Reflex Syncope: What You Need to Know

Reflex Syncope: What You Need to Know

You gave your patient a shot and he or she passed out! What did you do wrong? Nothing.

example of reflex syncope

No patients were harmed in this photo.

Vasovagal syncope is one of three related syncopes that share a common pathophysiology. Together, they are called reflex syncope. The three are vasovagal, carotid sinus, and situational. Vasovagal is what just happened to your patient. Pain, seeing blood, emotional reaction, and prolonged standing are triggers of vasovagal syncope. Situational is triggered by urinating, coughing, or swallowing. Carotid sinus is triggered by stimulation of the nerve bundle located in the carotid sinus of the neck.

These neurologically induced losses of consciousness are brief and resolve without specific treatment. They are usually preceded by feeling dizzy, sweating, tunnel vision, odd feeling in the chest, or feeling very hot or very cold. The pathophysiology is an abrupt slowdown of the heart rate and a dilatation of the blood vessels leading to hypo-perfusion of the brain. Basically, the pump can’t get blood to your brain and you pass out…and you fall down.

First of all, it’s important to NOT PANIC. There is nothing you can do to fix it. Prepare for it by observing your patient immediately after giving an injection or drawing blood because these are prime times for a vasovagal episode. Make sure the patient is already seated and if you notice your patient is getting pale, sweaty, stuttering, or acting odd, gently guide your patient to a lying position with the feet up. Sometimes the loss of consciousness comes with muscle twitching that looks like a seizure.  Unlike a seizure, there is no prolonged postictal period, muscle clenching, or incontinence. While the loss of consciousness will resolve as soon as the patient lies (or falls) down, he or she will probably pass out again if he or she gets up so keep the patient under observation and lying down. It’s a good idea to get serial blood pressures so you can document the resolution. Every five minutes is fine. Your first blood pressure will be low with a heart rate in the 60s or high 50s. Over the next five to 15 minutes the vasodilatation and bradycardia will resolve without intervention but if you let the person stand up…boom! Don’t let the patient get up until they have a documented normal BP and HR. You can bring them a blanket, a drink of water, some juice, anything you like. Nothing is going to make it resolve any faster.

How do you know it’s vasovagal syncope? Easy: Did you just give this person a shot, draw blood, or let them see a bloody bandage or wound? If so, did they then get pale and sweaty and fall down? When they were horizontal, did the loss of consciousness resolve? Yes? That’s it! The only thing you can do wrong is try to stand them back up again!

So what do you do if this happens to your patient? To recap, don’t panic, make sure the patient is safe, call for help, get serial blood pressures, and observe the patient until the BP and heart rate are normal. Usually there is no need to call for an ambulance unless the patient actually fell down and hit his or her head or the symptoms are not resolving.

Remember, it’s a common occurrence and patients that are prone to it will probably do it again. You didn’t do anything wrong!

Nursing Assistants Provide Care and Companionship

Nursing Assistants Provide Care and Companionship

For 41 years, nursing assistants have celebrated National Nursing Assistants Week during June. Career Nursing Assistants Day on June 14 kicks off the week of honoring the nursing assistants who care for elderly or disabled patients, especially in long-term care facilities, hospice care, home care, or nursing homes.

According to the National Network of Career Nursing Assistants, nursing assistants are a vital connection to patients as they help them with the basic care and activities of daily living. They help patients feel cared for and comfortable, while also providing the essential hands-on care that keeps patients healthy. While helping patients do things like bathe, eat, or gain movement, they are also able to form trusting relationships. Nursing assistants spend so much time with patients they are able to get to know them and learn about their lives.

When patients are away from the comforts of their home or far away from family and friends, nursing assistant s give a companionship so necessary for feeling better. They provide a gentle care from which patients and residents feel respect and a sense of belonging. When nursing assistants greet them by name and ask about their health or their physical ailments, they are taking an assessment of how the patient is doing on a basic physical level. Those are assessments that are essential to the medical team that oversees the patient.

But because of their close proximity to people, nursing assistants are also able to ask about the favorite foods of patients or residents, their upbringing, how they celebrated milestones, and family and friends who were once or are still close to them. They may get to know the visitors who come often and are able to hear and share stories with them. With that kind of knowledge, nursing assistants have many topics of conversation they can use to engage patients. Their familiar presence becomes reassuring and comforting as a patient’s moods may go up or down or as their physical discomfort increases or decreases.

According to the Bureau of Labor Statistics, the demand for this role will continue to rise at a faster-than-average rate. Those looking to get into this career field will find plenty of opportunity to offer compassionate and skilled care to populations that needs it most. The median salary of $27,500 annually will fluctuate with location and demand, and you’ll need to pass a competency exam. Like other jobs in the medical or care field, the work can by both physically and emotionally demanding, but the rewards of caring for patients and making a difference in their lives is great.

