Last Friday I happened to take care of a patient who had a very similar to one of my past patient who had been raped in prison for 9 months. Just having to take care of this patient triggered the memories of the patient I called Gamma in my true nursing story in hubpages. The patient I took care of had a long story that could be disturbing and so I advice reader discretion when reading nursing stories.

I will again not mention any names to protect patient privacy as required by the law. I will use the name "Alpha" to refer to this young man, again in mid 20's who had been a victim of gang rape.

As a man it is almost unimaginable how another man can rape you. And to make the matters well understood, Alpha was not rapped because he sexually provoked men potentially attracted to other men. Read more about Alpha's story.

Since puberty, Alpha had other medical conditions that made him frequently visit various hospitals with multiple admits. He had always maintained good grades in school and was a student with big life ahead and an American dream to live.

Alpha comes from a poor neighborhood and as it goes without saying, poverty and crimes goes together. Being a teenager, Alpha was recruited by teenage gang as one of their followers for his protection, not to mention that he was not as strong as the rest of the gang members due to his long history of being ill for a long time. His gang was very protective of him and as usual, gangs frequently engage in fighting and other crimes against other gangs.

One day, another gang that wanted to have control of the area Alpha's gang came from ambushed Alpha and his gang. These two gangs were composed of two different races, of which am not going to mention. As you would expect, Alpha's gang that had peers of his age would easily loose the fight against their opponents who had older and more experienced gang members.

As the fight got concluded with some of gang members shot to death and others seriously injured, weak Alpha was captured and instead of being beaten up, the gang decided to feast on him as their reward for conquering their enemies. The feast was nothing but "a dry rape".

Alpha had no choice but to feel the physical, mental and emotional pain all the way deep in his soul. As you would expect, in a gang of over 30 people in a neighborhood where crimes are high, you would expect at least one of them to have HIV in today's world. Alpha did not only inherit HIV from his rape but also other diseases like herpes and syphilis.

Diseases like AIDS and herpes are frequently linked with malignancies such as rectal cancer that Alpha had. This happens the same ways genital herpes (HPV) in women causes cervical cancer. Aids is also linked to some malignancies like Karposis's sarcoma. Alpha's rectal cancer has now metastized to the brain making him to get as many as 20 seizures in ah hour when he is not compliant with his seizure medications. Seizures by7 themselves can be scary even to medical professionals and can sometimes be incapacitating.

But for sure, Alpha could probably have avoided being gang raped by choosing the right people to hang out with. On the other hand, it appears like a total bad luck that this happened to him. There is no telling when bad things like those could happen to you and what you life might turn out to be.

See also "Gamma's" story on hubpages

I hope you enjoyed my story. Please pass on this to your friends. You do not have authority to copy or republish this article.

GREG

How To Get a Baby Boy!

How to get a baby boy

Lot of people all over the world wishes there could be a way to choose the gender of their unborn child naturally without going through artificial expensive procedures. It sound like a crazy wish to be able to choose the gender of your unborn child but it is a compelling factor to balance the family. So why am I talking about how to get a baby boy?

I happened to see one of my former co-worker on the streets and was happy for her that she was pregnant again. I asked her how excited she was at 7 months pregnant but I was surprised to hear her answer. She told me... "I am worried and afraid to go for a sonogram only to hear it another girl". I had to be sensitive to her feelings and careful at the same time bearing in mind that others would die to have any baby. To cut the whole long story short, I decided to write this article so that anyone out there can read it and maybe get closer to having a baby gender of their choosing... but this is going to talk about how to get a baby boy. I will in future tell you how to get a baby girl.

I MUST MENTION THOUGH THAT THIS IS NOT MEDICALLY PROVEN WAY OF DETERMINING THE GENDER OF YOUR UNBORN CHILD AND YOU SHOULD ALWAYS ASK YOUR DOCTOR ABOUT ANY MEDICALLY RELATED THEORY YOU WANT TO PUT IN PRACTICE. THIS ARTICLE IS ONLY FOR INFORMATION PURPOSES ONLY ON SCIENTIFIC THEORIES THAT IF PUT TOGETHER CAN BETTER THE CHANCES OF GETTING THE BABY GENDER OF YOUR CHOICE.

