Did they really say that?

NP's Place had a Change of Shift theme called, "Oh, no you didn't" recently. Maybe I should call this one, "Oh no you didn't really say that!" about this type of incident in my world.

Nurse minding her own business gets a call from department to which nurse has sent patient for procedure.

Call 1
RN Department X: "Hi, this is So-and-So from Department X. Are you taking care of Mr. C?"
Me: "Yes, I am."
RN Department X: "Well, I just wanted to let you know that around xx time Mr. C. coded as we were starting our procedure."
Me: "What?"

RN from Department X proceeds to tell me about all the labs drawn, etc. So, just for grins, I ask a couple of questions.

Me: "Did you call Dr. Y. to let him/her know what's going on?"
RN Department X: "No."
Me: "Okay, what will happen now?"
RN Department X: "We'll just send Mr. C. back."
Me: "Thank you." (hangs up phone and immediately calls Dr. Y.)

Call 2
Me: "Dr. Y, did you know about Mr. C. coding."
Dr. Y.: "No."
Me: I fill in details on phone and point to note in computer. Dr. Y. affirms finding note about incident.
Me: "I just wanted to inform you re: this incident."
Dr. Y.: "Thanks."

Welcome week

Yes, that's what they should be calling this week. People who were gone are returning and people we haven't seen in a while have come back. If only the Hotel wasn't such a great place to stay!

My day went well. I had the choice of assignment, so in the interest of simplicity for me today and the next time I work, I asked for my two characters from last week back. Yes, maybe I'm a glutton for punishment, or I've finally got them working with me. All went well, so that was nice.

I found I learned a few new things today. The docs are impressed that I read notes. I talked to one of the residents running around with the doc there and they were talking about someone's recent surgery. I told them what I knew about it, asked a couple of questions and got a quick 101 from the specialist. They seemed impressed that I knew what type of surgery it was.

After that, I was rooting around in some lab results and ran into this new bug: Providencia stuartii. eMedicine has a great overview of this family of enterobacter-type infections, which is really interesting.

The rest of my day was taking care of my people, admitting one of the regulars, troubleshooting some tech issues for some other staff, and passing pills for our nurse who was getting a little hypoglycemic from not eating. Ahh, what fun!

The folks on this end were getting restless looking for pills (since they were a few minutes late) until they found out I was delivering them. I've pushed pills down there for so long, I can almost read their minds...and they know I'll bring them what they want. (After the first 100 times, it's pretty easy to remember...I just look and bring the stuff along).

Finally, I passed all the meds, finished my paperwork, helped another person with theirs, and escaped on my merry way.

More to come...stay tuned!

And if you don't like the weather...

Stick around for a few minutes, and it will change, or so they say in our neck of the woods.

I'll be enjoying the extra light at night if the storms stop, and I'll be taking my time driving to work tomorrow on the first Monday after the daylight savings time switch.

More to come...off to enjoy whatever comes my way today!

Nuggets for March 7

Lucky 7! Happy March 7, all. I'm enjoying my weekend doing random housework and other assorteds.

Here are a few topics of interest I'm researching here and there while I have the time.

Dialysis is not common in my practice, but not unusual. This dialysis center company has an interesting blog on dialysis topics. Don't forget to check out a couple of dialysis nurse blogs, such as jo's Sinus Arrhythmia and U know PP. Wanna be one? Check out this dialysis nurse's page for a first-person account or check out this page for nurses at http://www.kidney.org/.

Your hemoglobin is low enough that you win a blood transfusion. What causes that anyway? This page at http://www.anemia.org/ has lots of references to the causes of anemia.

People are always looking for alternative treatments and this one was the topic of conversation lately. I found this via the blog, http://blog.bioethics.net/, which has lots of interesting articles, you don't want to miss.

NINDS at the National Institutes of Health has a lot of great articles on neurological disorders and stroke. A couple of my recent favorites: Spinal Cord Injury: Hope through Research and Stroke. The Know Stroke section has lots of great information on identifying stroke symptoms and what to do about them.

Speaking of getting lucky, KevinMD has a post about a researcher using his charms to get a favorable rating for Seroquel.

And finally, on a silly, but serious note, a lot of celebrity doubles are roaming around out there. One of our residents reminded someone of this guy.

Hot Friday

The unit (and some of our patients) was steaming...literally and figuratively.

As usual, in our neck of the woods, it was hot today. No one told this to the HVAC people, who last year, were lucky enough to have the heat on in mid-May when we had a cold spell. Oh, the joy of rooms that are so hot, patients sticking around in them get sick and vomit. This happened to one of our characters today...just as I was finishing my lunch.

His nurse of course, was nowhere to be found when he first started retching. I got the lucky job of elevating his head, turning it and getting him a bucket. By that time, it was too late. He was a mess. His nurse did show up and I did stick around to help her clean him up and get the doc to look at him, since he's a nice guy and he just doesn't normally do that. He had some other complaints that seemed a bit strange, so we gave him the full treatment...EKG and all. No surprise that after we got his IV access started he tells everyone, "I sure feel better now that I threw up!"

I had the same two patients and Mr. Colo. (They're still working on a colostomy for him...he needs it). I was working with some new nurses, too, so that made things interesting. Trying to demonstrate new stuff and have patients cooperate can be a challenge. Fridays are busy days and one of my normally reasonable characters got crabby fast. He wanted to be "waited on first". Thankfully, the charge nurse helped me out, but I was guilty only of not being able to be in two places at once.

This character is an anxious respiratory mess and you know that ABC stuff (airway, breathing, circulation)...well, he knows the routine and he just hams it up. Just for grins, I put him on an O2 sat monitor, as I start his trach trial (he needs to be plugged for several hours for his trip home). What do you know, he sats in the 90s all the time. All his entreaties for suction, etc., were driving me nuts. I just made him cough up the little bit of sputum he has (always white), because he needs to know how to do it. I still had to suction him twice this afternoon and he made a big mess going back to bed. Happily, I had a helper, so we got done reasonably quickly, but it was still a mess.

My other patients were reasonably less demanding, even the more demanding one. We kept his water cup filled and he was happy. It didn't hurt that I found an ice cream for him at lunch, either!

Needless to say, this wet and tired nurse was so happy to get out of Dodge and get a shower at home. The temperature at home was a delight. The night is young and so is the weekend, which I'll enjoy two days in a row off.

It doesn't get any better! More to come...

Ironies, part two

First, you second-guess if you did the right thing for the patient that died. Did I miss some signs they had or were there so many problems which could mask another, that I couldn't keep them straight? You find out that you weren't the only nurse to wonder...and maybe the MDs are pissed because they couldn't see any signs, either.

Next, your boss calls you up to ask what the acronym SCD stands for. Lucky me, I got to answer the phone. And no, I didn't even look it up first.

After trivia, you get the assignment to take your patient to an appointment and are looked at as a rare oddity--an RN as escort. Your boss could have told you this yesterday when you asked who was going for one of the other staff, but no, the boss wanted to save that for you. What's more fun than rushing around gathering things for your trip at the very last minute?

Of course, accompanying this patient was a little like going as a star's attendant. Everyone there (I'm not kidding) knew his name. You'd swear I was with Norm from Cheers.

Finally, the weather was beautiful and I was trapped inside for a while, so I took the earliest opportunity to walk two blocks just to enjoy it....and all the ironies of the day.

I get to rest...

On the evening shift. Yes, it's true. Days can be rough and today was no exception.

I got the characters I had on evenings last time. Joy. No one else wants one or both, so I get stuck in their room. When no one is anxious, all is good. When there's anxiety for them, there's lots of work for me.

Tomorrow will probably be different, though. One leaves early for his weekly appointment off-site. The other's got issues, and if that resident doesn't fix them tonight, he'll be going out with the last guy who was really perturbed that he was on bedrest all weekend. Alas, we'll see what happens.

More to come...

Nuggets for March 3

I'm off today, so I went in for my now yearly appointment today. The tech was nice and surprised I could handle it. (I was going to that happy place, I tell you on a couple of films!)

Anywho...WildDog is outside lollygagging in the breeze, waiting for the mailman, so I'm busy surfing away here. Here are a few items I've found today. Enjoy!