Help celebrate National Nursing Assistants Week by noting and thanking nursing assistants for the tremendous work they do.

3 Tips for Integrating Advance Directives into Your Practice

3 Tips for Integrating Advance Directives into Your Practice

The Patient Self-Determination Act, passed by Congress in 1991, requires hospitals, nursing homes, and other health facilities to provide information about advance directives to patients and to keep a record of any completed documents. An advance directive is a legal document outlining a patient’s preferences for treatment at the end of life. It allows patients to name a person (“agent”) to decide for them if they are unable to decide. As the population of older Americans is increasing, one in five Americans will be over age 65 by 2030 and a life-threatening situation such as cardiac or respiratory arrest can occur at any time. Nurses need to take an active role in educating patients about the different types of advance directives and must talk with their patients and families in terms of their goals of care and preferences for end-of-life care to ensure that patients’ wishes for care at the end of life are known and respected.

Here are three tips to help you integrate them into your daily practice.

1. Review and verify the patient’s advance directive status at his or her first patient contact.

Nurses can help patients explore treatment options and prepare them to participate and discuss with physicians in making the best possible option based on their preferences.

2. Assess the patient’s educational needs.

Patients must be provided with complete information about advance directives and have the opportunity to discuss all of their alternatives and options. Having sufficient knowledge will enable patients to make sound and knowledgeable decisions about their own advance directives. Their education should also include the benefits and risks associated with their choices. It is important for nurses to understand their workplace policy and procedures about advance directives and take any available education about advance directives to increase their knowledge.

3. Advocate for your patients’ decision representing what is best for them.

Nurses have an important role to promote their patients’ decision concerning the treatment or withdrawal of medical care and completion of advance directives. Understanding the options available to the patient can help nurses confidently and purposefully address their patients’ needs. It is imperative that nurses are knowledgeable about their state and federal laws related to end-of-life care and are able to answer the patient’s questions concerning different types of advance directives.

4 Essential Skills to Transition into a Leadership Role

4 Essential Skills to Transition into a Leadership Role

There is an increasing demand for new nurse leaders because of a growing number of retiring nurses and a complex health care delivery system. This high demand for nurse leaders brings an opportunity for young nurses to move up to a leadership role; however, the transition from staff nurse to nurse leader involves developing a wide range of skills. Here are four essential skills that every nurse needs to ensure a smooth transition into a leadership role.

1. Effective communication

It is important that you improve your communication, both verbal and non-verbal, as well as your listening skills. A great nurse leader needs to clearly communicate his or her ideas, visions, goals, and expectations to staff nurses and others as well as understand what other people are communicating.

2. Critical thinking

A great nurse leader needs to be able to think objectively and critically as well as utilize critical thinking ability at every level. Critical thinking is utmost to a leader’s success, especially in today’s complex health care environment. Having an optimistic attitude is also important as this will help to motivate other staff nurses in a positive way.

3. Time management

A great nurse leader needs to effectively manage time and fulfill his or her tasks and obligations. As a nurse leader, you cannot avoid the added responsibilities and demands, but without time management skills, it will be difficult to transition into your leadership role.

4. Conflict management

 A great nurse leader needs to properly manage conflicts in the workplace. You should have the ability to recognize and address problems quickly. Stress disappears, staff feels more motivated, and the workplace becomes a much better place to work as a result of conflict management.

To become a great nurse leader, continually strive to improve these four essential skills and never stop learning.

Why Now is the Time to Consider Being a Nurse

Why Now is the Time to Consider Being a Nurse

Being a nurse is a great career! Whether you’re caring for patients, assisting physicians, or talking with families, no day is ever the same. We polled nurses on why it’s a great time to consider a career in nursing in 2018, and here’s what they had to say.

“At the end of every day, I know I made a difference in someone’s life—every single day. I love being a nurse practitioner.”
—Yudelka Garcia, MS, RN, FNP-BC, Clinical Instructor, Columbia Doctors Primary Care Nurse Practitioner Group

“I love being able to help people recover or maintain their health while still being able to apply critical thinking skills and a knowledge of medicine. It’s always gratifying to have patients express their appreciation to me for taking care of them.”
—Paul Wohletz, BSN, RN, CCRN

“The health of the American nursing profession is as strong as ever in 2018. As an African American male nurse functioning in the role as a Nurse Practitioner, I stand on the shoulders of African American giants in nursing such as Beverly Malone, Elizabeth Carnegie, Mary Mahoney, Sojourner Truth, and Harriet Tubman, to name a few. It’s an amazing time to be a nurse and NP in 2018 because the profession and roles are making positive gains and are ever evolving and expanding. The nursing profession is so dynamic, and nurses along with their patients and stakeholders are moving at light speed to eliminate artificial barriers to create a more inclusive, collaborative, collegial work environment without professional constraints or perceived glass ceilings.

