Tuesday, November 19, 2013

Never Give Up. Never Give Up. Never Give Up!

I dedicate this post to every student who is feeling overwhelmed about his or her approaching examinations. Never consider the potential for defeat, but always consider the potential—YOUR potential—for VICTORY, and then make it your aim and goal to achieve that victory.
Never give up when you are faced with a massive amount of work. I know many—if not most of us—will be studying our entire Thanksgiving Break. While I understand that this may be necessary in order to do well on your tests, I believe it is also good to give yourself a break, even for a day. So, consider planning your study so you get at least one day completely off; your mind and body will thank you.  

In a commencement speech at his alma mater in 1941, Winston Churchill spoke these words: “Never give in, never give in, never, never, never, never-in nothing, great or small, large or petty - never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.” The enemy you will face after break is not a real adversary, yet it (finals week) is still an imposing obstacle to many of us. I want to encourage you to not fear; rather, TRUST the LORD in EVERYTHING (Proverbs 3:5-6). Do your best to prepare, and then leave the rest up to Him (Psalm 37:4-5, 55:22). The best thing I ever do with my tests is surrender the outcomes to God because, when I do, He gives me peace (Philippians 4:4-7; Psalm 62:8; Proverbs 16:3; 1 Peter 5:7). 

Stand fast (1 Corinthians 15:58). Remember how far the Lord has taken you (Isaiah 63:7). If you're a junior nursing student, you've already taken three Med/Surg and three Pharmacology exams. You’ve made it! There’s just a little bit left for you to accomplish by God’s grace (2 Corinthians 12:9-10). You can do it!  Consider your last week of school your opportunity to SHINE (Matthew 5:16).

Sunday, November 17, 2013

Where Is God in the Storms of Life?

Today, my pastor taught about Job and the great trials that bombarded him during his great trials. In the first few chapters of the book, Job loses his monetary possessions, numerous servants, and his seven sons and three daughters. In rapid succession, he received horrendous reports from the last surviving servant from each area telling him of the loss of his oxen, donkeys, sheep, camels, and dearly beloved children. In the twinkling of an eye, he was transformed from the wealthiest man in the East (Job 1:3) to a bereaved man stripped of his earthly possessions.
What struck me was his response to such grief and heartache. Instead of blaming God, he worships God in his grief.
“Then Job arose and tore his robe and shaved his head and fell on the ground and worshiped. And he said, ‘Naked I came from my mother’s womb, and naked shall I return. The Lord gave, and the Lord has taken away; blessed be the name of the Lord.’ In all this Job did not sin or charge God with wrong.” (Job 1:20-22)
These few verse challenged me today to consider, “How will I respond the next time I am faced with a trial, testing, or grief?” Will I praise God in my grief and in my trial or will I question the good and perfect character of the Lord? My desire is that I will have Job’s response. That I will not charge God with wrong but instead praise God in the storms of life because He is there in the midst of them (Mark 6:48).
Here is God’s promise to you:
’. . .Fear not, for I have redeemed you; I have called you by name, you are mine. When you pass through the waters, I will be with you; and through the rivers, they shall not overwhelm you; when you walk through fire you shall not be burned, and the flame shall not consume you. For I am the Lord your God, the Holy One of Israel, your Savior. . .’” (Isaiah 43:1-3)

Saturday, November 9, 2013

10 Suggestions for Writing a Solid Patho Paper

1.      Figure out the main problem/diagnosis. The main medical diagnosis is usually what brought them into the hospital or it could be the root cause of their visit. For example, a patient who had a heart attack two weeks ago may present to the hospital with dyspnea and new onset heart failure. While dyspnea is their main complaint, the main problem is heart failure since it is the root cause of their difficulty breathing.