With that out of the way, let's go through some very basic scientific facts. They may not be very basic to everyone but anyone with college education with some classes in biology, anatomy and physiology will see these facts as basic and true. Since to give the whole information about how to conceive a baby gender of your choosing would take me writing a whole book, I will only list the important determinants of conception and gender determinants in human body. I will give you a good resource that you can read and it puts together all these facts for you in a language you can understand. By the way, we are expecting a baby girl in two months just like we had planned. Our best friends got a boy and a girl in the order they wanted following these scientific facts but in natural way. Here are the facts that you need to know and then work things out to favor a baby boy. I am only going to talk about a baby boy because if I mix the two, people with limited attention span and those not from scientific background might get completely lost.

1. A sperm is the male egg. It contains either "Y" or "X" chromosome
2. "Y" chromosome is for a baby boy (I will only talk about getting a baby boy)
3. Sperms with chromosome Y for a baby boy have a long tail than "X".
4. Long tail means that they can swim faster than X for a baby girl.
5. Sperms for a baby boy dies very fast especially if exposed to vaginal acidity.
6. Even without being exposed to vaginal acidity, sperms for a baby boy live for about 12-24 hours.
7. They are normally produces three times more than that of a girl.
8. The vaginal fluid is acidic.
9. The uterus and the rest of the female reproductive system have alkaline PH which is favorable for sperm survival
10. Ovulation occurs 14 days before the first day of the cycle regardless your cycle pattern.
11. Timing the ovulation is important part of this process
12. The female ova survives for only about 24 hours after ovulation
13. Fertilization occurs in fallopian tubes.
14. The amount of sperms per ejaculation is directly proportional to the volume.
15. The number of healthy sperms capable for fertilization is directly proportional to the volume, but some people have unviable sperms, don't get me wrong on this. This is just for people without capability of fertilizing an egg and result to a baby.
16. To make it easier for these weak sperms to swim, vaginal mucous must be of the right thickness and quality.
17. A long foreplay is encouraged when trying to get a baby boy
18. It is advisable for the woman to have an orgasm before the male orgasm or at the same time. Orgasmic contractions push fluids from cervical area (alkaline) making it to mix with acidic vaginal fluid. So when you are trying to have a baby boy, enjoy good sex
19. A deep penetration and ejaculation as close to the cervix is advised
20. The final point is: timing is everything here. You must time the right time to have sex and get it right and do it right. Without any techniques involved, you have 50% chance of getting either gender but with the right technique, this can boost your chances even higher. I have no statistic but it can raise your chances significantly.

Here is a good book called "pick the gender of your baby". I think you should read it over and over again and get every word well understood! I recommend that book because I have read it and I approve it.

Here is what you need to do to get a baby boy. It is not a guarantee but you will increase your chances to a new high level.

1. Have sex only on the day of ovulation and especially, few hours after ovulation. This is because the baby boy sperm can only live for about 12 hours-24hours. But since they swim faster, they will get to the egg first and... there you have it!
2. The man should avoid any ejaculation for at least one week saving it for this day. You need large spern volume to conceive a baby boy. This increases the chances and probability of a baby boy conception.
3. Have a good foreplay and make sure to have both male and female orgasm. The female orgasm is recommended first. This will make the vaginal PH neutral. Remember acid + alkaline = Neutral
4. During male ejaculation, the man should go as deep as possible. Remember the sperms for a baby boy swim faster. You just made their journey shorter to fallopian tubes. You also saved them from swimming in a lot of acidic vagina by putting them close to the cervix.
5. Pray to God and thank God for any baby He might give you because a baby is a blessing. I will be willing to answer your questions or hear from you if you leave a comment on this post

This article cannot be copied on another website, sold or republished. If you would like to tell a friend about this article, just send them a link via email.

