Nursefriendly.com: Operating Room

Showing posts with label Operating Room. Show all posts

Wednesday, January 1, 2014

Surgical Patients Not Getting Information on Alternatives, Wall Street Journal #nurseup #nursefriendly

Surgical Patients Not Getting Information on Alternatives, Wall Street Journal #nurseup #nursefriendly:"It's awfully hard for patients to participate in decisions about their medical care if they don't know all their options. But that's exactly what seems to be happening, at least with many Medicare patients who received a stent procedure for coronary disease or prostate surgery for cancer, according to a new study. The research, published online by the Journal of General Internal Medicine, surveyed 685 patients who had prostate-cancer surgery and 472 who had stents for coronary disease about their decision-making process."
http://blogs.wsj.com/health/2012/03/02/surgical-patients-not-getting-information-on-alternatives/

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Discover! "Unconventional Nurse: Going from Burnout to Bliss" Michelle Podlesni, RN @MPodlesni
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Discover Martine Ehrenclou, @Med_Writer, Author of "The Take Charge-Patient"
http://www.thetakechargepatient.com/

Power Strategies For Nurses:"Do your nursing shifts feel like you’re running full speed ahead on a treadmill that you just can’t stop?
http://revolutionarynurse.com/power-strategies-nurses-program-2/

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Monday, April 18, 2011

Patients with do-not-resuscitate orders fare worse | Reuters

A new study could help people with a do-not-resuscitate order make better decisions about what surgeries they are willing to undergo.

About seven in 10 Americans die with such an order, which instructs healthcare workers not to use life-prolonging treatment if a patient's heart or breathing stops.
But other situations that aren't necessarily covered in the do-not-resuscitate, or DNR, orders may also be worth considering, researchers say.
The new report, out Monday in the Archives of Surgery, shows DNR patients have a higher chance of dying following surgery, although not with all kinds of procedures.

via reuters.com

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Monday, February 28, 2011

Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.

