Losing weight can be challenging for busy nurses. Long days, tons of stress, and sugary temptations—from goodies kept in bowls on desks to carb-loaded snacks coworkers bring for celebrations—can make it difficult to lose unwanted inches and pounds. A healthy weight can help you prevent or manage diseases and other conditions, boost your body image, and give you more energy. Here are 9 habits to make part of your daily routine to curb calories:
1. Eat a healthy breakfast.
Protein and healthy fats such as avocado and eggs are more filling than sugary food. Breakfast will help you think and perform better at work.
2. Bring lunch.
Grab-and go-meals may taste good, but do you know what’s in them? Make your own meals (organic if possible) to allow you to control ingredients, cut calories, and save money. Add protein and nuts to your salads to make them tastier.
3. Get a work partner.
An accountability partner on the job can provide that extra motivation to stay on track. Set a weekly weigh-in goal and check in with each other.
4. Add healthy snacks.
Raw almonds, seeds, a boiled egg, and fruit can easily be stashed in your bag, drawer, or the office fridge. Stay prepared to avoid vending machine snacks.
5. Take the stairs.
Increase your heart rate by climbing up the steps. Research shows taking the stairs can help keep your brain young. Make the elevator a rare option.
6. Practice portion control.
Eat a sensible amount of food to stave off hunger. Even if you slip, instead of a slice of a coworker’s birthday cake, stop at a couple of bites or split it. Chances are someone in the office is trying to cut calories, too.
7. Keep a food journal.
Writing down daily meals and drinks provides an honest look at food habits. It’s a tool to keep track of calories and make changes to achieve your goals.
8. Do a daily walk.
Get outside for fresh air. Aim for at least 30 minutes or 5,000 steps. Even if it’s just 10 minutes at a time, walking will provide a break and boost your energy while reducing stress. Use part of your lunch to get some steps in.
9. Drink water.
Often, overeating stems from thirst and not hunger. Set your cell phone alarm to remind yourself to drink throughout the day. The extra trips to the restroom mean more steps. Dehydration can also make you feel drowsy and sluggish.
Losing weight won’t happen overnight. But practicing these healthy habits will move you closer to your goal, which will improve your overall health.
Did you know that domestic violence affects one in three women during their lifetime? Each year up to 1,600 women are murdered, often by their husbands, boyfriends, ex-boyfriends, or partners. For women in abusive relationships, knowing their risk level for homicide can save their lives. Did you know that information is available?
Women can learn how much their safety and well-being is in jeopardy by taking the Danger Assessment, an online tool developed by Jacquelyn Campbell, PhD, RN, FAAN, a professor at Johns Hopkins School of Nursing.
Campbell was named an American Academy of Nursing Edge Runner last month (July) for creating the free program, Danger Assessment: An Instrument to Help Abused Women Assess Their Risk of Homicide. The honor recognizes nurse-designed models of care and interventions that improve health care quality, cost, and consumer satisfaction.
“This is an extraordinary honor and another opportunity to shed light on domestic violence,” Campbell said in a statement. “I am grateful for the Academy’s recognition and for the commitment of so many colleagues and organizations that have prioritized research and funding for this distressing public health problem.”
The Danger Assessment (DA) predicts a woman’s risk of being killed or almost killed by an intimate partner. For more than 30 years, law enforcement, health care professionals and domestic violence advocates identified and assisted women with a high risk of being harmed by using the tool created by Campbell in 1986. There is also a version to download that predicts reassault in abusive female same-sex relationships.
Available in English, Spanish and Portuguese, the DA is divided in two parts: a calendar to record when abuse and injuries occur, and a 20–item questionnaire about risk factors such as past death threats, partner’s employment status, and partner’s access to a gun.The DA also provides information about shelters and counselors.
If you, or someone you know, are in an abusive relationship, take action to avoid becoming a deadly statistic. For more information about resources, contact the National Domestic Violence Hotline (https://www.thehotline.org) at (800) 799-7233.
First described by the Egyptians in 1550 BC as “sending forth heat from the bladder,” the urinary tract infection (UTI) is a frequent diagnosis seen in urgent care and doctor’s offices. Burning upon urination, urinary frequency, urinary urgency, smelly urine, and new or changed discharge—these are the hallmarks of a UTI.
