#Nursing interventions

[artisticdivasworld]

Breathing Easy: A Comprehensive Guide to Helping Patients with COPD

Living with chronic obstructive pulmonary disease (COPD) can be challenging and overwhelming for both patients and their loved ones. COPD is a progressive lung disease that affects millions of people worldwide and can significantly impact their quality of life. However, there are various strategies and treatments available to help patients manage their symptoms and breathe easier. In this…

[muirmarie]

i'm at work but someone dare me when I'm off to write the cas/hawkeye/margaret (dean/cas & hawkeye/margaret) time-traveling post 15x19 ptsd fic that I suddenly very much want to write

[hereticalseraph]

I’ve cared for two separate patients on a telemetry/cardio step-down unit who were admitted for complications related to their gastric bypass.

In terms of difficulty holding on to vitamins/minerals? One had chronic issues holding onto potassium and was consistently low. For those unaware, potassium helps control heart/nerve function and low enough potassium levels can cause fatal arrhythmias if left untreated.

Another patient had, among other complications, no less than 20- that’s not a typo, twenty- incidents of gastrointestinal bleeding and a hemoglobin level as low as 3.2. For reference, a normal hemoglobin level for women is around 12.5 to 15. She was planning to have her bariatric surgery reversed- something I didn’t even know was possible.

The fact that bariatric surgery is pushed as an end-all be-all ‘solution’ for so many fat people- including those with no other health issues- without any serious consideration for the very real and very common adverse effects and complications that occur- risks that far outweigh (pun not intended) any potential and possibly only temporary benefits?

In my opinion, is a violation of the principles of veracity- to be fully honest with patients- and of nonmaleficence- to do no harm.

Hallo!! I really appreciate your blog and how open and invested you are in wellbeing outside of medical fatphobia and other ways medicine as an institution can suck. It's also great to see a humanized side of working in medicine, so thank you for your openness :) You mentioned recently not prescribing bariatric surgery to patients except in rare, specific cases. If you have time and energy, would you be able to share a little more about what you think about bariatric surgery when those particular conditions aren't present? Also please feel free to ignore this ask if you're not up for it. Hope you have a great day! 🌸🌼🌺

When someone is fat to the point where they can't do daily activities of living like dressing themselves, walking, etc., then bariatric surgery probably has a place.

However, bariatric surgery has risks. Lots of them. To start with, there's the on-the-table risks. These are a lot lower than they used to be--anesthesia in this day and age is incredibly safe. Getting to bariatric surgery is challenging for most patients, as insurance in the US will typically only work with a few centers that have wrap-around teams including the surgeons but also other specialists, especially nutritionists. So lots of patients go to Mexico. I haven't had a single one of my own patients, since I started having my own patients four years ago, get from the phase of thinking about bariatic surgery to actually having it done in the US. I've had three patients go to Mexico and have it done. I will withhold judgment, because I haven't been to those centers, I don't know what those doctors and teams are like, but I do know the overall out of pocket cost for patients is about 5 grand, which is so much cheaper than it is in the US that it doesn't bear comparison.

Just-after-surgery risks include blood clots that can go to the lungs or the heart. There is always a risk of wound infection, which can be devastating. If a prolonged hospital stay is required, pneumonia is a significant risk.

Any time you have intra-abdominal surgery, your body develops scar tissue. Places where scar tissue fuses different structures together are called adhesions. Having a re-operation after that is more risky because of those adhesions. You are also at higher risk for intestinal obstruction, because your intestines can hang up on adhesion and twist so that they cut off their own blood supply. This is a surgical emergency. When bowel dies, it becomes leaky and lets dangerous intestinal bacteria into the otherwise sterile environment of the abdomen. That higher risk of intestinal obstruction never goes away.

People who have had bariatric surgery are also at risk for dumping syndrome. This is a condition where the small intestine becomes overly stimulated immediately after a meal, because the food is not moving smoothly through the stomach into the small intestine on the natural time scale. That stimulation leads to excessive insulin release in comparison to the amount of glucose absorbed, which can means hypoglycemia, which is life-threatening.

Rapid fat loss leads to significant amounts of excess skin. Many people who've had bariatric surgery go on to have skin removal surgery. This is actually a riskier surgery than the bariatric surgery itself, because you are tampering with the barrier between the inside of your body and the world outside it. And if it's done too early, you can end up needing your skin to stretch again, and having stretch marks in addition to the scars.

After bariatric surgery, you are also worse at absorbing good nutrients. You need lifetime monitoring for vitamin levels, including vitamin B12. If you don't have enough vitamin B12, your nerves start to die. This results in pain that starts in the feet, since the neurons running from the spinal cord to the big toes are the longest and therefore most susceptible in the body.

But perhaps the most upsetting aspect of bariatic surgery to me is that it is presented as a definitive solution.

Is it?

Not for 20-25% of people who have bariatic surgery, who struggle with significant weight regain.

So if the most extreme intervention we have--literally surgically altering your gut--isn't enough to make weight loss permanent, how is anything else going to do it?

You can be skinny. For a little while. But attempts to lose large amounts of weight, including surgically, have high failure rates. The 75% success rate for bariatic surgery is significantly higher than for any other method currently widely available, but the risks are also significantly higher. I don't think it's worthwhile for most patients, especially given how many patients are lied to by their doctors about how much their weight is likely contributing to their health problems. Most of my patients focus on their weight rather than activity levels, they beat themselves up about how they're not doing intense enough exercise but don't incorporate lower-impact exercises like swimming or walking, they try to eat less rather than eating a diet more rich in vegetables and fruits and lower in highly processed foods. You can do so much for yourself without ever framing it as being about weight.

And if you've done that--if you're struggling with being so fat that you can't live your life--then sure. Talk to your doctor about a referral for bariatric surgery. But don't be shocked if the results are not what you were told to expect. Don't be surprised when you find that you actively resent the people who suddenly find you tolerable, even desirable, now that you're not so fat. Don't let them sell you bariatic surgery as a no-downside cure-all, because it most emphatically is not.