I'm really tempted to print this out and hang it on my locker. I know jo featured it once on her blog, the appropriately titled magicbulletsaway.blogspot.com.

The nurse attorneys are at it again...check out a couple items below:

• Taralynn Mackay has an article about jobs for nurses and board actions.
  
• LaTonia Denise Wright reminds us of the 24/7 nature of nursing. Oh, if you only knew how much I think about pummelling idiots...think is always the key word.

And finally, from my ANA daily newsletter...the 83-year-old ER nurse in Syracuse, NY comes in whites and cap two shifts a week in a local ER, when not tending her garden. If I have half that energy at 83, I'll be good!

More to come...stay tuned.

Am I seeing a pattern?

Last year, one day after the traditional end of February, I was on my old unit at Saintarama getting some paperwork done. While I was there, a patient coded.

Yesterday, I'm walking in the door and notice one of the people I usually see was not there. I asked what was going on. The answer: he coded in the early AM on the night shift.

The day shift was busy, too. I ended up with one less patient on my assignment. This one didn't code, but he won a lights and sirens trip to the nearest hospital for a dose of tPA.

Just makes you wonder...

Ironies

I was driving down the road the other day and saw this license plate on a BMW:

BM-ING

Oh, the rehab nurse in me was just laughing out loud...if this man only knew how this would be received on my unit. Many punny comments would be exchanged and probably no one would want to ride in that car!

I'm coming up on my anniversary as a nurse and I keep thinking about some of the things that have happened to me since I've become a nurse.

1. I'm not too afraid of bodily fluids, but vomit gets me. Everything else--nasty, draining wounds, poop, etc., rarely faze me. It's that rascally vomit that is my Kryptonite. I go to that happy place really quickly when people vomit, or I'd be going to Emesisland with them!

2. I've learned to like gloves. It never bothered me if a foodservice person wasn't wearing gloves before, but it really does now.

3. I like teaching. In rehab nursing, we do a lot of this, and I've developed my own internal scripts, depending on the subject. One of these days, we ought to have a Rehab Nurse Learning Channel, tape our delivery of the educational topics and let patients watch on a patient channel, just like public access on cable.

4. I'm now fluent in several types of wheelchair drive systems. At least, I don't crash as much as I used to when taking them to the charging station. (Maintenance frowns on holes in the walls caused by staff).

5. I've always thought I was pretty resourceful, but I'm learning even more tricks. One of my recent patients, a quad with shoulder mobility, figured out how to use his rolled up washcloth (for his hand) to scratch his nose. It was great, but it kept falling out, so I used Kerlix and tape to attach it to his hand without gumming him all up. It worked great. At least it keeps him occupied enough, so he doesn't bug us ringing the call light to come scratch his nose!

Nuggets for February 28

Ah, the last day of the month...and working evenings again! What fun. I can think of better ways to spend my evenings, but in mere days, yours truly will get a vacation....seven days straight away from the big house.

Here are a few things that have been floating around in my world lately. Enjoy them and the rest of your weekend.

Sometimes I think they should call our unit, "Flaps-R-Us." This is a very common surgery to remedy the big bugaboo of rehab nursing (pressure sores) when all else fails. V-y advancement flap is a one way of doing it.

We don't see this much, but someone saw it on an x-ray recently: joint effusion.

Think you're seeing two thumbnails? We had one guy who said this. No, he wasn't losing it, he just has a case of onchomycosis.

Some very interesting lab tests I saw on a heme-onc report that we don't always see:

• LDH
• Haptoglobin
• Ferritin
  

Heave, ho!

There was a lot of heaving today. I had Mr. Colo again, and for a while, they had him on a prep. The gallon of GoLytely I delivered at 1600 yesterday was still in his room. He only made it through half of it. Since Mr. Colo was still stooling a bit, that was the beginning of the day. One of the nurse assistants told me the boss should assign him to two people. Yes, he should when we have really heavy patients (literally and figuratively), but he doesn't, so you have to go roaming the halls looking for help, as I normally do. Some people will help you (and I always try to reciprocate) and others will run when they see you going down the hall, so they're "busy".

Thankfully, J. was in charge, and I recruited her and K. and one of the LPNs, so I didn't have to ask the same person too many times. J. does a lot when she's in charge. She goes out looking for things to help people with and it's nice. I helped with a couple of orders, but not many, because my two patients and the meds kept me running literally the whole day. I sat for 20 minutes while I charged my cell phone today and ate lunch and that was it.

Tuesdays can get crazy because the docs have meetings early, then they round with one of the specialists, and sometimes they don't get done rounding until just as lunch is arriving. It makes for some interesting predicaments such as one today with Mr. Colo. I'm in the middle of passing my pills to the whole hall to which I'm assigned. Mr. Colo was very distended with gas. The docs tell me..."oh, we dig stimmed him and relieved some of the gas, so you'll need to clean him up." What.In.Hades.Is.Going.On?! I'm in the middle of passing pills and I have to stop, drop and roll to do a clean up. Yes, this was not a drill. Since no one told me exactly what kind of results I'd find, I had to stop and get J. to go in with me so I could clean up Mr. Colo, then go back to my pills. One of these days, the docs will figure this out!

I also had DQ on my team again and I managed to get him up into the shower and he was all fine and happy until we told him he had to move next door since his double room was needed for two isolation patients. (I so love bed bingo!) Of course, he skipped out on afternoon therapy, since he had to make sure we didn't mess up any of his stuff. He just hung out in the halls and got in the way as we moved Mr. Colo to DQ's room and then DQ to Mr. Colo's room as the housekeepers finished cleaning the rooms. DQ wasn't happy with the way we arranged the room, so he rearranged it several times until he found a configuration he liked. He's not happy with it, but we had no choice. The inn is full of isolation patients!

When I wasn't busy with my own patients, I helped K. get a couple of hers up to go places. One guy went and bought a pair of reading glasses. He was the happiest I've ever seen him. He was sleeping all morning, and when he came back he was so alert and social. K. left him up on his stretcher for the evening crew to return to bed.

At 1400, K. got an order to send another patient to x-ray for a hip film. We got him loaded up for the transporter, then put him back to bed when he returned.

I left the med cart for the 12 hour nurse (and her orienting student) and got everything cleaned up. At 1600, I told J. and K., "Let's run before we have to move anyone else." and so the day ended.

Evenings creeps up again Thursday. I'll rest my heaving shoulders until then...more to come.

I don't want to clean...

The house really needs it, though. Yesterday was the crazy day (with a capital C) of the week and I'm so happy I'm off today and tomorrow.

Here are a few snippets of my Friday.

1. Get Mr. Colo ready for his close-up (yes, the colonoscopy was yesterday). Mr. Colo gets taken to the test only to find out one of his labs are out of whack and they won't do it.

What does he win, Pat? Well, I saved Mr. Colo some pizza from the Marine luncheon today, but I told the charge nurse to give it to someone else, since Mr. Colo will be on a liquid diet until they can try again Monday (assuming his numbers are better).Yuck!

2. Boss says I need to show one of the new nurses how I pass meds. Yes, I had the med cart again and the new nurse got my general AM rundown of how I do things (print a sheet, highlight, talk to people, etc.) At 1130, I ask new nurse to help me pass the pills. New nurse says I'll be right there. New nurse doesn't show up for 15 minutes. This nurse is behind with pills and perturbed. New nurse complains to another new nurse (we have a few right now) about not being compensated for previous degree. This nurse quashes urge to strangle New Nurse or run over with med cart.

3. The Slug, sitting on her derriere as usual, reminds me that I didn't update ALL of my PRN docs for the PRN pills yesterday. Literally, out of her mouth (in front of New Nurse, of course), "You had a lot left over last night, so you better fix that." (She followed me on the evening shift--working--or slacking--another double) Reality: I left exactly two, for two meds given within 15 minutes of the end of shift. It didn't help that I was busy and the regs say we should do them at 30 minutes AFTER the drugs are given.

and the topper....

4. While all of this was going on, I get a call from School Nurse that Bubba has a "contagious disease" and must be picked up immediately. Yes, as I'm passing the pills and halfway down the hall. Bubba apparently got itchy at lunch time and someone saw him scratching and reported him to the nurse.

