Mammograms and Trials: Free and low Costs for Breast Cancer Awareness month Mamografías e investigaciones: gratis y a bajo costo para cáncer de mama (Octubre: mes de concientización )

Foreign physicians: Universities instructors positions (Anatomy, microbiology and others)

Pharmacology key points (NCLEX type questions, key points and epidemiology facts) : Diabetes Mellitus, anti-coagulation, and Reproductive medications: According to CDC (2024) approximately 30 million people in the United States have been diagnosed with diabetes, about 98 million (adults) more than 1 in 3—have been diagnosed with prediabetes and it’s one the leading cause of death (7th ). Healthy People 2030 focuses on reducing diabetes cases, complications, and deaths. WHO(2024) points out that this chronic endocrino-metabolic disease is the principal cause of blindness, kidney problems and failure, cardiovascular disorders, and stroke. Diabetes during pregnancy usually doesn't have any symptoms. In the United States, Caucasian people are more likely to develop type 1 diabetes than African American and Hispanic or Latino people. Cultural beliefs and values can influence the diet, nutritional habits and lifestyle (this last is relative) Type 1 diabetes 5-10% of people with diabetes have type 1(less common that type 2 diabetes (CDC, 2024) Read the ATI chapters, Karch chapters (Prep-U) Key points: nursing or NCLEX exam 1. If a question asks to choose the correct Insulin for an emergency situation such as hyperglycemia or ketoacidosis : Regular Insulin that is a short acting (IV): onset less than 30 min. 2 . How to store the Insulin : questions clues: if it is an open vial (at room temperature up to 1 month ) to minimize the tissues injuries. If it is an unused Insulin (should store it in the refrigerator), prevent exposure to sunlight, inhibit bacterial growth, and maintain potency 3. It is not necessary to aspirate the Insulin or medication prior administration, the client or nurse should mix compatible solutions (regular or short with NPH) to reduce risk for additional injection. 4. Remember sites for SC injections of insulin (abdomen and thighs) and rotate the sites for each injection. 5. Before administer Insulin: assess Vital signs, symptoms, signs, Glucose (fast glucose Accu-chek) : 6. If a meal is skipped, the insulin(mealtime dose)should not be given. (patient self-care: adjusting the amount of insulin based on blood glucose. Kids the electronic device CGM sensors such as Dexcom G6, Guardian sensor 3 inserting a minuscule device on the arm or stomach and read the glucose around the clock paired to smartphone: reduce finger-stick glucose meter, and improve self-care (school nurses should know about it) 4. Steps for mixing and administering the insulin: Inspect vials or recipient's labels Roll NPH vial between palms or hands Inject air into NPH insulin vial Inject air into regular insulin vial Withdraw short acting (clear/rapid) insulin into syringe Add NPH (cloudy) to syringe (remember caution/precautions) Remember the question that ask in what options the patient or client need for further teaching: Example: a client who explain that if he/she skip a mealtime I will use insulin Glargine in my Insulin pump (The Insulin pump is designed to administer rapid acting or short acting during 24 hrs. Glargine is a long acting and is administered at the same time each day. Thus this statement needs further explanation and teaching by the nurse or health provider. 2. If I skip lunch, I will skip my mealtime dose of Insulin. 