Med Surg

MED SURG[ COMMON CONCEPTS ] FINAL EXAM REVIEW JULY 2014

What are some important things the nurse asks when she assess the immune system?

How do you feel? Have you had any operations? Ask about unexplained weightless or fatigue.

Hepatitis B vaccine is active or passive immunity? Does Hepatitis B last a lifetime?
Active immunity; acquired.  Technically it does, but we know now we may need to give boosters. Check titers if not sure to see if high enough level. Titers tell immunity levels. Chicken pox is an example.

When you talk about Osteoarthritis and doing teaching with a patient, what will be your focus?

 Eating healthy, weight bearing exercise and remaining active

If somebody is having trouble sleeping, what do you want to stress to them?

Consistent times

What clinical assessment finding would you find in a patient with Paget’s disease?

Bowing of legs

How do we help avoid unusual stress on the joints? What is a lifestyle modification?

Weight and posture. To prevent unequal stress on your joints so you don’t get degenerative joint disease.

If somebody is complaining of phantom pain, they had an amputation of their right leg, below the knee. The patient complains their right foot hurts, what are you going to do?

Treat the pain

What are the symptoms of compartment syndrome?

Numbness and tingling

What is compartment syndrome?

It’s a lot of pressure, usually will be under a cast or a splint.

If the patient develops lot of pressure (compartment syndrome) under the cast, what are they going to do?

They need to get to a place where they can take the cast off quickly.

When you have prolonged immobilization, what happens to your muscles?

Atrophy

Which of these is a priority assessment for someone with a knee injury and why?

My knee aches.

My feet are cold.

My foot is swollen.

My toes are numb.[Toes are numb because of nerve compression.]

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

a. Bunions are congenital and can't be prevented.

b. Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth.

c. Some bunions are congenital; others are caused by wearing shoes that are too short or narrow.

d. Bunions are caused by a metabolic condition called gout.

 C- Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

A patient with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit; heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

FAT Embolism

 A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which priority intervention in the postoperative care plan?
a) Keeping a pillow between the client's legs at all times
b) Maintaining the client in semi-Fowler's position
c) Turning the client from side to side every 2 hours
d) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift

Rationale: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

A patient returns to the clinic 4 hours after being fitted for a cast of a fractured radius. He states my arm hurts even more than when I broke it. General manipulation of the fingers by the nurse causes excruciating pain. Which of the following interventions by the nurse is the priority?

Notify the provider right away. Remove cast asap due to compartmental syndrome.

A nurse is caring for a patient with osteomyelitis following wound debridement. IV and antibiotics have been administered for 7 days and the patient has been discharged with continued care in a home setting. Which of the following statements can the nurse include in the home care of osteomyelitis? What are they going to be doing for about 3 months after discharge if the patient has osteomyelitis?
They will be prescribed IV antibiotics for 3 months. (have a home infnusion nurse come visit).

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
a) Prevent internal rotation of the affected leg.
b) Keep the hip flexed by placing pillows under the client's knee.
c) Use measures other than turning to prevent pressure ulcers.
d) Keep the affected leg in a position of adduction.

Rationale: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

How do you assess motor response in a comatose patient?

Eye not opening; 3 on Glasgow coma scale. Nonverbal; 3 on Glasgow coma scale. Apply painful stimuli. Sternal rub. Observe arms and legs. Score is based on what they do with their arms and legs. Do not pinch the nipples, nailbeds,  or squeeze hands. If a patient responds to a verbal command before a physical, shows a higher level of functioning.

The nurse is providing care for a patient admitted to the hospital with a head injury and who requires regular neurologic vital signs. Which of the following assessments will be components of the patient's score on the Glasgow Coma Scale (GCS) (select all that apply)?
a. Judgment
b. Eye opening
c. Abstract reasoning
d. Best verbal response
e. Best motor response
f. Cranial nerve function

To maintain airway patency during a stroke in evolution, which nursing intervention is appropriate?