Enjoy:

GREG

Gastro-Esophageal Reflux Disease  (GERD) Case

          I know it has been a while since I last posted an ICU case but today I have an exciting one about GERD. I am sure most of you already know what Gastro Esophageal Reflux Disease is or at least have heard the word FERD. Gastro-Esophageal Reflux Disease is a very common disease that affects people of all ages and commonly known as heart burn. When you talk about heartburn though, you should be aware that it is not all heartburns can be called GERD.

          As usual, I never give any personal identifying information to keep privacy in observance of HIPPA laws. This case about Gastro-Esophageal Reflux Disease is about a young male in 40's who was admitted in ICU in critical condition.

The patient went to seek medical help after he couldn't swallow anything including his own saliva due to pain. On arrival to ER, he had very low hematocrit and appeared malnourished.

His heart rate was in130's and 140's and his blood pressure was very low with systolic blood pressure of 70's and 80's. These are critical findings on admission that made the patient to be automatically admitted to ICU. Immediately he arrived in the ICU, the GI-Team came and did an endoscopy on him only to find that his esophagus had eroded so much to a point of having perforations. There was no way to repair such a damaged tissue other than to remove it.

In Gastro-Esophageal Reflux Disease, the acid produced in the stomach regurgitates through the esophagus and can be felt as a burning sensation with belching. Sometimes it may be happening when a patient is lying down especially at night sleeping and so may not be noticed immediately until some significant changes have occurred.

This patient had to be taken to operating room for a long urgent surgery to repair his torn esophagus. Can you imagine acid so potent that it can erode your esophagus to a point of getting perforations? In surgery, the surgeons took out his esophagus all the way down to the stomach. Then, they cut a part of his small intestine called Jejunum and improvised it to become his new esophagus. This was a long procedure that took hours by a team of 3 surgeons.

So I took care of this patient for 2 days and it has been in a while since I saw someone in so much pain that even on dilaudid epidural pump, the guy was still in pain.

You will notice that I am changing the style of my nursing stories. I am changing it such that anyone reading this blog post can benefit from it whether you are a nurse like me or you are a consumer, someone who might be a looking for information about the topic am blogging about.

So what causes Gastro-Esophageal Reflux Disease?

GERD is mostly caused by foods we eat and lifestyle and we have a lot in our hands that we can control to avoid GERD.

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

1.      Coffee alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Be careful the way you take your vitamins. Taking these before bedtime especially can cause evening reflux.

2.      Antacids based on calcium carbonate (but not aluminum hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.

3.      Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.

4.      Eating within 2-3 hours before bedtime.

5.      Large meals. Having more but smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.

6.      Carbonated soft drinks with or without sugar.

7.      Chocolate and peppermint.

8.      Acidic foods, such as oranges and tomatoes.

9.      Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.

10.  Milk and milk-based products containing calcium and fat, within 2 hours of bedtime. Now this sounds tricky as you may have heard that milk actually help curb GERD. NO, Milk only makes you feel relieved as you swallow it down soothing your esophagus. Milk also causes a lot of thick mucous secretion (take warm glass of milk and try to spit. You will see how much thick mucous you gotJ)

Now that you know what may cause GERD, what are you going to do about it? Do you think you might be doing something that might put you at a risk of having GERD? Or do you actually have GERD but not aware of it?

¨       If you sometimes feel like there is something in your throat that you can't swallow, you may be having Gastro-Esophageal Reflux Disease.

¨       If you sometimes get horse in your voice especially in the mornings, you may have Gastro-Esophageal Reflux Disease

¨       If your baby/children are having tooth decay that is linear or has a pattern, they may be having Gastro-Esophageal Reflux Disease.

¨       If you sometimes feel hot sour tasting regurgitation in your mouth, you may be having Gastro-Esophageal Reflux Disease.

¨       You need to see your doctor.

This blog post is written by Gregory R.N and cannot be copied for selling purposes, you may not copy this post or part of it in any website without consent. You may refer other people to this post by sending them the URL to this article.

