Vacation...all I ever wanted!

Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!

Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.

I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.

One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.

I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.

We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.

I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.

As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?

Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!

Stay tuned...back to work next week!

Not so late

Thankfully, everyone showed up for the night crew. I was warned in advance because as a rule, the charge nurse must stay over if anyone is missing from this shift. Since our charge had already volunteered to work as the fourth person, if someone called in, I'd have to stay. (We have other people who could, but usually they decline or have already left by the end of shift...which is a whole other story). Alas, this did not come to pass.

I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.

I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.

My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.

Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!

More later.

Shifting gears

RIP Paul Newman...now there was a guy who could really shift gears!

Yes, I'm back to the evening shift and so far, things have not been too bad. I've had two patients and a med cart to lug around, but since our census is lower than it's been in a while, it's not too terrible. Our nurse who's famous for calling in on his/her shift to work on Friday even showed up last night.

Our census may stay low for a while since we don't have too many admissions scheduled for next week and only one or maybe two discharges. I'm sure all of the admissions will wait until I come back from my time off next week (Sometimes I think my middle name should be Murphy...as in Murphy's Law.)

My patients have been pretty good considering everything. Mr. AB #1 was back on my list. For some reason, I don't complain about people and I get to take care of the same people over and over. I hear my co-workers say things like, "If I have Mr. X for another day, I'll kill myself." so the boss reassigns them...to me. I must have "team player" or something stamped on my forehead in invisible ink, since I'm always "taking one for the team." At this point, I'm beginning to think that some of my coworkers have more mental issues than some of our patients, or just a heck of a case of compassion fatigue. I think my own compassion fatigue and stress from being the newbie has resolved itself...for now, anyway.

Mr. R. is also one of my customers. He's a trainwreck, who's heading to Washington this week for surgery. He's been made aware that it's very likely he could die during the surgery or not be weaned off a vent after, but he's going for it anyway. His chances of long-term survival are slim. I watch him very carefully, and thankfully, he's been pretty calm when I'm working. He desats when we reposition him in bed, so it makes things really interesting. The one good thing is that his bed actually goes into Trendelenburg mode, so we can move him more quickly and easily.

Finally, I have been busy planning in my off time along with other things, like buying a new furnace and air conditioner (ours is 20 years old and the furnace is dead) and going to doctors appointments. I'll get to do some fun stuff (manicure and pedicure) before Dahey and I go out and celebrate our anniversary. What joy! I love the pedicure place and by a stroke of luck, I found out about a deal with them, and it starts next week!

Gotta run and do work before I go to work. More later...

Life's comings and goings

Lots and lots of stuff happening this week...so today on my day off, I'm doing the usual errands including taking our dog to the groomer. He hates getting a bath, but he needs it. He's been shedding like mad and really needs the haircut.

The story of the last few days has involved that famous (or infamous) condom catheter.

They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.

Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)

We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.

More goodies later....gotta take the dog to his groomer.

Heard on the unit...

Here are a few of the gems I heard this weekend on our unit.

"I'm getting my own room in front to be closer to you." Mr. J.

Mr. J. said this to me when he got moved up to our private room when Ms. R. left this week.
What did he do to win the suite, you ask? Why he came up positive on his last UAC&S for acinetobacter in addition to the MRSA he already has in his wound. He was just saying that because my boss seems to assign me to the patients on the front end of the unit a lot more than the back.

"Ah. My Pepsi angel!" Mr. K.

I brought in a couple for him to keep him quiet but it didn't work. His behavior may or may not have been related to his suddenly missing Gabapentin order. He's got it back now and is more lucid than he's been in days.

"I hear the boss is alphabetizing everyone." Mr. J. (again)

Mr. J. got booted from his private suite when the other Mr. J. came up positive for acinetobacter, too. Besides that, two of our Mr. HIJ's (not their real names, but they are similar) got put in the same room, too, because the boss needed a three-bed room available for our new admissions next week. So much for avoiding similar names in the same room. It just makes for more excitement with the bed bingo that always seems to happen on our unit.

Fun Friday

This happens when one, the census is down, two, both of your patients have doctor's appointments at the same time and three, you are not working the weekend. Oh, what joy!