A. Thicken all dietary liquids.

 B. Restrict dietary and parenteral fluids.

 C. Place client in supine position.

 D. Have tracheal suction available at all times.

Rationale: Because of a potential loss of the gag reflex and potential altered level of consciousness, the client should be kept in Fowler's or a semiprone position with tracheal suction available at all times. Thickening dietary liquids isn't done until the gag reflex returns or the stroke has evolved and the deficit can be assessed. Unless heart failure is present, restricting fluids isn't indicated

When preparing for a patient with a suspected lumbar herniated nucleus pulposus for MRI. Which nursing intervention should be done prior to the test? Ask the patient if they have any metal implants.

Question the client about allergy to iodine if using contrast. Ask if claustrophobic. Ask to remove all jewelry and ask about body piercings. Do not bring the chart into the room.

A client is sitting in a chair and begins having a tonic-clonic (general) seizure. The most appropriate nursing response is to:

carefully move him to a flat surface and turn him on his side.

 A patient has been admitted to Exacerbation of multiple sclerosis (MS). What’s the priority of nursing care for a patient with MS?

 Pain & risk of falls

Nurse is assessing a patient with meningitis. What are the signs of meningitis?

Nuchal rigidity(neck stiffness), terrible headache

A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?
a. "You may have difficulty believing this, but the paralysis caused by this disease is temporary."
b. "You'll have to accept the fact that you're permanently paralyzed. However, you won't have any sensory loss."
c. "It must be hard to accept the permanency of your paralysis."
d. "You'll first regain use of your legs and then your arms."

A patient has an embolist to Right carotid artery that causes the stroke, what kind of stroke do they have?

Ischemic stroke; disrupted blood flow to the brain.

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following?

TPA

Thrombolytic therapy has a time window of only 3 hours.

What are contraindications to TPA?

Hemmorahagic stroke, too long of a time frame(longer you wait, less effective and more dangerous it is), bleeding disorder, hypertension. If can’t get blood pressure under 185, we can’t administer TPA.

If blood sugar is high  after ischemic stroke what does that increase the risk for? What does it do in the brain with high blood sugar? happens to brain?

Increases swelling because metabolizing sugar in anaerobic environment and products of anaerobic environment that interferes with lactic acid, waste products and all the chemicals that rush to the site, causes more swelling. Very important to control blood sugar after stroke from seizures. Seizures increase metabolism.

High risk for seizure after a stroke. What are some things you want to prevent after a stroke?

High blood sugar, seizures, very low blood pressure, very high blood pressure, high fever.

A patient with Parkinson’s is having trouble getting enough nutrition in. What are some nursing interventions?

 High calories, allow more time to eat, space out protein throughout the day.

How to position a patient after a stroke?

Semi fowlers; Head 30 degree in neutral position to prevent CSF flow

When administering TPA, what is your priority assessment?

 Monitor blood pressure, signs of bleeding for hemorrhage. Heart rate would increase due to the drop of blood pressure.   Level of consciousness would decrease. Perform frequent neuro assessment. Glasgow Scale can be done every 15 minutes but you would do a more in depth neuro assessment. if there’s a change in glasgow scale, it indicates irreversible neurological damage.

A nurse is assessing a patient with a terminal illness and notices the patient is in denial about the condition. Which of the following would be the most important for the nurse to develop patient’s plan of care?

Seek help from help team members to address the patient’s denial.

Explain to the patient that denial is not healthy

Correct the patient’s misconception about outcome, treatment and goals

 Accept the patient’s denial of the situation.

Denial is the first stage of the process. As nurses, we know acceptance is important.

A patient has C-dif (Clostridium difficile ) related diarrhea and has been diagnosed with FVD(fluid volume deficit) . The nurse providing the care for the patient should anticipate which of the following?

Decrease level of bun

Increase level of potassium

Administration of hypertonic IV solution

Administration of hypotonic or isotonic IV solution

Normal Blood PH Range : 7.35-7.45

Al[K]alosis; K-kickin the pH up >7.45

 Aci[D]osis; D-slidin the pH DOWN <7 .35="" span="">

Respiratory problem:    CO₂ is less than 35mmHg(alkalosis)

CO₂  greater than 45 mmHg(acidosis).

Metabolic problem:       HCO₃ is less than 22mEq/L (acidosis)

HCO₃ greater than 26mEq/L(alkalosis).