There are several ugly things that once you see them, you pray to never see anything like it ever. Some things are so "disturbing" to look at that you might find yourself having nightmares about them. Recently, I happened to take care of a patient who had herpes related to HIV disease. This patient had extensive herpes blisters that were covering all his genitals and perianal area.

A lot of people have herpes type one and this does not show up until your body is under enough stress and pressure. Example is when one is exposed to extreme cold for long periods of time and may form herpes blisters on the lips. This is an indication of body stress either physically, or psychologically. It is scientifically known as herpes febrilis.

Genital herpes on the other side is a disease caused by herpes simplex virus 2. (HSV2). Presence of herpes blisters indicates that one is contagious and contact with fluid from those herpes blisters would result to a herpes infection.

This patient was full blown AIDS with a CD-4 count of <10. That means that his immunity was so compromised that he had almost no immunity to anything. He has herpes blisters that resembled broccolis only that they were pink and not green as broccolis.

Now that his body had almost zero defense, he had all sorts of opportunistic infections but herpes was took a toll on him because he could not excrete his bowels or urine without suffering severe pain. From his confession, he stated that he has been a "generous gay person" and admitted prostituting in clubs and truck rest areas on interstates.

Herpes does not have a cure but can be prevented by using condoms and avoiding indiscriminate sex. When herpes virus is dormant, it resides inside the mitochondria or nerve ganglia. A person may have herpes and not show any physical signs. Genital herpes is contagious during an outbreak and blisters are present. Sometimes these blisters might be tiny and may not be seen especially if they are inside the vagina or on vaginal labia.

Expectant mothers with history of labia should report this to their doctors and should not be let to have a natural delivery as long as they are having active herpes of their genitals have blisters. In this situation a caesarian section must be performed to save the baby from getting infected. Newborns infected with genital herpes usually die within a few weeks to months.

Herpes febrilis found on the mouth lips can be transferred to the genitals through oral sex and become genital herpes. Avoid indiscriminate oral sex and it can be equally dangerous as natural intimacy.

If you think that you might be having herpes, see your doctor immediately. You should not have any sexual encounter if you suspect that you are having a genital herpes outbreak.

Yours GREG R.N.

How to conceive a baby girl

Millions of parents from all over the world wishes they had a chance to control the gender of their baby before conception in order to balance their families. Millions more have conceived baby genders they never wanted and continue to live with a wish for a baby girl.

While any baby you conceive should be considered as a blessing and you should thank God, at least you can conceive something, having an extra edge in determining the sex of your baby is an added advantage to have a happy balanced family.

A few weeks ago, I wrote an article on how to conceive a bay boy and it got a buzz all over the Internet that many more people wanted to know how to get a baby girl. Today, here I am again giving you tips on how to get a baby girl. Since I already gave the scientific basics on my previous article on how to get a baby boy, I will not go into details about body physiology and anatomy. I will also not repeat the sperm physiology and biochemistry in relationship to body environment.

I MUST MENTION THOUGH THAT THIS IS NOT MEDICALLY PROVEN WAY OF DETERMINING THE GENDER OF YOUR UNBORN CHILD AND YOU SHOULD ALWAYS ASK YOUR DOCTOR ABOUT ANY MEDICALLY RELATED THEORY YOU WANT TO PUT IN PRACTICE. THIS ARTICLE IS ONLY FOR INFORMATION PURPOSES ONLY ON SCIENTIFIC THEORIES THAT IF PUT TOGETHER CAN BETTER THE CHANCES OF GETTING THE BABY GENDER OF YOUR CHOICE.

Here is how to increase the chances of getting a baby girl. Just remember that you have about 50% chances of getting a baby of any gender. These points are only a few that you should know and adhere to. For complete details about how to conceive a bay girl or a baby boy, I recommend you read, "Pick the gender of your baby ebook" by Ashley Spencer. Here are the highlightsJ.