Cystitis is an infection of the lower urinary tract. Pyelonephritis is an infection of the kidneys. UTIs affect about 150 million people every year with women greater than men. During any one year, about 10% of women will have a UTI and half of all women will have a UTI in their lifetime. Risk factors include sexual intercourse, diabetes, obesity, female anatomy, and family history. Although sex is a risk factor, UTI is not considered a sexually transmitted disease and a female can get a UTI even when a condom is used. E. coli is the most frequently isolated organism, though other coliform bacteria or yeast could be the culprit.
Most UTIs are caused by bacteria entering the bladder from the urethra. Bacteria then ascending the ureters into the kidneys causes pyelonephritis. Bloodborne pathogens can also lead to pyelonephritis. The urethra is shorter in women so the path to infection is shorter. Use of antibiotics can increase the risk of UTI, probably because the normal flora of the vagina or external urethra in men is disrupted. Indwelling catheterization is also a strong risk factor for UTI from organisms ascending the catheter and the normal complete emptying of the bladder is impossible due to the design of the catheter inlet opening above the balloon. It is estimated that for every day a patient is catheterized with a balloon catheter, the risk of UTI goes up 3-10%. Between the ages of 20 and 50, there is a 50-fold difference between female and male infection rates with that number decreasing over the age 50 and favoring males due to prostate enlargement, decreased bladder emptying, and increased rates of catheterization. Other risk factors are incontinence, poor hygiene, systemic disease, and hospitalization.
The gold standard of diagnosing the uncomplicated UTI is the presence of symptoms and isolation of a pathogen by culture of the urine. In reality, most uncomplicated UTIs are diagnosed clinically and with the aid of the multi-reagent urine dipstick. There are various algorithms used in diagnosis with varying levels of sensitivity (true positive) and specificity (true negative). The presence of nitrite, a product of bacterial respiration, along with leukocyte esterase and/or blood in the urine are strong indicators of a UTI and usually enough to warrant treatment with an antibiotic. For some practitioners worried about overuse of antibiotics and the resulting problems with resistance, a prescription is given with instructions not to start until the culture comes back, usually 48 hours unless symptoms progress.
Gram-negative bacteria often associated with UTIs convert the nitrate in urine to nitrite as part of cellular metabolism. This test isn’t particularly accurate because other organisms (Gram-positive) and yeasts that cause infection do not possess this trait. You can’t hang your hat on this test alone.
Leukocyte esterases are found in certain leukocytes normally associated with bacterial urinary tract infections. They are not found in normal leukocytes, epithelial cells, and bacteria of the healthy urinary tract. Certain conditions like trichomonas, chlamydia, and interstitial cystitis/nephritis can evade detection with this test so it is indicative only.
Blood in the urine can come from trauma (kidney stones) or bacterial mechanisms that lyse red blood cells and so blood can be detected either as whole blood cells or as hemoglobin, the molecule within the cell which has been spilled out by the bacteria. A dipstick positive for blood, nitrite, and leukocyte esterase in addition to one or more patient symptoms (frequency, urgency, pain, or discharge) has a high specificity for a UTI. It’s important to note that the presence of stones is also a risk factor for infection.
A complicated UTI is considered any UTI in a child, presence of a structural or functional urinary tract obstruction, recent urological surgical procedure, or a comorbidity increasing the severity of infection such as uncontrolled diabetes, chronic kidney disease, or the immunocompromised patient.
An uncomplicated UTI is usually treated with a short course of antibiotics such as nitrofurantoin, Trimethoprim/Sulfamethoxazole, or a fluoroquinolone. Some resistance is seen for all of these medications. Complicated UTIs may require longer courses or higher concentrations using the IV route. Many institutions now automatically perform a culture and sensitivity (C&S) when a urinalysis is positive. This identifies the organism (culture) and which antibiotics it is susceptible to (sensitivity).
Pyelonephritis is more serious than cystitis, sometimes necessitating hospital admission. Back pain, fever, malaise, and nausea can accompany kidney infection and this patient often looks and feels very sick. The treatment is a longer course of oral or IV antibiotics along with supportive care. The renal capsule is a tough fibrous material resistant injury. When the kidney is infected, the pressure within the organ rises and it becomes acutely sensitive. One diagnostic test for pyelonephritis is Murphy’s percussive test. One hand is placed over the costovertebral angle of the patient’s back and the other hand thumps it, causing the kidney to vibrate. Pain during this test or immediately afterwards, especially unilaterally, is highly suggestive of pyelonephritis in the patient with flank pain and fever.