Nurses and Nurse Practitioners are not only serving as Chief Nurse Officers, but are also serving with pride and distinction in other capacities including: Chief Executive Officers, Chief Operating Officers, Nurse Scientists, Deputy Surgeon General of the United States Public Health Service, Chief Medical Officers, and many more.

The Gallup survey reports nursing as the “most trusted” professionals in the U.S. because of very high honesty and ethical standards. It is our time, right here, right now!”
—Captain James Dickens, DNP, RN, FNP-BC, FAANP, AANP Board Member-Elect, Manager of the Office of Minority Health, U.S. Department of Health and Human Services

“It is great to be a nurse because I get the privilege [of] caring for people in their most vulnerable times…and I get to wear pajamas (scrubs) to work!”
—Jordan Kaczor, RN, BSN, PCCN, University of Kansas Health System

“You have the opportunity to help others who are in need.”
—Moonja Shin, RN, High Focus Centers, Ambulatory Detox, Paramus

“Now more than ever before, nurses are proving to be forces of change in the health care industry. Traditionally, the nurses’ role was limited to the four walls of the hospital. Now, nurses are taking their role as patient advocates to the next level by letting their voices be heard across multiple disciplines. Nurses are increasingly participating at the legislative level through federal lobbying, as well as getting involved in industries including technology, pharmaceuticals, education, and law. Nurses are even playing a larger role in fashion by designing scrubs, and in architecture by helping to design hospital units. It’s an exciting time for nurses as they expand their responsibilities both within the hospital and in their communities, working to affect lasting change in health care. It’s critical our nurses are able to apply their valuable firsthand experience as caregivers and feel empowered to influence leadership.”
Aparna Bala, MSHI, BSN, RN, Clinical Transformation Consultant, AirStrip

“Nursing is the most fantastic career opportunity of which I am aware. With multiple entry points and endless possibilities ranging from the daily heroism of bedside nursing care to amazing research opportunities, leadership roles, management roles, and my personal favorite: academic nursing. A career in nursing means being surrounded by brilliant, caring people engaged in endlessly fascinating pursuits.”
—Robert Muster, PhD, RN, Regional Dean of Nursing Rasmussen College

Oncology Nurses Offer Compassionate Care

Oncology Nurses Offer Compassionate Care

No one ever wants to hear a diagnosis of cancer, but when it happens, oncology nurses are the rock-solid support many patients turn to. As the latest numbers show cancer continues to be a steadily rising health concern, oncology nurses will continue to play an essential role to patients and families.

May is Oncology Nurses Month and honors all the ways oncology nurses help their patients navigate a road they never expected to travel. Oncology nurses have duties that help patients understand a diagnosis, become educated about options and treatment, and adjust to a terminal prognosis or one that includes living a life after a cancer diagnosis and as a survivor.

The National Cancer Institute states “In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States and 609,640 people will die from the disease.” However, as cancer treatments become more effective, oncology nurses are also caring for the increasing number of cancer survivors.

According to the Oncology Nursing Society, this year’s theme “The Art of Caring, The Science of Care,” highlights both the reassuring guidance and compassion nurses show as well as the intricacies of cancer treatment.

Patients and their families often need time to absorb a diagnosis of cancer, and oncology nurses are there to help them figure out what to do next. As treatment advances, they are there to offer support, give exceptional care, and prepare patients for any treatment side effects. If a patient’s diagnosis is terminal, they are able to help them adjust and live life comfortably. Oncology nurses help patients understand the medical treatment they need and the various options they might have available.

But through all the medical decisions, these nurses also offer compassionate and knowledgeable care. With the rapid-fire developments in cancer treatment, oncology nurses must stay up-to-date on the cutting edge treatments that might become available to their patients or in advising patients on how to reduce cancer risks. They are a shoulder to lean on and a valuable resource for families. They are able to help patients manage pain and discomfort, offer advice for dealing with unpleasant side effects, and report any adverse side effects of treatments.

Oncology nurses also are on the front lines, hearing patients concerns and helping to guide them through insurance issues. They ask if patients can afford the treatment and what alternatives they may have. But they are also able to hear the fear and listen to the concerns of patients and their loved ones.

Because oncology nurses are working so closely with patients, they see exactly how cancer can have a devastating impact on lives and families. From this viewpoint, they are excellent advocates for cancer policies in government, in insurance, and in research. Oncology nurses have a valuable and respected voice to help create changes in policies that impact cancer patients.

This month as oncology nurses reflect on the vast scientific knowledge they possess to the deep wells of compassion and empathy they use to support their patients, they can be reinvigorated by the reasons they go into the field. Patients and families depend on their steadfast care and the reward for this field are great.