If arrows are both in same direction=metabolic; if opposite direction = respiratory

PH 7.47 =alkalosis

CO2 = 30 respiratory

Study abgs

A nurse is caring for a post op patient of abdominal surgery, which of the following nursing interventions should the nurse perform to prevent respiratory complications?

 Assist the client with the use of an incentive spirometer. Mobilize as soon as possible. Assist the client with coughing and deep breathing, provide a pillow or folded blanket so that the client can splint as necessary for abdominal incision.

Do you inhale or exhale using an incentive spirometere?

 Inhale.

How often reposition surgical patients?

At least every 2 hours

If you’re administering moderate sedation for bronoschopy, what are you going to tell the patient , how are they going to feel during the procedure?

Kind of awake but have amnesia with IV, NPO, won’t remember much during procedure

After procedure:  feel groggy, don’t drive.

If patient tells you that their medicine makes them sick? How should you respond?

How does it make you sick? What do you mean? Tell me what symptoms you have.

When giving Narcotic pain meds for older adults, what should you keep in mind?

Need less meds, get confused, can get toxic easily(slow liver & kidneys).

Where does gas exchange occur in lung?

Aveolar membrane

Teaching for obstructive sleep apnea. What are some lifestyle modifications? What should you tell the patient?

Lose weight, no smoking, avoid alcohol, avoid hypnotic meds, don’t take naps during the day can cause insomnia at night.

Before performing tracheal suction, what should you do?

Hyperoxygenate and listen to lung sounds before and after checking heart rate & stat o2

Patients with TB get admitted to the hospital, what should we keep in mind?

TB- isolation room with negative air pressure; use N95 mask                                                                                    

What’s the best way to deliver medication when someone is having an acute asthma attack?

Give nebulizer

Teaching for  COPD, what should you keep in mind?

 Have rest periods, stop smoking, increase calories, if eat too many carbs, can turn into sugar-CO2 levels increase and metabolize. Eat more of high fat, high protein diet. Position for breathing better. Incentive spirometer.  If cold and fever= infection. Inform them of signs of respiratory infections and to seek help immediately.

With Atherosclerosis can it cause angina?

Yes, it can. Narrowing cardiac muscles; as it narrow get vasospasms. Plaques obstruct coronary artery, not veins! Athero means arteries.

How do kidneys respond to hypertension to help normalize blood pressure?

 Excrete sodium and water.

If someone has kidney failure, can’t regulate blood pressure like you should; what do you do? Give ace inhibitors to people who have diabetes to prevent kidneys from getting bad.

What are ways to reduce blood pressure if you have been diagnosed with hypertension?

 Exercise, diet, decrease sodium, change position slowly when waking up, smoke cessation

What is the goal for patient with coronary artery disease and has developed angina from the CAD?

 Enhance myocardial oxygenation;

Where does oxygen travel to?  Where does blood travel to? Everywhere

You are taking care of a patient who sudden looses consciousness and you can’t palpate ceratoid pulse. What is priority action?

Get help and then initiate CPR (cardiopulmonary resuscitation).

What is your high priority, assessment for a patient  with heart failure?

Respiratory status due to fluid overloads leading to pulmonary edema.

If patient has mechanical valve replacement, take antibiotics before teeth cleaning. Why?

To prevent infection of the heart; valve.

If someone had peripheral arterial disease, how would you improve circulation to their legs?

 Keep legs in dependent or neutral position.

In arterial flow, why do you not elevate legs? Don’t get enough arterial blood flow.

In venous flow, why do you keep the head up? Venous blood comes below to go up; prevent blood clot to the brain.

What are some early interventions to prevent blood clots in surgical patient?

Early ambulation for venous blood flow(best answer)[, then SCDs to help patient get out of bed and prevent clots]

A patient with NG feeding feels full and uncomfortable, what should you do?  

Stop feeding and assess placement and patency.

What is gastritis?

Inflammation of gastric mucosa (lining of the stomach)

What causes gastritis?

Coffee , alcohol, smoking, spices, caffeine, NSAIDS, aspirin, steroids, bacteria-viral, viruses,steroids

H.plyori loves to live an environment that has ulcers. Breath testing for h. plyori

Patient has a BMI for 32. What are they considered?