That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)

Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.

Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.

The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.

All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).

Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.

I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.

Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!

Ahoy! CoS is up and running, mate!

Yes, it's Talk like a Pirate day today, and so the latest installment of Change of Shift has a pirate theme over at crzegrl's place.

This swabby even has a post noted there. Thanks a ton, mate!

Nuggets for September 16

Yes, I'm off today, so I'm surfing again before I start the real vice...baking. Fall has come to our neck of the woods, the furnace is dead, so why not heat up the house by baking!

To the blogs we go...
Alas, here are a couple of newer blogs I've found since I was reading my sitemeter stats today. You gotta love the link love! Many, many thanks to all of you who link to this blog. I appreciate it! (Mucho, mucho, mucho...as I tell Bubba).

PerfectRN is also a second career RN like me in the Midwest (yes!) who's chronicling her adventures in her blog.

And via PerfectRN, I found Booty Nurse (what will Google do with that...whoa!) who's giving us her view from Endoscopy in rural New England. BN, I gotta tell you, I thought endoscopy was pretty cool when I saw it on my clinicals. And no, I'm not just saying that to get any brownie points from my brother-in-law, the gastroenterologist. He's the man who loves Katie Couric because of this story.

DisappearingJohn is one of my favorite ER RN bloggers. I loved this quote he found from atyourcervix. John, if you only knew how much poop (literal and figurative) there is on evenings in rehab!

Articles of note from the NY Times

ER patients often left confused after visits
This should be an interesting topic on all the other ER nurse blogs (MonkeyGirl, GuitarGirlRN, DisappearingJohn, etc.) I doubt this author actually talked to one nurse. If she did, she camoflages it well.

The strep that wasn't...a cautionary tale
This was a scary story. If you have kids, you must read this one. It really scared me.

Spit it out...the DNA testing fad
This was actually listed under the Fashion section, but it does have some health implications. Who'd a thought DNA would turn glam? Ah, yes, the CSI effect...

Death and a new nurse
Another second career nurse describes her thoughts on this subject and what happened to her.

A good cause

If you want to help military and veteran families who are in the hospital, support your local Fisher House.

A Fisher House is “a home away from home” for families of patients receiving medical care at major military and VA medical centers. The homes are normally located within walking distance of the treatment facility or have transportation available. There are 38 Fisher Houses located on 18 military installations and nine VA medical centers. Five more houses are under construction.

We're still waiting for ours at Madison. It's on the drawing board, though.

How to know the moon is full

Listen up, all you nursing students, although you may have thought meteorology has nothing to do with nursing outside of being listed before it in the class schedule, the full moon can make a difference on your unit.

In my short time as a student and so far as a nurse, I've heard from psych to labor and delivery to LTC nurses that the change in the phases of the moon brings out the strange and unusual more than you'd think.

Well, since yesterday was the full moon, here's a few of the fun things that happened at Madison.

1. The crazy people get crazier. Yes, lil' ol' Mr. K. keeps forgetting he's a quad, even when he's reoriented, and in between, he even acts lucid. Last night's installment: he kept wanting to put on his pants and get up, so he kept ringing his call light. Not even the two Pepsis (he loves Pepsi so much they could use him in ads) I brought in as a bribe kept him quiet.

I'm starting to like the idea of aerosolized Haldol for not just patients, but some of my coworkers.

2. Your coworkers get edgy. When I asked about Mr. K. and his light buzzing, I remarked, "Wow, has he been quiet all night?" since Mr. K. did not buzz once while I was sitting at the nurses' station (which was not long). The Slug, true to her pain in the backside self replied, "You've been smoking crack."

Nevertheless, I blew her off, since I spent most of my night actually on the floor with patients, while she sat by the phone and played secretary in between her med passes. It's actually better for her to sit by the phone because whenever you work with her, because you'll get about 20-25 calls a night and 99% will be for her. It's just a whole lot easier not being at the desk so you don't have to be her secretary.

3. The normally quiet people decide they need something...now! Mr. H. decided to do this last night before the end of shift. I guess he got tired of me going into his room and always giving his roomies their PRN pain meds. I've delivered meds on his hall for a while and this was the first time I've ever given him a pain med.