1. Baby girl sperms have a X chromosome. For a baby boy, the sperm has a chromosome Y. The mothers always have a chromosome X and so mother's egg does not determine the sex/gender of the unborn baby. The father's sperm is the determining factor in the gender of unborn baby. The chromosomes forming a baby girl are XX.
2. The sperm Y swims slower and has a thick cell membrane that can survive longer in vaginal acidity. It can live up to 72 hours in the woman body, centrally to X sperm for the boy that can only live up to 24 hours on the higher side.
3. Enjoy sex every day from the first day of your cycle to the 12^th day. This is assuming that the ovulation will happen on 14^th day. Sex every day lowers the sperm count and since for every 1 Y sperm are 3X sperms, this decreases the number of boys in the sperms. If sex is stopped on 12^th day, by the time ovulation occurs, all the boys' sperms will have died, and the girls' sperms will be alive.
4. Discourage female orgasm when trying for a baby girl. This prevents alkaline fluid from the cervix from flowing into the vagina, neutralizing the vaginal acidic environment. You want the baby boy sperms exposed to this acidity and die, leaving only girls' sperm alive.
5. Ejaculate shallowly so as to give the sperms a longer time before reaching the alkaline environment from the cervix all the way up.
6. Do not resume sex until 18^th day of the cycle to lower the chances of introducing new healthy boy sperms, incase of late ovulation.
7. You must pinpoint your ovulation day. This is NOT an option. It is a MUST know and be as accurate as possible.
8. Avoid douching to change the vaginal acidity as some books may suggest. Douching has been associated with serious infections that may lead to infertility of huge medical expenses.
9. This method will increase your probability of conceiving a baby girl up to 85%, based o natural probability of 50-50% chances.
10. Always pray God as the creator and the provider of our lives. Be happy about any baby you conceive. Millions cry day and night wishing they could conceive any baby gender.

This guide only gives you highlights but does not give refined details on exact points. Knowledge is human best weapon. I recommend you read, "Pick the gender of your baby book" that explains many more things you should know when choosing the gender of your baby.

Cancer story. Nursing story about cancer fatality to a young expectant mother.

WARNING:

This story can be disturbing and emotionally traumatic. I recommend you stop reading it if you cannot handle painful truth that hurts, even if you do not know the patient. This case happened in an intensive care unit. I happened to take care side by side with the primary nurse who took care of this 20 years old expectant mother. Reader discretion advised.

SYNOPSIS

This young mother had a history of malignant lymphoma and underwent successful treatment. She was visiting cancer specialists often and all scans and blood test showed she had no cancer. She was in cancer remissions for over 3 years and never took anything for granted. Here is the story.

The shift started as usual and assignments allocated by intensive care unit charge nurse. We all took assignments and one nurse was assigned to this 20 years old expectant mother. The fact that she was expectant, young and medically needy made her to be of higher acuity. This warranted 100% attention from top qualified registered nurse.

The 20 years old had been in cancer remission for over three years. She underwent serious testing before she became pregnant. Gynecologists and cancer specialists closely monitored her pregnancy every month. Her scan 2 months before she was admitted in ICU was clear and she was cancer free.

Few weeks after her previous negative scan, she started to develop a cough, and something that she assumed was normal. After all, who doesn't develop a cough no and then, especially when pregnant? The cough persisted and this time, she started developing shortness of breath. She immediately called her gynecologist who advised her to go to emergency room immediately. The gynecologist followed up with her in the emergency room and a scan showed an egg size lymph node tumor in her chest area.

Radiological scans like x-rays are not recommended for pregnant mothers but when the mother life is on the line, it is better to take the risk than not at all. The severity of breathing difficulty was getting worse by the hour. She was taken for CT scan that revealed multiple lymph nodes swellings, including 2 more golf ball size around the neck region. These two had the potential to obstruct the airway, something that could make it a deadly medical emergency.

She was admitted to intensive care unit and after series of top qualified physicians and gynecologist, they decided to start her on radiation therapy the following day. These tumors were inoperable because her platelets level was critically low. She was admitted in ICU to receive intravenous platelets and stabilize her electrolytes levels in order to start radiation therapy and emergency surgery if needed.

