What It’s Really Like to Care for a Dying Parent

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It’s really tough to decide the best course of action for someone who is dying, especially in our society where life, any sign of life, is prized, and not necessarily the quality of life. It’s truly difficult to make a decision for someone’s life especially if you love them.

But the better question is, would you want to live in that fashion?

Talk about death decisions with your loved ones so they know what to do in case something happens. This will save time and grief among the family and friends. The health care proxy doesn’t have to be guilted into making that hard decision that no one is willing to make.

As for organ donation, if someone willingly signed up to be an organ donor, I would assume any organ is ok as long as it’s usable and that I don’t look completely mutilated after the process. I mean, in the end an organ is an organ. If it can help save another life and I’m already dead, why not help out someone else?

CCRN: How to Pass The First Time

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Last Updated: July 13, 2020

Disclosure: I love sharing my favorite products and this post contains affiliate links where I may receive a commission if you chose to buy at no cost to you.

I passed the CCRN last week! Yay!!! The CCRN is a certification exam for critical care nurses. It verifies your knowledge about critical care concepts after working 1750 hours in the last two years. The benefit of getting the CCRN means getting a pay raise or a bonus. Or intellectually, it solidifies your basics. But if you’re reading this, you probably already know that. You have the more important question — how do I pass the CCRN?

Before I studied, I also searched the internet for the best way to study for this difficult exam. There were two things that stood out to me.

  1. Listen to Laura Gasparis’ videos.
  2. Do all of the questions from PASS CCRN. Buy the physical book to get the online code for the online questions.

I got all of the material from a friend, from another friend.

I listened to all of the videos and wrote down notes the first time around so I wouldn’t have to listen to it again. It meant I had to pause the video sometimes to write notes. There were 6 videos about 2 hours long. So roughly 12 hours. I did 2 videos each week while working full time. It took 3 weeks to complete.

Then I did all of the questions from Pass CCRN. Doing the questions will make you go through the important concepts and details. I gave myself the goal to complete either a complete short and easy section or about 20-40 each day. Cardiac (20%), pulmonary (18%), and ethical (20%) are the most heavily weighted sections.

What are the important things to know about the cardiac and pulmonary sections?

For the cardiac and pulmonary sections, it initially took me about 2-3 hours to complete 30 questions because I would read the rationale and write a flashcard for the material. There are over 300 questions on cardiac alone, and there’s a good reason for it.

I felt the most important things about cardiac are:

  • The different medications
    • Examples include vasopressors, vasodilators, diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, ARBs
    • How it affects afterload, preload, and contractility
    • Side effects
  • How do stroke volume (SV) and heart rate (HR) affect cardiac output (CO)?
  • In different disease states, what is lacking, and what do you need to fix the problem?
  • How does the intra-aortic balloon pump (IABP) help? Complications?
  • What does the pulmonary artery measure, what do those values mean, and what do you do when you see a value out of wack? What are the physical assessments would you find?
  • What are the different types of murmurs, where do you listen, what typically causes stenosis vs. regurgitation?
  • Different types of chest pain, MI.
  • 12 lead EKG — this took some time for me since at work it’s only required to know how to read a lead II EKG. But since I started studying, I’d look at 12 lead EKGs at work, and it’s kinda fun.

For pulmonary:

  • ABG interpretation (compensated vs uncompensated; what would breathing too fast or too slow cause? How would you treat different values?)
  • Ventilator settings – which ones affect respiratory rate? What does PEEP do? How does that relate to the V/Q ratio?

Where should I write flashcards?

As I did the questions, I used a flashcard program called Anki. It’s a fantastic memorization tool using the concept of spaced repetition. And the best part is that it’s free to download on the computer or laptop and to use over the internet. It’s $25 to download on your iPhone or Android but it’s worth it.

I did the questions on one side of the screen, and had Anki opened on the other side. Anything I didn’t know or wanted to review, I either copy and pasted questions or answers, or paraphrased the concepts. It’s easy to put too many things to memorize on one card and that’s the last thing you want to do. When you’re reviewing the card, you don’t want to think, “oh I got half of the card correct… so do I choose that I got it right or wrong?” You want to be decisive and pick whether or not you got it correct.

I have the flashcards that I created for the CCRN that is easy for you to download, although you should probably create your own or edit mine to make it easier for you.