[thenursingtime-blog]

7 Simple Steps to Master Acute Renal Failure NCP

Creating a great nursing care plan (NCP) for acute renal failure (ARF) doesn’t have to feel like solving a riddle! If you’re a nursing student or even a curious teenager interested in healthcare, this guide is for you. With a structured plan and a clear approach, you’ll learn all about acute renal failure NCP, including its importance, steps, and how to create one from scratch. Let’s dive…

[bonumhomehs-blog]

In home health services in Burbank, California, the focus is increasingly on providing comprehensive support to individuals recovering from illnesses, injuries, or disabilities. Among these essential services, occupational therapy plays a pivotal role in helping patients regain independence and improve their quality of life. By assessing and addressing the specific needs of individuals, occupational therapists can create tailored strategies that enhance daily living skills, making it easier for patients to perform essential tasks at home and in their communities.

[myrawjcsmicasereports]

 Prenatal control of pregnant women in the First Level of Care by Alejandro L. Villalobos Rodríguez in Journal of Clinical Case Reports Medical Images and Health Sciences 

Abstract

Introduction: Normal pregnancy is the physiological state of the woman that begins with fertilization and ends with the labor process and birth with physiological changes present. However, there may be complications that seriously affect the binomial; Self-care refers to the human capacity of individuals to perform actions whose purpose is to care for themselves and others.

Results: During the study period of March 2023, 19 cases of pregnant women entitled to Issste were recruited. The average age was 32.5 years, and the standard deviation was 5.4; weeks of gestation had a mean of 27 SDG and a standard deviation of 10.6. Five patients (26.3%) attended prenatal care for the first time, followed by 14 pregnant women (73.6%). Regarding their protection vaccination, 19 pregnant women received the anti-influenza vaccine (100%) and the TDPa vaccine in only six cases (31.5%).

Discussion: Prenatal care providers are encouraged to assess maternal weight at each prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Today, nearly 50% of women exceed their weight gain goals, and overweight and obese women have the highest prevalence of excessive weight gain. The risks of inadequate weight gain include low birth weight and failure to initiate breastfeeding. In contrast, the risks of excessive weight gain include cesarean section deliveries, postpartum weight retention for the mother, large-for-gestational-age babies' macrosomia, and childhood overweight or obesity for the offspring. Vitamins and minerals are essential for normal fetal development. The World Health Organization recommends supplementing iron, folic acid, vitamin A, calcium, and iodine during pregnancy.

 Keywords: Nursing; Pregnancy; Educational intervention.

Introduction

Normal pregnancy is the physiological state of the woman that begins with fertilization and ends with the labor process and birth with present physiological changes. However, complications may seriously affect the binomial (1).

Nicotine use by mothers during pregnancy is associated with numerous deleterious effects in children, especially concerning obesity. Children exposed to nicotine prenatally tend to have a lower birth weight, with an elevated risk of becoming overweight throughout development and into adulthood (2).

Alcohol is perhaps the most widely used and socially accepted psychoactive substance. Alcohol consumption is highly addictive, and evidence indicates that it can cause severe systemic side effects, such as heart and lung disease, and increase the risk of cancer and susceptibility to some infectious diseases (3).

Cannabis is the most common illicit drug used by pregnant women; Prevalence rates during pregnancy range from 3-10% in the United States, with some variability depending on the legal status of cannabis in all states. Some women use cannabis on purpose during pregnancy to combat symptoms such as nausea and pain, although recent reports suggest that cannabis use may cause nausea and vomiting (4).

Anemia has been a significant public health problem worldwide, especially in developing countries. The WHO has defined anemia in pregnancy as hemoglobin < 11 g/dL. The most common cause of anemia in pregnancy is iron deficiency anemia, defined as serum ferritin < 15 μg/L (5).

HIV remains a significant global public health problem. Worldwide, approximately 37.7 million people are living with HIV, of whom 1.7 million were children aged 0-14 at the end of 2020. In addition, women are at increased risk of acquiring HIV during pregnancy or breastfeeding, and those women who acquire HIV during pregnancy or the postpartum period have more likely to transmit the infection to their offspring (6).

Preeclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality worldwide, affecting approximately 2-5% of pregnant women. These patients present with hemolysis, elevated liver enzymes, low platelet syndrome, and cardiovascular disease later in life. PD contributes to approximately 10% of stillbirths and 15% of preterm deliveries (7).

Materials and methods

40 pregnant patients were recruited who attended the first level care Health Unit of the ISSSTE in Playa del Carmen, Q. Roo, for pregnancy control during the study period. A descriptive analysis was carried out with measures of central tendency, measures of dispersion, and percentages.

Results

During the study period of March 2023, 19 cases of pregnant women entitled to ISSSTE were recruited. The mean (X) age was 32.5 years, and the standard deviation (S) was 5.4; weeks of gestation had a mean of 27 SDG (X) and standard deviation (S) of 10.6. Five patients (26.3%) attended their prenatal check-up for the first time, and 14 subsequent ones (73.6%). Regarding their protection vaccination, 19 pregnant women received the 100% anti-influenza vaccine and the TDPa vaccine in only six cases (31.5%). All pregnant women (100%) received folic acid from the first trimester of pregnancy.

Discussion

Vitamins and minerals are essential for normal fetal development. The World Health Organization (WHO) recommends supplementation with iron, folic acid, vitamin A, calcium, and iodine during pregnancy. The American College of Obstetricians and Gynecologists also recommends supplementation with choline and vitamins B6, B12, C, and D. Prenatal vitamins do not have a standard formulation. However, most contain calcium, iodine, omega-3 fatty acids, zinc, and vitamins A, and also eat more iron and B vitamins and about twice as much folic acid as multivitamins (8).

Regarding prenatal factors, studies have shown that poor maternal exercise, exposure to tobacco smoke and secondhand smoke, unhealthy dietary pattern, maternal BMI before pregnancy, maternal weight gain during pregnancy, as well as poor birth outcomes, such as low birth weight or small for gestational age and preterm birth, are associated with an increased likelihood of childhood obesity (9).