All consent had been signed and it was just a matter of few hours before she could begin aggressive cancer treatment, this time, to save her life.

It is a common practice in intensive care unit to secure the airway by intubation to patient with poor oxygenation and those with a potential of losing their airway. Her case was one of those that required intubation. Several attempts to intubate her were unsuccessful because these cancer tumors were blocking the airway. However, she still could keep her oxygen saturation at 100% on 40% oxygen.

In ICU, the emergency anesthesia team was paged STAT to re-attempt the intubation as it was becoming harder by the minute for her to maintain oxygen saturation above 92%. This time, she was on 100% non-rebreather mask and still could not maintain good oxygen saturation. Her family was by bedside holding her hands as bags of platelets infused to bring up her platelet level. Without normal platelet levels, any attempt to operate could have made her to bleed to death.

When attempting to intubate, doctors discovered something even more serious. Those tumors had a pulse of their own, making them even harder to operate especially to a patient with low platelets level.

There was no way to save the 26 weeks baby in her uterus with platelet levels <2,000. Her urine was pink, indicating spontaneous bleeding from her bladder and urethra. Her eyes were bleeding despite how fast platelets were transfused. Her cancer was growing by the minute.

She started gasping for the air, only a few hours after being admitted in the ICU. Every hospital in the state she had ever gone had recommended she go to a level #1 cancer and trauma hospital. She was in the right place for this condition.

2200: Oxygen saturation was in high 80's, already lower than what is required to maintain acidity and alkalinity balance of the blood. An emergency meeting was held between the surgery, medical, oncology and gynecology teams. They came up with no answers.

2100: Breaking news: There is nothing medically possible that can be done at this time to save her life. The neck region tumors were swelling by the minute. That explained why it was becoming harder and harder for her to breathe by the minute.

2200: The fetal heart rate this time was becoming slower and slower. Again, there was nothing that could have been done that soon. The attempt to remove the baby would have been bleeding to death.

2300: bleeding was evident even from the vagina. Vaginal bleeding obviously indicated intrauterine bleeding. In a few minutes, we lost the fetal heart rate. Nothing could have been done. Everyone around could not avoid bursting in tears including us the nurses and doctors themselves.  The gynecologist pulled the family in a private room.

2400: Breaking news. We have lost the fetus! It was too late to do anything and the rate by which we were losing the ability to breathe was too fast to maintain fetal oxygenation. But the mother was still conscious and fighting for her dear life

0100: heart rate was in 150's and blood pressure was trending downwards. Oxygen saturation was getting worse by the minute. Attempts to breathe were becoming harder by each breath. She could be heard gasping for breath from a distance.

0200: breaking news: She became unresponsive but the monitors could show heartbeats and a low blood pressure. The heart rate this time is coming down slowly. The heart is about to give up without oxygenation. The tumors had also blocked the access for emergency tracheotomy.

0300: The family signed does not resuscitate order (DNR) despite their denial and painful impeding and irreversible/unstoppable loss.

0330: No chest movement of breathing could be detected by visualization or by the monitor. It was just a matter of minutes before the heart could stop.

0350. The heart stopped with her whole family holding her hands. She was dead. The curtains were drawn to give the family some privacy and time to digest the loss.

We all tried our best to save her life. The obvious was impossible due to speed at which these events were happening and underlying conditions. The 20-year-old American girl and a 26 weeks old fetus were dead. A life lost to cancer.

The most disturbing thing was, we helplessly watched her suffocate to death! Painful!

Update: I have had a lot of mixed reactions from the readers of this article and it is expected. It is a disturbing story. A lot of people are asking why the baby was not saved at a viable age of 26 weeks gestation. Others are stating that there is no way cancer can grow that first.

First about the baby. Medical procedures like those requires consents from the patient. Where the patient is not able to sign such consents, a legal next of kin can do it with witness. If Next of kin cannot be reached and the patient cannot sign the consents, two phycisians from different team can sign the concent, something you may hear being called "double doc".

