On the front lines of medical care, nurses are down in the trenches carrying out orders for patients. Yet they are anything but mere handmaidens to doctors in ivory towers. Highly educated, highly skilled and technically savvy, today’s nurses are repositories of some of the most practical advice you could ever hope to receive about your health care.
Read on for tidbits gleaned from local nurses that will help you navigate your way through the ever more complicated process of managing your health. Their advice is not always trendy or hip, but it all comes with a strong dose of common sense, straight from the heart.
General Medicine
Know Thy Meds—I recommend knowing medications—including the dosages—and the last time they were taken. Especially the older population—who take six or 10—it’s hard to memorize them, so have a written list. A physician can tell a lot about a patient just by what meds they are on. It gives a lot of background.
—Becky Roberge, RN, emergency room charge nurse, Mercy General Hospital
Have Someone in Your Corner—If you are having a serious health issue, if it is at all possible, have an advocate with you for all appointments, treatments, hospitalizations, etc
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—Jean Randolph, RN, adult medicine charge nurse, Kaiser Permanente Folsom
Get into Your Health History—Patients should know what their history is. Do they smoke, have high blood pressure, have diabetes, or are they overweight? People don’t think that because they have diabetes they have a higher risk for heart attack, but they do.
—Becky Roberge
Plan Ahead—If patients are going to be admitted, make sure they bring their advance directive (a document where your health care decisions are spelled out ahead of time).
—Becky Roberge
Question Authority—I think having people, patients, not be intimidated by the system is important. Health care, insurance—the whole system is very cumbersome. It’s difficult to get through, but be willing to talk. If you’re in the ER and going to have a procedure and you don’t know what it is—ask! Some people are just intimidated because they don’t understand health care and hospitals. Don’t be afraid to ask questions and get help. Patients don’t understand how it all works—the system is too complex.
—Becky Roberge
Make Healthy Choices—Sometimes things happen in spite of our best efforts, but the majority of illness and disease that we see every day in our clinics are directly related to unhealthy behavior choices.
—Jean Randolph
Emergency Medicine
Coping, Companions and Constipation—My thing is people’s coping abilities. A lot of people come to the ER because they want something to be wrong with them; they just can’t cope with their lives. Lots of elderly people call an ambulance in the middle of the night because there’s no one there to talk to and give feedback. It’s lifestyle stuff—they don’t sleep right. But there’s no one to tell them, “No you’re not having a heart attack. Or a brain tumor.” Lots of people come in with abdomen pain and they’re just constipated. No matter what— if people feel they need to talk to a doctor they should come. Part of our service is to provide peace of mind.
—Barbara Todd, RN, emergency room manager, Sutter Roseville
Don’t Use the ER As Your Primary Care—Have a primary care physician. So many people use the ER as their Don’t Use the ER As Your Primary Care—Have a primary care physician. So many people use the ER as their primary care. But the ER only can deal with the current problem, not maintain your health.
—Dana Covington, RN, emergency room nurse, UC Davis Medical Center
Don’t Go to the ER To Get Prescription Refills—We’re not going to do it because we don’t know you. It’s a waste of your time.
—Barbara Todd
Ambulance vs. Automobile—If there is an emergency, don’t just throw somebody into a car because you’re afraid of an ambulance taking too long. Call 911. Have the paramedics come. There are a lot of things the paramedics can do, such as preliminary interventions, to prevent a deteriorating event. Paramedics can also call ahead to ER to get prepared with special equipment or drugs.
—Becky Roberge
Different Sex, Different Symptoms—People should understand that the same disease can present different symptoms in men and women. For instance, during a heart attack women typically don’t have crushing chest pain—women have shortness of breath. They just don’t feel good; they have abdominal pain. Eighty percent of the time women will not show chest pain. Educate yourself. When in doubt, call 911.
—Becky Roberge
Nurses Don’t Check Insurance—We’re going to see everybody. Nurses don’t ask what kind of insurance you have.
—Barbara Todd
Cardiology
No One Else Can Fix You—People need to understand is that the primary responsibility for their health care is on them. We have some people who come in who believe that the doctors and nurses who see them should be able to fix them, and then they can just forget about their role in their health.
—Bill Bryant, RN, cardiac intervention unit nurse, Mercy General Hospital
Call 911—If patients are experiencing chest pain or shortness of breath, call 911. We get so many calls [to the clinic] from patients asking what to do. We also have a lot of patients who walk into the clinic with these symptoms. It’s frustrating, because we’re just a cardiology clinic. We don’t have the proper equipment to take care of someone with those symptoms.