Preterm birth remains a global epidemic, with a global incidence of 15 million births annually. Globally, preterm birth is the leading cause of death in children under 5 years of age. According to data from several countries, premature births have increased. According to the WHO, around 1 million children are estimated to die each year due to complications of preterm birth (10).

Prenatal care providers are encouraged to assess maternal weight at each prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Currently, nearly 50% of women exceed their weight gain goals, and overweight and obese women have the highest prevalence of excessive weight gain. The risks of inadequate weight gain include low birth weight and failure to initiate breastfeeding. In contrast, the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age babies, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools they can use to incorporate weight counseling and other health behaviors health in their routine prenatal practices. Because many women are motivated to improve their health behaviors, pregnancy is often considered the optimal time to intervene in eating habits and physical activity issues to prevent excessive weight gain. Weight gain during gestation is a potentially modifiable risk factor for some adverse maternal and neonatal outcomes, and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy may help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women (11, 12).

Since 1990, exposure to air pollution has been one of the significant health risks influencing the global burden of disease and injury, and the trend has been increasing. Globally, only 7% of children live in environments with air pollution levels, according to WHO guidelines, indicating a lifetime impact of air pollution exposure on most children. In addition, the increasing prevalence of allergic diseases in recent decades represents a significant challenge for children's Health and imposes a global economic burden. Emerging evidence indicates that specific forms of ambient air pollution, such as particles 2.5 or 10 mm in diameter, sulfur dioxide, nitrogen oxides, nitrogen dioxide, and oxides of nitrogen, are associated with the development of asthma in the pediatric population. Besides direct inhalation exposure during childhood, prenatal ambient air pollution exposure during the fetal stage might increase the risk of childhood asthma (13).

There is increasing evidence that prenatal environmental exposure to chemicals affects pubertal development. Many chemicals are present in the environment because of their extensive use, resistance to biological and chemical degradation, and bioaccumulation in the food chain. Exposure to these persistent organic pollutants continues for long periods after their production and use have been prohibited by law. Humans are exposed to environmental chemicals through food, drinking water, and air. POPs include polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers, dichloroethane, pentachlorophenol, hexabromocyclorodecane, and others. PCBs are chemicals produced between 1929 and 1985 for application in various products, including refrigerants in heat transfer systems and lubricants in plastics. The prenatal period is vulnerable because many developmental processes are initiated, and disruption of these processes can influence outcomes in later life. Prenatal exposure to polychlorinated biphenyls has been shown to interfere with children's neurological, immunological, metabolic, and endocrine development. Development is a multifaceted process under the control of various hormonal mechanisms; PCB exposure could interfere with pubertal development. Evidence shows that hormone disruptors can advance or delay puberty (14).

Pregnancy is the psychologically most vulnerable period for women. During pregnancy, women are prone to varying degrees of stress due to changes in hormone levels and many other factors, such as brief bouts of fear, nervousness, and the possible long-term persistence of negative emotions. Negative emotions in women, such as stress, anxiety, and depression, are common during pregnancy. Negative emotions during the prenatal period can present potential risks to maternal Health and the Health of the newborn. Antenatal stress, anxiety, and depression are not only associated with fetal development and adverse pregnancy outcomes, such as low birth weight, preterm delivery, and fetal distress but also have more lasting effects, directly or indirectly, on growth and the development of children. Children of women who experience one or more negative emotions during pregnancy are more likely to have behavioral and emotional changes, attention deficit hyperactivity disorder, and autism in childhood. They are also more likely to have depression, impulsivity, and cognitive disorders in adolescence and suffer from schizophrenia in adulthood. In addition, women with prenatal symptoms of anxiety, depression, perceived stress, and post-traumatic stress disorder may experience more severe pain and be at higher risk of developing pregnancy complications, such as diabetes and preeclampsia, during childbirth and are more likely to of suffering from postpartum depression (15).

Prenatal maternal stress can arise from malnutrition, major life events, bereavement, catastrophic events, depression, or anxiety. Selye described stress as a physiological response pattern that occurs in response to an external or internal stressor and will last if the stimulus persists. The stress response is a homeostatic process and involved in this response is the neuroendocrine system called the hypothalamic-pituitary-adrenal (HPA) axis, which regulates various physiological processes, including energy expenditure and storage, digestion, the immune system, mood, and the emotional response to stress through the release of glucocorticoids. The acute stress response does not produce long-term changes in the stress response axis, whereas chronic stress can exert long-lasting effects. Dysregulation of the HPA axis caused by repeated or extreme exposure to stress is associated with elevated cortisol levels and may be related to the anxiety and pathology of depression. Maternal prenatal stress increases fetal plasma cortisol to levels that overwhelm the metabolic capacity of placental 11β-hydroxysteroid dehydrogenase. This enzyme usually protects the fetus from higher maternal glucocorticoid levels by converting cortisol to inactive cortisone. Elevated levels of circulating fetal cortisol bind to glucocorticoid and mineralocorticoid receptors that are expressed at high levels in multiple regions of the fetal brain, including the limbic system, hypothalamus, and cortex, where it impacts neurogenesis, gliogenesis, and synaptogenesis, suggesting its role in influencing cognitive, behavioral, and morphological development. These structures have been implicated in aggressive behavior, a phenomenon defined by Moyer (1971) as "overt behavior that is intended to inflict physical harm on another person" (16-19).