1. The patient immediate family wanted the mother to be saved but there was no concent available for such procedures.
2. The hemodynamics for the mother were severely compromised and in such events, the fetal circulation from the mother shunts all resources to the vital organs to save the mother, hence, the reason why the baby died first.
3. On CT-scan, The baby was nodular (I forgot to mention that), a reason good enough not to attempt the surgery.
4. The risks of attempting a surgery were higher than not doing it!
5. ... and yes, some types of cancer can worsen in a few hours.

Newborn infants may sometimes need a urinary catheter and as sensitive as it may sound, you might need to insert a urinary catheter to an newborn. Infants with an indwelling catheter shall have catheter care performed daily by licensed nursing personnel.

Purpose

1.     To obtain a urine specimen for diagnostics purposes.

2.     To relieve urinary retention.

3.     To determine the existence of residual urine.

4.     To provide continuous bladder drainage.

5.     To monitor urinary output accurately.

6.     To perform cystography.

7.     To provide continuous bladder irrigation in the case of bleeding to prevent clot formation and retention.

Equipment needed for newborn catheterization.

1.     Sterile gloves

2.     Urine catheter - (use smallest diameter catheter to avoid complications; A 3.5 Fr catheter is recommended for infant< 1000 grams and 5 Fr catheter for larger infants)

3.     Urinary drainage collection system

4.     Povidone-iodine swabs

5.     Water-soluble lubricant

6.     Sterile gauze

7.     Sterile towel

8.     Sterile container

9.     Baby soap and water

Procedure

1.      Identify patient per procedure

2.     If laboratory analysis is required take provider's order and laboratory test order chart and complete requisitions per your facility policy. Your unit secretary may help.

3.      The nurse shall verify at the patient's bedside that the name and medical record number of the infant (id band and crib card) matches the name and medical record number on the provider order, laboratory requisition and patient label. This step must be completed prior to specimen collection.

4.     Gather equipment. Equipment must remain sterile throughout the procedure to prevent introduction of bacteria into the bladder or the specimen.

5.     Perform hand hygiene.

6.     Utilizing sterile technique introduce items needed for the procedure onto a sterile field. Open water-soluble lubricant package and squeeze onto sterile field.

7.     Place infant on a sterile towel and position supine in the frog-leg position if possible. For infant's with a myelomeningocele keep in the prone position.

8.     Don sterile gloves.

Today I am going to give you tips about taking care of a Foley catheter. Foley catheters are used to drain urine from the bladder in a critically sick patient, surgical patient or long-term care patient especially the elderly.

Since the elderly tend to use the Foley catheters for a longer time than the rest of the groups, I will give you tips on how to take care of a Foley catheter and how to prevent developing infections like urinary tract infections (UTI)

1. A Foley catheter should always be inserted using a sterile procedure by either a registered nurse of qualified vocational nurse.
2. Foley catheter should be done at least once daily. This includes washing the penis with warm soapy water, and the vagina in females.
3. Foley catheters should be changed at least once every 28 days and where contamination is suspected, should be changed sooner.
4. Patient with Foley catheters should be given urine-acidifying foods like cranberry juice. This acidity prevents bacteria colonization causing UTI.
5. Keep elderly patient with Foley catheters well hydrated. Elderly tend to loose third drive, making them not to crave for water or other fluids. This dehydration is attractive to bacteria.
6. Urine culture is recommended atleast every 2-4 weeks on patient who are chronically on Foley Catheters.

Here are some of tips about general Foley catheter care.

1. Never put a Foley catheter on a patient suspected or already diagnosed with UTI. This could push the infection into the bladder
2. Always use a sterile technique when inserting a Foley catheter.
3. Never take the patient to operating room without a Foley catheter. You need to monitor urine output every hour during surgery.

Call the doctor immediately if an elderly patient becomes confused with falls or likelihood to fall. These are the earliest signs of UTI in elderly patient.

Every nurse out there regardless what part of the world can tell you that it was not easy in nursing school. I still remember my first day in nursing school clinical rotation in the hospital doing personal care.

