Sunday, August 31, 2008

The smell of the week...

Sure it's summer and barbecue season. When I think of summer as a kid, I remember the smell of charcoal lighter fluid, Coppertone 4 sun lotion (no one called it sunscreen then), chlorine and the smell of food on the barbecue pit. Those smells still evoke fond memories for me.

This week, the smell is C. diff, as one of my assigned patients has this dreaded spore. It's really a hard to describe smell. To me, it's a flat, acrid smell that just seems to stick in your nose. It got so bad the other night, that I actually left the unit to sit outside in the breeze for a while. I had gowned, gloved and thoroughly washed my hands when I was done, but that smell (or the memory) hung around in my nose for a while. So far, this patient hasn't developed colitis, but we'll have to wait and see.

If you want more information on C. diff, check out these sites:
CDC
C diff project website (Netherlands)

On another smell note, totally unrelated to rehab nursing, check out Luscious Cargo. I got some perfume samples from them this week after I read a NY Times article about perfume. They even sent me a free one for Fracas, which is a very interesting scent.

Their smells sure beat C. diff!

More later...two more shifts on evenings this week.

Tuesday, August 26, 2008

Happiness is...

Only having two patients instead of three (one crashing) and a new admit. Why? Lots less paperwork for one thing! I only had two patients today, Mr. S.and Mr. M. and it was like heaven. No rushing, no fussing, everything got done, charted and I was out on time. Hooray!

Sadly, Mr. H. who I took care of a couple of months ago was back at Washington in the ER. Apparently, he was taking too many drugs over the weekend and developed a subarachnoid hemorrhage. He's now on a vent and not expected to make it.

I'm off tomorrow, so more fun starts later this week on evenings...stay tuned.

Sunday, August 24, 2008

CRRN prep, book club

The big Rehabilitation Nursing book by Shirley P. Hoeman arrived this week. I'm using it, along with Rehabilitation Nursing Secrets to start my quest for the CRRN next year. Only eight months to go, so I'll be reading away.

I'm also reading a stack of interesting stuff from my local library. Here are a couple of books on the stack so far...

The Ostomy Book by Barbara Dorr Mullen and Kerry Anne McGinn, RN ARNP
We deal with quite a few patients with ostomies, so I plan on giving this book a thorough read.

The Sexual Paradox: Men, Women and the real Gender Gap by Susan Pinker
Not sure how far I'll get with this one, but it's on the stack right now.

And if you don't have enough to worry about..

Check out this article from the UK on the use of "stripper therapy" for some Huntington's disease patients. Thanks MJ from www.nurseratchedsplace.com for that one.

What a can of worms this would open up here in the US....just a few things to consider...

1. What would our other patients think if they wanted to go along, but didn't have the requisite disease...I see trouble on the unit!

2. Would the rec therapy folks get fired, since all we'd have to do is take the folks to our favorite red light district for "therapy"?

3. Would they start hiring "nurses" from said red light district? And as MJ mentioned, could you imagine the care plans?

And now, since I've finished reading From Silence to Voice, I find it incredibly ironic that the "nurses" arranged this trip. Wouldn't the "nurses" need doctor's orders for the patients to leave the unit for said trip? And do you see the word "doctor" anywhere in this story? No, you don't.

Hmm...and we wonder why people think what they do about nurses.

Friday, August 22, 2008

Every good turn deserves another

I have had a wonderful three days at work, even though I feel like all I've done is run. I was taking care of the meds on one hall and I took care of two guys at the other end of the hall. I hadn't taken care of those guys in a while, and it was really fun.

There's been a few posts I've seen regarding Phil Baumann's Eight Ways to Become a Better Nurse.

Here are my own ways (I also posted them in his comments)

1. Improve one thing you do every day. There may be a lot of things you need to do, but work on it by choosing one thing every day.

2. Leave work at work. Unload before you leave the door. Your family will appreciate it.

3. Find outlets for creativity in your work.

4. Make patients smile.

5. Be kind, especially to those in need, whether they're your patients, someone else's patients or your coworkers.

6. Take care of yourself.

7. Keep your eyes on the horizon. Look out for trouble that may be coming.

8. Say please and thank you to everyone...and mean it.

I'm off this weekend, so I'll be working on all sorts of stuff, here, there and everywhere. Stay tuned!

Wednesday, August 20, 2008

Work is still...work

Yes, one day off after working an evening and then waking up early with a kindergartener is an exhausting experience. After a very nice day visiting my sister, seeing some of my old friends in that second largest 'burb of the county where I used to work and having lunch with C., then coming home and baking a couple of pies, I was too tired to do much around the house. I put my favorite vaccuuming CD on the stereo, cranked it, and vegged for a half hour.