Thankfully, Dahey was available to go get Bubba from school. Bubba has a rash on his leg that I have been treating (with a doctor's advice and good ol' Lotrimin for several days) that is apparently a reportable (only in our school district) that requires a note stating he's been on meds for 24 hours before returning to school. We didn't know about the note part, so that was a blast, considering that we didn't notice it on him until he returned from school one day last week.

Bubba has his note, still itches a little and had a great half a day with dad. He'll be back to school on Monday.

Needless to say, I was so happy to go home at 1600. More later...I'm really going to clean now!

Nuggets for February 20

Here are some interesting tidbits that have recently shown up in my mailbox and/or practice. Enjoy!

Lots and lots of veterans have Acinetobacter baumanii. AB, as we call it, is appearing in more and more hospitals and in some strains, it's resistant to all but the most potent antibiotics. This article, Deadly bacteria defy drugs, alarming doctors, from the LA Times talks about the latest bugs on the loose.

We just got one of our own designated, so the CNL role is becoming more popular in this "pay-for-performance" environment.

No surprise here: Amputations much more common in diabetics (from www.medscape.com)

Still going...

I had the colonoscopy patient again today. I had to try to sell the GoLytely gallon again, and I fell short of my quota (only 3/4 of a gallon went down). I did have plenty of help from the other nurses on the unit to get Mr. Colo turned and cleaned up each time.

Did I mention that Mr. Colo is big? Not just big, really big. His bariatric bed takes up most of the room. Imagine your favorite football linebacker in bed and you'll have a pretty good idea of his size. Mr. C. has very large legs and he cannot help us turn. As a result, he has the usual pressure sores: on the sacrum and legs. Surprisingly, since we're doing the prep, he's turned a lot. We have to get him clean, and we have to turn him to do it.

Mr. Colo finally got his liquid lunch after I scoured the unit looking for broth and juice. I only found broth, so we got out one of his clear sodas until it arrived. Thankfully, our dietary staff did not include red gelatin on this tray. I'm just hoping he got enough GoLytely that he's cleaned out for the procedure. If not, he gets to do it again next week.

Besides Mr. Colo, I got one of my other patients up in the wheelchair and I got the med wagon on my favorite end. Most of the people on that end are pretty mellow, but they were getting antsy today. It must have had something to do with their special monthly luncheon or something. The volunteers served it early, so they were wigging out when I wasn't down to there rooms by the stroke of 12. Eventually, they calmed down.

Happily, I got the last round of meds passed and I didn't hear a peep out of any of them. There weren't too many pills to deliver and everyone was in a good mood.

One more day...hopefully, Mr. Colo's prep is done by the time I get there tomorrow. More later. The weekend's just a day away!

No going lightly...

It was a non-stop day. I didn't wake up late, but it seemed like it. After I got up, I had to get Bubba up and ready and he was in no mood to get moving. Finally, we were on our way about 15 minutes later than usual.

I got to work and realized I needed to run some errands this afternoon. I talked to the boss before report and he let me use my "get out one hour early card" today to achieve all my backed-up errands.

Then, it was to the trenches. I got one guy up and in his chair so he could go off to therapy. I set up his roommate to get ready. Then I went to the third patient and found out no one had given him his GoLytely. Arrgh! I went to the med nurse, got it mixed up and I started getting patient #3 ready.

It's not much fun getting a big guy cleaned up, only to mess him up later with GoLytely. Here's how I did it. First, I brought the gallon in and explained he'd have to drink it all. Much moaning and groaning proceeded...so I told him, "You can drink some, we'll stop, get one thing done, then you can drink some more and we'll keep rotating." It worked. Patient drinks a pitcher. RN shaves patient. Patient drinks another, and on and on until we got the entire gallon down and all the AM care done. Elapsed time: 1 hour and 20 minutes.

Thankfully, his dressing survived the onslaught, based on it's location, so I changed it later in the day when we had to roll him to do cleanups. I had to find a willing participant, each time I cleaned him up. Nobody, of course, wants to help, but you can guilt trip them into it if sweet-talking doesn't work.

Lunch was the clear liquid diet. This afternoon, the bisacodyl tabs. Tomorrow, if he lets me, another gallon of GoLytely.

And yes, if you're asking, it really does roll downhill in this bed. Thank goodness we have extra absorbent pads!

RehabRN book club

And now for something completely different....

Tired of reading a bunch of boring old literature that's not very interesting? I went to the stacks of the local library recently and found an interesting book. Do Gentlemen Really Prefer Blondes? by Jena Pincott is subtitled Bodies, Behavior and Brains--The Science Behind Sex, Love and Attraction and this book is an easy read since it's got a lot of small sections that describe the larger categories of bodies, behavior and brains.

Here are some interesting things mentioned in the book.

1. Praat software (found here) can analyze the attractiveness of your own voice right on your PC or Mac.

2. The relationship of the size of your index finger and ring finger can tell you about prenatal hormone exposure.

3. On page 248, the authors of one study discuss the Nash equilibrium related to dating and buying your date gifts. Who'd have thought game theory would appear in this book?

Nuggets for February 17

I'm luxuriating in my regular day off, and I feel a little better so far. Here are a few things I've encountered recently and some interesting news and sites I've found online.

Stuff from the mailbox and in my neck of the woods

Hospitals fight to keep new nurses from quitting (from www.msnbc.com)
All I have to say to this one is "Duh!". As I learned many moons ago in school, some people only respond to problems if they have a dollar sign (i.e. how much money will it cost you) attached.

And if you stick around...
Nurses Have Many MSN Choices to Advance Their Career (from www.nursezone.com)
I'm pondering this myself, and happily, the number of online choices is quite large.

One of our patients was on methenamine hippurate. I had to look that one up, but alas, my Nursing Central didn't have it listed in my Palm's Davis Drug Guide reference.

We had an interesting case of staph epi on our unit. BTW we don't isolate people for this bug.

From the blogosphere...

From www.aboutanurse.com I found out that Fat Doctor got downsized. Go apply at your nearest VA, doc! We need you!

Head Nurse always has her interesting neuro What to Expect articles (the latest is lumbar drains). In addition, I am very much in agreement with this post on nails. And some people wonder why people don't take nurses seriously!

More later, folks! Have a great day!

Presidents' Day

One federal holiday I actually will be off this year (I'll just have to wait and see which other ones I get.) Hooray!



Bubba was off school and the day care was closed, so he got to spend the day with tired momma. At 8AM, he came in and woke me up to tell me he was hungry and wanted an Egg McMuffin. We had all the fixins, so we made ours at home. I didn't get out of my robe until 11. Another cold/random virus is stalking me and darn it, I'm trying to dodge it by resting, pushing fluids and all the other good stuff to do. It's a trick, though.

More later...

TGIS (or my last shift on evenings)

Thank goodness it's Sunday! Surprisingly, I won't have another evening this week after tonight, thanks to a good ol' Federal holiday...and then my regular day off. Hooray!

Things were quieter yesterday. They can be around holidays because the folks get either 1) lots of visitors and/or 2) lots of food, since we usually have visitors from every imaginable organization coming in to bring things to the veterans while they're with us during the holidays. We had balloons, we had a clown making balloon animals and we had food and candy everywhere. All the diabetics had higher than normal blood sugars from all the extra carbs.

One patient in particular was registering higher numbers than usual. We thought someone was feeding him all the goodies, but he said, "I think I'm getting sick." Whoa...what could be brewing? It should be interesting.

My patients were reasonably good, but I am wondering what will happen with DQ. Some strange things have been happening. One, he was quiet (but that was explainable--plenty of PRN Valium, which he admitted to enjoying.) and two, the NG tube secretions were brownish, but turning an odd color. The day staff tested them for occult blood, and while there was no coffee-ground emesis, it still doesn't look too good. The patient did have some drinks on his table of a similar color, so we made those disappear. We'll see if the color disappears with them. It hadn't by the time I left. It should be interesting to see what happens today.

My other patient complimented me on being on time for all the regularly scheduled turns. It was easy when DQ wasn't screaming or making a fuss.

Hopefully, tonight is peaceful and quiet, too. It won't bother me one bit! Stay tuned.

Friday the 13th...

And for me, it's evenings again. Last night, there was nothing unlucky about it. Yes, I did end up with the med wagon again, but I had three patients who were relatively easy to take care of, so all went off without a hitch. It also helped that the schedule was stacked with more RNs to the rest of staff, so it makes the load lighter. (Not that I don't like the LPNs and NAs, they just can't do everything...)