Exome sequencing (ES) is becoming increasingly available in prenatal diagnosis. However, data on its clinical utility and integration into clinical management remain limited. The BACs-on-Beads™ (BoBs) prenatal assay was introduced to rapidly detect abnormalities of chromosomes 13, 18, 21, X, and Y and nine specific significant microdeletion syndromes. According to the WHO, congenital disabilities affect 4 to 8% of births worldwide, and their incidence varies between countries. Non-invasive prenatal testing is widely used to detect common fetal chromosomal abnormalities. However, the ability of NIPT-Plus to detect copy number variation (CNV) is debatable (20). Skeletal dysplasia is a group of rare genetic disorders associated with cartilage and bone abnormalities. Skeletal disorders are clinically and genetically heterogeneous, with more than 350 genes that explain the diversity of phenotypes of these diseases. Non-invasive prenatal screening has the potential to detect the maternal X chromosome that causes X-linked ichthyosis and may guide prenatal diagnosis of ichthyosis and reflect the family history to improve the pregnancy as well as the management of the Health of children and family members. An optimal intrauterine environment is essential to maintain fetal development. Harmful regents have been identified to be associated with significant congenital malformations, primarily neurological and cardiovascular congenital disabilities. The current view suggests that various cardiovascular diseases in adulthood are related to prenatal exposure to toxins such as glucocorticoids, antibiotics, antidepressants, antiepileptics, etc. HBB-associated hemoglobinopathy, with its two general subtypes as thalassemia and abnormal hemoglobin (Hb) variants, is one of the most prevalent inherited Hb disorders worldwide. Fetal macrosomia is common in pregnancy and associated with several adverse maternal and neonatal prognoses. Although, the accuracy of the prediction of fetal macrosomia is still poor (21). Exposure to environmental stressors during pregnancy plays a vital role in influencing and later susceptibility to certain chronic diseases through the modulation of epigenetics, including DNA methylation. Diagnosis of a microdeletion of chromosome 22q11.2 and its associated deletion syndrome (22q11.2DS) is optimally made early. Definitive diagnosis by chorionic villus or amniocyte genetic testing using a chromosome microarray will detect clinically relevant microdeletions. Maternal genetic effects can be defined as the effect of a mother's genotype on her offspring's phenotype, regardless of the offspring's genotype (22, 23).

This research contributes to the emerging evidence of the impact of community health workers on coordinated systems of antenatal care. It may guide policymakers, practitioners, and administrators to target effectively. Resources and enrollment to potentially reduce the cost burden for health systems. In Arizona, this study provides strong evidence for the sustainability of investing in rural health worker home visits to ensure continuity of Maternal Child Health care and equity among geographically diverse women. Investment in Health should begin engaging with nulliparous young women (including adolescents) throughout the municipality. They could improve reproductive health planning and preconception Health and reduce unwanted pregnancies through adequate engagement with prenatal care (24).

Conclusion

The first-level health units must have support personnel such as psychologists, dentists, and nutritionists. Services already established must cover all shifts 24 hours a day, 365 days a year. The supplies of medicines, laboratory, dental, etc., must be sufficient. Nevertheless, health personnel must primarily understand the importance of treating patients who require their services.

[unamused-kookaburra]

I have three days of education starting tomorrow to learn about chemotherapy, a subject I have zero interest in, in preparation for my next six month placement in a cancer outpatient clinic where the only things I'm looking forward to is the regular hours and no ADLs, pray for me

[ivfsunflower]

Best Endoscopy Doctor in Ahmedabad India

Sunflower Infertility & IVF Center is a trusted hospital offering the best endoscopy in Ahmedabad. We have the best doctors and surgeons for advanced GI endoscopy in India. Our state of the art laboratories and experienced nursing team offers you precise treatment and proper care. Book your  appointment and visit our endoscopy specialist today.

[jambalaya-enthusiast]

saying that anya should've talked to swansea first instead of curly is extremely weird and borderline mysogynistic because if you think that she should've went to the buffest and the oldest guy on the tulpar for 'safety',it says more about you then it does for the game.

Anya did not need 'saving' she didn't need a man to come and save from her misery disney princess style,she wasn't a damsel in distress.

What she needed was simply, intervention. Anya was aboard the tulpar not for vacationing,she was there for her job,a formal duty where she expected everyone else to remain professional as well.

I hate how the fandom has turned her into her demise. how all of the art I've seen of her simply minimize her character into what had happened to her,she is not just a victim of rape. she is the victim of ignorance,capitalism,and failure as well. and she is not just a victim. She is the nurse aboard the tulpar who had been tirelessly working her butt off to get into medical school.

she went to the captain of the ship,to file a complaint against the co-captain. She didn't go to a friend to simply rant about another friend. she didn't go to swansea because,curly was the one with responsibility of the entire crew.

Anya is more than what happened to her.

[nationwidechildrenshospital]

"Pediatric surgery has such a variety of diagnoses and surgical interventions. To be able to care for children in the perioperative time frame can be complex and gratifying at the same time."

Morgan Mocniak, Pediatric Nurse Practitioner, General Surgery, Nationwide Children's Hospital - Toledo

[artisticdivasworld]

Compassionate Care for Chronic Kidney Disease: A Nursing Perspective

Chronic Kidney Disease (CKD) is a progressive loss of kidney function over time. Managing CKD is not just about slowing the progression of the disease but also about enhancing the quality of life for those affected. Nurses play a crucial role in this process, providing care that is as compassionate as it is competent. This blog post will explore the nursing interventions and desired outcomes that…

[softspiderling]

like, ever | j.v

summary:

“Hey, I’m worried about you.”

You glanced up from your laptop screen to see Rhaena standing in your doorway, her arms crossed.

“Why?”

She gave you a look, before her eyes roamed your room: your textbooks stacked half-hazardly on your desk, two empty ice cream tubs, another half melted one on your nightstand, an empty tissue box on the floor and you on your bed, wrapped in your blanket like a burrito.

OR; You and Jace break up because of a stupid reason, but you’re both too proud to apologize.

pairing: jacaerys velaryon x reader

warnings: kinda toxic behavior from both of them, but like the usual issues in communication that’s so common in people our age idk what to tell you

word count: 4,1k

author’s note: modern au!jace is the president of the frat Alpha Draconis (it's co-ed, Rhaenyra was president during her time at uni), Jace/Aegon/Baela and their respective siblings are all cousins, but this is NOT in the same universe as can I go (where you go). thank you to my wonder sister wife beta @eldrith as usual <3

✦ . 　⁺ 　 . ✦ . 　⁺ 　 . ✦

“We broke up.”