3. I will change the needle every 3 days 4. I will store the unused Insulin in the refrigerator. Type 2 diabetes: Education on self-care: a healthy diet Regular physical activity, maintaining a normal body weight, also it’s recommended avoiding tobacco, alcohol, to delay onset and/or complications of type 2 diabetes. For regular exercise: 150 is the magic number (150 minutes weekly): You could aim for 50 minutes of exercise (three times a week),also recommended 30 minutes five times a week or 25 minutes six times a week. For the blood thinners medications: Remember: Assess the patient or client for bleeding, Heart rate, decrease blood pressure, petechiae, hematoma, black tarry stool. Heparin pathway Affects intrinsic pathway Uses: prophylaxis and treatment: DVT, PE, (does not dissolve clots that have already formed) Use in pregnancy Heparin and LMW heparins (monitor thrombocytopenia) route IV (infusion) or SubQ onset Rapid Drug interactions Few drug interactions Aspirin, NAIDS,: increases risk of bleeding with Heparin 4 G: garlic, ginger, glucosamine, ginkgo: increase risk bleeding Resveratrol, saw palmetto: antiplatelet effects Assess bleeding and: therapeutic range APTT : Keep at 1.5 to 2 times the baseline Effectiveness evidence by: APTT 60 to 80 sec antidote Protamine(IV): 20mg/min Heparin (prophylaxis): 5000 Unit (fixed) SC every 8 or 12 hours is an effective and safe form of prophylaxis in medical and surgical patients at risk of venous thromboembolism. Low-dose heparin reduces the risk of venous thrombosis and fatal PE by 60% to 70%(Anticoagulation guideline) Vitamin K antagonists should be taken at the same time every day, this allow to adjust or hold the dose the same day that the INR result becomes available (Anticoagulation treatment guidelines, 2020) Heparin: Enoxaparin: Monitor vital signs, platelet count, signs of bleeding, avoid Aspirin, and monitor sensation and movement of lower extremities. Heparin and LMW heparins are used during pregnancy, if anticoagulation is desired. For pregnants who have heparin induced thrombocytopenia, Argatroban should be prescribed. Warfarin : Acts on the extrinsic pathway Uses: Prevention DVT, PE, atrial onset: slow Many: Heparin, Aspirin, Acetaminophen, Glucocorticoids, sulfonamides, Cephalosporins increases the effect of Warfarin Phenobarbital, Carbamazepines, Phenytoin, oral contraceptives, and Vitamin K decrease anticoagulants effects. Monitor Bleeding, Vital signs, INR, PT INR 2.0 to 3.0(most accurate) P.T: 18 to 24 sec Warfarin: Category D: pregnant with mechanical heart valves, Category X: for other pregnancies due to risk hemorrhage antidote Vitamin K Example questions: A client who has atrial fibrillation and receives Heparin to extend or decrease clotting time. APTT resulting in 80 seconds is double the control value and indicates effectiveness of the heparin therapy. Stop Heparin if platelet count: less than 100,000/mm3 Important: heparin does not dissolve clot. It stops new clots from forming. Clopidogrel: Inhibits platelet aggregation: nurses and health providers recommend to stop the medication 5 days before any surgery. Remember : Concepts infections: Resistant infections : when bacteria, viruses, fungi, or parasites create the ability to resist antibiotics medicines example: methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus (VRE) multidrug resistant. Nosocomial infections: infections acquired during the process of receiving health care (ambulatory settings, long term care facilities, hospitals) that were not present before client or patient admission or before receiving the health service. Superinfections : Acquired during or after antibiotic treatment ( by disrupting the body’s normal flora or microbiome, producing an imbalance example: Candida, MDR gram negative rods, Clostridium difficile, MRSA. Remember than a questions clues could be: symptoms and signs of a disease: for example: sudden weakness, numbness of the face and one arm or leg indicate risk for stroke and in a group of patient could be a priority to receive emergency service (anticoagulants), remember ABCD, Maslow theory needs, and other evidence based practices. Remember grapefruit juices modify and alter the activity of specific enzymes(CYP3A4 and CYP1A2), mainly in older adults These enzymes decrease the rate at which medications enter into the blood, thus grapefruit juice can increase toxicity of many drugs through this inhibition: Statin or cholesterol and lipid lower medications, Sertraline, Amioradone, Verapamil, Simvastatin and others. Anticonceptives frequents questions on ATI, Kaplan, Saunder: Example: if a patient or client complains