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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 

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Be in the Moment.

First Crack of Dawn–Bar Harbor, Maine


"Live in the moment, put in the work, it is all worth it to get to this place and beyond."

Matthew Parker took 37 photos over three mornings at the crack of dawn in Bar Harbor Maine. He had been diagnosed with Stage IV Breast Cancer in February 2021. He used photography and his background in architecture to make art. His brush with death helped him to learn how to live in the moment. I love that he says that you have to put in the work in order to put all of the pieces together.

I have been thinking about critical thinking and managing time lately. At my current job I have to make split second decisions with limited information or I am given false information. So, I have to rely on the facts that I see and the feelings that I get. Nursing involves science and art. The "art" is the intuition that you use to make decisions. Like Matthew Parker's art, we have to take pieces of a puzzle and rearrange them to make a cohesive picture. As nurses we are constantly rearranging the pieces as more information is learned. The "science" are the tests and assessments and questions asked to help put the puzzle together.

Here is an example from Medscape.com, a free medical website with resources for physicians, nurses and healthcare professionals. The presented case is part of a Clinical Challenge written and presented by Dr. Warren Harvey. The case is of a 30-year-old male who was complaining of nausea, vomiting and paranoia after a party.

"The patient appears anxious. He is vomiting and tearful. His heart rate is tachycardic, at over 130 beats/min. His blood pressure is 140/89 mm Hg, respiration rate is 20 breaths/min, and temperature is 98.6°F (37°C). His pupils are dilated and reactive; mild conjunctival injection is noted. His skin is diaphoretic and warm to the touch.

Results of the cardiac examination are normal, with the exception of tachycardia. His lungs are clear to auscultation bilaterally. Examination of the abdomen reveals mild diffuse tenderness without focal peritonitis or localized discomfort. The neurologic examination demonstrates normal cranial nerve testing results, normal strength and sensation in the upper and lower extremities, normal reflexes, and normal gait testing results. However, the patient is experiencing lightheadedness when he stands up. The patient is alert and oriented to self and place but remains agitated and paranoid. No clonus or muscle rigidity is noted. Deep tendon reflexes are normal. The patient is able to provide a urine sample.

The initial diagnostic workup in the ED includes ECG, complete blood cell count, basic metabolic panel, urine drug screen, and ethanol level. Owing to the patient's undifferentiated altered mental status and vomiting, noncontrast head CT is ordered as well.

The ECG shows sinus tachycardia with a normal axis, normal intervals, no ST elevations, no ST depressions or T wave inversions, no Brugada sign, no delta wave, and no prolonged QT. The results of the urine drug screen and the ethanol level are pending. Noncontrast head CT reveals no acute intracranial abnormalities. CBC and other labs are WNL (Harvey, 2023).

But this is when you need to listen to your intuition and ask more questions. He is 30 years old and went to a party. Other than drinking what do people do at a party? Drugs!

After further focused questioning, the patient admitted to ingesting an edible cannabis "gummy," which contained approximately 100 mg of tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis (Harvey, 2023).

Most people do not react to cannabis with paranoia but there is a small percentage who have a "paradoxical: reaction to cannabis. As a nurse, in order to make quick decisions, you have to clear your brain of everything else and focus on the pieces (photos) in order to find a cohesive whole. Again, I will say, put your phone down, take a deep breath and open your entire brain to the information that is in front of you.

Jon Hawes, a nurse and founder of Nursing.com says that critical thinking is done using 4 steps:

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in all that you do.

  1. Suspend ALL Judgement

  2. Collect ALL Information

  3. Balance ALL Information

  4. Make a Complete and Holistic Decision (Haws, 2021)

It is so important in collecting data that we suspend judgement in order to make a correct decision. If the patient with cannabis toxicity had been 75 years old instead of 30 years old, would you have made the same decision about the cause of the problem? Probably not since we typically do not think of older adults or senior citizens using cannabis.

I learned a valuable lesson when I was a Clinical Instructor with LVN students. A female student asked me to give her interventions to help the pain she was having after eating. She said she always had lower abdominal pain after a meal. I told her to see her PCP and told her to ask for GERD medication. Since I was past childbearing at that time, I completely missed her symptoms related to OB/GYN issues. A few days later she was in the hospital with an ectopic pregnancy!

Critical thinking requires that we collect all data, suspend all judgement and put the pieces together to form a holistic picture.

Harvey, W. (2023, June 14). A 30-Year-Old Man With Paranoia and Vomiting After a Party. Medscape. https://reference.medscape.com/viewarticle/940708

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