“No you didn’t.”

“Yes, we did.”

Baela gave you a look, narrowing her eyes at you as she pushed her Econ 1 assignment away. You dropped down on the couch next to her, leaning your head back.

“Why?”

“I don’t wanna talk about it,” you huffed and Baela whacked you in the arm.

“You just came home and dropped a bomb like that, you can’t just not talk about it.”

“Not talk about what?”

You internally groaned when Helaena’s voice floated from the hallway, the front door shutting behind her. An intervention was inevitable at this point. At least Rhaena wasn’t home yet, you knew she was volunteering until six.

“She and Jace broke up,” Baela told her and Helaena paused in the doorway to the living room, a frown on her face as she undid her braid.

“You didn’t.”

“That’s what I said!”

“You know, normal friends would offer ice cream if their friend was going through a break up.”

“I’d offer you ice cream if you were sad,” Helaena pointed out. She sat down next to you, patting your shoulder. “You don’t look sad.”

“Well, I am sad,” you sniffed, but Baela fixed her brown eyes at you until you threw your hands up in frustration. “Fine! I’m mostly mad, okay? Pissed off, actually!”

Baela folded her legs under herself. “Tell us what happened.”

“I don’t know, she just rubs me the wrong way. It’s like she knows you have a girlfriend and she chooses to ignore that.”

You and Jace were laying in his bed, your head on his chest. He had been telling you about the new pledges of the term, and you weren’t exactly fond of one of them - Laura, a nursing major. You were aware of her being especially touchy with Jace, twirling her hair while she was talking to him and always searching him out at every event. Which was fair, he was the president of the frat after all and at first you had told yourself that you were just projecting but the you noticed that she was laughing at all of Jace’s jokes. She was definitely into him. He was not that funny.

“I don’t know, it’s just the way she is, I think,” he said, and you frowned at him.

“Jace, come on, she’s totally into you.”

“Well, good thing I’m into you,” Jace pointed out, turning his head to nose along your neck but you pushed him away, starting to get annoyed that he wasn’t taking this seriously.

“I mean it, Jace.”

“So do I,” he answered, irritated. “Why does this bother you so much?”

“Because I don’t like another girl’s hands being all over you?”

You sat up, leaning away from him with a frown and he only sighed, laying his head back on the pillow, shutting his eyes. He was starting to piss you off.

“She’s not into me! Everyone tries to butter me up because they want to join the frat. And even if she was, why does it matter?”

“It matters because it bothers me and you clearly don’t care!”

“Of course I care,” Jace sighed. He opened his eyes, reaching out for you, and you had to admit your resolve was starting to crumble. “You’re overreacting.”

And just like that, the wall was back up.

“Wow, thanks.”

Your voice was biting as you spoke, tugging your hand out of his grasp and standing up, grabbing your hoodie. Jace was quick to follow you, brows furrowed. Great, now both of you were mad.

“You’re making a big deal out of nothing!” Jace snapped and you only glared at him.

“Thanks for invalidating my feelings, Jacaerys,” you said sarcastically. “If I’m making a deal out of nothing, maybe we’re both nothing.”

Jace’s face fell and he stopped in his tracks, letting out a huff. “You don’t mean that.”

Maybe you didn’t. But you weren’t about to backtrack now. You were a woman of your words.

“Yes, I do.”

You pulled the door open and rushed out of his room, slamming the door shut behind you. Distantly, you could hear Jace call after you and you secretly hoped he would chase after you, but by the time you made it downstairs to the front door, he was still nowhere to be seen.

“That’s…”

Baela and Helaena exchanged a look and you frowned at them. While you hadn’t expected for them to immediately spring into assuring you that they were on your side - you were dating their cousin after all - you also didn’t quite imagined them being so… Shocked.

“What?” you asked, suddenly growing insecure. “I had a point.”

“Well, yeah,” Baela started, “But so did he.”

“Why did you immediately jump into breaking up?” Helaena asked with a soft voice, the voice you knew she used when she didn’t want to hurt your feelings. You lifted your shoulders, then dropped them again, unable to answer her question.

“Did you want to break up?”

“No!”

You tucked your chin against your chest, a pit forming in your stomach. Did you maybe overreact?

“I was just mad,” you said, frowning, picking at the hem of your shirt.

“.. And you wanted to hurt him?” Baela said, finishing your sentence. Your head shot up, a denial on your lips, but your mouth closed when her words sunk in.

“… Maybe.”

“You two really are hotheaded and stubborn,” Helaena pointed out, wrapping an arm around your shoulders. You only glowered, the anger from earlier dissipating and instead was replaced by misery and a little bit of guilt? Luckily, Helaena and Baela left you to your wallowing after they realized you needed some space and you fled to your bedroom, trying to bury yourself in your assignments.

There was only one slight problem. You couldn’t find school bag anywhere.

“Where did I leave it?” you muttered to yourself, checking under your desk for your bag, even opening the drawer for good measure. You were crawling on the floor looking under your bed when it finally dawned on you.

“Fuck.”

You had gone over to the frat’s house right after class, with your school bag. And after the fight, you must have forgotten to grab it.

“Ugh,” you groaned, dropping your forehead on the floor You’d rather crawl under your bed and sleep with the dust bunnies that have been collecting under there than go back to the frat house right now. But you had no choice. The assignment was was due the day after tomorrow and Professor Cole already was in a bad mood because his date went badly.

“Fuck me,” you muttered to yourself, turning to lay on your bad and cursed the Gods for making you miserable as you stared at the ceiling, collecting your wits.

“Oh.”

Luke Velaryon, Jace’s younger AND biological brother, stood in the doorway, apprehensive. He had always been the more sensitive one between the two brothers, but he was also unwaveringly loyal. You had no doubt that Jace had already told him everything about your fight.

“Hey Luke,” you said, giving him a wry smile.

“Hey,” he replied hesitantly. “Jace is not here.”

“I know.”