about a missed dose, the nurse should recommend to take the missed dose immediately, then continue with the pack as ordered. Emergency oral contraceptive: Progestin with levonorgestrel (PO): Inhibits ovulation 72 hours before unprotected sexual intercourse. Estrogens: (oral, IM, IV, intravaginal, transdermal): Estrogens functions: participate in growth and maturation of the female reproductive system, follicular phase of the menstrual cycle, also blocks bone resorption, nad reduce low density lipoprotein. It used as contraceptive with progestin, acne, relief of moderate to severe menopause, treatment of dysfunctional bleeding and other (ATI book ch29) It is crucial to educate the patient or client to avoid smoking during contraceptives treatment. No interactions with anticoagulants, oral hypoglycemics, or thyroid medications. Encourage: visit the primary health provider frequent, obtain baseline of breast exam, pap smear, assess swelling, erythema of lower legs etc. Levels of diseases prevention: primary, secondary, tertiary, level of cares in relation to pharmacology. a frequent question is : If a patient or client receive treatment with Insulin: The nurses is providing tertiary prevention action because the client has a disease (Type 1 diabetes example), and the nurses is avoiding complications, and treating a disease. Remember the six rights and the assessment of the vital signs before administer any medication, and it's crucial to read carefully the health providers prescriptions (with critical thinking all the time)

My name is Joel Collazo. I am a medical doctor from Havana, Cuba. I left my natal country about 4 years after I graduated and when I was about to finish my specialization in Histology. I lived in Peru, where I practiced medicine and did ultrasound. In 2007, I moved to the United States with the idea of either obtaining the license to practice medicine or studying nursing. However, I always loved teaching and I did have the opportunity to begin teaching in 2009 at Miami Dade College (MDC) as an adjunct faculty for anatomy & physiology, and biology. At some point I started thinking about obtaining an “American diploma” that qualified me to get a job in an “easier” way and it was while I was working at a private college while still at MDC that I was “required” to have a master’s degree, which I completed at Barry University. I did it and right after finishing, a friend and colleague told me and some other friends/colleagues about a Ph.D. program in Public Health with specialization in epidemiology, fully online, and without too many pre-entry requirements like exams, etc. I decided that that could be an excellent opportunity for me to earn a terminal degree that would help me further my job opportunities and at the same time, give back to the country that I was so grateful for. The master took me less than two years, but the Ph.D. took me 8 ½ years. Here comes my advice, never give up although the horizon looks so far that is invisible. My doctoral dissertation was my first research ever. It took me about 3 years to fine tune my research topic because I did not know how to organize, prepare, and conduct a secondary data analysis. This frustrated me because I had an approved prospectus on Epigenetics and Epidemiology of Breast Cancer however, I did not have data. I thought about giving up sometimes but my desire to demonstrate to myself that it is never late in life was bigger than anything else. Also, I had similar feelings regarding my family, especially my daughter, and then my students. I always tell everyone that it does not matter what or how you will be successful, if you do the right thing. Bottom line, you are in a new country, and you want to succeed. That is why you came here, and as a professional in your country, it may happen that you need to adjust, or even change that profession. Maybe you were not a professional but now you have decided what you want to be. Whatever your situation is, do not give up. It is not easy to be reborn, but when you are, the opportunities can be endless. Joel Collazo, MD., Ph.D.