One of his roommates is a basket case. He's taking every psych drug, pain pill, and sleeping pill we'll give him. That's what happens when you can't deal with the life you've created on the outside. The roomie is having problems with his wife and infidelity again. The story gets better and better--he was with the other woman when he was injured and she is having his baby. Other Woman decided to let the wife know once he was injured. Said wife was really perturbed when he visited Labor Day weekend.

With real-life stories like this, who needs to watch a soap?

4. Although it's not related to the full moon here in our neck of the woods, the weather's been crazy. Ike's remnants flew through the midwestern US and left us with a whole bunch of water. Lots of low-lying areas around here that don't normally flood filled up really fast. We had fun taking not one but two detours to get to a family reunion yesterday. After the second one, I told Dahey to just go back home and take the route closest to our house, since that doesn't normally flood and it worked out well. I just wish we could have stayed longer at the reunion. It stunk having to leave and go to work.

One more evening, then back to days. Stay tuned for all the excitement.

Remnants of Ike...no Tina

Yes, we're getting that rain here in our neck of the Midwest. The yard now has a big lake in it. Three of my five evening shifts are done and the last few days have been interesting enough.

Friday I went to a prescription drug abuse seminar put on by a local psych hospital. They even had free CEs for the RNs and all sorts of goodies. I registered via e-mail and got a confirmation but I forgot to bring the e-mail along. I show up early figuring my name is on the lists there and my name is no where to be found (for CE people and non-CE people). I was very agitated about this, but a lot of other people were, too, (and they actually paid for the CEs and need them this month for their various licenses) so I decided the best course of action was to find the local Starbucks, get a coffee and read my e-mail.

I had plans for lunch, so I found a Starbucks in the neighborhood, so I didn't have to drive around in rush hour traffic. I couldn't get on to the wifi hotspot on my Palm, so I read my Rehabilitation Nursing magazine from cover to cover (it's on polytrauma), which I had meant to do for a couple of weeks. It was a good read and I highly recommend it. I wanted my e-mail, though, so I headed up the street to a local eatery that had accessible wifi and I found a nice booth and newspaper and I read my e-mail and the paper until lunchtime. It was a diversion, but a pleasant one nevertheless.

After my fun surfing and reading, I met my friend C. for lunch. C. was happy I got bumped so she could escape the office a little earlier. We had a great time.

At work, I've been lucky enough again to be pushing the med cart. Supposedly, we get a less taxing assignment when we're giving pills, but it's not necessarily the case. I had the AB boys (that's what I'm calling them because of their bug--acinetobacter) up in the front and it was hellish. The room was so hot. Something is wrong with the HVAC system and these guys have fans, but to go in their room garbed up in an isolation gown makes me sweat like mad. It's a lot of work. They can be needy. Thankfully, C. the charge on Thursday kept them quiet for me while I adjusted to being back at work and on the pill delivery route, which, incidentally is all the way at the other end of the unit. (Our boss is really good at crazy geographical assignments like that!)

Outside of that, our new schedule came out and yes, I did actually get those vacation days I asked for recently. I got lucky and found a couple of blank spots on the calendar and asked my boss if I could take off three days in October and three days in November. I'll actually be away for six whole days, since those days are right before my normal weekend off. My husband Dahey is going to surprise me this year for our anniversary. He's making all the plans. All I have to do is show up. At least that was a good excuse for buying a new dress and some other new clothes recently. Bubba will be hanging out with my friend's boys while we're out, so he should have fun.

More later. Stay tuned.

Nuggets for September 11

First of all, I pause to remember those lost this day seven years ago. It's hard to believe it's been that long ago, and that I was living another life as an IT person. How things have changed!

A few of these items have been hanging out on my list for a while, so I will pass them along, right after I get off my soapbox on this first one.

No, this is not in my area of rehab per se, but due to a connection with an expert in the field, I feel a need to discuss this.

WARNING: Soapbox ahead!
Nurse.com has a great article about radiation safety. How does this affect you, you say? Well, if you work in an area where portable x-rays are done regularly, you are a student hanging out in such areas or if you accompany your patients to x-ray or any other radiological procedure and have to position them while the machine runs as I sometimes do, this article applies to you.