Updated December 16, 2016: these flashcards can only be used with Anki on a computer or phone. If you are thinking about downloading the flashcards, please download Anki first and make an account. Also, please do not download these flashcards unless you will use them right away.

Updated August 3, 2015: I’ve given the CCRN Flashcards to many people who have used them and passed the CCRN. Since it is time-consuming for me to email everyone who asks and I’ll have no income for the next two years while I’m in school, I’ve decided to sell them to help me pay for food during school. People have said that it’s worth $50, but I won’t charge that much for it, especially since I really want you, as my reader, to pass!

Updated July 13, 2020: The new CCRN exam came out during the pandemic on March 25, 2020. The exam percentages from the old exam and to the new exam are exactly the same. The AACN has new preparation material where you can try 30 questions for free for 7 days and then have to pay for it.

Another option is to try PocketPrep. I’m currently going through the questions to see if they are similar enough. They also have a free version but to get the most out of you, you must get the paid subscription. It contains 600 questions, as a question of the day (QOTD), a ‘quick 10 questions’, a rationale for the answers and a way to flag questions you want to review. When I finish going through the questions, I’ll write a more detailed review.

How many questions do I need get right to pass?

Just 89 out of 150 questions to pass. So you can do it! 25 are for research. Only 125 actually count. You have up to 3 hours to take the exam.

How much is the exam?

The exam is $245 if you’re a member of the American Academy of Critical Care Nurses (AACN). You’ll go to goamp.com to pick a test site and register for the exam. You’ll get 3 months to take the exam. You can change the test date once for free. Majority of the test sites are in the HR Block. How nice of them!

I took mine in Astoria, NY. I was the only one and it was quiet. Good experience.

Anyways, go for it! Good luck in your endeavor.

How to Memorize Anything

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I wish I knew about this program when I was in nursing school — it would’ve made memorizing anything possible. But it’s been a couple years out and I learned about this amazing program.

It’s called Anki.

It’s flashcards. On steroids.anki

And the best part is that it’s free to download. Unless you decide to download it on your phone (iPhone / Android).

You know how you cram everything in for an exam, only to forget in a few hours or days later? Yeah, that won’t happen anymore.

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This flashcard system is based on science of how people remember and forget things. It uses a spaced repetition system so that the card shows up right before you’re about to forget the information on that card.

spaced-repetition-forgetting-curve

The great part about these flashcards is that you won’t have to review every single card every single day to remember. It spaces itself out depending on how well you’ve remembered the card. You will look at the card, decide on an answer, click on the card and see the answer. You will choose whether or not you got the question wrong (leading you to seeing the card sooner), or right. You can pick how easy or difficult it was for you to remember the answer. If it was easy, then the card will show up days later. If it was difficult, the card will show up sooner. If it was ‘just right’, then the card will continue down its algorithm.

While initially the Anki was created to remember languages, it can also be used to memorize nursing concepts. I used it personally to study for the CCRN, the certification exam for critical care nurses. So I know that this works.

It may look seemingly difficult but it’s actually easy to use.

You have to commit to it, and Anki will be there for you.

Don’t hit nurses

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People should not think that it’s ok to hit anyone, especially nurses. Even if you’re mentally crazy or angry or whatever you’re feeling, it doesn’t give you the right to hit nurses. Violence is not ok and should not be tolerated. Hospital administrations should support nurses and those closest to the patients.

http://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/?WT.mc_id=SA_HLTH_20150106

Top 5 Posts in 2014

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Happy New Year’s!

I can’t believe that it’s been 2 years since I became a nurse. I remember 2 years ago, I was looking for a nursing job, and it was so difficult as a new graduate nurse. Nearly every posting I saw, it stated, “2 years of experience, preferred.” But at that time, I thought, how can I possibly get those 2 years experience if no one gives me a chance?

Somehow, I got lucky. Relatively, it’s been a relatively smooth career. I would say that NYU nurses work are all over NYC and wherever they decide to go (back home to their home state — New Jersey, Michigan, Texas, California, Oregon, etc) or they’ve gone back for their Master’s (I personally don’t know anyone who’s gone back for a doctorate degree yet).

By June this year, it’ll be the first time I renew my license. I’ll let you know how that goes.

In 2014, there has been more readers than ever — so thank you for reading my blog! Here are the top 5 posts in 2014.