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Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary: Sponge Counts are a basic and critical safety measure during a surgical operation. In this case, the standard three counts were not performed. A sponge was left in the patient that would later lead to infection. When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges.
The patient was admitted for surgical repair of a hernia. The operation was performed and the patient returned to the floors without obvious incident.
"A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions."1
Post-operatively, the patient's incision would not heal. It would soon after start to display signs of active infection.
"Postoperative wound infections have an enormous impact on patients' quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Approximately 1 million patients have such wound infections each year in the United States, extending the average hospital stay by one week and increasing the cost of hospitalization by 20 percent."5
In investigating the situation, it would be found that a sponge had been left in the patient in the Operating Room. The patient sued both the surgeons and the nurses who had assisted in the procedure.
"Materials counts are necessary to provide a standard of quality of care for the surgical patient and to provide a method of accounting for items placed on the sterile field for use on a surgical procedure."2
The patient claimed that substantial negligence on the part of the surgeon and nurses contributed to the sponge being missed and the development of complications. These complications, the plaintiff asserted, could have been avoided had proper procedure been adhered to. Specifically, if accurate sponge counts had been maintained and the missing sponge accounted for.
Questions to be answered:
1. Who is primarily responsible during an operation to verify sponge counts and prevent one from inadvertently being left in a patient.
2. What are the explicit responsibilities of the Nurses and Physicians involved.
For the operation in question, less than a dozen sponges were required. It was standard policy and procedure for three sponge counts to be performed during the operation.
Anytime there is a discrepancy, the surgeon is to be notified immediately. Upon notification, it is his duty to the patient to resolve the discrepancy to the best of his ability.
"In cases where there is an incorrect sponge count, wound closure absolutely must not be completed (unless the patient is unstable) until the missing sponge is accounted for. The surgeon should not pressure the nursing staff to ignore an incorrect count. If after appropriate steps have been taken to find the missing sponge or instrument and it is unsuccessful, every detail of the search should be documented and the surgery completed."3
Neither the nurses or the surgeon involved stated that they clearly remember the operation in question.   The nurses' documentation of the event would show that only a single sponge count had been performed. The hospital policy in effect at the time required three per procedure.
"The nurses count the unused, sterile sponges and note on a form that sponges were counted.   When the surgeon completes the operation, the nurses do a second count by combining the number of unused sponges with the number of used sponges that have been removed from the patient. The total of the unused and used sponges must correspond to the number of sponges originally laid out prior to surgery.
If the sponge count does not correspond, the surgeon is to be notified by the nurses. The nurses complete a third count shortly before the surgeon closes the incision.   If nurses fail to account for a sponge, they are to report this directly to the surgeon. The nurses must note the results of the second and third counts on the same form on which they noted the initial count."
The surgeon in his notes would document that a third count had been performed. He also documented that only after receiving this confirmation from the nurse, did he "close" up the patient.
Is it plausible that the surgeon simply documented as if by habit, that the third count had been completed? A nurse documenting her assessment may sometimes by habit write "lungs clear" and "bowel sounds active x 4q." A moment later it is realized that in fact that was not the case and a correction made. Could the surgeon have fallen into the same trap?
Upon discovery of the missed sponge and resulting infection, the surgeon insisted that "counting sponges" was not his responsibility. He went on to explain how in the body cavities they can become soiled with blood and take on the color of internal viscera.
It was the surgeon's argument that it was the nurses' responsibility, not his that a proper sponge count be maintained. The surgeon, not the nurse is the person manipulating the sponges inside the patient's body. Can the surgeon release himself from responsibility for a sponge left in a patient because he relied on an inadequate sponge count given by a nurse?
"Counting is the legal responsibility of the surgical team. Each institution must develop a policy and procedure for such counts and should include the delineation of materials counted, interval of counts, mechanism for performing the count , and documentation of the count status on the intraoperative record. The responsibility for accurate sponge counts rests with the circulating and scrub nurses. The operating room nurses are charged with the responsibility to ensure that no foreign objects remain in the body at the conclusion of surgery."
The standards of care clearly state that if a sponge is missing, the nurse must notify the surgeon. There's little mystery to the fact that objects "left" inside patient's bodies can have catastrophic effects.
The question remains, will the surgeon blaming the nurses get "off the hook" because a count was incorrectly reported?
"While the surgeon may rely on the nurses' sponge counts the surgeon is ultimately responsible and liable for any foreign object left in a patient after surgery. Only x-ray detectable sponges should be utilized. A retained sponge occurs almost always in the presence of a normal sponge count."
The trial court held, and appeals court confirmed that the surgeon shared in the negligence. The standard of care governing both the nurses and the physicians respectively had been breached.
It is quite interesting to observe how quickly the physician sought to "dump" the blame on the nurses.
The nursing staff by poorly documenting the sponge counts (omitting the 2nd and third) left themselves open to scrutiny. Had a proper count at least been documented, the surgeon would have had less ground to stand on when blaming the nurses for his mistake. Related Link Sections:
Sponge Counts, Operating Room Links:
Sources:
1. Pleatman, MD, Mark A. No date given. "Questions and Answers about Hernias."   Retrieved May 23, 1999 from the World Wide Web: http://www.laparoscopy.com/pleatman/hernia.htm
2. San Antonio Chapter of AORN. No date given. "Counts, Sponge, Needle, Instrument." Retrieved May 23, 1999 from the World Wide Web: http://www.connecti.com/~remmert/p0008.txt
3. The Standard of Care. August 1998. "Retained Surgical Foreign Body." Retrieved May 23, 1999 from the World Wide Web: http://www.standardofcare.com/publications/980801.htm
4. 38 RRNL 2 (July 1997
5. Woods, Ronald K. and Dellinger, E. Patchen. June 1998. "Current Guidelines for Antibiotic Prophylaxis of Surgical Wounds." Retrieved May 23, 1999 from the World Wide Web: http://www.aafp.org/afp/980600ap/woods.html