Obese. 30+ obese 35+ morbidly obese 40+ supra obese

A patient is considering bariatric surgery. In the time leading up to the surgery, which of the following nursing diagnoses would be the primary focus intervention?

Altered growth and development r/t obesity

Risk of injury r/t obesity

Knowledge deficit r/t implications of bariatric surgery

When planning care for a patient with small bowel obstruction, which should be a priority?

Maintain fluid balance

Which of the following should be the first priority after a patient recovering from ostomy surgery?

 Stoma care

If you have Fluid retention from acute glomerulonephritis, what sign and symptom do you expect to see?

High blood pressure, increase of edema of face and body.

What would your priority assessment be for that patient, everyday?

Daily weights. [daily weigh-in]

What findings support a diagnosis UTI infection?

 WBC, positive Leukocytes on dipstick, pyuria(pus)

What should you teach the patient to do if they have kidney stones?

Strain all urine to check if stones are calcium or uric acid

If patient is taking Ibuprofen for pain, how do you instruct them to take it?

Take with food.

If patient is on continuous bladder irrigation and starts complaining of severe spasms. They just had cystourethroscopy, what should you do?

Check patency and irrigate blood clots to prevent blood clots from going into the bladder.

Why do we advise young adults to get HPV?

Prevent cervical cancer and prevent some long term complications for men

Sign for hyperglycemia:

3 P’s = polyuria, polyphagia, polydipsia [excessive urination, excessive hunger, excessive, thirst]

If you’re teaching a type 1 diabetic, what should you teach them regarding meals?

Don’t skip meals or insulin (take insulin just as ordered). If diabetic is sick, their insulin needs increases.

Nursing Dx[diagnosis] for diabetes insipidus:

FVD related to increased urinary output

A patient with Hyperthyroidism is having trouble maintain weight and have a nursing diagnosis of “less than body requirement; altered nutrition.” What are some interventions to help this?

Increase calories, small frequent meals

Your patient is going to MRI, what are some things you are going to check?

Check pacemakers and hearing aids; allergies; claustrophobic, implants, dentures, medications, patches,

What are the nursing interventions following a lumbar puncture:

Lay down flat 3 hours, monitor site for swelling and hematoma, increase fluid intake, finger stick immediately to check blood sugar.

What percent should your blood sugar be in the spinal fluid? If lower what does it signify?

2/3(two-thirds). If lower than 2/3,  will signify infection.

Aaaah! Reverting all my old posts to 'drafts'

Moved back from Dallas. About to move to a new city. new place. new friends.

 Be they Muslims, Jews, Christians, or Sabaeans,

Those who believe in God and the Last Day

And who do well

Have their reward with their Lord.

They have nothing to fear,

And they will not sorrow. 

(Qur'an: 2:62 and 5:69)

A love so raw and so pure.

I want a love, so raw and so pure. I want to hold it in my hands. I want the kind of love that brings such a bright light in a cruel world. I don't want to fail. I don't want to hurt. I will never lie. I want to be held. I want to be danced with in the moonlight. I want to run and jump streaking down a street with that kind of love,with that lover. I want to make the other person smile and trace it with my fingers and my tongue. I want to make his heart soar and his mind open into a new way of thinking and beliefs. I want to show him the world isn't so cruel that there is bright times if you look for them. I want to hear his story, I want to just hear him. I want to tell him that everything is going to be okay in his life when he tells me why he thinks theres evil inside. Inside of me, I would jump with joy when I hear his voice. Just having that kind of love would keep me from jumping off the cliff of my mind into insanity. That kind of love, he would be my anchor. I would love so much. I don't know why I feel these kind of feelings. If I had this kind of love I know I wouldn't be able to breathe or focus without him. I would crash and burn without him. Wouldn't ever be able to imagine living life without that kind of love after having it. I need that kind of love. Someday I want kids or atleast 1. I want to end up having the best husband and keeping our vows. There would be trust,confidence. We would understand finances and trust each other on our financial decisions. We would have intellectual intimacy. We would praise each other. I would try my best to be the perfect wife for him(Ibn Hibban narrated that the Prophet (pbuh)said, what translated means, "If a woman prayed the five prayers, fasted in Ramadhan, protected her honor and obeyed her husband; then she will be told (on the Day of Judgment): enter Paradise from any of its (eight) doors.) He would take care of me or suprise me when i'm sick. If we had kids, he would take them out for their favorite icecream or have a playdate with them atleast once a month. He wouldn't mind spending family time. I want to be with that same person for ever even if it's rocking chairs in the middle of no where. I would cook all day. I would want to make that person laugh and make them proud of me. I would continue to live just so I could hear their voice. I want to suceed just so I could hear them say you did a great job baby. I would do anything for that person wether it's to run in the middle of a busy road or to be chased by a scary big dog. He would make me want to do the impossible. He would widen my horizon, make me think more. I would truly suceed in life and with him because I would actually love him. I would forever be by his side and be there for him. I would protect him as I know he would do the same for me.