It was back to work today and I felt really slow. First, we had an in-service today on Fragmin. Most of the people were watching the shiny stuff--the pens that light up and the other goodies. Besides being a big sales pitch, it was reasonably interesting. We even talked about the famous debate of "should you blow the bubble". Second, my boss changed my assignment. I was a little perturbed, but I got two reasonable patients and the med cart on the main hall. I was running a little, but it turned out reasonably well considering everything, including an irascible patient or two and an exploding colostomy bag (happily a controlled explosion!).

In the last few days, I've found some interesting sites and articles on the internet. Hope you enjoy them. More items to come...

Check out the patient safety info at this site: http://www.patientsafety.gov/resources.html

The NY Times recently ran an interesting article on Hepatitis C: http://health.nytimes.com/ref/health/healthguide/esn-hepatitisC-ess.html

Can chewing gum may shorten your hospital stay? The jury's still out on that issue, but there may be more research to come. Could Wrigley's be the next sponsor? Stay tuned.
http://www.medscape.com/viewarticle/579243

Monday, August 18, 2008

When RNs are left to their own devices...

Some of us start doing homework! Yes, that's right. Since many of our current continuing education items are now in the VA's much-vaunted LMS system (learning management system), we're playing catch-up whenever there is a free moment.


I did my required items recently, so I helped my coworkers to log into the system. It's amazing how people complain about the system not working, especially when they won't read the startup instructions.

Besides the goodies in LMS, we often have educators drop off sheets to read on our lunchroom table. Once you unearth them from the hubris, you can get those learning items done, too. One of our recent ones was about a new feeding pump, which had a very nice DVD, which I just popped in one of the PCs and watched the other night.

Outside of those learning activities, I decided to check out a few other things when I had a spare moment. Stay tuned and I'll have more goodies later this week!

Saturday, August 16, 2008

This week at Madison

Here are a few of the interesting topics I've encountered dealing with my patients this week. Links to appropriate resources are also included for more information.

Before I headed back to the evening shift, I got to admit a fellow from a far western state. Our unit may be the red-headed stepchild of the SCI system, but we have a reputation for healing people with wounds that can't get healed anywhere else. (It also helps that our boss has friends in a major research hospital in town, too.)

The new guy, Mr. C., got a room with a fellow (Mr. W.) who's also had step one of the same type of surgery he's being evaluated for--girdlestone surgery. Said patient is pretty nice, but physically, mentally and emotionally, he's been a trainwreck. Patient was a victim of violence. Patient has several health problems now directly related to the incident: short gut syndrome, and a whole bunch of other things. The dietician has put him on an FAA diet (free amino acid) with a different type of formula--Vivonex. It's really amazing that he's as positive as he is.

Mr. K., our elderly gentleman who's just about to hit one year at our place (on and off, with trips to acute at Washington) came back yesterday from Washington. He had some mental status changes (possibly medication related) and also mastoiditis. Some of the staff were a little upset with him because he told the folks at Washington that there were "drug problems" at Madison. (One of his previous roommates was discharged due to drug issues.) While Mr. K. is a little off sometimes, more often than not, he's very astute to things. As a consequence, he's very upset that he's back in his old room, and he told us if he could get up he'd probably slug his roommate. Nice. It should be interesting to see what the boss decides to do with him, since we're running at full capacity and getting four new people next week. There aren't enough rooms to make another room isolation right now...

Nuggets
Here are a few other goodies to check out this week, if you haven't already.

I found this cancer article in the NY Times this week, along with another article about doctors and condolences.

MonkeyGirl's Rehab post was just a riot. Head on over and read it for a good laugh.

RehabRN book club items
I recently finished reading Best care anywhere by Phillip Longman. Even if you don't work at the VA, this is a fascinating book.

I'm still working on From Silence to Voice by Suzanne Gordon and Bernice Buresh about nurses and communicating to the public.

On a non-nursing note, I finished Elizabeth Berg's The day I ate whatever I wanted. This was a great book. I really loved the apple pie recipe story near the back.

BTW visitor 5000 showed up here on 8/12/08 at 11:42:55PM from beautiful, downtown Chicago, IL via www.nurseratchedsplace.com. Thanks for your visit!

More later...stay tuned.

Sunday, August 10, 2008

Quick study...5000

Yes, I'm popping in for a new feature. I'm calling it quick study, since it will give you a good overview of some of the topics this rehab nurse has encountered lately.