—Denise Phillips, RN, BSN, cardiology clinic nurse, UC Davis Medical Center
Pill Poppers—It’s frustrating when people don’t know their meds. “Oh, I take a little pink pill in the morning, and a gray one at night, and an odd-shaped one at lunch.” It leads us to believe that they may not be taking them correctly.
—Bill Bryant
For Congestive Heart Failure—If people have congestive heart failure, they should ask their doctor what their ejection fraction is. It’s a measurement of how well their heart is pumping blood. It’s a painless test measured by ultrasound, and shows how bad their congestive heart failure is.
—Bill Bryant
Exercise Constraint—We become more sedentary as we get older. We tend to put on pounds. If you can, at least take a brisk walk every day for 30 minutes. If you’re afraid of walking in your own neighborhood, go to the mall. It’s safe and air-conditioned. Lots of people exercise in the mall. Just don’t bring your wallet.
—Bill Bryant
Block and Inhibit—Almost all congestive heart failure patients should be on an ACE inhibitor and a beta blocker. They’re proven to help heart patients. Patients should ask their doctor if they are taking these, and if not, why not? There are instances when these meds are not appropriate, but patients need to know why if they have not been prescribed.
—Bill Bryant
Follow the Directions—Patients should take their meds as prescribed. Don’t change them! Patients end up in the ER because they’ve changed their beta blockers—they end up hurting themselves.
—Denise Phillips
Pass on the Salt—Salt tends to make people retain water, and that overloads the heart. The extra fluid adds a burden to the heart. It’s like carrying around a pail of water.
—Bill Bryant
Cancer Care
How Much Do You Want To Know?—I wish patients knew how important it is for them to ask questions. We want to provide them with as much information as they would like. It can be difficult to know how much a patient wants to know about their disease, treatment options, etc.
—Susan Krueger, RN, clinical research nurse, Kaiser Permanente
Be Aware, Not Scared—There have been so many advances in cancer treatments in the last few years. We have better drugs not only for treating the cancer, but also drugs to allay some of the side effects associated with cancer. For instance, we have better drugs to control nausea and vomiting—with the new antiemetics, most patients don’t experience any vomiting and nausea is usually minor. If they have nausea or vomiting, there is probably another drug to try. We use drugs to combat neutropenia (decreased white blood cells), which can lead to infection, hospitalization, etc. We have better antibiotics if patients get infections.
—Susan Krueger
Your Needs Are Important—I wish patients knew how important their needs are. While it is important for patients to receive chemotherapy on time, it is also important that patients do things that are important to them. For patients with advanced disease, if they want to take a vacation, we can work around their schedules.
—Susan Krueger
Dialysis
Your Body Is a Temple—I’ve worked both dialysis and transplant. Dialysis patients are often treated as though they were in a factory setting. I wish that they remembered that their body is still their own. They need to treat their dialysis access as if it was their most precious jewel. They need a two to three minute scrub of their arm with antibacterial cleanser. They should follow all the guidelines for correct care regardless of whether it takes an extra 10 minutes. People who don’t take care of their access have a good chance of getting bacteremia, or catheter-related sepsis.
—Jana Cinder, RN, dialysis access nurse, UC Davis Medical Center
Make Lemonade—Patients can take advantage of dialysis cruises. Talk to their social worker. Make dialysis as positive an experience as possible. Try to interact well with the staff and team. We know that dialysis is a difficult lifestyle and we admire them greatly.
—Jana Cinder
Pediatrics
Restrain Your Kids—Seatbelts absolutely make a difference in outcome. Kids aren’t restrained and they usually go against or through the windshield. It’s a big difference in their outcomes, people who use seatbelts are a lot better off.
—Dana Covington
Boost Their Chances—Don’t take your kids out of booster or car seats just because they’ve reached the right age. Children should use boosters and car seats until they reach the correct height or weight limits, even if it makes them feel like a baby. I tell my daughter, “I love you too much to let you get hurt.”
—Dana Covington
Follow Directions—Make sure you have the instructions for a booster seat or car seat you got at a yard sale. It’s heartbreaking because most of the time the family doesn’t know how to do it right—how to put on the belts right or use the car seat correctly. If a child is not wearing their booster seat belt correctly—maybe using the lap belt but not the shoulder belt—they can get a perforated bowel.
—Ellen Kissinger, RN, pediatrics, UC Davis Medical Center
Let Us Help You Cope—Let the nurses know what’s going on in the family. We had a mom with a child in the pediatric ward. The mom was unusually stressed and upset. Finally it came out that grandma and grandpa were visiting from across the country and mom wanted her sick child to get a haircut. Nurses have insights. Ask the nurse.
—Ellen Kissinger
Make a Home Away from Home—Families should bring in things to make their kids as comfortable as possible in the hospital—special pillows, blankets, stuffed animals—whatever signifies comfort to the child.