2.      Clearly structure your paper. This stems from a good outline. Before I ever sit down to write the Pathophysiology portion of my profile, I figure out what the main diagnosis/problem my patient is facing. Once you know the top problem, write down the various other issues that your patient is dealing with and then arrange your patho in a way that organizes the information in a logical fashion. For example, if your patient’s primary diagnosis is heart failure (HF) secondary to a recent myocardial infarction (MI) complicated by renal failure (RF), I would outline the paper like this: Hx of present illness, patho of HF (from macro to micro level, i.e. down to the cellular level) and how the diagnosis of HF was made (echocardiogram, BNP, etc.), patho of MI in relation to the development of HF, patho of RF which was caused by insufficient perfusion secondary to the decreased cardiac output associated with HF, discuss the patient’s current status (edema from fluid overload secondary to HF and RF, dyspnea secondary to fluid overload leading to pulmonary edema, etc.), and conclude with a paragraph discussing patient education (e.g. call the doctor about significant weight gain in short period of time) and follow-up care (nutritional consults, congestive heart failure out-patient clinic).    

3.      Spend sufficient time discussing the pathophysiology of the primary diagnosis. Write as much as you need to sufficiently cover the topic, including the normal anatomy and function, the pathophysiology of the disease, and the manifestations of the illness and what causes each of them. When discussing acute kidney injury (AKI), for instance, discuss the normal anatomy and function of the kidneys (nephrons, tubules, glomeruli and how they are involved in filtering urine and regulating fluid status), the original insult to the kidneys (e.g. decreased perfusion from low cardiac output associated with HF), the stages of renal failure, and the stage the patient is currently in and how each manifestation (peripheral edema, hypertension, and decreased urinary output) relates to the diagnosis of AKI.

4.      Be sure to include procedures and studies related to your patient’s diagnoses. If your patient has HF, discuss how it was diagnosis such as by Transesophageal echocardiogram (TEE) and BNP values. Discuss how this procedure, TEE, is performed and the physician’s interpretation of the results (ejection fraction, hypertrophy of ventricles, etc.).   

5.      Write at least one paragraph or more on the other diagnoses related to your patient’s primary condition. For instance, if the patient has HF, RF, and past MI. Discuss how the MI led to his HF, the patho of MI, and how it is currently affecting the patient (this could easily be three paragraphs). Also, discuss the patho of RF and why it resulted from HF and how it manifests in the patient.

6.      Relate the information to your patient in each paragraph. At the very minimum, include your patient (e.g. their presentation, diagnosis, etc.) in the topic sentence (usually the first sentence in a paragraph), and in the last sentence of the paragraph.

7.      Integrate your patient’s labs into your paper. This is one of the best ways to relate your topic to your patient (#3). Whenever you give your patient’s labs don’t just list their lab values, include the normal ranges (specific to age and gender) and the correct interpretation of the labs (low/high/normal). Then apply this information to the patient and their diagnosis and prognosis. For example, your patient has low hemoglobin, hematocrit, and red blood cell count; you know this because these values are lower than the normal levels for an adult male, indicating that he is anemic. After explaining this, address the reason for his anemia. For example, he could be anemic as a result of insufficient production of erythropoietin secondary to his renal failure.

8.      Integrate your patient’s medications into your patho. This shows your understanding of your patient’s condition as well as the indication for the medications which they are prescribed. For example, your patient is on a statin, ACE-inhibitor, aspirin, and beta-blocker; these are all standard medications prescribed to a patient post MI. Don’t just list the medications; instead, talk about the specific medication your patient is prescribed, its drug category, mechanism of action, and indication for your patient. For example, your patient is prescribed metoprolol (Lopressor), a cardioselective beta-blocker, which decreases heart rate and blood pressure by blocking the beta-1 adrenergic receptors in the heart. This medication is given to treat hypertension by lowering this patient’s blood pressure.

9.      Read before your write. It is so much easier to write a patho if you’ve read about the diagnosis and the related issues in your Med Surg and patho textbooks and journal articles before you start writing. By doing this, you can avoid the risk of plagiarism that arises from writing as you read. You also are able to demonstrate your understanding by writing the information in your own words.  

10.  Read your patho before submitting it. The flurry of patho writing it is easy to miss grammatical mistakes and spelling errors that you will be able to catch on your final pass over your paper. I usually like to read a paper out loud before submitting; this keeps me from just skimming the content. Remember to use spell check and Google the spelling of words you are not sure how to spell. Finally, the undergraduate writing center at Liberty University is another great resource. They usually take a few days to review your paper, so start working on your patho and send it to them early if you want to be able to update your paper based on their comments before the deadline.