I had one patient I'll call DQ (that's for Drama Queen). Every time he goes into some rant, I just want to stand outside the room, applaud and yell, "Bravo!" for his Oscar/Emmy/Golden Globe performance. I told the MD about his gentle rant (no one on either side of the hall in the other rooms complained about this one...) yesterday at the beginning of the shift. Since he's not going with the bowel program (which is a big, big problem on our unit), she told me to give him this message, "If the bowels are plugged, I'll just have to drop the pain meds." We'll see what actually happens. Hopefully, he'll be reasonably good again on my shift.

We expect to have a discharge today, but we'll probably get one or two people to take his place. It really depends. Since the Hotel is pretty much to capacity with isolated patients, it's getting more interesting to find places to put people...especially the ones who aren't on isolation. My favorite charge worked with us last night (which she normally doesn't do) and her take is, "we always get extra people in on our weekend." The scary part is that she's usually right. We don't take people back on the weekends, but on Fridays, if any of our folks are at Washington and nearing discharge, they're pleading to come back to us before nightfall. Ahh, isn't it great to feel loved? Hmm....

I'm not too superstitious, but I'll be hoping I'm lucky enough to have another night like last night, which was not too crazy.

More to come...stay tuned!

More Nuggets

They just keep coming! One more day before Honest Abe's 200th birthday. Here are a few interesting articles (honest!) that I've encountered on the internet recently.

The good...
A happy hospital makes for happy patients
You may think this is a joke, but this is a very interesting article. Too bad we all can't work in this type of hospital, where the boss gets calls on off hours!

New surgery may give amputees more control (from http://www.msnbc.com/)
This article discusses how a new surgery will help those with arm amputations.

A great first-person account of prostate cancer treatment: Love in the Time of Prostate Cancer (from http://www.nytimes.com/)

The bad...
Drugs recalled due to manufacturing problems (from www.msnbc.com)

Pentagon reports US troop obesity doubles since 2003 (from http://www.usatoday.com/) Not unusual to see 25+ BMI anymore in our neck of the woods.

And the really ugly...
We deal with a lot of bodily fluids on our unit, but this one is a story about one that is absolutely horrible.

Only Grandpa today

Yes, that's what some of the folks call my patient and he was it today. Officially, I had two patients, but one was gone the entire day, so I really couldn't do anything for him. Grandpa was balky and happy, but never at the same time. I did his dressings, but he had to complain about them first.

Next, he complained about his bed, but he's been doing that on and off since the weekend, so I was told. He complained so much, I called the vendor's 800 number, the tech came out and he checked it out. Nothing wrong, the tech said, and Grandpa was happy...for about 2 whole minutes. Happily, since Grandpa is demented, he forgot about being mad and was busy watching TV the last hour I worked.

So I wandered around...and found stuff to do. My admission never showed up since they kept him at Washington instead of sending him here. I helped other nurses transfer people going to x-ray and therapy, I filled isolation carts with gowns, I filled glove dispensers with gloves and I passed out trays at lunch. I picked them up afterward and put them on the dirty cart. I took off orders. I witnessed a consent with one of our docs. It wasn't too bad. I hate sitting around doing nothing!

At 1530, we got a call that one of our patients had to be moved since he's now a double isolation patient, and one organism is C-diff. Joy. Nothing like bed bingo for four people (yes, that's how many we had to move to get them straight) so late in the day. Housekeeping had left the unit, so our charge was left to her own devices to get things squared away. We moved them in pairs and it worked out smoothly.

My second patient came in the building, just as I was leaving for the day. Evening shift was out of report, so I was relieved of my duty. Hooray! The weather's been great here, so I just hope it stays that way...without any tornadoes or floods thrown in. I could use a day to rest!

More to come...

Nuggets for February 10

Here are some interesting items I've encountered on the internet lately, via directed searches or via random reading. Hope you enjoy!

I'm studying for certification this year, and since our boss is a neuro who's big on everything spinal cord, I've done some reading on MS lately.

There are lots of things coming out in literature about treatments that may stall or stop MS from progressing. First, this article from the Saskatoon Star Phoenix discusses vitamin D and its role in MS. Another article discusses the use of immunosuppressants in treating MS.

On the subject of immunosuppressants, I recently went to a great CE presentation on working with post-transplant patients. Kidneys are the most commonly transplanted solid organs, so this presentation discussed many aspects involved in kidney transplants. The docs also talked about things such as CMV, diabetes and osteoporosis.

There was a great graph on kidney disease course and it showed how going on dialysis is just as difficult in terms of quality of life as transplant, but patients tend to bounce back faster from transplant than long-term dialysis. I found a very interesting DaVita article (by one of their social workers) which discusses quality of life. This is a very big deal in kidney disease as jo the dialysis nurse could probably tell us multiple times.

While transplantation short-term survival is up, long-term rates are flat. At the current time, there may be no breakthroughs in transplant treatments this decade, but there are plenty of promising agents in trials, such as ISA247. All we can do now is wait...and see.

Back to the old grind...

It's always an adventure on our unit on Mondays. The booking agents (a/k/a the NPs) try to get our people in on Monday or Tuesday, so hopefully, they can get someone home by the weekend. This is particularly true in the case of folks coming for tests or general stuff.

I only had two patients and no med cart. Hooray! I know this will change when I go back to evenings, so I'm just enjoying it while I can. It is bliss!

I got to do some fun stuff today...get people up into a wheelchair with a head and shoulder control. It's a little dicey, but it works. Why the patient won't use the controls all the time is another story.

My other patient had an undetermined suprapubic catheter. Since I searched the notes and couldn't find one with a date when it was last changed, and it wasn't on our board, I got the pleasure of changing it. I don't think this is a coincidence. I am noticing that I'm one of those people the docs and NPs ask to do stuff when they want it done. It's so nice to feel wanted! This same character just got put on a Clinitron bed last Friday and his wounds are really healing well. They look incredible compared to the last time I took care of him.

I had to report to the next shift, and my head and shoulder guy came back late, so I had to get him in bed and undressed before I left. Thankfully, one of our new nurses helped me get him back to bed. I finally escaped at 1625 after I wrote my last note. I had all my other charting done, since I did it as I went along, or I'd have been there later.

More tomorrow...we'll see how it goes. Stay tuned!

Ahh...the weekend!

Just what I needed! It's been a thrilling week and I was glad to be spending my weekend at home, thank you very much. The full moon and the crazy people at work were enough for me! I'm feeling better, since those meds kicked in my doc finally sent me. Hooray!

I left late Friday because I volunteered to take a patient to Washington for a scan. The tech left early, so when we got there, we had to wait for the on-call to show up. "He'll be here in 15 minutes" actually took over an hour. Thankfully, this was not an emergent scan, although it was ordered stat. The scan took 5 minutes and I got a whole lot more OT. Said patient wasn't too crazy except for when the "people" came back on the ride back to Madison. Oh, hooray! More documentation for the boss for me.

My days were pretty decent, even though I ran and ran and ran. My day seemed like this for a while: Do AM care, dressings, etc., get patient in chair. Feed or set up for lunch, let patient sit in chair some more (or go to therapy) then put to bed before end of shift. Heaving three guys around (even not big ones) with a lift, still is taxing. I did not have to do meds at all on day shift, which was a welcome change.

One of our long-time people decided to become a DNR this week after much discussion with the medical staff. We'll see what happens next.

An observation: all of our rooms, except one, are isolation now. You name the isolation, we've got it: MRSA, MRSA/VRE, MRSA/AB, and MRSA/VRE/AB. MRSA's just so popular in our neck of the woods that we have multiple rooms with people on this isolation. One coherent patient was so funny. He was calling MRSA "Mercedes", as in, "I've heard a lot about that Mercedes bug on TV."

The temps have been ricocheting around (one day 10 degrees, the next 50) so it makes you really sweat with the isolation gown and gloves on. I was in the non-isolation room one day with just gloves on for five minutes and my hands looked as if I had had them in water for 10-15 minutes straight. Ahh, you just gotta love the heating and cooling system when the weather does gymnastics.

