Get the inside scoop of nursing school from someone who is going through it. Join nursing student, Melanie, each week for tips on everything from acing your Foundations class to getting your very first job as a nurse.
Chronic Kidney Disease
What do you need to know as a nursing student about Chronic Kidney Disease?
Today I'm going to be talking about chronic kidney disease.
When a patient has a problem with their kidneys, it can either be an acute problem or a chronic problem. So it could be acute kidney injury which can often be reversed and fixed or it could be chronic kidney disease and that is not reversible. With chronic kidney disease they will eventually need dialysis or a kidney transplant. Chronic kidney disease is an irreversible loss of kidney function that happens slowly over time. It's often called a “silent disease” because it usually presents with no symptoms at first. We can say that a person has chronic kidney disease once their glomerular filtration rate or GFR is less than 60 ml per minute.
Let's talk about Cirrhosis! Learn about the signs and symptoms, the complications, and what you, as the nurse, can do about it.
Over 44,000 people die every year from cirrhosis, so it’s the 9th leading cause of death in the US. Cirrhosis is an incurable form of liver disease that happens slowly due to inflammation and scarring of the liver tissue. When you think of cirrhosis, think of scarring, or “Scarosis”. The main cause is chronic hepatitis C. The other two causes are: drinking too much alcohol, and nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease is when too much fat gets stored in the liver cells, and this can be from obesity or diabetes.
So the liver cells get damaged, they try to fix themselves, but just wind up making scar tissue instead. So instead of having a nice, smooth liver, you’ve got a lumpy mess of a liver with constrictive bands that cut off the flow of blood and bile. Remember bile is made in the liver, and then has to go to the gallbladder to be stored.
So why do we care so much about the liver? What does it do for us?
Our liver detoxifies alcohol and drugs. It breaks down proteins and carbs, and steroid hormones. It makes blood clotting factors, so if your liver isn’t working, you’re gonna have a decrease in every coagulation factor, except factor 8. The liver makes blood proteins, like Albumin, and if you remember, Albumin is the main protein in your blood, and the main thing regulating your oncotic pressure, or the thing that’s keeping your fluids in your blood vessels, and not seeping out into the tissue. So when the liver isn’t making enough Albumin, we’re gonna see edema and ascites. Ascites is when too much fluid builds up in the peritoneal cavity, causing a big swollen belly.
A normal liver will store glucose as glycogen for later use, but with an impaired liver, we could see hypoglycemia or hyperglycemia cause the body’s having a hard time regulating the glucose levels. The liver makes bile, and bile absorbs fat and gets rid of bilirubin. Bilirubin is a yellow pigment that’s a byproduct of your old red blood cells getting broken down. A healthy liver will take that bilirubin and put it in your poop with bile to get rid of it. This is what makes your poop brown. So without that bile, your poop is gonna be pale and clay-colored, because you’re not getting rid of the bilirubin pigment, and that bilirubin is gonna keep building up building up and make your skin and the whites of your eyes yellow.
Hyperthyroidism & Hypothyroidism
This week, the most high-yield topic is hyper and hypothyroidism. You’ll see a lot of your test questions coming from this subject.
I’m gonna talk about hyperthyroidism first, and then I’ll cover hypothyroidism.
So, What is hyperthyroidism? It’s when your body makes too much of the thyroid hormones T3 and T4. I’m not sure how much of the A&P you remember from forever ago, so to review how T3 & T4 are made, your hypothalamus in your brain releases Thyroid Releasing Hormone; this makes the Pituitary gland release TSH, or Thyroid Stimulating Hormone, and that makes the thyroid, the little butterfly-shaped gland on your neck, produce T3 and T4.
In both hyper and hypothyroidism, the main causes are autoimmune disorders. The autoimmune disorder that causes hyperthyroidism is called Graves disease. With Graves disease, the patient will have a goiter, or an enlarged thyroid gland, that’s sometimes so big, you can see it from the door of their room. They’ll also have the characteristic bulging eyes, or exophthalmos. This will also be very noticeable, cause it’ll look like they are staring at you in a creepy way, and their eyes are protruding out of the sockets. Usually, our upper eyelids cover the top half of our iris. But in a patient with exophthalmos, you’ll be able to see the white of their eyeball above their iris, below their upper eyelid. So, if the patient has green eyes, you’d be able to see some white between the green and their upper eyelid. Sometimes the exophthalmos will be so bad that they can’t even close their eyelids all the way.
Hypothyroidism is when the thyroid gland doesn’t make enough T3 and T4. So just the opposite of hyperthyroidism. The most common cause is the autoimmune disorder, Hashimoto’s thyroiditis. I remember that Hashimoto’s causes hypothyroidism like hypO, HashimOto. Hashimotos is when your body makes antibodies that destroy your thyroid gland, which decreases T3 and T4. This causes the gland to grow bigger to compensate, which creates a goiter. So you can have a goiter with both hyper and hypothyroidism.
Another cause of hypothyroidism is simply not getting enough iodine in your diet, but this isn’t an issue here in the US, because we put iodine into our salt.
Also, if someone is getting treated for hyperthyroidism, like they get a thyroidectomy, or radioactive iodine ablation, those can both overcorrect to lead to hypothyroidism. Even if they are just taking antithyroid medication, and they take too much.
8 Tips To Get The Most Out Of Nursing Clinicals
If the hospitals in your area are allowing students to come in, then you’ll likely be starting your clinical rotations soon, if you haven’t already. Today I’m going to share some tips that will help you really get the most out of your nursing clinicals.
Tip #1: Daily Goals Post-it-Note
Tip #2: Ask to Watch or Do
Tip #3: Don't correct the Nurses or Techs
Tip #4: Be Brave
Tip #5: Don't Cry
Tip #6: Be a Team Player
Tip #7: Keep a Clinical Journal
Tip #8: Embrace Failure
Doing a head to toe assessment is something you will be doing day in and day out for the rest of your nursing career, so let’s learn how to do it quickly, and efficiently.
For the 1st week of nursing school, the most high-yield topic is tissue integrity.
Well, what is tissue integrity? It’s your skin’s ability to repair itself and stay healthy. Let's talk about it!
Awesome! PLEASE keep going!!
I love how you break it all down in an easy to understand body systems! I’m sure you’ll be great at whatever you record! Please keep it coming!
Very good resource!
Great podcast and resource!
I’m happy I found your podcast, this is calming to my nervous which is all over the place, love the ways you explain, (hope my lectures will be similar lol... thanks and I really appreciate you.