Sometimes it drives me crazy that i'm only 20 and I think so maturely. People tell me all the time I don't know what love is...but do they really know what love is??? I think the perfect way to describe it in English(i'm so slow at translating arabic into englishwords) is verse from the bible 1 Corinthians 13:4-8 Thats the kind of love I need and want. The kind that i'm waiting for.

But then sometimes I feel like....in this world, this reality. Maybe love isn't for me? ) : but who knows. ;) Gotta love God and the feelings, mind, spiritual beings we are that he has created. So beautiful.

Heaven

"Perhaps they are not stars, but rather openings in heaven where the love of our lost ones pours through and shines down upon us to let us know they are happy." I stared at the stars tonight. One shined extra bright and I couldn't help but smile&think back of memories with all my lost beloved friends&fam♥

Rip<3

Trevor G,Michael Lilly, Rob Schilling,Grandma, Jordan Wilson, Sterling Walker,Gr8 Uncle,Hayyan Khan & Iman Haq.

6 Days till Vanilla Boo is OUT :] I was actually looking forward to doing fireworks with him this year or atleast having a chance to :/ I've never done fireworks. No plans this year, just about to sleep, fireworks banned in Lake C. and i'm not going back to my apartment for a few more days.

Dear Future Fiance-Husband

Dear Future Husband,

 I can admit that sometimes I wonder, do you really exist?

Every girl has a vision of prince charming since she was young. At the age of three, it usually is somsone who can save her from evil and wake her up from eternal sleep or give "true loves kiss"

In elementary school, he becomes the boy with the least cooties, the one who's willing to cross the playground to share his Zebra Cake even if it makes him a target for the week of all the other boys.

Since high school, I didn't get to go prom nor was I allowed to date, hopefully you can provide me with an experience. Create a prom for just both of us, or also our islamic - married couple friends...but please complete my experience  with photos that we can keep for decades to come and you'll give me a corsage made of orchids.

Nineteen years into this life, i'm still unwilling to give my heart away, I am still that same girl who hopes for her prince charming. And although I wonder at times why is it taking you so long to sweep me off my feet and take me to your palace on horseback... I know that it is probably because meeting you will be better than any fairytale I could've ever read or seen as a kid.

Eventually i'll have a few heartbreaks from my friends but a few years wiser though, I will admit that there are times when I find myself questioning your existence. Because I have yet to meet the guy who makes me hear songs like "All My Life" or "A Whole New World" in my head when I see him does not mean I don't hope that it'll ever happen.

I may already know you or may still meet you someday. Something I leave completely up to Allah(SWT) because i'm positive that our will be epic. Maybe by the time we meet, I won't even have "epic" in my vocab.

But, I can't promise you that I wouldd make the world's most perfect princess. In fact I'll probably keep you on your toes and amuse you with my eccentricities. There are a lot of them. I'll probably steal a bunch of your T-shirts and turn them into my shirt dresses, or drive you slightly mad with my obsessive compulsivity and my need to fix your collar constantly- unless you happen to not wear collars. Hopefully you can wear that Alladin Khurta/Shirt atleast on Fridays & family gatherings.

I can promise to be your best friend ,be that person you can rant to after a rough day, the hand you can hold when you get sad, or the person you can text when situations get awkward. By than, i'll probably have unlimited texting plan on my phone.