Somatic symptom disorder. Somatic symptom disorder is characterized by physical symptoms that cannot be explained by a physical disorder. The client comes to the nurse's station and reports chest pain. The nurse knows this is a new symptom for the client, in a similar case the nurse should assess the patient, reassuring, without judge them. The type and frequency of symptoms in somatization disorders differ depending on the culture in which they are expressed. For example, there is a higher reported frequency of somatization disorder in Greek and Puerto Rican men than in men in the United States. Therefore, the symptoms reported could be linked to the cultural beliefs and values. Factitious disorder, also known as Munchausen syndrome, is characterized by the conscious fabrication of symptoms or self-inflicting injuries to gain attention. Clients who have factitious disorder can have multiple hospitalizations or even surgeries as a manifestation of this disorder. Patient with factitious disorder has unexplained pain Clients who have factitious identity disorder can experience unexplained abdominal pain, surgeries, bleeding, fever, hypoglycemia, seizures, or cancer, which can be manifestations that are manufactured or self-inflicted. The neurological symptom disorder often worses or becomes more apparent when a client is experiencing a stressful situation. Statement response by the health professional or nurse: " We will work with you to help you develop ways to manage your symptoms that are caused by the disorder" Functional neurological disorder, also called conversion disorder, is characterized by neurological manifestations that have no neurologic cause. Autistic Spectrum disorder : A nurse can act as an advocate for a client in coordinating care, education, and skill development with counselors, teachers and school staff to promote good outcomes. Young children who have ASD often exhibit restricted, repetitive patterns of behavior, interests, or activities. This may include repeating the words and actions of others without reason or context. A client with a stereotypical motor disorder would have difficulty controlling impulsive movements when excited, so a good outcome statement to evaluate progress of interventions would be to control these movements effectively. Young children who have ASD often exhibit restricted, repetitive patterns of behavior, interests, or activities. This may include repeating the words and actions of others without reason or context. Advocacy also includes talking to the provider about changing the dose of medication or switching to a different medication to decrease negative effects. Completing homework requires attention and mental effort. The nurse should then discuss behavioral interventions with the guardian when implementing interventions for addressing the child’s behaviors at home and school Tourette: multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more Conduct disorders risk factors and symptoms : School history of negative behavior (being impulsive) , aggressive treatment to animals, parental history of neglect, bipolar disorder, conduct disorders, and substance use, living or family dysfunction that include a history of frequently running away from home and now having no permanent home , and displaying disregard in interactions with other clients are all indications of conduct disorder that have led the client, as an adult, to display manifestations of antisocial personality disorder. Behavioral disruptive disorders are a group of disorders linked to difficulty in self-control and aggressive behavior toward others. Conduct disorders . The nurse should first address the client's safety, followed by their refusal to take their medications. Clients who have intermittent explosive disorder, frequently have impulses that result in explosive rage that is disproportionate to the situation. These rage explosions can be dangerous and destructive in nature and can cause injury to the client or others. Oppositional defiant disorder (ODD) is a disruptive behavior disorder appearing during childhood or adolescence and frequently is given by persistent angry or irritable mood, unruly and argumentative behavior, and intention to seek revenge (vindictiveness) . It frequently manifests in hostility toward authority figures Reporting the breach of confidentiality upholds the ethical and legal obligation to protect client privacy. Establishes boundaries: The nurse should clarify the boundaries refocusing the client back to the issue of the session. Avoid options that may be judgmental and may provide an opening for a verbal struggle or those that are a social response and could be misinterpreted by the client. Delirium risk factors: Include increased severity of physical illness, older age, and baseline cognitive impairment such as that seen in dementia. Delirium usually develops over a short period, rapid onset, throughout the course of a day. An older adult client with sepsis is at the highest risk for the development of delirium due to the seriousness of the illness. It is typically a direct physiological consequence of another medical condition, substance intoxication or withdrawal, exposure to a toxin, or multiple etiologies. Alzheimer:’s disease: Affected executive function including planning, decision making, and working memory.The nurse should identify a client who has Alzheimer's disease and is having difficulty multitasking is experiencing a cognitive deficit of executive function, memory loss that affect daily activities progressively (ADLs) Impaired attention, memory, and abstract thinking: cognitive disorder references: Videbeck. LS (8ed) Kluver, W (2023) Physichiatry mentalhealth/nursing.

Being a registered nurse (RN) in the USA is one of the most interesting, fascinating jobs, and it's a health career with wide of possibilities. According to the U.S Bureau of Labor Statistics (2024), registered nurses are one of the most rapid evolving professions (6 percent from 2022 to 2032), quicker than average over all in relation to its dynamic, annually new opened positions and broaden horizons in its proper development. Being a registered nurse (bachelor's degree in nursing, an associate degree in nursing, from a recognized approved nursing program) means that this professional can work in diverse medical and nursing settings. Some of these settings include, but are not limited to, private companies, public health departments, school nursing program, hospitals, occupational, research, education, legal offices, health insurances, and your own business. During 2022, almost 60% of the RN jobs placement were hospitals, 18 percent worked in ambulatory healthcare facilities (traveling nurses, physician's offices, outpatient care centers, and home health cares), 5 percent worked in the public or government sites, and approximately 3 percent in educational settings.