One of our patients has IBS and is using a different drug to treat it--Elavil. Here are a few links to some articles of interest I've found.

http://www.webmd.com/ibs/guide/irritable-bowel-syndrome-ibs-treatment-overview

http://www.emedicinehealth.com/irritable_bowel_syndrome/page8_em.htm

http://www.emedicine.com/ped/topic1210.htm

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/ibs/ibs.htm

Another patient suffered from phimosis, so he won the most common treatment: circumcision.

http://www.emedicine.com/med/topic2873.htm

The 5000 references the number of hits I've nearly met for this blog. To all my visitors, thank you! And please come back again!

Thursday, August 7, 2008

Update

I'm running, running, running. Lots of things going on in my life and I'm still rearranging all the pieces.

I'm working on finding the things that make me happy and I've dropped off the blog for a little while to do that. Things are getting clearer for me, so rest assured, I'll be back later. I'm finding that this blog has a lot of potential. Just think of getting into a well-maintained car with a full tank of gas. There are so many places to go and often, with the freedom of travel, comes restraints (such as how much time and gas money you have.)

So, for now, I'm consulting the road maps, and getting ready to continue on the trips, whether they're long or short.

Stay tuned!

Friday, August 1, 2008

Some things you just can't forget...

1. Seeing a patient for the first time and how sick they look when they come to you for rehab.

2. Seeing that same patient after discharge and they look so alive they glow.

3. Nurse Practictioner's Place talks about those two dirty words that are unforgettable.

Saturday, June 28, 2008

Nuggets for June 28

Here's today's installment of interesting items from my perusals on the internet. Enjoy!

On epidemiology (a/k/a My favorite bug)
The MRSA Bug (from Medscape Nurses blog)

How private is your curtain?
Not very if you work in a double or triple room, like I do at Madison. ERnursey talks about Patient Privacy in the ER. The British Journal of Nursing also has an abstract on the issue of patient privacy here. Another article talks about noise shielding curtains, but I have yet to see any more literature about their use.

Non-formulary (a/k/a Stuff you can't have)
On the alternative medicine front, you may enjoy two unusual posts at Hell on White Clogs for June 25 and 26. The best (or most hilarious): an order for shots (not SQ or IM) and a patient dunning letter.

Monday, June 23, 2008

Nuggets for June 23

Today's installment features a few important (and sometimes funny) aspects of nursing.

First of all, there's a nursing shortage. Surprise, surprise. I know a few of you are rolling your eyes as you're looking at the latest newbie RN on your floor. Nurse.com has a great article about the Versant RN residency program which is being used in various hospitals throughout the US. According to the article, RN residency programs are keeping new RN turnover levels lower than the national average.

Residency program prepares new Texas RNs (from http://www.nurse.com/)

Next, it's not the newest post she has out there, but PixelRN has a great one about nursing and the Maternal Suckling Thing. The moral of the story: Don't worry, some people just don't get nursing in today's modern hospitals. Hopefully, Flo's not spinning over this one!

After that biology lesson, head on over to Podunk Memorial for an Ode to a Node. I don't read many ECGs, but it makes me want to get the book referenced in this post.

Finally, let's look at an oldie but goodie that bears repeating. I really enjoy reading Taralynn Mackay's blogs, Information for nurses and A Nurse Attorney's Thoughts. Both blogs spotlight legal interest stories that are appropriate for nurses. Just because someone tells you, "Oh, you're a nurse, don't worry." you should. As grown-ups and nurses, our job is to know what is going on in the world and what's going on with our patients.

This post, appropriately called Why you don't want a stupid nurse really made me think. I was flabbergasted in May when I attended a symposium for new grads in an accelerated program when one of my younger, louder classmates, commented that I was stupid because I thought it was important to recognize failure to rescue. "We don't do that every day. You don't need to worry about that." Well, yes, we do Ms. Jen, yes, we do.

And that is all for today, so enjoy your goodies, folks. More later!

Monday, June 16, 2008

Nuggets for June 16

Here are a few of the latest finds from various blogs on the internet. Enjoy! Happy Monday!

Get some ed-ju-macation (or educating yourself in the blogosphere)

Spook, RN (aka Drug Pusher) talks about the vocabulary of the medical folks he found out there a while ago, called Gallows Humor.

Lost on the Floor has a link to another slang list you may enjoy, if you're looking for something in the same genre. Someone at Madison just told me about the 3H enema last week.

Although, it's not a nursing blog...