Luke pressed his lips together, his eyes darting around as if he was expecting his older brother to come out of the bushes any second. “Are you okay?”

You let out a small laugh, shaking your head. What a sweet boy.

“Yeah, alright enough I guess,” you replied, sighing. “Listen, I forgot my bag in Jace’s room and I really need it to do an assignment, could you let me in?”

“I don’t know….” Luke answered slowly. “Jace should be back soon though. Maybe you can just wait until he gets back? And then you guys could talk?”

Bless him.

You bit on your lip, running your hand through your hair, exasperated. “Listen Luke, I really appreciate you trying to look out for Jace, but I really can’t see him right now.”

Luke exhaled, shifting on his feet like he was undecided. The longer it took for him to decide, the higher chances were you’d run into Jace on your way out.

“Please, Luke, I just need to grab my bag really quickly. He won’t even notice I was there.”

With a loud sigh, Luke finally nodded, opening the door wider and taking a step back.

“He’s gonna be back soon, you need to hurry up.”

“Thanks Luke!”

You hushed past him into the house, walking the familiar way up the stairs to Jace’s bedroom, shutting the door behind you. With a small sigh, you looked around, trying to discern your stuff from his. It was harder than you had first anticipated, your belongings strewn all over the room. Picking your favorite scrunchie off of his nightstand next to a picture of the two of you during New Year’s Eve, you put your hair up as you narrowed your eyes, feeling relief settle in your chest when you saw your backpack lean against the desk.

“Thank God”, you muttered, grabbing it quickly. Just as you headed to the door, hand on the door knob, you could hear voices down the hallway through the closed door. You cursed, recognizing it as Jace and Cregan.

Fuck.

Immediately, you let go of the door knob, taking a few steps back, trying to come up with a way you wouldn’t be caught standing in the middle of Jace’s bedroom. Did you have enough time to make the climb out of the window and scale down the roof?

“- it’ll blow over. I’ll give her some time to calm down and-”

Before you could make a decision, the door swung open, and Jace entered. He was looking back at Cregan, who raised his brows when he saw you in the middle of the room.

“Wha-?” Jace turned his head, his mouth dropping open. “… Hey.”

“Hey.”

Cregan glanced between the two of you, narrowing his eyes. Meanwhile, Jace was rubbing the back of his neck.

“Did you forget something?”

“Yeah,” you answered - LAME! - lifting your backpack.

Jace nodded slowly. “Was there anything you wanted to say?”

You frowned at him, confused.

“Like what?”

“I don’t know,” Jace said, shrugging with his shoulders. “I thought you were here to apologize.”

Cregan groaned, leaning his forehead against the door frame as you felt all the anger from before welling up again.

“Me apologize?” You repeated, your voice shrill. “What about you? I bet Laura’s thrilled to hear we broke up.”

“You just ended things for no reason! Laura’s not even into me!” Jace snapped and Cregan pushed himself off of the door frame.

“Maybe we all should just calm down.”

“Shut up, Cregan!” You and Jace yelled at the same time, your anger very briefly directed at Jace’s best friend.

Cregan flinched, raising his hands defensively. “Jesus, sorry. I’ll never try to help again,” he muttered. “Let me give you two a minute.”

He stepped out of the room but you held your hands up, stopping him with a scoff.

“No, I’m done here,” you huffed, shaking your head in disbelief. With one last angry look at Jace, you pushed between them, running out of the house, smoke coming out of your ears.

You spent the rest of the week distracting yourself. Burying yourself in assignments and reading, eating ice cream - there was a deal at Whole Foods, five for three, your freezer was full - and you only cried once.

“Hey, I’m worried about you.”

You glanced up from your laptop screen to see Rhaena standing in your doorway, her arms crossed.

“Why?”

She gave you a look, before her eyes roamed your room: your textbooks stacked half-hazardly on your desk, two empty ice cream tubs, another half melted one on your nightstand, an empty tissue box on the floor and you on your bed, wrapped in your blanket like a burrito. You sighed, letting the blankets fall from your shoulders.

“I’m fine, Rhae.”

“Hey, did you convince her to come?” Baela skidded to a halt next to Rhaena, looking from her sister to you. Rhaena only sighed while you narrowed your eyes at Baela’s get up. She was wearing black leather pants and a brown corset; she looked like she was going out.

“Come where?”

“Alpha Draconis’ summer term opening party.”

Right that. The party you had helped Jace plan. Before you broke up.

“I don’t know guys,” you sighed, leaning back against your headboard. “I don’t think it’s a good idea for me to go.”

“You don’t have to go,” Rhaena assured you but Baela shushed her, shaking her head.

“No, you absolutely have to go,” she insisted. “We’ve let you wallow in your misery long enough. It’s time to put your big girl pants on and face Jace. You broke up with him for a shitty reason and yes, he was being a jerk, but you were being a bitch. Now suck it up and get your man back.”

You gaped at her, and Rhaena whacked Baela in the arm, but she only shrugged, ever the unapologetic brutally honest one.

“What? You know I’m right,” Baela only said, frowning at her twin before she turned to you. “So?”

With a groan, you closed your eyes. You knew Baela was right, in a way, and it was no use sitting around when your friends were going out. You had to see him eventually.

“Fine,” you gave in, pushing the blanket back as Baela cheered, immediately disappearing. Rhaena only shook her head, stepping into your bedroom, helping you clean up a little.

“I’m driving,” she told you. “Just tell me if you want to leave, okay?”

You nodded, giving Rhaena a grin when something soft just hit you in the face with no warning, courtesy of Baela having returned to your bedroom.

“Put that on.”

The projectile fell to floor, and as you picked it up, you recognized it as a dark red dress, tags still on.

“Hel’s headed to the party from work, so we’ll meet her there in an hour, go take a shower and I’ll do your hair,” Baela said, reaching for your hand to pull you up. “Come on, up up up!”