If your patient is “sending forth heat from the bladder,” you should definitely do a point of care multi-reagent dipstick and send the urine off for a C&S. Flank pain, costovertebral angle tenderness, and fever should elicit a careful work up and diligent follow up.
Every day, nurses come to work providing care for patients requiring multiple levels of skilled nursing care ranging from basic to complex. Some patients may require vasoactive or vasopressor drugs to reduce or increase a patient’s blood pressure and other devices, such as a ventilator, intra-aortic balloon pump, or continuous renal replacement therapy, just to name a few, in order to preserve a patient’s life. In addition to caring for patients, nurses also have to make sure the patients’ family members understand the different aspects of the patient’s plan of care, such as the medications’ indication, side effects, and expected outcomes, as well as blood tests and diagnostic tests.
On a daily basis, nurses deal with the various level of stress caring for their patients and family members. These stressors could be the workload, time management, difficult patients and/or family members, discharges, admissions, and cardiac or respiratory arrest events. While nurses set goals to provide quality care that leads to better patient outcomes, nurses have the tendency to neglect themselves while working for the welfare of their patients by occasionally taking shorter meal breaks.
The big question is: who cares for nurses so they can continue to provide quality care every day to achieve positive outcomes? I see myself as a guardian angel for nurses whom I work with every day. Driving to work, I talk to God and ask him to help me make a positive difference, whether it is a soft touch of my hands, my soft-spoken voice, or my tight hugs. I believe that nurses should be cared for similarly to the way we take care of our patients and their families. Therefore, I look for a bible verse that would facilitate me making a difference in the lives of others. The bible verse I read is Proverb 3:6, which reads: “In all thy ways acknowledge him, and he shall direct thy paths.” The reason for this particular verse is that I need God’s guidance so I can be a blessing to others. The way I believe that I am a blessing to others is demonstrated by monthly birthday cards and luncheons for coworkers who are born in a particular month as well as greeting cards and gift cards for expecting mothers and fathers or weddings. I also recognize coworkers if they have achieved any type of certification or graduated from college.
Sometimes, I make and bring in desserts and have food delivered for lunch. On our unit, we are a melting pot of people. Every year in August, we celebrate International Culture Day where the staff brings an entrée from their culture and shares a little bit of history and its meaning. Additionally, I show concern about them as a whole and will ask them how they are feeling, what is going on with their children, dogs and/or cats, and their commute to work. The admiration of taking care of nurses and others as extended family members at work gives me great joy and pleasure that leaves my heart full of exhilaration every day.
“I feel dizzy” is a common complaint in the ER and triage nurses sometimes use the shorthand, IFD, when describing the patient’s complaint. Finding a diagnosis for this vague symptom can be challenging. One thing the nurse can do to speed up the process is to drill down to a more firm description than dizziness.
Dizziness is a complaint that can include four separate symptoms, sometimes overlapping. A careful history will reveal one or more of these: vertigo, disequilibrium, presyncope, or lightheadedness.
Vertigo is the feeling that the room is spinning. Often, there is a false sense of movement. Sometimes vertigo is accompanied by nausea, vomiting, sweating, and/or nystagmus. It gets worse when the patient’s head is moving. The question the nurse can ask to differentiate vertigo from other forms of dizziness is, “Do you feel like the room is spinning or moving around you?”
Vertigo has relatively few causes. Benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and labyrinthitis are the most common. Less common are brain tumors, brain injury, stroke, MS, and migraines. You can see that they divide into central and peripheral causes; central causes involve the brain and peripheral causes come from the middle ear. Anything that causes inflammation in the structures surrounding the organs of balance can lead to vertigo. Often the patient will have a cold or sinus problems. Tinnitus, hearing loss, and feeling of fullness in the ear can accompany vertigo. There is a rapid compensatory process when things go wrong with the organs of balance. Usually the course is self-limiting and resolves within a few days.