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Send comments and mail to Andrew Lopez, RN
Created on Saturday, May 22, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Monday, January 3, 2011

PeriAnesthesia Nurses Association of California | PANAC

Announcements

ASPAN Seminars

ASPAN has 4 seminars that they will be presenting throughout the state in the next few months. Click on events for further information. Click on attached brochure for dates and pla

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PANAC's District 4 Sacramento Chapter 1st meeting

PANAC's District 4 Sacramento Chapter 1st meeting will be on Jan 10, 2011 from 5-7pm. Guest speaker -Chris Pasero, MS RN-BC, FAAN on Safe Titration Opiod Analgesia for Pain

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PANAC's Winter Conference

PANAC's Winter Conference will be held Feb 26, 2011 at the Marriott Ventura Beach Hotel. ASPAN's Past President Lois Schick will be the speaker. Brochure is HERE.

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View all announcements

Upcoming Events

1/10/2011

District 4 Sacramento Chapter Meeting

1/22/2011

ASPAN Perianesthesia Certification Review Seminar

2/26/2011

PANAC's Winter Conference

View All Events

via panac.org

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Wednesday, December 29, 2010

Study: Surgical Delays Have Profoundly Adverse Impact | National Nursing News

A new study emphasizes why caregivers must work to minimize delays in certain elective surgical procedures for patients who have been admitted to the hospital.
Delays substantially increase the risk of infectious complications and raise hospital costs, according to a comprehensive study in the December issue of the Journal of the American College of Surgeons.
Using a nationwide sample of 163,006 patients ages 40 and older between 2003 and 2007, the authors evaluated patients who developed postoperative complications after one of three high-volume elective surgical procedures: coronary bypass graft, colon resections and lung resections.
For each type of procedure, according to the researchers, infection rates increased significantly from those performed on the first day of admission to those performed a day later, two to five days later and six to 10 days later. With each procedure, there was a difference of at least 10 percentage points between infection rates performed on the day of admission and those performed six to 10 days later.
Delays also increased total hospital costs from $36,079 to $47,5237 for CABG, $20,265 to $29,887 for colon resections and $26,323 to $30,571 for lung resections.
The occurrence of infection after surgical procedures remains a major source of ill health and expense despite extensive prevention efforts via educational programs, clinical guidelines and hospital policies, according to the researchers.
The analysis “confirms a direct correlation between delaying procedures and negative patient outcomes,” lead author Todd R. Vogel, MD, MPH, FACS, assistant professor of surgery at the University of Medicine & Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, said in a news release.
“As pay-for-performance models become increasingly prevalent, it will be imperative for hospitals to consider policies aimed at preventing delays and thereby reducing infection rates.”
Patients more likely to experience in-hospital surgical delays were age 80 and older, female and minorities. They had existing health issues such as congestive heart failure, chronic pulmonary disease and renal failure.

via news.nurse.com

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Thursday, December 2, 2010

Musculoskeletal Transplant Foundation

The Musculoskeletal Transplant
Foundation, the nation’s largest
tissue bank, changes lives by connecting donors with surgeons and transplant recipients. As a non-profit service organization, MTF is dedicated to providing quality tissue through a commitment to excellence in education, research, recovery and care for recipients, donors and their families. Since our inception in 1987, MTF has recovered more than 60,000 donors and has distributed more than 3 million grafts for transplantation.

via mtf.org

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Monday, November 15, 2010

Australian and New Zealand College of Perfusionists

The Australasian Board Of Cardiovascular Perfusion was established pursuant to the Rules of the Australasian Society of Cardio-Vascular Perfusionists Incorporated, now ANZCP. The Board therefore forms part of the incorporated association and has no separate legal existence outside the College. The Board is required to establish and support the credentialing process

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Perfusion Line

Perfusion Line is the largest directory of Perfusion resources available to professionals and students involved with extracorporeal technology. We offer several special features to our registered members. Signup for a membership and enjoy all the exclusive sections. Our members support a website that offers scientific material for fundamental and continuing education to the international perfusion community. Join Perfusion Line Today.