Begrudgingly, you let Baela usher you into the shower, shutting the door behind you very decidedly. You stared at yourself in the mirror, eyes rimmed red and hair a mess and you allowed yourself a minute of respite before you turned the shower on. If you had to go to that stupid party, you’d make sure to look the absolute best.

“Am I crazy or is it even more crowded than last term?”

You winced as you followed Baela and Rhaena through an especially crowded spot in the house, glancing around.

“No, it’s definitely more people,” Baela agreed, squeezing your hand to make sure not to lose you in the mass. “Has Helaena said where she is?”

“She said she was in backyards,” Rhaena replied and Baela steered you in the direction of the backyard. Meanwhile you tried not to let your eyes roam too much; you didn’t want to seem like you were looking for Jace, even though that was exactly what you were doing. Just as you reached the patio doors, Helaena appeared, stopping you in the doorway.

“Hey guys,” she said, breathless, her eyes flitting over to you as you greeted her. “Should we go get drinks?”

“I’m not dragging my ass back through that crowd,” you moaned, shaking your head. “Let’s just sit down by the pool for a second before we go back in.”

You nudged Helaena out of the way gently, but the blonde grabbed your arm, trying to pull you back.

“But I’m really thirsty.”

“Hel, come on,” you laughed. “You’ll survive ten more minutes without-”

The rest of your words died on your tongue when you caught sight of Jace sitting by the pool, surrounded by his frat brothers and of course, Laura. Now you knew why Helaena was so adamant to get you away from the backyard. It was too loud to hear what Jace was saying, but he must be telling an extremely funny story with the way Laura was laughing, touching his shoulder. They weren’t doing anything scandalous, but it still hurt you to see him still talking to her after you voiced your concerns. You tried not to let it get to you. It wasn’t your business anymore anyways, but you were still a little sick to the stomach.

With a scoff, you turned away, embarrassment burning your cheeks as your friends looked at you with pitiful eyes.

“Sorry,” Rhaena said and you only shrugged with your shoulders.

“Whatever,” you muttered, clearing your throat. “I told you, she was into him. Now he’s free to do as he pleases.”

Baela winced. “We can leave, if you want.”

“No, I’m not leaving because of that clown.”

The girls let out a laugh and Helaena wrapped her arm around you. You gave her a wry smile, leaning into her.

“Let’s go get you that drink.”

As Helaena dragged you away, you couldn’t help but glance back to Jace and for a split second, your eyes met. You quickly turned away, feeling a lump form in your throat. You couldn’t wait to get drinks. After getting to the kitchen, the four of you did two rounds of shots, knowing where the boys kept their expensive booze; Rhaena then mixed you some drinks before you settled on the couch in the living room. Taking a careful sip of your cup, you immediately pulled a face, looking at Rhaena.

“What the hell is in this?”

“I think Grey Goose and Coke.”

“You think?” you asked, wincing when you took another sip. “This is awful Rhae.”

“What is awful?”

Aegon, Helaena’s brother, one cousin of many in the Targaryen family, suddenly plopped down on the couch next to you.

“Oh great, Aegon is here,” Baela deadpanned and Aegon only mocked Baela as he reached for your drink.

“Sure, just go ahead and take my drink.”

Aegon took a big gulp of your drink, humming. “It’s not bad,” he said, offering the cup back to you but you politely declined. You didn’t know where Aegon’s mouth had been in the last 24 hours, there was no way you’d drink out of the same cup he had.

“So, what’s this I hear about you and our cousin breaking up?” Aegon asked, throwing his arm around the back of the couch and you scooted forward, trying to escape his touch.

“You heard right,” you said, throwing him a dirty look and Rhaena rolled her eyes.

“You’re a dick, Aeg.”

“What?” Aegon exclaimed. “’t was just a question, no harm done, right?”

You let out a deep sigh, pushing away from the couch.

“I need some air,” you told the girls and Rhaena furrowed her brows, worried.

“Do you want me to come with you?”

“We can make Aegon leave,” Baela offered and Aegon made a noise, frowning at his cousin but you shook your head,

“Nah, I’m good. Just, text me if you guys go somewhere, okay?”

“Are you sure, babe?” Helaena asked and you nodded, patting her shoulder gently.

“Yeah, ‘m fine. I promise.”

With a small wave, you disappeared into the crowd, hearing the cousins starting to argue, but it was background noise to you. Instead of heading to the front door, you inconspicuously headed upstairs, past a kissing couple, and to the bathroom on the second floor. The door was shut, but unlocked and unoccupied as you opened the door. You let it fall shut in its hinges after you, walking over to the window, like you had done so many times before, but never alone. Clicking the window open, you carefully climbed out to the roof, sliding the window closed behind you again. You traipsed over the roof, before settling down on the small nook that sat right above Benjicot’s bedroom, stretching out your legs.

Jace had shown you this place when you first started dating, and sometimes when the parties got too much, the two of you snuck out here to be alone. It was probably risky to go here; but it was the only place you felt like you could retreat without having to go home.

The noise of the party downstairs could still be heard, especially the conversations in the backyard, but to you, it seemed quieter as you closed your eyes. It had cooled down significantly since you had come to the party, but you enjoyed the bite of the cold on your bare arms. A deep breath escaped your lips, your chest heavy.

Looking back on it, you knew what you had said was wrong. It was words hurled in the heat of the moment, chosen to provoke a reaction out of Jace and if you could take them back, you would. But now it was too late, it had seemed like Laura had already sunken her talons into Jace as soon as he was available - not that she had cared much about whether he had a girlfriend or not - and he seemed to be lapping it up.

“Stupid,” you muttered to yourself, wiping the tear that escaped your eye from your cheek with the back of your hand. You froze, when you heard the bathroom window slide open; not daring to look back. His steps were careful as he walked towards you, as if not to spook you, but before he came into view, a soft jacket was draped over your shoulders, engulfing you in his scent. You let out a breath you hadn’t realized you were holding, tugging the jacket tighter around your body when Jace sat down next to you.

The silence between you stretched on, before Jace cleared his throat.

“You were right.”

You let out a small scoff at his words, glancing over to him.