I'll probably mess up your hair sometimes and hug you for too long, but that will  only b because I absolutely adore you. I'll bury my head in your shoulder during scary movies and make you feel like superman when you kill those flying cockroaches that really shouldn't exist. I'll wake you up every morning to pray together. I'll make sure you look fresh when Friday comes for Jummah prayers. Can't promise that i'll cook your favorite food every Jummah as my mom does for my father but  I'll cook your favorite food the days you reasonably request it & definitely on your birthday and try my best to make friends with your entire family. It probably will feel so genuine because the love you give to others is what you take. If I can love you, i'm sure I can love your entire family.


Hopefully you'll be able to love my crazy-strict conservative family and understand their lifestyle, in return.

I willl respect your nights out with the boys and make you seem like the perfect guy to my friends. I'll watch basketball or football games with you(or even soccer if you're into that), and not complain when you cheer too loudly at the TV set.

I will know the difference between giving you space and being constantly there for you;;even if it means sitting and playing video games with you or taking hot chocolate runs or go groceryshopping when it rains.

I will listen to your music and we'll go on epic adventures together,seeing the world, taking awesome pictures, eating awesome food, and never running out of things to tell each other along the way. You might get tired of me running my mouth, but as long as you love me... I think that'll be fine.

I won't be waiting for you to sweep me off my feet and take me on a magic carpet ride like Aladdin did for Princess Jasmine, because I know I won't need anything like that to fall for you. I will love you for you.

You will be that someone to make goofy faces with in pictures, to lace fingers with when I'm lonely, and to take long walks under the stars with on the beach. For now I don't mind walking on the beach alone and  hardly anyone can catch me smiling in my pictures but with you it might be different. After all you will be the one that completes me, my character and half of my deen.

You willl be the guy who takes me the way I am and will laugh as I burst into Disney song or pick out pink wallpaper.

You will be that someone I envision a future witth;; us filling out visa forms as we travel the universe, picking out our first dog/persian kitten together and arguing about what to name it, or being snap-happy stage parents in our preschooler's annual mini-plays. &&& I keep hoping that maybe someday when we find each other, you will become that someone whose smile I wake up to in the morning & the last face I speak to every night.

So to the man I know that does exist, and who will help me maybe make sense of the world someday; this Man I can't wait to love.. PLease know that I can't wait to spend the rest and my entire life with you; But for now, I can wait. In the mean while, i'll continue practicing my faith and honoring my dignity/morals.  Fingers crossed and palms held together, I hope that you're out there somewhere, waiting for me, too.

With the hope I will be yours for always(iA),

Meena

"Death makes angels of us all and gives us wings where we had shoulders smooth as raven claws.."

Had Deja-vu all over again. Another dream, horrible day.

Fudge. I felt so numb a few days ago upon hearing that my realest, my ride or die friend passed away from a relapse. I didn't know relapse was an option. My boy got cleaned up. Rehab. Built new friendships. I thought he was living a full life. I was happy for him & thought now we're older maybe I needed to give space for his relationships. I remember in middle school-highschool, being the odd one out due to my ethnicity & faith. So much bullying and racial slurs I heard but Rob was always on top of it.  He would fight anyone if they offended my faith. I never got to attend parties but he would always share secrets and what happened. I knew things other girls didn't get any insight even while dating him. After school, we had our MSN webcam chats everyday. It didn't matter if I spent my summer overseas, he kept me updated by e-mails. The only boy who shares the same views on 'c0n$p!r@c!3s' and man I hope some day there's another cracker out there that thinks the sun shines out of my @$$ and has similar views --but this one. The boy even walked me to dance try outs in junior high when other girls were making fun of my bubble butt. I was legit crying thinking having a butt was a bad thing. He met my first 'crush' and didn't understand why I didn't want to date this boy. Handsome yet very girl including Rob&Jordan was obsessed except me. but man, I wish, I wish I had been more open with Rob instead growing distant after my wreck/surgery. Maybe he would've felt comfortable to hit me up one last time instead of the friend he chose to be around with in those last couple hours. RiP sweet boy, thank you for being the first male friend to show me so much respect & love. Thank you for being the older sibling I always wanted.