More goodies to come...I went to some great CE seminars last week, so I'll post a little bit about what I learned in some Nuggets.

Enjoy the rest of your weekend, wherever you are!

Nuggets for February 3

Since I woke up long enough to check a few things on the internet, here are some of my finds. Enjoy!

Hopkins transplant surgeons remove healthy kidney through donor's vagina
I found this one at www.physorg.com, which is a science and technology site.

Irradiation of food puts consumers on edge
This article, from www.nytimes.com, discusses food irradiation and the latest salmonella crisis involving peanut butter.

Disruptive innovation, applied to healthcare
This article, also from www.nytimes.com discusses continuum of care and the current healthcare system in the US.

Before dawn, darkness

The last few days, I've been feeling pretty terrible. The virus-of-the-month in December worked me over good enough, that I've succumbed to one or two more in the interim. I felt so terrible working on Sunday night that I finally surrendered today. It's been sinus hell and coughing for too many days, thank you very much!

I called the MD to see if I needed to come in or if something could be sent out. Apparently, I'm not the only person sick, so I got my prescription. My day today has been, first, take Bubba to school. Next, go back to bed. Wake up a couple of hours later, and call MD.

In the interim, I called in sick to work. Note: this only takes 7 (yes, seven) phone calls to actually reach a live person. What little voice I had left disappeared by the time I finally got my manager, so I creaked that I had called the MD and was not coming for my regular shift today. Manager sounded a little annoyed (no surprise), but nevertheless accepted. (At least I gave enough time to get a replacement!)

Next, I waited an hour after MD office called and confirmed that a script was sent to my local pharmacy. I got to the pharmacy and I waited, because, they, too were inundated with lots and lots of emergencies. No problem, I found a seat in the empty waiting area and sat with my coffee and a magazine. Got meds, and scurried home to take the first dose of my seven days of huge capsules. Then, it was back to bed again, to sleep a few more hours, before Hubby calls to check to make certain I'm still around...and yes, I was in the same spot...in bed!

The weather's improved markedly in our neck of the woods, but there is a bit of winter gloom still hanging around. One person I know went in for surgery and had complications that have changed her life. She's handling it well, thankfully, but when you look at the grand scheme of things, you wonder. Last year this time, one day her husband was alive, the next he had a cold, the following, he was dead.

I'm still wondering about our cancer patient. He's set for staging soon, and some days, he just won't get up. I've taken his meds to him on my med passes recently and I keep the mood light, just as I always have done, and he laughs. But, I worry for him. Hanging out in bed in a dark room in winter is just so depressing. I wish there was more I could do.

Finally, I read an interesting thing in my ANA Smart Brief today, which I get via e-mail daily. I've posted it verbatim below. I think it tells a story people don't really realize now.

Enrollment in nursing programs nationwide has increased every year for almost a decade and the worsening economy is making the profession even more popular. However, some experts say a lack of available spots in nursing schools and the hard work and dedication required of nurses could be barriers for some aspiring RNs. "Yes, it's a route to some form of job security, but you really have to want to be a nurse," said Frances LaFauci, associate dean of nursing for Suffolk County Community College, adding, "You have to be tough, physically and mentally."

Nursing is not for the faint of heart, or the paycheck. I totally agree with the toughness factor. In a way, I feel like a nurse has a lot in common with many tradesmen. I had to apprentice and learn and then go out as a journeyman (or person as you wish) and ply my trade. Everything I learn colors what I do, and I don't look at things the same anymore.

Builders build and/or maintain infrastructure that last far beyond the scope of their lifetimes. Some never see a completed project because it's so huge. What we do as nurses is immediate and visible in our practice and the lives of our patients, even if we don't see it directly. This is why I really enjoy rehab, since we see this happen literally right before our eyes.

Things change, but we adapt them and integrate them into our practice, and the life-changing component remains. And at this point in time, I can't imagine doing anything else.

Rolling into Super weekend

Yes, it's not any old weekend...it's Super Bowl weekend! Go Cardinals!

Anyway, it was back to the evening shift for me and it's been run, run, run ever since. I got lassoed into a med cart again, and since the census is close to our max, it's busy. Lots of fun stuff going on, including,

1. The charge got to write up an incident report the other night for an omitted IV. The IV nurse (yes, we have those sometimes) forgot--by several hours for this big-deal drug. He/she was embarrassed by the whole thing and I think he/she's learned a valuable lesson...don't surf and play with IVs. Said nurse might not have missed the time if he/she hadn't been on the 'net...just an observation as I was running back and forth down the hall.

2. The good cop/bad cop incident is okay, so far. Lovely manager assigned me to patient on Thursday. Charge talked to him and he's been civil to me so far. I know he's still irritated (he tells people this on the phone) but I think he realizes it's for his own good, since he got a new little PU on him since the incident. He's really a pressure relief/turning advocate now!

3. The Slug was with us again the last couple of nights. It's really a pain that no one does anything about her. If I hear how "valuable" she is one more time, I'm going to throw up! How valuable is an employee who's making six figures yet is too poor to go to FedEx or some place else to do her long distance faxes, and other assorted no-nos, like parking her kids in the nurses' station (that's right, next to the computers) until it's time to go home? Oh, I really would love to see the JC inspectors do a site visit with her working evenings!

Nevertheless, I get to work with one of the best charge nurses we have all weekend. It helps when you feel like someone's got your back if you need it!

More goodies later...stay tuned.

Nuggets for January 29: Occupation-specific issues

There are a lot of occupation-specific conditions that have been cropping up in the news and elsewhere. Here are some of interesting ones I've encountered recently.

The US Bureau of Labor Statistics has an interesting general article about occupational injuries for nurses. They also have a great IIF (Illnesses, Injuries and Fatalities) section.

The NY Times recently ran an article about degenerative brain disease among former NFL players. For more on chronic traumatic encephalopathy, check it out at eMedicine.com.

You'd never think that they'd have this kind of information, but Apple, yes, the computer, iPod and iPhone people have a great section on ergonomics and reducing eye strain.

And in the "No, I didn't make this up" category, it's been outed as a hoax disorder--the infamous cello scrotum. Alas, gentlemen, the symphony can go on!

Good cop, bad cop

That was my day yesterday. Instead of playing good cop like I usually do, I had to play bad cop. One of our folks violated one of the rules he agreed to and I had to go to the big man (our director) to have him play the heavy. (It was helpful that he was strolling around on the floor...I didn't feel so bad about it...and he wrote up the note, too.) Nothing is more annoying than a patient who gets mad at you in the middle of the shift.

Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.

One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).

I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.

Bubba is off school today...so we'll be playing and working in the snow. More later!

Nuggets for January 27

Oh, the weather outside is frightful, but it's great inside! Here are a few tidbits of information on the stuff that's happening in my world from the internet and the blogosphere. Enjoy your day whatever the weather!

I ran into this interesting article about PTSD and smoking cessation on Yahoo!News in the Health section.

We don't run into this too often, but Brown-Sequard syndrome is a spinal cord injury that appears every so often on our unit.

It's interesting to read radiology reports on patients, but sometimes, I just have to look all over to figure out what's going on. Here are a few interesting items I've come across lately.

Since I couldn't figure out the acronym, I just went searching and I found out what exactly
IPMN tumors are from this article.

Finally, I found this great Google book on CT scans while I was looking up the definition of punctate cysts at www.m-w.com which now has a medical definitions section you can choose when looking up a word used in medical terminology.

From the mailbag...

Truthfully, I don't get much mail from this blog, and it doesn't bother me a bit. I read comments and that keeps me pretty busy.

Since we're officially in a recession, here's the latest job opening someone sent to me. Yes, I'm as shocked as you are, but if any of you know someone who wants or needs a new position and may fit the requirements, check this one out below.

If you want more information, go to the link below and tell them Wayne sent you.

Position: Director of Rehab
Location: Methodist Hospital, Houston, TX
Requirements: prefer masters prepared RN with rehab experience (didn't indicate any other specifics)
Website: www.methodisthealth.com
Contact: Wayne Wauters, senior recruiter

Get up and go Monday

I managed to get up and go, even if I felt a little slow. So did a couple of our patients.

Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.

Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.

I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!

The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.

It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!

Sobering

That was how my week ended. My patients were doing well, fluffed and buffed, but elsewhere on the unit, there was a cloud.