“You’re shitting me, right?” you asked in disbelief. “She was all over you like that and you still thought she wasn’t into you?”

Jace winced, ducking his head.

“That’s fair. Maybe I was a little oblivious. It’s just…” he paused, sighing. “I didn’t see it, because I don’t really see other girls. Ever since we met, it’s just been you. I didn’t even realize that she was flirting with me until she straight up asked me if we could go upstairs.”

Jealousy flared up in your chest at his words, and you frowned, quickly giving him a once over.

“Well, did you?” you asked, your voice tight. Jace gave you a look, his hands dropping down on his lap.

“I’m sitting here with you, aren’t I?”

Relief flooded your veins and you ducked your head to hide your face. Jace glanced over at you, his face vulnerable and you bit your lip.

“I’m sorry too,” you then said. “I didn’t mean what I said. It was petty and stupid, and I’m sorry.”

“Well looks like we both got to work on some things,” Jace said, tentatively reaching out to take your hand; out of reflex you immediately laced your hand with his. He quirked a smile at you, scooting closer to you and you glanced up at him, almost shyly before you leaned in, as he met you halfway, your lips touching. Jace wrapped his hand around the back of your neck as you kissed, and if you hadn’t felt warm before, you definitely did now.

“What’s happening?”

“They’re kissing!”

“No way! Move over!”

“You move over!”

A crash sounded and you pulled away from Jace, just to see Luke and his cousins spying on you from the bathroom.

“Nothing to see here, carry on!” Luke yelled, quickly sliding the window back down, but their bickering could be heard through the closed window.

Jace snorted out a laugh, leaning his forehead against yours and you only grinned lazily at him.

“Come on, let’s go face the circus before they break the window and we have to scale down the roof,” Jace said, offering you his hand as he got up. You let him help you up, as the two of you walked back to the bathroom window.

“You know I thought about scaling down the roof when you caught me in your bedroom?”

“You’re joking.”

✦ . 　⁺ 　 . ✦ . 　⁺ 　 . ✦

author’s note: tell me what you think <3 also will add the taglist tomorrow bc i’m so tired but wanted to post🫶🏼

[novelcsanchez]

My Last Day at King’s College Hospital

[andhumanslovedstories]

Last two shifts I worked, I had the same patients but was precepting (training) different nurses. So two nights in a row, I have a patient with a post-op complication (guts not moving) that the surgeons are taking a conservative approach to (wait and see if the gut starts moving). This treatment plan makes sense for the specifics of this patient, but that means we’re doing a lot of symptom management without directly treating the thing that’s causing the symptoms. In this case, symptoms are pain and nausea so bad that the patient said if they’d known this is how they’d feel after, they’d have skipped the surgery and just rolled the dice with what that colon polyp would do if left alone.

So we’re throwing meds at this patient, we’re walking them so their bowels can get moving, we’re giving ice chips and gum and cold wash clothes, we’re giving IV fluids (which is SUPER rare in the hospital right now because due to one of the recent hurricanes, we are critically low on IV fluids), we’re doing basically all my tricks short of putting another tube in this guy. And it’s working okay. Like we’re keeping pain and nausea just below “intolerable” but not by much.

That first night I have that patient, while I’m talking to the surgeon on the phone, my preceptee is in the room talking to the patient. I don’t get any new orders because most usual meds that would help are contraindicated in this particular circumstance. I’m feeling frustrated about that—I HATE when I can’t get symptoms significantly under control—when my preceptee comes up excitedly and says that the patient says they’re feeling much better after the therapeutic intervention my preceptor did. The intervention was hanging out in the room for 15 mins and talking with the patient about their hometown in Canada.

(Which, hell yeah. Very proud of that new nurse because she said one of the biggest things she wanted to work on was being less nervous talking to patients.)

Next night, I got the same patient, still miserable, and a new preceptee. We’ve got more meds this time, but still only marginal success with managing symptoms. I tell my preceptee, “next time you’re in the room, plan on staying and chatting with the patient for like ten minutes.” Next time we’re in the room, we do just that—we talk sports, hobbies, plans, past surgeries, how much this surgery sucks, just the three of us shooting the shit for a while before we have to go give pain meds to another patient. (It was a surgical floor. That night was mostly handing out ice packs and oxy.)

Anyway, the patient tells us that this chat has been the best they’ve felt all night. My preceptee comes out of the room, and my preceptee is like “wow that really was our best intervention.” And I get to be like “yes witness the power of chit chat as nursing intervention.”

Reflecting back, I’m grateful that the patient was so expressive about what we did that was working. I told the patient at one point, in the midst of their most acute misery, that we were going to give them everything we had available, and if that didn’t work, I had backup plans in mind. Like you might spend the night miserable, but it’s not because we didn’t keep trying stuff. And after I say that, the patient goes, “that was good, I like that you said that, that comforted me.” Which was very nice and convenient because before we’d gone into the room, I’d talked to my preceptee about how to make patients feel supported and cared for, even when none of the care we do is working. When we left after that, my preceptee was like “wow, you’re right, that really worked,” and I was like, “I KNOW, that’s cool right? I mean you always hope it works, but sometimes you just can’t tell if it actually does.”

I love really open patients, they are such fantastic teaching opportunities. For example, I had another patient both night who was also very open, specifically about what a bad job the hospital was doing and how everyone should just stay the hell out of their room. Considerably less pleasant feedback, equally valuable, about essentially the exact same situation that the first patient was in. Talking through that patient with my preceptees was also very useful and very easy, because the patient had been so explicit in their feedback.

It’s always odd training nurses because you don’t want bad things to happen to your patients, but you also need to new nurses to see bad things. And sometimes you get a patient assignment that is so good for teaching, it’s like it came from a textbook. Very convenient for me personally as a preceptor. Feels weird to say that about patients who are having absolutely miserable times, that their misery is useful to me, but (as preceptors normally say about stuff like this) if it’s happening, at least it’s happening where we can learn about it. Anyway, great couple of shifts to practice therapeutic communication.