Life is not easy. It’s not easy if you are struggling with addiction – or even if you aren’t. It’s all about evolution. The strong survive. It’s not just about physical strength; it is more about mental strength. Do you have the will to survive? Do you have the strength to make it one more day?

As a person who has never struggled with drug or alcohol addiction, I can only speak from that perspective. I feel like i'm being selfish for moving 200+miles to go to nursing school and return to teaching dance however I can not live at home when my parents are heavily involved with the muslim/desi community. If they only knew the truth about others, i'm sure they would take a step back and worry less about me making a wrong impression on others. Despite returning to north TX, I will continue to make frequent trips to visit everyone. Watching a few friends experience withdrawals is bittersweet but makes my heart ache. How did we get to this point in life? I thought abuse was bad during childhood but this...dependency on drugs...My insight into your world is only through observation. I do not wish to walk in your shoes, but I can tell you what it is like to walk in mine – if you are serious about recovery.

Every day, I have unfulfilled wants that some are not centered on anyone else. It may seem selfish, but I made a promise to myself. I wouldn't leave my family or run away when things get bad until my baby brother reaches the age of 16. I want things, I want different feelings, I want to be so successful that I am freed from feeling like i'm owned by my family,  that i'm able to help others overcome addiction, help orphans. I want changes in myself, in others, I want , I want, I want. It really never ends. I believe that desire is no different for anyone – for people with addiction and for those without.

Daily, there are people out there telling you no – bosses, friends, parents, spouses and significant others – and that is just a part of life. Disappointment and hurt are as much a part of living as joy, happiness and love. Hurt is the same for those with addiction as it is for those without. The difference is how we react to and cope with our emotions, whether they are good or bad. I don’t know what drugs do for a person with addiction to help cope with disappointment. I don’t know how drugs heighten the joy of happiness. But I do know that my life would be very monochromatic without its peaks and valleys.

I have no doubt from observing you that you hated every day you used substances. I can see how your life was out of control, spiraling into a pit of hurt and despair. You became so lost that the helping hands of others could not even be grasped.

I see your struggles with being in recovery, with more pain than joy. It’s a time in your life where the scales are not balanced. You are working so hard to survive but everyone is saying no. There are so many frustrations. “What is the point?” you may wonder.

There is one place where no one will say no. There is one life that will accept you. The life of substance use that you have known for the last several years. That is the easy path to take.

But please know that the immediate pain you feel now will eventually fade.

When my grandmother (mom's mother) died, I felt terrible pain and remorse. I wanted to pick up the phone and call her, but I knew I couldn’t. I wanted to one last time, for old times’ sake, annoy the crap out of her with our language barrier but I couldn’t. I flashed back to all the good times, but they were not to be anymore. I believe that feeling of loss is something similar to what you are experiencing in order to live on. Your old life must die, and there is tremendous pain with that death. Each day you will want to use substances just one more time. Time may heal all wounds, but the scars are there forever.

In time, the scales will balance and you will experience more joy than pain. But for now, you must travel the difficult path and find the will to survive. You will become stronger each time you choose to steer away from that dangerous and tempting path at the fork in the road. It may be hard to see because the path to recovery is difficult. But please know you are not walking alone – hands of help are reaching out to you with your every step. You may learn to hate me instead of love me because I will always, always push you to strive to be better. I will forever be that friend that you can call me anytime and despite how far I move, I will drop everything just to pull up even if it's 2am. Why do I care?

 Because you are all my brothers and sisters. What I love for myself, I love for all of you. I remember coming close to developing an addiction in highschool and it's yet too painful to process still because of the emotions but I didn't have anyone there for me, besides God of course. My "friends" didn't realize until towards graduation when I was trying to find any way to graduate a year early or get my GED just so I could start college sooner than later; so my life could have a meaning. 

I'm not sure who's reading this and or who will come across this but if you're specifically reading this post, I may not know you personally yet I have much love for you. You need a real friend? I WILL BRING THAT BLIMP TO YOUR FRONT DOOR TELLING YOU ANYTHING IS POSSIBLE! JUST BELIEVE. PLEASE don't give up.  Please don't hesitate to reach out. I value privacy as I hope you'll value mine just as well. (my skype is on my purevolume page---links to the right of the blog.)