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Cardiovascular Perfusion:College of Health Professions:SUNY Upstate Medical University

Cardiovascular Perfusion—Bachelor of Science

Perfusionists are operating room specialists who conduct cardiopulmonary bypass. That is, they pump and oxygenate the blood of patients whose hearts or lungs are stopped, usually during open heary surgery.

The cardiovascular perfusion program accepts six students each year. Graduates are eligible to take the American Board of Cardiovascular Perfusion's National Certification Examination.

A Cardiovascular Perfusionist's work is a matter of life or death. People who succeed in this field thrive on excitement and stressful situations. More >

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Thursday, February 22, 2007

It's A Very Simple Operation, Medical Jokes, Operating Room Humor

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It's A Very Simple Operation, Medical Jokes, Operating Room Humor
http://www.nursinghumor.com/operation
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A man was wheeling himself frantically down the hall of the hospital in his wheelchair, just before his operation.

A nurse stopped him and asked, "What's the matter?"

He said, "I heard the nurse say, 'It's a very simple operation, don't worry, I'm sure it will be all right.'"

"She was just trying to comfort you, what's so frightening about that?"

"She wasn't talking to me. She was talking to the doctor!"

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More Medical Humor, http://www.nursinghumor.com/medical

Cost of A Screw, Medical Jokes, Operating Room, Surgical Humor:"A well known rich businessman's wife broke her hip. The businessman got the best bone surgeon in town to do the operation. The operation consisted of lining up the broken hip and putting in a screw to secure it."
http://www.nursinghumor.com/screw

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A "Plumbing" Problem. Medical Jokes, Patient Humor:
http://www.nursinghumor.com/plumbing

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A Really Serious Mistake, Doctor Jokes, Medical Humor:"During the course of being interviewed by the press, the noted famous doctor was asked by a reporter:"
http://www.nursinghumor.com/mistake

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A Routine Physical, Nursing Jokes, Medical Humor:"A man goes to a doctor for a routine physical. The nurse starts with the basics. "How much do you weigh?" she asks."
http://www.nursinghumor.com/physical

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Able To Play? Operating Room Jokes, Medical Humor:"A doctor has come to see one of his patients in a hospital. The patient has had major surgery to both of his hands."
http://www.nursinghumor.com/play

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Christmas Carols for the Psychiatrically Challenged:
http://www.nursinghumor.com/carols

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Contraceptive Jelly, Birth Control Jokes, Patient Education Humor:"A young girl is getting married, so she goes to her doctor to find out which contraceptive she should use. After a lengthy discussion with him she decides on the diaphragm."
http://www.nursinghumor.com/jelly

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Diving Right In, Psychiatric Jokes, Medical Humor:
http://www.nursinghumor.com/humor/psychiatric.jokes.nursing.humor.diving.right.in.htm

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Do You Have A Dentist Appointment Tomorrow Too?
http://www.nursinghumor.com/too

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Doctor's Fee, Medical Jokes, Patient Humor:"An elderly man has just moved to a new town, when he is taken ill and decides that he needs to see a doctor. In the doctor's waiting room, he tries to find out a bit about the doctor. He asks the man sitting next to him if the doctor is a specialist."
http://www.nursinghumor.com/fee

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Eating Ants, Emergency Room Jokes, Medical Humor:"A medical student was doing a rotation in toxicology at the poison control center. One day, this woman called in very upset because she caught her little daughter eating ants."
http://www.nursinghumor.com/ants

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Exam Professionalism, Medical Jokes, Doctor's Humor:"A beautiful, voluptuous woman goes to a gynecologist. The doctor takes one look at this woman and all his professionalism goes out the window."
http://www.nursinghumor.com/exam