Many people in the world could be nurses; in fact, I believe there would be more nurses in the world if there was no personal care as part of nursing practice. But personal care is just the basics and it gets better and easier as one becomes proficient with nursing career. In many hospitals in USA, there are personal care assistance  (PCA) or certified nursing assistants (CNA).

My first time ever doing personal care was in VA hospital where I was required to change linens of a man who had moved his bowels in his bed. The nursing instructor was right behind me in everything I was doing, as I needed to be checked off for this "skill". I gathered my towels, diapers and all other things I needed to have at bedside except the linen bin, where one puts the dirty linens.

My nursing instructor was harsh and downright mean and rude. I started the process of changing the patient whose bowel movement and urine had soaked him up to his shoulders and not to mention, it was all diarrhea. I happened to be lucky and the nursing instructor allowed another student to give me a hand.

When I opened the bed sheets, the smell itself made me to start gagging continuously, thank God I did not vomit but my abdomen was very painful because of recurrent powerful gags. The smell was strong, I was even afraid to touch the patient even with the gloves on.

I hated everything I was doing and thought that this was too hard and emotionally draining to do. I finally finished cleaning up BM to a person who seemed not to appreciate anything we were doing, despite having a nursing instructor behind us, who was as mean as a crocodile.

After we thought we were done, I didn't have anywhere to put dirty linens and the instructor asked me... "Are you planning to eat those or where are you going to take them without a bin?" This was the most extreme insult in my life, to be asked if am going to eat bowel movements. I tried to stay strong and not cry but my face remained for hours and a terrible headache.

Later at the end of the shift, the nursing instructor came and apologized to me but to this day, still dislike her and will never like somebody who is out there to tear out young hearts that want to be nurses.

What is your story?

BASIC CARDIAC LIFE SUPPORT (BCLS) ROLES AND RESPONSIBILITES  

I. BCLS ROLES AND RESPONSIBILITIES

A. 1st Responder:

1. Determine if the patient is unresponsive by trying to arouse him/her with "shaking and shouting."

2. If unconscious, call for help and remain with the patient.

3. Open airway (using head-tilt/chin-lift technique) and observe for respirations by placing your cheek next to the patient's face, at the same time observing the chest to:

a. Determine the presence of respiratory movements (chest rise and fall).

b. Feel or hear air moving from the patient's lungs against your cheek.

4. If respirations are absent, begin bag/valve/mask ventilation or mouth to mask ventilation by giving two breaths.

5. Determine presence of heartbeat by palpating the carotid artery in the adult and child or brachial artery in the infant. If pulse is absent, begin external cardiac compressions.

6. Remain with patient and perform CPR in the ratio of 30 cardiac compressions and two ventilations for the adult, 30 cardiac compressions for 1 man CPR and 15 for 2 man CPR and 2 ventilations for the child and infant.

B. 2nd Responder:

1. Initiate STAT page  to notify the Housewide Resuscitation Team. (If not already done.) If not in hospital, call 911

2. Call additional personnel and bring Arrest Cart and AED/Defibrillator to the scene.

3. Connect bag/valve/mask device or anesthesia bag to flow meter and 02 source and turn flowmeter to 15 liters/minute or full flush (even COPD patients). Ventilate patient with bag/valve/mask device assessing for chest rise and fall.

4. Attach defibrillator, AED, Leads or patches to patient and turn on monitor/defibrillator. 

5. Place cardiac arrest board under the patient.

6. Open Arrest Cart. Insert oral airway and suction patient, if necessary.

7. Inform 1^{st Responder of change to Two-Person Rescue. 1st Responder should complete the cycle, then move into position to provide ventilations.}

8. Two-person rescue begins by the first responder providing two (2) ventilations, using the bag/valve/mask.

9. The second responder becomes the compressor.

10. The compression to ventilation ratio remains 30:2 for the adult and 15:2 for the child and infant. 

11. Continue rescue efforts until signs of life are noted or an ACLS provider arrives. 

12. Compressions will not be paused for ventilations when the patient has a protected airway or intubated.