BPPV is caused by loose granules of calcium carbonate moving in the semicircular canal. It can be diagnosed with the Dix-Hallpike test and can sometimes be effectively treated with repositioning movements called the Epley maneuver. BPPV does not present with hearing loss.
Meniere’s disease involves episodic vertigo along with hearing loss and a sensation of fullness, usually in one ear. There are few treatments and the disease is poorly understood. The course can last from 5-15 years before the episodes stop and the patient is left with mildly disturbed balance and decreased hearing.
Labyrinthitis is believed to be caused by a viral infection of the inner ear and can result in permanent symptoms of dizziness.
Disequilibrium exhibits itself in the patient’s gait. A stumbling or shuffling gait can be a sign of stroke, a life threatening emergency that calls for immediate activation of the emergency medical system. Other causes are Parkinson’s disease and peripheral neuropathy. Alcohol and drug intoxication frequently lead to disequilibrium. In older people, poor vision can accompany disturbances in gait, leading to falls. Benzodiazepines and tricyclic antidepressants can also lead to higher incidences of falls in the elderly.
Presyncope is a problem of circulation and is most commonly described as feeling like one is going to pass out without actually losing consciousness. It’s either a pump or a fluid problem and exhibits as orthostatic hypotension. When the patient stands up, he or she gets dizzy. It can be caused by dehydration (fluid problem), arrhythmias, myocardial infarction (pump problem), multiple medications, or debilitating illness. The nurse should ask the patient if he or she gets dizzy when standing up from a sitting position.
Lightheadedness is often associated with a psychiatric diagnosis and/or hyperventilation. Anxiety is the number one factor predisposing a person to lightheadedness. It is reproducible with voluntary hyperventilation.
Asking the patient a few extra questions and taking a careful history can assist the provider in making a diagnosis. Dizziness is not a very good descriptor of this problem, so drill down a little.
Mental health is no longer a taboo topic in much of society, but for many minorities, the stigma is still strong and prominent. July is Minority Mental Health Awareness Month to help those affected by mental health conditions get the treatment they need and begin to erase the stigma through education and awareness.
In general, people are talking about mental health much more than they ever did before. Advertisements for drugs to treat depression and bipolar disorder are common; celebrities openly discuss their mental health challenges; and support groups are often well attended across the country.
But for minority groups, the stigma of mental health struggles is often present. While some groups in the country feel freer to make their challenges known, minorities often struggle with mental health in silence. Afraid to bring their symptoms to light, they often don’t get the treatment that could help them feel better and make their lives easier.
As nurses know, mental health is a physical condition. It might be called mental health because it affects the brain, but anyone with a mental health disorder is struggling with a physiological disease. But because the topic has been taboo for so many for so long, the freedom to be honest about their disease remains elusive.
As a nurse, you can be especially in tune to these startling facts from the Office of Minority Health:
- Over 70% of Black/African American adolescents with a major depressive episode did not receive treatment for their condition.
- Almost 25% of adolescents with a major depressive episode in the last year were Hispanic/Latino.
- Asian American adults were less likely to use mental health services than any other racial/ethnic groups.
- In the past year, nearly 1 in 10 American Indian or Alaska Native young adults had serious thoughts of suicide.
- In the past year, 1 in 7 Native Hawaiian and Pacific Islander adults had a diagnosable mental illness.
According to the American Psychological Association, minorities have additional roadblocks. Even if they are ready to get help, they often lack access to high-quality mental health care and treatment. There might not be enough providers or those providers might be hundreds of miles away. Providers who take insurance might be hard to find and those who offer culturally competent care might be even more sparse. Speaking with a provider who isn’t aware of the cultural stigmas against minority mental health issues in a specific community could make the patient feel even more isolated.
You can learn more about the barriers to adequate care in your own community and begin to seek out solutions. Finding a few culturally competent providers, keeping a list of online resources, and referring patients to trusted specialists if they are available can be a big help as can keeping a compassionate and factual approach to patients who are struggling with symptoms and with stigma. If they are treatment resistant, you still have a powerful tool in voicing that mental health is a imbalance of brain chemicals, is not their fault, and that help is available.
Being an open ear can also help someone who is having a tough time but is reluctant to get help. Urge them to get relief, offer helpful resources, educate them to dispel myths they may be holding, and work with your team to raise awareness and ensure no unconscious bias exists.