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Excess Weight, Medical Jokes, Obesity Humor:"Well, Jonathan, what are you going to do about the excess weight you're carrying around," the doctor asked."
http://www.nursinghumor.com/weight

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Eye Surgery, Operating Room Jokes, Medical Humor:
http://www.nursinghumor.com/eye

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Feeling Exhausted, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/exhausted

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Getting Even, Nursing Jokes, Physician Humor:
http://www.nursinghumor.com/getting/

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Going Blind, Psychiatric Jokes, Medical Humor:"Jon and Dave were in a mental institution. This place had an annual contest, picking two of the best patients and giving them two questions. If they got them correct, they're deemed cured and free to go."
http://www.nursinghumor.com/psych

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Going To Operate, Medical Jokes, Operating Room (OR) Humor:"When his auto mechanic came in for an operation, Dr. Grimley couldn't help but take the opportunity to turn the tables on him."
http://www.nursinghumor.com/going

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Horrible Mistake, Doctors Jokes, Medical Humor:"There was a horrible mistake at the hospital. A man who was scheduled for a vasectomy was instead given a sex change operation."
http://www.nursinghumor.com/horrible

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Immunization Etiquette, Pediatric Jokes, Vaccination Humor:"While I was working as a pediatric nurse, I had the difficult assignment of giving immunization shots to children. One day I entered the examining room to give four-year-old Lizzie her shot."
http://www.nursinghumor.com/etiquette

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New Arrival, Medical Jokes, Organ Transplant Humor:"A new arrival, about to enter hospital, saw two white coated doctors searching through the flower beds."
http://www.nursinghumor.com/arrival

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New Ears, Medical Jokes, Patient Humor:"A man lost both ears in an accident. No plastic surgeon could offer him a solution."
http://www.nursinghumor.com/ears

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Observation Skills, Medical Jokes, Doctor Humor:"A lecturer in a Medical school was tutoring a class on 'Observation.' He took out a jar of yellow-colored liquid. "This," he explained, "is urine. To be a doctor, you have to be observant to color, smell, sight, and taste."
http://www.nursinghumor.com/observation

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Overdue Appointment, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/overdue

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Pre-op Examination, Operating Room, OR Jokes, Medical Humor:"A beautiful young girl is about to undergo a minor operation. She's laid on a hospital trolley bed with nothing on, except a sheet over her. The nurse pushes the trolley down the corridor towards the operating theatre, where she leaves the girl on the trolley outside, while she goes in to check whether everything is ready."
http://www.nursinghumor.com/pre

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Taking As Directed, Medical Jokes, Doctor Humor:
http://www.nursinghumor.com/directed

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Three Times A Week, Doctors Jokes, Marriage Humor:"

An elderly woman went to the doctor for a check up. After examining her and checking her cardiovascular activity, the doctor recommended that she engage in sexual activity three times a week."
http://www.nursinghumor.com/three

The Right Size, Medical Jokes, Surgical Humor:"John was successful in his career, but as he got older he was increasingly hampered at work by terrible headaches."
http://www.nursinghumor.com/size

Treating A Cold, Medical Jokes, Patient Humor:"When Pat and Mike met each other on the street one day, Pat noticed that Mike had a terrible cold. "Have you seen a doctor about that cold?" he asked."
http://www.nursinghumor.com/treating

Top Ten Signs You Need A New Doctor, Medical Jokes, Top Ten Humor:"- He calls you at two in the morning "just to talk." Instead of rubber surgical gloves he wears oven mitts."
http://www.nursinghumor.com/need

Too Late, Doctors Jokes, Gallows Humor:"The orthopedic surgeon I work for was moving to a new office, and his staff was helping transport many of the items."
http://www.nursinghumor.com/late

The Circumcision, Medical Jokes, Kids Humor:
http://www.nursinghumor.com/circumcision

How Long? Emergency Department Jokes, Medical Humor:
http://www.nursinghumor.com/how

