like that everything’s back to normal. This is so weird. I start giving report on my other patient. In the corner of my eye I see the family walking down the hall. Oh my god I told them he was going to be okay. They see the post-code mess and the patient lifeless in the bed and start shrieking. “What happened to him?!” I can’t find words. Another nurse steps in and puts her arm around the woman and says, “I’m so sorry… he just passed.” She throws the nurse’s hand off of her and the entire family goes into the room and starts wailing. I continue finishing my report.

At the end of report I went in to talk with the family. I felt terrible. There were so many of them crying and yelling. The grandson was like, pounding the countertop in frustration. People are asking me to control the noise. I went in and told them that this had literally just happened, and I was so sorry. They kept saying they knew something was wrong. I guess I did too.

What I learned

I kept replaying the night over and over again and thought about what I could have done differently. At the end of the day, they already said his coronaries were shit and he didn’t really have any other options. So eventually this guy would have died anyways. However, I believe there were a lot of opportunities for myself and others to intervene before it got to a code situation.

  1. I should have gotten the midnight EKG. If there were issues then I would have called and medication could have been given at that time.
  2. At that early point in my career, I felt like I had done everything in my power. I had gone to the resource nurse for guidance, I had called the doctors throughout the shift. Everyone was aware of what was going on. So I felt good about that.
  3. The nurse helping me boost could have stopped and talked through things with me. Experienced nurses should always investigate a situation like that, and help when necessary. It was the end of the shift, and it was crunch time. Gotta make sure canisters are changed and blankets are tucked for dayshift.
  4. Lastly, I learned to ALWAYS trust your instincts. I knew something was wrong all night and I was right about wanting the midnight EKG and medication. Today, I would have laughed when they said no to the EKG and ordered it anyways. But being new, it really is hard to stick up for yourself when someone with thirty years of experience is telling you what to do. Experience does not equal knowledge. Remember this.

Since that day, I have always been confident in regards to how I feel about my patients. Nurses get vibes you know? Trust them always. It’s better to be over-paranoid than too chill about critical situations. Be proactive and don’t second-guess yourself.

Codes get easier with experience. Get involved when you can, observe people’s roles, and debrief post-code. A code blue is only part of the end of life struggle we all see as ICU nurses. Stay tuned for a future post on how to deal with code status discussions and death/dying as a nurse.

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4 Comments on My First Code Blue

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4 comments on “My First Code Blue”

  1. Nalu
    June 11, 2018 at 11:52 am

    I stumbled on your IG account and blog. This post was truly riveting. You are right about getting vibes about patients – I always get a feeling when something’s off and I can’t put my finger on what it is. However, that resource nurse did let you down and you did what you could at the time. Thanks for sharing!

    Reply
  2. Taylor Thompson
    May 23, 2018 at 4:13 am

    Hi! I just found your Instagram and blog through another nursing Instagram account. I was reading through your posts and was sad to see there were only 3 pages! I learned so much from your code blue post and the Being new in the icu. I worked as a nurse intern in a Neuro icu and now will be starting orientation as an RN very soon. Please keep writing! I also love your travel posts and I think it’s amazing you don’t let anything hold you back from travel even if you have to work 8 nights in a row! You’re awesome girl, xoxo – Taylor

    Reply
    • lipstickandlifesaving
      May 23, 2018 at 10:32 am

      Aw thank you so much for reading! Posts like this keep me going! Thank you so much 🙂

      Reply
      • Katrina
        July 13, 2018 at 2:05 pm

        I second what Taylor said! I just read the majority of your posts on nursing and found them so helpful and encouraging. I did my preceptorship in the ICU and just graduated and passed NCLEX. I’m beginning my job search and reading your posts helped me identify that it’s okay at this early part of my career to go after a position in the ICU. I was thinking, “Who am I, I can’t just go straight to ICU as a new nurse”, but I was hooked from the moment I stepped foot in there. Do I think it will be easy? No way. But I’m willing to work my butt off and thank you for your insight! Please keep posting!
        – Katrina

        Reply

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Hi, I'm Marissa.

