Intermediate power objective (usually 40× or 50×): Search for an area where the RBCs are evenly distributed and barely touching each other. A dry look and subsequently an oil-immersed look can help in quantifying white blood cells (WBCs) and platelets to see if they align with what is reported by the hematology analyzer. This can help in excluding platelet clumps as a cause of apparent thrombocytopenia and in identifying the presence of abnormal-looking WBCs or giant platelets. In the last 3 years did your hospital provide training on pain assessment to the nurse staff? n (%) High power objective (usually 100×): A closer look at the oil-immersed field can help in identifying morphologic abnormalities in WBCs (e.g., toxic granulations or Döhle bodies) and RBCs (e.g., Howell-Jolly bodies). Moreover, quantification methods to assess the manual blood counts can be done by examining multiple fields.

Unable to escape the noose of addiction, he eventually lost the trust and support of everyone who had ever loved him. Lisa is such an inspiring, empowering voice to have in my life. This is a podcast, but it's so much more than that. It's empowered me to finally seek help with the health challenges I've struggled with, taught me so much about the female body, fertility awareness, women's health, and so much more. Now he’s a social media personality with millions of followers, and an entrepreneur, marketer, podcaster, YouTuber, and author who hopes to use his voice to shine a light for those whose own lights have grown dim. Tompkins DA, Hobelmann JG, Compton P. Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017; 173 Suppl 1:S11–S21. doi: 10.1016/j.drugalcdep.2016.12.002Although tolerance, physical dependence, and addiction are different conditions, they may coexist. However, it is important to distinguish tolerance and physical dependence from addiction. This book sees Mike in the gutter, lower than low and the life choices that he made to battle his demons and better his life. His life is full of lying, sneaking around, selling drugs, family problems, police problems, and a whole hell of a lot of danger. While I can't call a book on such a difficult subject entertaining, Mike does a great job of detailing his slow and painful descent into the hell of drug addiction.

I never thought he would get clean, but so glad he did. Having said that, I was surprised at some of his choices for his recovery, but since it is HIS recovery, I will leave it at that. In your hospital, what is the current percentage of departments that record pain as the fifth vital sign in all patients? n (%) Patients rely on nurses and other health care professionals to adequately assess and manage their pain. As the coordinator of patient care, be sure to accurately document your assessments and actions, including patient and caregiver teaching. Beware of adverse effects of acetaminophen (hepatotoxicity, nephrotoxicity) and NSAIDs (GI bleeding, nephrotoxicity).Now he's a social media personality with millions of followers, and an entrepreneur, marketer, podcaster, YouTuber, and author who hopes to use his voice to shine a light for those whose own lights have grown dim. Purser L, Warfield K, Richardson C. Making Pain Visible: An Audit and Review of Documentation to Improve the Use of Pain Assessment by Implementing Pain as the Fifth Vital Sign. Pain Manag Nurs. 2014; 15( 1):137–42. doi: 10.1016/j.pmn.2012.07.007 Many patients are reluctant to report pain. When they do, they may underreport its severity. Patients may not share their existence of pain because they want to be “good” patients or do not want to bother or distract their caregivers from other issues in their care. In patients with a history of cancer, pain can be an unwanted reminder of the disease and its progression.

I am so happy I found this podcast!! As an (allopathic) physician, I appreciate Lisa's recommendation that all women work with a team of providers. I am blown away by how much I've learned from her podcast in such a short amount of time — much of it I never learned in medical school, including FAM! I highly recommend this podcast to everyone, but especially those planning to try to conceive, actively trying to conceive, and couples facing infertility. Lisa, thank you for taking the time to educate us on FAM and natural resources for improving our fertility! I love this podcast and recommend it to so many of my supporters and readers looking for holistic reproductive health information. Lisa offers so many perspectives, angles within the field of sexual health, reproductive health and body literacy. Statistical analysis of P5VS implementation was carried out by estimating the proportion of hospitals that reported having a proper place to record patients’ pain intensity in hospital charts. Giving the hypothesis and aims previously stated, descriptive analysis of the frequencies and inferential statistics through Chi-square or Fisher exact tests were considered appropriate for the comparisons between public and private healthcare systems and a 95% confidence level was used. The questionnaires were filled by the head nurse (63.0%), by the nurse supervisor (13.0%), by the supervisor anaesthesiologist (8.3%), by the head nurse advisor or nurse coordinator (6.5%), by the clinical director (4.6%), by the general nurse (2.8%) and by the chairman of the hospital board (1.9%).The main goal for the implementation of P5VS is to assess and manage undertreated pain, consequently reducing the patient’s suffering and its associated healthcare costs. Adequate pain assessment and control may also help to reduce surgical readmissions and emergency department visits after hospital discharge [ 5, 8, 9, 15]. However, some of the results in the literature are contradictory. A study found that routinely measuring pain intensity may not increase the quality of pain management [ 16]. However, this study was performed in a single clinic, and the pain was managed based only on its intensity scores. On the contrary, several studies demonstrated that after the proper implementation of P5VS, the number of patients reporting moderate to severe pain significantly decreased [ 8, 17– 19]. Nevertheless, introducing P5VS may not be enough if some principles of practice are not implemented, carried out and audited to effectively improve the patient’s health. A starting point would be to make pain assessment visible in hospital charts and to promote staff education on adequate pain assessment and prompt management, mainly during the postoperative period [ 2, 6– 9, 20]. The present investigation showed that almost all NHS hospitals provided the staff with pain education and written information, hopefully contributing to pain management improvement, as reported in internal audits. This is a raw, realistic, and honest break down of easy way in which trying his first joint leads him to eventually selling drugs, and his absolutely painful dependence of oxy. He vividly recalls his increased dependence on drugs, as the withdrawal problems increasing over time. Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal I like Mike Majlak, but he is not a writer and that is noticeable when you read the book. While reading it, I got the impression that the book was written because 'there needs to be a book as well'. I suppose this is what you get when a professional marketeer and content creator writes a book.

Idvall E, Ehrenberg A. Nursing documentation of postoperative pain management. J Clin Nurs. 2002; 11( 6):734–42. 688 [pii]. doi: 10.1046/j.1365-2702.2002.00688.x The Fifth Vital is an amazing memoir by Mike Majlak. He recounts his troubled past with a detailed first person account. Daniel Humberto Pozza, Formal analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – original draft, Writing – review & editing, # an iatrogenic syndrome created by the undertreatment of pain. It is characterized by patient behaviors such as anger and escalating demands for more or different medications, and results in suspicion and avoidance by staff. (p. 1) Character and quality of pain. What words does the patient use to describe the pain and its character, quality, or intensity?Within this video was Mike Majlak. Mike always seemed to come across as the wise one, the guy with his head screwed on. The older guy in the group who has the experience and the know-how to guide this crazy train of fame whilst maintaining a level-head. adaptation manifested by a drug-class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. (p. 1) A person with chronic pain usually adapts to these physiologic changes as the body attempts to compensate for and adapt to noxious stimuli. The pain no longer serves as a necessary warning. Patients with chronic pain, then, often develop coping skills and may appear to look quite well. Make sure the smear was done within two to three hours of blood collection: This usually results in the best staining which will be needed for proper interpretation. His dreams, potential, and future were all being devoured by a relentless addiction too powerful to fight. Despair filled him as he realized he wasn’t going to survive.