Virtually Deaf? Getting Older Jokes, Medical Humor:"An elderly gentleman finally invested in a hearing aid after becoming virtually deaf. It was one of those invisible hearing aids. Soon after, he went for a check-up."
http://www.nursinghumor.com/deaf

She Didn't Make It, Medical Jokes, Emergency Humor:
http://www.nursinghumor.com/it

Met Professionally, Doctor Jokes, Marriage Humor:"A doctor and his wife were sunbathing on a beach when a beautiful young woman in a tight-fitting bikini strolled past."
http://www.nursinghumor.com/professionally

New Secretary, Doctor's Jokes, Battle of The Sexes Humor:"Dr. Johnson got himself a new secretary. She was young, sweet, and very polite. One day while taking dictation, she noticed his fly was open."
http://www.nursinghumor.com/secretary

Auto Enthusiast, Surgeon Jokes, Medical Humor:"A 70-year-old man sat down in the orthopedic surgeon's office. "You know, Doc," he said, "I've made love in more exotic cars than anyone I know. Must be at least a thousand."
http://www.nursinghumor.com/auto

Blind Drunk, Emergency Department Jokes, Medical Humor:
http://www.nursinghumor.com/drunk

Stern Sibling, Labor & Delivery Jokes, Sibling Humor:"An old county doctor went way out to the boondocks to deliver a baby. It was so far out that there was no electricity. When the doctor arrived, no one was home except for the laboring mother and her five-year-old child."
http://www.nursinghumor.com/stern

Last Words, Doctor Jokes, Priest Humor:
http://www.nursinghumor.com/last

Quick Diagnosis, Doctor Jokes, Physician Humor:
http://www.nursinghumor.com/diagnosis

Come Quick! Medical Jokes, Marriage Humor:
http://www.nursinghumor.com/quick

Taking Notes, Doctor Jokes, Getting Older Humor:
http://www.nursinghumor.com/notes

Fine Art, Medical Jokes, Gallows Humor:
http://www.nursinghumor.com/art

Healthcare Dollars, Medical Jokes, Healthcare Humor:"In reviewing how our healthcare dollars are spent, the following statistics were revealed."
http://www.nursinghumor.com/dollars

Medical Bloopers Found In Patient Charts, Doctor Jokes, Medical Humor:
http://www.nursinghumor.com/bloopers

Skin Graft, Medical Jokes, Marriage Humor:"A married couple were in a terrible accident in which the woman's face was severely burned. The doctor told the husband that they couldn't graft any skin from her body because she was too thin. So the husband offered to donate some of his own skin. However, the only skin on his body that the doctor felt was suitable would have to come from his buttocks."
http://www.nursinghumor.com/graft

Big Words, Children's Jokes, Medical Humor:
http://www.nursinghumor.com/words

Small, Medium or Large? Doctor Jokes, Marriage Humor:
http://www.nursinghumor.com/medium

Bad News, Worse News, Medical Jokes, Geriatric Humor
http://www.nursinghumor.com/news

A Future Physician, Medical Jokes, Parenting Humor:
http://www.nursinghumor.com/future

Obsessions, Psychiatric Jokes, Medical Humor:"A psychiatrist was conducting a group therapy session with four young mothers and their small children. You all have obsessions," he observed."
http://www.nursinghumor.com/obsessions

Sun Burn Treatment, Medical Jokes, Patient Care Humor:
http://www.nursinghumor.com/sun

The Good News, The Bad News, Medical Jokes, Doctor Humor:
http://www.nursinghumor.com/good/

Isolation Precautions, Infection Control Jokes, Physician Humor:
http://www.nursinghumor.com/isolation

Not Good Looking, Medical Jokes, Marriage Humor:
http://www.nursinghumor.com/looking

Practical Jokes, Bedside Nursing Humor, Doctor Jokes
http://www.nursinghumor.com/practical

This Won't Hurt Much, Medical Jokes, Military Humor:
http://www.nursinghumor.com/much