I'm a first year SRNA. Here you can find some education & motivation, along with a touch of sass to keep you sane in a difficult but rewarding career path. Thank you for stopping by!
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For those who have been struggling with staying se For those who have been struggling with staying serious about COVID, wearing a mask, limiting gatherings, then this is for you. I’ve seen this trending, and it’s to show awareness of how COVID has affected so many people. 
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I’ve talked to lots of my coworkers, and we can all agree that it’s hard for people to believe in something unless they have been affected by it. The goal of this post is to visually represent everyone that has been affected by this virus.
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Post the hearts that relate to you:
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❤️ Lost a loved one or friend to COVID.
🧡 Know someone who has lost a loved one or friend to COVID. 
💛 Have taken care of a patient with COVID.
💚 Have personally suffered from COVID. 
💙 Have a loved one or friend who has suffered from COVID.
💜 Have been an essential worker on the frontlines of this pandemic.
🤍 Have had a loved one, friend, or personally lost a job due to COVID. 
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Here’s mine: 🧡💛💙💜🤍
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What’s yours? Comment below and share, or repost to see how your followers have been impacted too. 💕
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#frontliners #frontliners #nurseonduty #crnaschool #srna #srnalife #anesthesiaschool #nurseanesthesia #nursingschoolprobs #wearfigs #awesomehumans #frontlineheroes #frontlines #frontlineworker #essentialworker #covidicu #nursesofig #nursesareheroes
Santa Klogs are comin’ to town 🎅🏼 Comment Santa Klogs are comin’ to town 🎅🏼

Comment if you’re working > 8 hours/day?

> 3 shifts a week?

> You’ve developed back problems from working bedside?

Haven’t worn Klogs in a few years and definitely forgot how comfortable they are. Perfect for these COVID days - wipeable, anti-microbial, non-slip. These shoes are great for all of you awesome healthcare providers working long hours and need the extra arch support for better posture. @zappos offers 365-day returns on these shoes and tons of other styles too 👟👠👢

Check out my latest blog post for the full review!

#sponsored #zappos #zapposxklogs #klogsfootwear #walkwithus @zappos @klogsfootwear
💙🚨CODE BLUE 🚨💙
Do you remember your H’s & T’s?

🚨A PEA Arrest stands for Pulseless Electrical Activity. If the patient is on a monitor, you can see electrical activity on their EKG. But, if you feel for a pulse they’re pulseless. This can sometimes last a couple of minutes before they flatline. 

🚨This is really important to catch early. If I know my patient is circling the drain and I’m expecting a code... my fingers are feeling for a pulse nonstop, even if I see a normal EKG on the monitor. You want to catch them in cardiac arrest ASAP for the best outcome, and start compressions the second you lose a pulse, not wait for the monitor to show you. 

🚨Even if you’re not in the ICU with a monitor, if your patient codes it is still so important to run through possible causes of the code. These are your H’s & T’s!

🚨Codes are chaos, we all know this. It’s so easy to let the adrenaline kick in and be the first to grab the meds or start compressions. OBVI this is important but don’t get too caught up in the process that you forget to assess what caused the code in the first place. You can do compressions on an acidotic patient all night long, and they’re not gonna come back unless you treat the cause of that acidosis (push an amp of bicarb, treat the K etc). 

🚨It’s extremely important for the code team to communicate. Be the one to shout out possible causes and run through them with others. All of the interventions listed in this diagram can be life saving ✨

#acls #codeblue #icunursing #futurecrna #nursingeducation #criticalcarenurse #nursingschoolprobs #srnalife #srnaproblems #srnatocrna
HOW TO REMEMBER DRUG CLASSES BY SUFFIX 💊 ⠀⠀ HOW TO REMEMBER DRUG CLASSES BY SUFFIX 💊
⠀⠀⠀⠀⠀⠀⠀⠀⠀
🩸Anticoagulant: -arin
ex. heparin, warfarin
⠀⠀⠀⠀⠀⠀⠀⠀⠀
🤧Antihistamine: -ine
ex. diphenhydramine (Benadryl), loratadine (Claritin)
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🤢Antiemetic: -azine
ex. promethazine (Phenergan)
⠀⠀⠀⠀⠀⠀⠀⠀⠀
💥Antiulcer: -tidine
ex. famotidine (Pepcid), ranitidine (Zantac)
⠀⠀⠀⠀⠀⠀⠀⠀⠀
✖️Proton Pump Inhibitors (✖️gastric acid): -prazole
ex. lansoprozole (Prevacid), omeprazole (Prilosec)
⠀⠀⠀⠀⠀⠀⠀⠀⠀
🦠Antiviral: -vir
ex. acyclovir
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🧫 Antibiotics:
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Aminoglycoside: -mycin
ex. vancomycin
⠀⠀⠀⠀⠀⠀⠀⠀⠀
Fluoroquinolones: -floxaxin
ex. ciprofloxacin
⠀⠀⠀⠀⠀⠀⠀⠀⠀
Tetracyclines: -cycline
ex. doxycycline, tetracycline
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😞Antidepressants/Anti-anxiety
⠀⠀⠀⠀⠀⠀⠀⠀⠀
Tricyclic: -triptyline
ex. amitiptyline (Elavil)
⠀⠀⠀⠀⠀⠀⠀⠀⠀
SSRIs: -pram/-ine
ex. citalopram (Celexa), ecitalopram (Lexapro)
 fluoxetine (Prozac), sertraline (Zoloft)
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