Deep Thoughts

With all due respect to Jack Handey, I've been pondering the following lately.

1. Why, oh, why would someone's family think it's appropriate to bring granddad alcohol to the hospital? Especially when he's on meds that will make him really, really stupid (and potentially sick)?

2. What doctor would purposely forget a patient's Baclofen order, when s/he's been on a high oral dose for ages?

3. Why on earth, in this, the 21st century, do we still have to have books that read like this? And why on earth would your coworkers tell you, in a diverse organization, "That's just the way it is."
That, like rehab bowel programs, smells really bad and for one, I'm tired of it. It's one of the things that drives me nuts about Madison.

And on that note, I leave you, back with Jack...check out the notecards. They are a riot!

More to come....from happier climes.

Cookin'

Yes, literally and figuratively, I've been cooking and baking for Dahey's party today. He's celebrating his upcoming natal day with a gathering of his friends at the house. Thankfully, we have a place to put all of them while they're eating, drinking and being merry.

Work was hot, but not as bad as it has been. The spring is turning back into winter again as we get that old, crazy weather back again. One day, it's 80, the next, 30 with snow. I just make sure I have a coat handy to handle everything!

I've kept busy reading the charts again, since I'm prepping for a couple of exams. I've decided I'd better take the GRE since I need it for most grad schools. I'll be doing that in a couple of months and I've sunk my money into the exam, so now I'm stuck! Guess I'll really have to read those study guides!

My first certification exam will be the week following the GRE and hopefully, it will include another conference trip. After all that, I'm sure my head will explode in mid-air sometime around June 1. If all goes well, I'll round out the year by testing for the CRRN. This week I found out I'll be working on some stuff for the October annual conference, so that was really exciting.

Since I'm always nosing around to learn something new when I'm not pestering the specialists who visit us, here are a few things I've turned up recently.

One patient of ours had a nasty case of pyocystitis. Another we read about another who suffered a traumatic intraperitoneal rupture of the bladder (due to accident). This Google Book on Urology called the House Officer series, has a lot of interesting information on urological topics.

Finally, I got to look up some drugs. I'd say 90% of our people take similar stuff. Baclofen (or Lioresal) is pretty much the drug of choice on our unit for a variety of patients. I wish I had a $1 US for every Baclofen I've given since I became a nurse. (It hasn't been long, but boy, do we hand them out!) This week's excursions into the drug lists included Forteo (aka teriparatide, which is a drug used for osteoporosis) and prazosin, an anti-hypertensive.

Gotta go back to the party...stay tuned!

The evenings of 2009

Last night wasn't terrible, but when you have a whole lot of demented people on your unit, it can get interesting! I had one of the hootin' and hollerin' characters (I say this since mine looks like a skinny, white-haired version of Yosemite Sam) who threatened to hit me if I did his bowel routine. Happy New Year to you, too, Buddy!

Sammy did let me do his dressings and turn him and by the end of the night, he was nice, sweet and replying "yes, ma'am" to everything I asked.

The rest of the cast of characters:

1. The man who wanted President-elect Obama to be his power of attorney, and then, he wanted screenshots of his TV as "proof" of neglect. It's starting to look like the Baclofen is messing him up, since his order just got changed. Thanks, docs, we need a little more excitement on evenings and nights.

2. His roommate wasn't seeing anything last night, but he wasn't believing much, either, especially when I politely asked him to check his med cup before he tossed it. He had pills in it that I did not want to go get again from the Pyxis when he could just take them as they are.

3. The nice, sweet man down the hall with the massive dressing changes is now refusing them. Not sure if he's PO'd at the staff, or if they told him he may have to leave. Sometimes, people like to take it out on the nurses when the docs aren't available. We're just handy targets.

Thankfully, the staffing was great. We had a lot of people on evenings who I don't normally get to work with and that was nice. Everyone was helping each other out a lot, which makes the load lighter.

I'm not sure how tonight will turn out, but the first evening of the year went pretty well. One down and four to go!

Topics of note

Here are a few items I've encountered in my day-to-day practice and some related articles.

Oral care
How many of you out there really know if your patients brush their teeth? For a lot of SCI patients, if the nurses don't do it, patients don't get their teeth brushed. Reuters Health ran an interesting article in the past week about the relationship between oral hygiene and pneumonia. It's not just associated with ventilators anymore, folks.

Devices and other goodies
On our unit, we have lots of people with Baclofen pumps. Baclofen pumps are wonderful things that can get a patient who's in what looks like a permanent fetal position back to the straight and narrow, so he or she can ride in their wheelchair and do lots of other normal things we take for granted.

One of our patients who came in this week has an interesting variant: he has a baclofen/morphine pump that delivers both drugs intrathecally.

Bugs!
A recent patient came in and screened positive for a UTI. The culprit: E coli, which according to Todar's Online Textbook of Bacteriology is responsible for 90% of UTIs. This same patient has a history of odd bugs, including Kocuria Kristinae.