Common Forms of Office Illness, On The Job Jokes, Medical Humor,
http://www.nursinghumor.com/illness

Coffee and Viagra, Medical Jokes, Marriage Humor:
http://www.nursinghumor.com/viagra

Rusty Tools, Viagra Jokes, Marriage Humor:
http://www.4nursing.com/humor-bedside-nursing-jokes-viagra-marriage-rusty-tools.html

Top Ten Things You Don't Want To Hear When Regaining Consciousness, Medical Jokes, Operating Room Humor:
http://www.nursinghumor.com/regaining

Working In The Dark, Psychiatric Jokes, Medical Humor:
http://www.nursinghumor.com/dark

The Business Trip, Medical Jokes, Patient Humor
http://www.4nursing.com/humor-medical-doctor-patient-jokes-business-trip.html

Sex Therapy, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.sex.therapy.htm

Post-Op Blues, Medical Jokes, Anesthesiology Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.post.op.blues.htm

A Star In The East, Medical Jokes, Physician Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.a.star.in.the.east.htm

The Forgetful Patient, Doctors Jokes, Medical Humor:
http://www.nursinghumor.com/humor/the.forgetful.patient.htm

Doctor's Funeral, Medical Jokes, Physician Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.doctors.funeral.htm

Buying Condoms, Pharmacy Jokes, Infidelity Humor:
http://www.nursinghumor.com/condoms

Odds & Ends, Medical Jokes, Physician Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.odds.and.ends.htm

Heart Transplant, Organ Donation Jokes, Medical Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.heart.transplant.htm

Passing Wind, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.passing.wind.htm

Removing Patches, Medications Jokes, Pharmacy Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.removing.patches.htm

Top Ten Reasons For Becoming An Anesthesiologist, Medical Jokes, Hospital Humor:
http://www.nursinghumor.com/anesthesiologist

Screwed Up Laboratory Results, Medical Jokes, Laboratory Humor:
http://www.nursinghumor.com/screwed

Taxonomy of Medical Professionals, Medical Jokes, Hospital Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.taxonomy.of.medical.professionals.htm

The Center of Attention, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.the.center.of.attention.htm

Approving The New Hospital Policy, Medical Jokes, Physician Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.approving.the.new.hospital.policy.htm

Patient Confidentiality, Medical Jokes, Patient Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.patient.confidentiality.htm

Five Benefits of Mothers Milk, Breastfeeding Jokes, Medical Humor:
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.five.benefits.of.mothers.milk.htm

Arkansas Medical Definitions, Medical Terminology Jokes, Redneck Humor
http://www.nursinghumor.com/

Anyone Need A Doctor? Medical Jokes, First Aid Humor
http://www.nursinghumor.com/medical

A Cure For One Man's Cough, Medical Jokes, Drug & Pharmacy Humor
http://www.nursinghumor.com/cough/

Ambulances As Medical Necessities, Medical Jokes, Patient Humor:"These are all GENUINE replies from patients asked why they needed an ambulance to and from hospital..."
http://www.nursinghumor.com/ambulances

Viagra Variations, Drug & Medications Jokes, Prescription Medicine Humor
http://www.nursinghumor.com/humor/drugs.prescriptions.medications.medicines.viagra.variations.htm

A Grandmother's Insomnia, Doctor's Jokes, Pregnancy & Medications Humor
http://www.nursinghumor.com/insomnia

Shooting Blanks, Medical Jokes, Physician Humor
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.shooting.blanks.htm

I Think My Wife Is Going Deaf, Medical Jokes, Marriage Humor http://www.nursinghumor.com/humor/medical.jokes.humor.my.wife.is.going.deaf.htm

A Doctor, A Nurse And A Shredder, Nursing Jokes, Medical Humor
http://www.nursinghumor.com/humor/medical.jokes.humor.a.doctor.a.nurse.and.a.shredder.htm

He Thinks He's A Surgeon, Medical Jokes, Pearly Gates Humor
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.he.thinks.he.is.a.surgeon.htm