No, not the "happy cloud" the instructors told people to go to in the class some of our cohorts took, but a pall of the doom you know is coming.

One patient came in and within a couple of hours got his first order of vitamin K and some more elaborate diagnostic tests. Someone was drinking a little more than they let on...

Another got the bad news that he's got a terminal illness. No timeline yet, so he just hid under the covers most of the day.

Finally, I managed to bugger up the med cart. Technology is great, but the instructions on resetting it were not. Trial and error can be your friend, but when you're busy, you just don't want to go there.

Thankfully, I resolved the problem and got things to work. Hooray! More to come next week. Enjoy the rest of your weekend...wherever you are!

Nuggets for January 23

It's a happy, happy Friday, all! I love the weekend, especially when I'm not working.

Since the week is done, here are a few interesting things I've encountered lately.

What do you do when you get a needlestick? Here's the VA's resource for occupational exposure and HIV. While digging around on this very subject, I found a great resource on HIV called The Body Pro.

It's a little more complicated than a needlestick, but we had to deal with a patient who recently had a transbronchial biospy of the lung this week. Thurlbeck's Pathology of the Lung has some interesting facts about this type of procedure used to diagnose all sorts of lung conditions, from cancer to infection.

Finally, with all the MRSA and shenanigans going around we had a patient with a very scary looking butt cheek and one of these. If it's not MRSA, I'll be surprised. I've only seen one previous to this, on my pediatric clinical in nursing school and it involved MRSA and I & D and it was nasty!

On that memorable note, have a great weekend! We'll be eating cake (for Bubba's birthday party with all the kids).

It never happens...usually.

That was my day today. Even though, I'm coming down with another cold (I'll be happy to get rid of them once and for all!), my day went along smoothly.

Surprisingly, since it usually never happens, I had some of the same patients I had on my evening gig. I told them I was just as surprised as they were. I got both of them rolling quickly and it was great. I had to check the computer for orders, and that went well, too. One patient got up in his chair, rolled around and checked things out. It was a beautiful, sunny day, and the temperature even started creeping up to pleasant January levels.

My boss told me I got my permanent appointment. He was a bit taken aback which kind of makes me wonder about him. I think that four hour meeting he was in today fried his brain a bit.

Happily, the census is down for the moment. Hopefully, it will stay that way for a while. I know we'll enjoy the reasonable quiet.

More to come...stay tuned.

Nuggets for January 20

Happy Inauguration Day to all!

Here are a few things I've encountered at work lately and some interesting resources.

Proteus Mirabilis was on the list of UTI causes for one of our folks and just so happens to be one of the major causes of SIRS, systemic inflammatory response syndrome, which has a mortality rate of 20-50%.

This article discusses prealbumin levels and we monitor this frequently, particularly, since we have a lot of patients with stage 3 and 4 pressure sores.

We monitor albumin levels, too, and this article from Dr. Michael Eades talks about this lab value.

This article entitled "Nursing industry desperate to find new hires" on http://www.msnbc.com/ was my favorite. I have yet to see a lot of these sorts of tricks in my neck of the woods. Last year, maybe. I just don't think everyone's doing this right now, even though this article makes it look that way.

And now for something completely different...

I saw this on CNN.com for your favorite old-school vinyl audiophile.

One of my patients, who likes to draw, was working on an EDM schematic, instead of his usual watercolors. I didn't understand the schematic, but this guy is using these notes for the basis of a book he's writing with another author. Who says you can't do productive things on bedrest?

This isn't work-related, either, but from a public health standpoint, it's interesting. (from today's www.nytimes.com)
E-cards on the rise for notifying re: STDs

One to go...

Ahh, I really like Mondays when I know that I'll be finished with my five-in-a-row schedule. Sure, I only get one day off and then I'm back until the end of the week, but one day off after five on is better than nothing!

I still feel like I'm hanging on to that random Christmas virus I got. A little nose running, a little hacking cough, a lot of perturbed nurse, who's been trying to rest and beat it. Well, we shall see how it goes!

The last few days I've had pretty much the same assignment--two patients and the med wagon again. Even with LPNs on most of this weekend, I haven't lost that. I don't mind really, since I have an easy area to deal with, and I know pretty much what they want after dealing with them all this time.

Bubba has his birthday this week, so I'll be busy getting ready for the party this weekend. We had a little craziness here with the weather, so that messed me up a bit, but now I'm getting all my stuff going. I'll be really busy tomorrow! I'm glad it's my day off!

More later...

Nuggets for January 15

Well, it's back to work today, and I still have a bunch of stuff to do before I go. Here are a few things I've found while traversing the internet and various blogs.

My Own Woman has a great post for new nurses. Read it and live it. (I'm not brand new, but I'm still new at nursing and it really made me think.)

Tex from Weird Nursing Tales always has a great sing-a-long on his site. The latest, describes what I get to deal with on evening shift.

As a student nurse, I really enjoyed my trips to OR land at PrivateU's hospital. I almost considered going that route after getting my degree. If you're interested in the jobs of the OR nurse, check out UnsinkableMB's post on life as an OR nurse.

Jeepgirl has one of the reasons why I'm happy there's no full moon this weekend. Some of our people will just be crazy, anyway. All I can hope for is that a few more of them make it out by Friday, so the census comes down a bit before the weekend!

Wax on, wax off

I'm not doing any waxing here or at work, but, I am off tomorrow. Yes!

Today was a busy day, even though we weren't saddled with the admissions of yesterday. Mr. AKA blew his IV at 0500 and I could not stick him because he'd already been stuck 7 times before I got to him. How many people did it take (and sticks) after that to get a working IV? Only 5 more tries with two veteran nurses. It was terrible. Why they didn't give him a PICC is beyond me. He was off fluids today, so I had to encourage PO fluids and he's still tired. I got him cleaned up finally, which was the first bath and shave he's had in a week. (The Washington folks were "short-handed" he said, so he didn't get a bath). I just can't stand to have people be dirty!

We had to feed him his breakfast, he nibbled at lunch and I had to really push him to drink. He drank more in the afternoon than he did all day. I checked him out again before I left and he was doing better. I still worry about him, though. He's been through a lot.

My other guy went off to his appointment, so all I had to do was get him cleaned up and ready for the pickup. That was a breeze. His neighbor, Yosemite Sam, got cleaned up in the shower today, since he agreed to let his nurse do that. He wouldn't agree to a total scrubdown, though, so she just had to shoot water into the crusty beard and rub.

I got all the rest of my work done with five minutes to spare. It was nice to stroll out on time.

More later...

Walking...in the ICU?

I can only imagine how many nurses and support staff it will take to get some of these folks out of bed.

We deal with lots of tubes and wires in a rehab setting, but I can only imagine that number squared in an ICU.

Foley, anyone, Foley?

That was my day today. I had three patients and I got to change two Foleys. Both of them needed it...they were gross! Each patient got a nice, clean, silicone catheter (a 16 and an 18). One I put in at a nice, leisurely pace, and the other I had to do in five minutes or less. Thankfully, I had most of the stuff already in the room.

One patient came in from out of town (Mr. Foley #2) early (no one noticed the error until he showed up) and my other patient came back from our mothership, Washington. Mr. AKA was happy as a clam to see us, even though he felt nauseated. His next door neighbor at Washington was a demented character who had a sitter but chose to yell all night and keep him awake.

Before he left Washington, the docs decided Mr. AKA needed an echocardiogram, so that slowed his return. Mr. AKA has hypokinesis and diastolic dysfunction. Being late was not a bad thing in hindsight, though, since the bed guy had not yet returned his low-air loss mattress as was promised earlier this morning.

Our PT doc assessed him and she was fried. She decided to admit too many patients (3 out of 4) and she was really snapping people's heads off left and right. She refused to let me look at the wounds with her, so I had to do my skin assessment and redress the wounds later. I was a bit irritated by that, but I survived. Mr. AKA felt a little better before I left, so I was happy and finished by 1615.

I got everything done and charted but I just don't feel like I did my best work. Hopefully, tomorrow is bit smoother. At least, we won't have four admissions like we did today!

Stay tuned...

RehabRN book club

Hopefully, this year, I can be a little more regular on this segment.