Mainly, follow the guidelines noted in this article. If you are supposed to wear your dosimetry badge, wear it. If you are hanging out in the PACU and they want to do a portable on someone in one of the bays, go hang out across the room behind a wall. If you position patients during a procedure, keep your hands out of the beam and wear your lead apron. If you remotely think you are pregnant, tell someone and stay out. If you have any questions, ask for the radiation safety officer and/or his/her's designate to know what's going on in your facility.

By doing this, hopefully, you'll help guarantee a long career as a nurse. That is all. End of soapbox.

Now for a few other items I've run into lately...

Dementia and Margaret Thatcher. This article discusses the book released in the UK by Thatcher's daughter and the ethics of such a release. (from the Blogs section of http://www.nytimes.com/)
http://newoldage.blogs.nytimes.com/2008/09/02/margaret-thatchers-open-secret/

VA voter drives anytime soon? We shall see. None yet at Madison, anyway. (from http://www.nytimes.com/)
http://www.nytimes.com/2008/09/09/us/politics/09vets.html

This article discusses all of the places you'll find technology in use by nurses. (from http://www.nursinglink.com/)
http://www.nursinglink.com/careers/5322-technology-in-nursing

And for something completely different, check out Tex's post about working with women and why he loves it. I can identify with the flipping part, Tex. Lots and lots of flipping in rehab!

The colors of rehab

Yes, you'd see a lot of colors on our unit, and it's not just in the scrubs worn by the staff. There are colors in therapy--yellow, pink, blue Theraputty in those tubs. Next, you have the therabands in blue, green and red. The drugs even have pretty colors, too--the clear dark-red of guaifenesin, the fruity-smelling, clear with a gold tinge of liquid Neurontin, the neon yellow-green of Tygacil. Our patients have colorful equipment, too--the red, blue, black, silver, American flag print, green and even purple wheelchairs.

Also, if you didn't know it already, you see a lot of colors in the input and output for patients. The strangest thing I ever saw on a bed pad recently was an aqua-blue serous looking drainage. The patient never had it during the day, because I looked each time I turned him. I told the docs about it on Monday and everyone just said, "Oh well," and that was it.

So yesterday, I saved the pad after I cleaned him up and bluish dressing. The docs didn't figure it out right away, but the NPs took one look and they did. "Pseudomonas!", they chimed in chorus. "We have to get something to put on that dressing." MA ordered Iodaform gel, but we couldn't get it by the end of the day, so she gave me a new order to use Gentamicin cream with the dressing until the gel arrives. I fixed him up, fluffed, buffed and turned him and before I knew it, it was time to go home.

Outside, the sky was a brilliant, sun-filled blue with just a hint of the fall coolness to come and the end of another interesting day. More later!

ARN journal now online

If you're a member of the Association of Rehabilitation Nurses, you can now access the journal Rehabilitation Nursing online at http://www.rehabnurse.org/. VA nurses: take note. This new issue is dedicated to polytrauma and has some great articles about OIF/OEF veterans who are suffering from multiple injuries.

Rehabnurse.org is a great site, especially if you're looking for information about being a rehab nurse. It's especially advantageous, since you get access to regular free CEs online.

In addition, you can also find some great general rehab-oreinted documents. Specifically, I found a guide on bowel care, which is a very important part of the rehab process. As my old friend G. used to tell me, "rehab is all about bowel, bladder and skin."

TGIF, baby!

Oh, I rejoice! The weekend is here...and I'm not working down at Madison. Hooray!

The last three days have been fun, really, with ol' Mr. K. and Mr. J., especially since Mr. K. is getting his Haldol titrated, and having less hallucinations, but today was busy, even though at 1020, I was ahead of the game.