5. SBAR – How to Give a Good Report

4. Is NYU Nursing worth it? How I paid off my loan

3. Med-Surg to ICU Interview Questions

2. NYU Nursing Accelerated 15-Month Program FAQs

1. How to Get a New Grad Nursing Job in NYC

For those looking for their first nursing job — my take on it is that any nursing experience is better than waiting around for the ‘ideal’ experience. Just keep in mind what you really want (where in nursing do you want to end up?) and keep heading in that direction. Opportunities open up for those who are ready and looking for them.

This year, I want to go over one evidence-based practice each month. Unfortunately, the conversion rate from science to real practice takes an average of 10 years (WHAT??). The goal is to reduce this rate and start practicing new findings sooner in practice.

For the last 2 months, I’ve been studying for the CCRN, which is a certificate offered by the American Association of Critical Care Nurses (AACN) that reflects the dedication you exemplify as you provide direct bedside care to acutely and critically ill adults. It can be taken by those who’ve practiced in critical care for 1750 hours within the last year. I’ve definitely learned a lot from it, especially things that I don’t use as often. It’s been great to incorporate what I’ve learned from there into practice.

2014 in review

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The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 34,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 13 sold-out performances for that many people to see it.

Click here to see the complete report.

The Flu season is back

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You either get the flu shot or you don’t. If you decide not to, you must sign a waiver and then wear a mask at all times once you’ve stepped inside the hospital… At least until the flu season is over, usually sometime in the beginning of April.

This requirement is so serious that if you didn’t comply, you’d end up with leave without pay and eventually fired within a week. So hop to it!

Most people don’t want to get the flu shot because they feel more tired and ill afterwards. They fear getting the flu from the flu shot. But people are much more likely to get the flu from the community than from the flu shot.

Some have an egg allergy, or a family history of Gullian Barre. In this case, definitely don’t get it. Or if you’re body is immunocompromised from another disease. Then adding a dead strain of the flu to your body is probably not a good idea.

Anyhow, wearing a mask all the time isn’t so bad. In fact, in Taiwan majority of hospital workers wear masks, partially due to the H1N1 and SARS virus that broke out a few years ago. The only annoying thing about it is if you wear glasses, it sometimes fogs up the glass or if you have an allergy to the mask material and you break out from it.

I never got the flu shot prior to 5 years ago. I was at Employee Health to get cleared to volunteer at a Cancer Center. The nurse asked if I got the flu shot. I said no and I didn’t want it.

What she said next changed my life. She said,

It’s not just about protecting you; it’s about protecting others.

Cancer patients are definitely immunocompromised. The radiation and chemotherapy is killing off good and bad cells, unfortunately. If I got the flu, my body may be able to fight it off easily but if I cough on someone else (by accident of course), it’d be much easier for them to get the flu.

That day I didn’t get the flu shot because I had a certain pride of never getting the flu shot.

2 days later I got the flu shot. I didn’t want to be that agent to pass on the flu.

For my boyfriend, I encourage him to get the flu shot. Last year we were at a Breast Cancer event in October in Providence, Rhode Island. There, Walgreens was offering free flu shots. So he got one.

This year I encouraged him to get the flu shot again. He didn’t want to because it’s an out of pocket expense. However, at his work they were doing an experiment on ways to encourage people to get the flu shot. They offered it for free. So he got one.

Cost and fear of getting the flu are the 2 major barriers for not getting the flu shot. Protecting yourself and others are my reasons for getting it.

What’s your reason for getting it or not getting it? Comment below!

NYC Marathon Volunteer

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The 2014 NYC Marathon
Medical volunteer
For the first time
At mile 15
In Queens

Keep those cramps and aches at bay…
PT to the rescue!
Massage, massage
Ice, ice
In 3, 2, 1
Off you go

Don’t drink too much water otherwise
You’ll get hyponatremia
Eat some salt!
Drink Gatorade to replace electrolytes!

Vaseline for chaffed thighs

Tylenol 650, not Advil
And only once
red dot
drink it down
Off you go again

Too cold
Warm up
Sit in the warm ambulance
Keep going!

Blisters
New bandaid

Ankle hurts
Wrap, wrap

And of course,
Scan in, scan out,
The fastest documenting ever

Inspirations abound
Spirits high

Let’s go!!

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