Besides reading all those nursing-related books, (see CRRN posts) I'm going to highlight some of the stuff I read in my nursing off-time.

One of the first good books I've read lately is The Edge of Medicine by William Hanson. Okay, it's sort of a shop book (medicine), but a good one which points out how breakthroughs in medical technology will change how we live. If you're using telemedicine or eICU where you work, you'll understand what I'm talking about, because the future is already in progress.

Just today, I finished reading Fixing Hell by retired Army Col. Larry James. This was a very moving book.We haven't gotten a lot of OEF/OIF vets yet in our area, but this book has helped me to clarify and understand some of the PTSD issues as a nurse. It also helps to see how the psychologists have to deal with the same issues themselves.

More later...stay tuned.

OT for the weekend...nope!

Hooray, it's Friday and I got out on time. The boss wanted me to stay over another four hours, but Dahey already had plans, since this is my off weekend. I'm sitting here with a nice glass of wine and all of my administrative tasks at home are pretty much done. That holiday paycheck was nice!

My patients were good. Both got up and went to therapy and got evaluations for various stuff, like Aspen seating. One patient got a new loaner chair, so we had to work with him on driving it (the other had a neck-controlled drive system which was great, except when you had to lift in and out of it!).

The medication administration IT team was on the floor again, because those new med carts we got are actually the first ones for our hospital system period, not just for Madison. We gave the sales rep a lot of ideas for stuff we wanted, particularly for locking up controlled substances.

The big problem: rehab units tend to have a lot of people walking and/or rolling around in them, so having a cart that only uses a simple code to get into it is not a good thing. The company's answer was, "Don't leave the cart unattended." and while it may not be unattended, a nurse may need to turn his/her back. Lots of things can happen when you turn your back. Happily, the bigwigs are working on getting us a controls drawer that requires us each to have a special user ID to unlock it. Personally, I won't be storing my controls on the cart until they do. I may just do like one of my coworkers said today and put them in my pocket in a Ziploc, so they're in my possession!

Happy weekend all! Stay tuned...more next week!

Another day...until the weekend

I got some good news this week. I may actually get my permanent appointment soon. The paperwork is in...hooray! This document tells a little bit about classification and nurses in the VA. You can cure insomnia if you read all of Title 38, just like you can with economics readings as I mentioned to one of my coworkers today.

One of my patients was up and out right away to an appointment. One was out at 1030, so all I had to do was get him ready and he was gone the rest of the shift. The other one stayed in bed until after lunch and then he got up in his chair and rolled around. He was with us when I started this spring, so it was nice to see him come back and everything went well.

More goodies tomorrow!

Heard on the unit

In this first of the year installment, I didn't have to do much to hear some pretty interesting comments. Happily, there is no smellavision (yet) on the internet or some of these would be harder to bear.

"The first time I smelled Jack Daniel's (whiskey) I thought it was my grandmother's perfume." Picasso

Picasso's not his real name, but this guy is one of our regular artists in residence. No, he didn't get any big honors like our other guy who got to be a VIP late last year, but he's always got something new going on, like his secret pastel drawing in the sketch book.

He keeps making drawings for some of the nurses, so I guess I'm going to have to commission something from him to get one myself. This one about Picasso's Granny just happened to pop up as we were talking about French-Canadians. I guess Granny liked the taste of Jack to some old silly perfume!

"I like it up here at the penthouse level (waving his hand in front of his nose)." Mr. VIP

Somebody was emitting noxious odors in VIP's room, so to get away from it, he had someone raise up his bed about 4 feet off the floor, which is pretty far away from that nursing standard of a "locked and low bed."

"It's all in the technique, folks, all in the technique." Mr. AMA
Yes, Mr. AMA returned to us again to get healed up and promises not to leave AMA this time. (just like the last few times...) AMA's nurse and I tried to get him positioned right to go to x-ray and he bellyached until one of the nursing assistants reoriented his pillow, hence the quote. (The NA got it just right!)

"W., it's been nice knowing you. I'm leaving here for good. Dr. T. won't let me smoke. Screw him!" Ms. Cig
Ms. Cig did not agree to not smoking on our unit, so she asked for and got transportation back to her home. (Note: our boss does not let patients with pressure sores smoke.) She was so happy to get her carton of cigarettes back on her way out the door, that she disappeared and had a smoke before the ambulance came to pick her up. It didn't help that they were over an hour late!

It's back to the old grind tomorrow. Stay tuned!

Read, read, read

That was my day today...after I took a nap to recover from my last evening shift of the week. I'm so glad Dahey works at an industrial site because I really needed those earplugs to silence the crazy barking Beagle next door (it always barks during the day just as I'm trying to sleep!)

The great countdown to the CRRN exam is on! I have until April 15 to apply and I have to take the test sometime in June according to the ARN web site. Hopefully, I can get a day off when(and if) I need it!

Here are a couple of the books I was reading today, some of which came from this list.

1. Rehabilitation Nursing by Shirley Hoeman. It's the classic, it's big, and it's got a lot of information in it. The fourth edition was revised in 2008, which also makes this book the newest one I have.

2. Gerontologic Nursing by Meiner and Lueckenotte. It's not the one on the ARN list, but I figured it looked pretty good.

3. Nursing TimeSavers: Neurological Disorders. It's 20th century, but has some really good sections with diagrams in a small package on neuroanatomy and signs and symptoms of various diseases.

4. Rehabilitation Nursing Procedures Manual, Second Edition. This book comes from the folks at the nation's premier rehab hospital, the Rehabilitation Institute of Chicago (RIC). It's 20th century, too, but just leafing through it today, I picked up a few new tricks about taking care of patients with TLSOs, halos and helping with donning and doffing clothes.

I also ran through a few units in the Rehab Nursing Series for the CRRN. It has a workbook which you must print from PDF (it's about 200 pages). I've been working with just the book and it was really helpful to sit down with both today.

Now it's time to get ready for work tomorrow. More to come.

Happy hump day to me!

Well, it's not really Wednesday, but I'm on the downward slide of my evening rotation, so this is always a good thing.

My patients have been pretty good and I'm secretly hoping we're fully staffed tonight so I can ditch the med wagon, even if it means I get another patient. I have one good one and one wacky one, so hopefully, if I end up with a third, it'll be a good one to tip the scales and keep my sanity.

I got acquainted with a new drug yesterday--the belladonna/opium suppository. One of my patient's gets this for his pain (he's a quad who's been getting up a ton for therapy since his debilitating illness). He's quite a character. At least, he's liking his CPAP now, but he still needs his "muscle relaxer" once he's ready to put it on every night at 2300. I found out that his "relaxer" is not Baclofen or something else, but rather, good old Ativan.

I still feel cruddy, but with rest and fluids and good old Mucinex, I'm tackling work pretty well. All this resting makes me feel like I'm slacking at home, but I'm hoping it'll pay off later and I'll be done with this virus soon enough.

I'm still working on my CRRN stuff. Since this is the first week of the year, I'm going to have to start a countdown.

More later on that...gotta get ready for work!

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!

Happy New Year!

Oh, it's still cold, and I'm still hacking from this cold/random virus, but it's great to get to sleep in before I go back to the evening shift tonight.

We had lots of fun here at the homestead last night. I actually made that red lentil soup in the crockpot, and even though I put a tad too much chicken stock in it, it worked. I packed up the remainers and Dahey will have a hot, steamy bowl of soup next week (a few times, actually) in his lunch. Since I've been on a soup run of sorts lately, he's had soup in his lunch just about every day. Right now, this is the fourth variety in our freezer.

Bubba went straight to bed at his usual time and Dahey and I retreated to the TV room with the remaining sparkly wine and watched this movie, since it's still technically the holiday season. We laughed and laughed. I got on the couch to watch the 10PM news, saw maybe two minutes and fell asleep. I woke up at 0035 to a talk show with Tiger Woods on it, and so I turned off the TV and went to bed.

Speaking of Dahey, no movin', movin' yet. Such is his work and contracting. Thankfully, he's still working, so we'll just be happy with that. Too many people are unemployed right now and work + paycheck = paid bills and no foreclosures, so I must say, that is the best gift of all.

I had some free time yesterday, so I ran through last year's resolutions. So far, this year's look about the same.