I was still driving the drug wagon as the med nurse on the most populous hall (we have 13 people here instead of the 11 on the other one...), but luckily, people weren't so agitated about how fast I got them their pain meds. Sometimes, the natives get a little restless down there...I really wanted to kill the Slug today, because she was being so onery and lazy about doing the accuchecks to which she was assigned. To relax, I sat in my car and ate lunch and charged my phone. I did not want to sit one minute in the lunch room with her, because I would have put my license at risk. (Going to Federal prison for killing her is not on my list of things to do right now!) It was lovely! It was only 15 minutes (I came in and checked my e-mail at the nurses' station for the other 15) but it was an oasis. I'm not going to detail everything, but I find that escape does have its advantages, especially when you're contemplating killing your co-worker for being such a slack.

The rest of the afternoon went well. Everyone got their pain pills, their Ativan and whatever fixed their ailments, including pillow fluffing, so they were happy. I got to hand over the keys to my med cart to K., instead of B., which was also a relief. He's another story, but I only deal with him on evenings, so I won't worry until next week!

Happy weekend! More later...stay tuned.

Change of shift

Yes, the famous Change of Shift is up at Nurse Ratched's Place, and check out all the cool pulp fiction covers over there.

Nuggets for September 2

Yes, it's been a long time since I posted Nuggets, but I really missed them, so...Now that I've returned from my trek to ye old neighborhood pet store to get an electronic fence for the wild ol' herding dog at my house who nearly got hit chasing a scooter yesterday, I discovered a couple of goodies out there of note.

Enjoy!

Long-term ills tied to bad food (from www.washingtonpost.com)
That salmonella or E-coli can cause trouble for years in some folks.

The Well at the New York Times website is a blog that has lots of interesting articles on health-related topics.

Here are a couple of the more interesting ones out there right now:

Voices of Crohn's disease is a multimedia collection including audio files with comments from folks with this disease.

Best online psychology tests Just in case you needed a break!

The Wall Street Journal also has a health blog with a great story this week about a study regarding older fathers and kids with bipolar disorder.

No truer words

"nursing is head on, hands on, heart on. all together. all at once. maybe that is enough explanation why there is a nursing shortage. it is because not a lot of people can be all that, all at once."
--may at www.aboutanurse.com

If you haven't already discovered may's aboutanurse blog, do not pass go, do not collect $200, go straight there. I have been reading it for quite a while (I know I started in nursing school) and there is always something to think about.

My evenings are over for this week. Thankfully, everything went reasonably well. I had the same guys all five days and everyone was doing well. Mr. H. got in the shower, not once, but twice. I also let him know that M., our charge nurse, will get him there, too, if he wants to shower when she works, since M. does not rotate shifts like me. Mr. H. is a para amputee, but M is known on the unit for getting quads up and in the shower. Mr. B. was her longtime customer every Friday night until he left. Consequently, Mr. H.has been in a pleasant mood. I really think the showering is doing him a lot of good.

Mr. O., his roommate, is reasonably new. He's one of our few rehab patients. He's got a balky bladder, due to some previous cancer history, so I've been working on the rationale (aka sales pitch) for intermittent catheterization with him. He's been balky with some of the other nurses, so I go in and tell him very nicely and slowly how important it is that he empty his bladder. So far, he's agreed to cath more than he's refused. I cathed him, not once, but twice last night. Hopefully, they can get him on a schedule and just do it until he can get his urodynamics study.

The man across the hall, Mr. B. is still on C diff precautions and still has that foul, smelling stool. He is eating better (mostly Taco Bell, but he's actually eating other stuff with that), but we really have to sell him on drinking water. He drinks almost no water during the day when he has visitors (sometimes 20+ people), because when I was checking him on first rounds, his urine was always dark. By the end of the night, when I'd encourage the fluids and he'd drink them, it would get lighter. Who said nursing wasn't a sales job? I do a lot of encouragement and followup to get people to do what they need to do to succeed at the program. His halo is intact, but still causing him pain, so until the C diff stooling stops, we can't try getting him up into a chair.

I'm going to stop here...so many things to do in a short time on this day off. More later...

A good one

Sometimes you need a good laugh...especially when you wake up itching and sneezing...again. Alas, ragweed season seems to be in full bloom in our neck of the woods.

Head Nurse has this simple test for all you nurses out there, so if you don't have to labor today on Labor Day like me, (even if you do) check it out.