Near Death Experience, Medical Jokes, Gallows Humor
http://www.nursinghumor.com/humor/medical/near.death.experiences.plastic.surgeries.htm

The Aspirin And The Job Interview, Medical Jokes, On The Job Humor
http://www.nursinghumor.com/humor/medical.jokes.humor.the.aspirin.and.the.interview.htm

A Work of Art, Medical Jokes, Patient Humor
http://www.nursinghumor.com/work

Multiple Specimens, Medical Jokes, Doctor & Patient Humor
http://www.nursinghumor.com/humor/medical.doctor.physician.patient.jokes.multiple.specimens.htm

Perfect Shape Considering Your Age, Medical Jokes, Physician Humor
http://www.nursinghumor.com/humor/medical.perfect.shape.considering.your.age.htm

Six Months To Live, Medical Jokes, Physician Humor
http://www.nursinghumor.com/humor/medical/six.months.to.live.htm

It Hurts All Over, Medical Jokes, Physician Humor
http://nursinghumor.com/hurts

Actual Medical Quotes From Patient Charts, Medical Jokes, Physican Humor
http://www.nursinghumor.com/humor/medical/actual.medical.quotes.from.charts.htm

First Proctology Exam, Medical Humor, Doctors Jokes
http://www.nursinghumor.com/humor/medical/first.proctology.exam.htm

A Short History Of Medicine, Medical Jokes, Physician Humor
http://www.nursinghumor.com/medical/a.short.history.of.medicine.htm

Anyone For Pasta, Medical Jokes, Marriage & Infidelity Humor
http://www.nursinghumor.com/pasta

A Cure For One Man's Stuttering:
http://www.nursinghumor.com/humor/medical/a.cure.for.one.mans.stuttering.htm

The Best Thing, Doctor Jokes, Patient Humor:"David wasn't feeling well and so he went to the doctor to get himself checked."
http://www.nursinghumor.com/thing

Breastfeeding Technical Support, Medical Jokes, Obstetrics Humor
http://www.nursinghumor.com/breastfeeding

Dehydration, Medical Jokes, Physican Humor
http://www.nursinghumor.com/medical/dehydration.htm

The Difference Between Doctors & Veterinarians, Medical Jokes, Veterinary Humor
http://www.nursinghumor.com/medical/the.difference.between.doctors.and.veterinarians.htm

Five Doctors Go Duck Hunting
http://www.nursinghumor.com/duck

Making It Look Easy, Doctor Jokes, Medical Humor.
http://www.nursinghumor.com/medical/making.it.look.easy.htm

My Elbow Hurts!
http://www.nursinghumor.com/elbow

Professional Courtesy, Medical Jokes, Physician Humor
http://www.nursinghumor.com/medical/professional.courtesy.htm

Screening Medical Students
http://www.nursinghumor.com/screening

The Doctor's Visit, Medical Jokes, Physician Humor:
http://www.nursinghumor.com/doctors

Very Simple Operation, Medical Jokes, Patient Humor:"A man was seen fleeing down the hall of the hospital just before his operation. "What's the matter?" he was asked."
http://www.nursinghumor.com/operation

Who Can Read This? Doctor's Handwriting, Medical Humor:"Did you hear about the doctor who wrote out a prescription in the usual doctor's fashion? The patient used it for two years as a railroad pass."
http://www.nursinghumor.com/read

Who Makes the Best Patient?
http://www.nursinghumor.com/best/

You Might Be an E.R. Doctor if..., Medical Jokes, Emergency Humor:"1) Your favorite hallucinogen is exhaustion. 2) Discussing dismemberment over a gourmet meal seems perfectly normal to you. 3) You think that caffeine should be available in IV form. 4) You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants."
http://www.nursinghumor.com/erdoc

**
Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.4nursing.com info@nursefriendly.com ICQ #6116137, AOL “nursefriendly”
856-415-9617, (fax) 415-9618

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