Work:

1. I will work hard to be a team player. (I notice that since there's a nursing shortage, people can act like NFL free agents sometimes, which can be hard to deal with. I don't want to be one of those people!)

2. I will learn something new every day. (It helps that I'm reviewing for certification!)

3. I will make sure I do one thing better than the day before.

4. I will grumble less and smile more. (Gotta keep those wrinkles away somehow!)

Home:

1. I will organize my paperwork. (This will be on my list forever!)

2. I will be nicer to my husband and son. (Sometimes Mommy can be a tad...bi%$chy...oops, glad "speller" doesn't read this blog! )

3. I will watch what I eat and drink more water. (Water = good, eating...well, not so good lately! Too much candy and cookies for the nursing staff!)

4. I will read more. (This is one from last year. I just need to put more in the RehabRN book club.)

Hope your start of the year is happy wherever you are. More to come!

And so it goes...

"For last year's words belong to last year's language and next year's words await another voice. And to make an end is to make a beginning."
--T.S. Eliot

See you next year!

Nuggets for December 31

It's finally here, the end of 2008. The year always seems like forever for me until I get to December. Funny how when you have your birthday late in the year, it can put things into perspective !

Nevertheless, I'm not going to do a recap of all the best nuggets this year. You'll just have to go look at the rest of them and decide on your own, but here are a few of the latest crop.

Enjoy your 366th day today...it'll be over soon enough and you won't get another for four more years.

From the 'net...

Tight blood sugar control is mentioned in just about every article you read about diabetes these days. This article from the NY Times mentions another great reason to keep your blood sugar controlled--memory loss.

I, like some of my other fellow nurse bloggers, am a big fan of soup in winter. I ran into this handy, dandy red lentil soup one today. Get your protein (when combined with rice, etc.) and enjoy the cold with this aromatic soup. Since we're all coughing and hacking here, it can't hurt!

Did Santa bring you some new shoes? This article from ADVANCE for Nurses talks about what kind of shoes nurses should wear to work.

Goodies from work (or a few things I've encountered recently on the floor...)

Here are some of the pharmaceutical items:

• Short chain fatty acid enemas- This was a big, 60cc syringe of cloudy fluid one patient used twice weekly. This article on ulcerative colitis talks about this treatment.
• Mometasone Furoate - It also goes by Asmanex and we've got a few people using this twisty inhaler lately.
• Vantin - 'Tis the season for pneumonia, especially in SCI patients.

Finally, I had a patient recently with a history of PSVT. Medscape has a great article about this arrhythmia with sections on diagnosis, treatment and a multimedia section with graphics of what an EKG might look like.

More nuggets to come...stay tuned!

The beginning of the end

No, it's not the end of blogging as Monkeygirl is doing, it's the end of the year. And what a year it's been!

In the news today, I saw an article about the vaunted rumor that there will be no more free pens at some of the conferences because of perceived conflicts of interest. What, oh what, I ask, will the docs and NPs bring to impress the floor nurses with now, since there is no more swag? An old, leftover pizza from that drug rep's lunch just doesn't make the same impression as the light up pens and the pens with highlighters AND post-it notes attached. I guess we like them because they're things we can actually use.

As the year counts down, I'm thanking my lucky stars that I came to the VA from Saintarama Rehab. The top three reasons: no low census, no low census, no low census! Some of the things that go with the job aren't the greatest, but that benefits package is great considering everything in these recessionary times.

Finally, I'm thankful that I still have this blog. It keeps me out of trouble and keeps my mind humming. I have so many ideas for next year, I ought to be busy!

The end is near, but this is just the beginning...so stay tuned and have a great night!

Ack!

Nothing like calling in on a Monday morning. The supervisor didn't sound too thrilled, but then again, it's sucks when 1) you've hacked and coughed green stuff all night, 2) you can't talk and 3) you ache so bad you feel as if you've just completed an assignment with 3- 300+ lb. tetraplegic patients.

Back to bed for me...more later.

The party's over...

We survived, even though, the guest list was short again. The crazy weather drove away more than a few people. We did have fun, though. The cold has returned, as I found out when I got the paper today...no ice, yet.

The kids were a riot. Some of them just prefer boxes and bows to toys. You'd be surprised how long three boys were playing with some curling ribbon.

We cleaned up and were done by 2030 last night. We've all got colds now (guess Zicam didn't quite work...) so it wasn't too bad to turn in early. I washed my new scrub sets (came yesterday via mail) and tried to watch one of my new DVDs (I fell asleep before it finished).

More fun next week...from days to evenings again. It's always a trip doing that.

Party? Maybe...

I'm all ready, the food's ready and I got my first call-in at 10AM. One of my friends will be spending her time at the hospital with her hubby. He just had major surgery and is in a stepdown unit, which was not originally how they planned to spend this weekend.

The weather here is crazy. We're seeing rain, when usually in this area, all we'd see now are fluffy white flakes. When you can go outside with a light raincoat, you know something sinister is afoot. We'll just wait and see what happens.

The crock pots are warming away and so is my spiral ham. Off I go to glaze it...more to come.

Happy Boxing Day

Believe it or not, it's a holiday here in the US if you work for the VA. It's not really Boxing Day per se, but W declared it a federal holiday, so most federal workers could get an extra day off. I was at work, but I'll get holiday pay...hooray!

Today was not too terrible. I had the assignment I've had the last three days, so it's been manageable. Get the one guy who gets up up and at 'em right away, so he's happy, then take care of the other two.

For the most part, the other two are very nice, although, the quad is very demanding. He's on the phone constantly, but doesn't want an ECU (no private calls that way). He really needs a Bluetooth with a soft touch button he could use with his one working arm, but that's way beyond what we have at Madison. Sometimes he won't even use the soft touch, much to my chagrin (and it's pretty darned unsafe, too!)

Nevertheless, Oscar and Felix (they really are odd but get along) are doing reasonably well. Felix is in pain a lot, but we medicate him before dressing changes and with his new low-airloss bed with the slick sheet, he can turn a lot easier without him screaming out in pain every time we turn him. He had more pain and problems with his "good" leg today, so hopefully, that is better this weekend. He is a trainwreck in terms of dressings, and he's got grounds for a lawsuit against the place he came from in another state. Thankfully, he is not mean to us (he is upset) but he is thrilled he's at Madison, since we should get him healed up well, barring no other issues.

Oscar has been with us many times. He likes to leave AMA when it suits him. He was here when I started, but left before summer. He's back again, with another suspected caregiver-inflicted wound. It's a doozy and the other hospital tried treating it with a WoundVAC. If only they'd read the instructions about using one with necrotic tissue....arrgh! The docs were aghast when they saw that and away it went as soon as he arrived. We're treating it with the old reliable Santyl moist/dry dressings BID until Dr. Plastic has a look at it after the holidays. Thankfully, it's starting to look better.

'Tis the season for game playing...and I don't just mean with the new games sets that a few families dropped off on the unit yesterday for Christmas, but with the patients, too. We've been having a lot of different varieties.

One is the "Oh, I can't get up to go to therapy" game. This is one of our active rehabbers who's playing this one. He is such a pervert (wiggles his tongue around suggestively when he's getting his intermittent cath) and I really, really wanted to kill him the other night, because he was being such a jerk.

The other game said jerk was playing was "Divide and conquer". Some of our patients try to do this by using the old standby of "no one of this race (color, uniform, you name it) will take care of me right because I'm white/black/Marine/Army/Navy/etc., etc." Said jerk had one of our nurses in tears on my last stretch of evenings. I was really pissed off.

What did he win for that? A smackdown from the neuropsychiatrists. If I would have had one on call, I'd have had them smack him at 2200 while he was up to all his shenaningans, but he had to wait until the next day. They're all off on vacation right now, so they won't harass him until next week. If he were in private rehab, his derriere would be kissing the curb right now since most of them have the "no therapy, no stay" rule. If you decline to go to therapy, you get to leave. Not us, we serve the veterans, and the RPIAs (royal pains in the a*&) really push it sometimes.

Nevertheless, I am happy I survived my holidays at Madison. Now, I'm going to get ready for a holiday party...more to come.

Merry working Christmas

Back to the old grind today, just like yesterday. Should be interesting....more to come. There's lots brewing but with all the work going on, little time to talk about it.

Stay tuned!