—Ellen Kissinger
We’re Adaptable—On admission, we try to ask families, what’s the normal routine? A nap at 1 o’clock? Preferences are huge. Nurses will adapt to your routine.
—Ellen Kissinger
Women’s Health
Make Yourself Comfortable—Select an OB/GYN physician or nurse practitioner who you feel comfortable with. Be open and honest regarding your health history. Your doctor bases treatment decisions on current and past information that you provide.
—Nina Wilson, RN, women’s health department charge nurse, Kaiser Permanente
A Time To Laugh—I wish women laughed more—took time for their spiritual/psychological health more. Modern medicine is wonderful, but it is better to stay healthy than to treat illness.
—Susan Abbott Rogge, RN, NP, breast health center nurse practitioner, UC Davis Health System
Test Yourself—Get a mammogram annually if you are over 40 years old. Get a Pap smear and HPV test every three years or as advised by your physician. Perform monthly breast self exams. Early detection saves lives.
—Nina Wilson
Supplement Your Health—Take your vitamins. Women of child-bearing age should include a folic acid supplement. Talk to your health care provider about bone health and calcium supplements.
—Nina Wilson
Orthopedics/Joint Replacement
Just Do It—Patients must do exercises two to three times a day—whatever their surgeon says. They have to do their exercises. For the hip replacement it’s not so much to get range but to get balance. For knee replacement it’s imperative to get range of motion and strength, for straightening their knee—unless you get your knee straight (which is the least fun exercise) you won’t walk without a limp.
—Debbie Zakerski, RN, orthopedic/joint replacement nurse, Sutter General Hospital
Dieting Not Allowed, Nor Constipation—When you have surgery don’t go on a diet, do eat healthily. Anytime you have pain medications and anesthesia, constipation is a problem. Make sure you do have a bowel movement after surgery within 48 hours. If you are a caregiver, try and assist them back to their normal pattern as soon as they can.
—Debbie Zakerski
Take Your Meds—Incisional pain can be intense after an orthopedic or joint replacement operation. You’ve got to be able to get through the medication part of it to do your exercises. If you can’t get through your exercises, you’re not ready to cut back on your pain medication. If you’re somebody who does have a problem [with addiction] talk to your doctor so that you can get the proper pain management. They have done studies that people who take their pain meds do better.
—Debbie Zakerski
Doctors Have the Catbird Seat—Follow what your surgeon says to do. They have a bird’s eye view in there—in your joints and tendons. They tell you what to do for a reason. It doesn’t matter if your neighbor down the street was told something different. Don’t compare yourself to others or even to your own prior operations—all are different.
—Debbie Zakerski
It’s Payback Time—The best time to have surgery is when you have more help at home. If you have kids who are teachers and have summer off. . . If they can do it for you, let them do it for you.
—Debbie Zakerski
Infection Control
In these scary times of bird flu and talk of pandemics, stopping the spread of disease is more important than ever. A team of infection control nurses from Kaiser Permanente put their heads together to come up with the following tips:
Don’t Live Hand to Mouth—Hand washing is one of the most important ways of stopping the spread of germs. Practice good hand hygiene (use soap and water or waterless hand degermer) after coughing or sneezing; after using the restroom; before preparing food, eating or drinking; or when hands are visibly soiled.
Keep Your Fingers out of Your Nose!—This is one of the primary ways flu and cold viruses are introduced into your body.
Protect Yourself and Others—During the cold and flu season, cover your cough. Use a tissue or cough into your elbow area to avoid contaminating your hands. Don’t sit close to someone who is obviously ill (coughing or sneezing). Stay home from work or school if you are ill. Keep ill children home and away from school and day care.
Immunize Yourself . . . Against vaccine-preventable diseases like influenza, pneumococcal pneumonia, pertussis and Hepatitis B.
Exercise Some Sense—At the gym, clean off high-touch areas of the workout equipment before use and place a towel barrier on items such as weight benches. Don’t share towels!
Visitors Not Wanted—Don’t visit a friend or family member in the hospital if you are ill with a cold or flu.
Don’t Share—Teach your children not to share drinking cups or utensils. Don’t share food like Popsicles, or take “bites” of other peoples’ sandwiches or fruit.
Shopping Sagacity—Shopping carts are dirty. Many grocery stores are now providing antiseptic wipes in dispensers for customers to use. You can never be too careful in public places.
—Margot Fermer, PHN (public health nurse), Kaiser South Sacramento; Karin Dentinger, RN, infection control nurse, Kaiser Sacramento; and Betty Goetsch, RN, infection control nurse, Kaiser Roseville.