Stories of the Incredibly Stupid blog about life in the pharmacy has some really funny stories lately. My favorites are the Making it Fun series and Karma.

Tuesday, June 10, 2008

Nuggets for June 10

Happy Birthday to my brother, AJ. (Now we're all in a row--37, 38, 39)

Here are a few goodies for the rest of you, in honor of today's birthdays and the political season.

In the news
Just in case you missed Hillary Clinton's trip to the hospital, Barack Obama shadowed a nurse in St. Louis today.

I hope no one coded on you, Senator.

After all the stories about bad tomatoes in the news lately, maybe buying local is the best thing after all.
Boosting health with local food (from www.nytimes.com)


The weird section
Monkeygirl always has something interesting, and I just about fell over when I read this one:
Life's little drain plug

It reminded me of Terry's post from earlier this year (from Counting Sheep) called Speechless.

Let them read this over your shoulder at work...
Showing the patient the door...permanently (from www.nytimes.com)
People were actually gasping behind me when they read this one over my shoulder yesterday.
It may have something to do with the fact that our docs might actually enjoy this with a couple of specific patients.

Wednesday, June 4, 2008

Nuggets for June 4

Since I've had the day off, besides cleaning gutters and doing some trimming, here are a few items of interest from my perusals on the internet. Enjoy the ride!

Even if you've already heard this...
Some moms go above and beyond. A China earthquake story about a policewoman who nursed babies who needed it.

A great Google book:
Spinal Cord Diseases: Diagnosis and Treatment, edited by Engler, Cole and Merton

On brainy topics again:
The science of sarcasm (like you care) (from http://www.nytimes.com/)
Vaccine may boost survival of brain cancer patients (from http://www.forbes.com/)

Something hubby (an old Navy nuke) will appreciate:
Nuclear cleanup could derail an experimental cancer treatment, study says (from www.nytimes.com)

Other health-related items from the internet:
A calorie counter to get to your goal weight (from http://www.nytimes.com/)

Monday, May 26, 2008

Memorial Day nuggets - May 26

Many many moons ago, I spent Memorial Day in Le Havre, France, searching for a drawing that turned into a project that lead to a book in my home town by a local historian. I get shivers thinking about how things were there in 1945 on the same day, just before D-day.

In honor of Memorial Day, here are some internet items that you should see:

Ambulance Drivers ode to Memorial Day

History.com has a fascinating site with recorded interviews of veterans from WWII to Vietnam, with lots of information on this holiday.

David Merchant, a Navy veteran, has lots of Memorial Day information on usmemorialday.org

Thursday, May 22, 2008

Nuggets for May 22

Here are a few goodies I've encountered on the web recently. Enjoy!

From the strange but true category:
And you only thought nurses and medical personnel were worried about brain stem edema...
Check out this post from Photoshop Disasters.

On my mind, or maybe brain this week:
Lots of brain-y stuff in the news this week with the revelation Tuesday that Senator Ted Kennedy has a malignant glioma.

Another great article about the brain from Wednesday's New York Times:
An older brain may be a wiser brain

Second Chance to Live is a blog by Craig J. Phillips that describes how he's living with TBI.

The American Epilepsy Society is also realizing that some veterans with TBI are developing epilepsy. This page shows a bill that was sponsored in Congress last year and also has links to many resources of the Society. Check it out for more information.

Don't forget...this weekend is Memorial Day weekend (May 26 actual holiday). Remember our veterans, who have died and been injured keeping this country free for you and me.

Check out this link to the National Park Service to see various DC memorials on a map.

Friday, May 16, 2008

Nuggets for May 16

Here are a few interesting and silly tidbits I've found on the internet and in some of my favorite blogs. Enjoy the ride!

In the rehab and sports category:
Disclaimer: I love reading the New York Times. I've been a reader since the 1980s (yes, I'm dating myself!) when I discovered it in my high school library. I'd read the Sunday Magazine from cover to cover each week.

I particularly enjoyed this story about wheelchair racers called A blur of hands, spokes and determination (from www.nytimes.com)

As a spinal cord rehab nurse, I'm always thinking about what Dr. V. used to say about wheelchair athletes and clothespins...that some athletes use them to increase their blood pressure during events.

Some fun and some sobering facts:
JustCallMeJo of Sinus Arrhythmia, an escaped from rehab to ICU nurse, has had some great posts of late. Here are two of my favorites:

The fun:
...and then there are good days (about the patients you enjoy)

The sobering:
If you haven't seen this you need to discusses medical triage and what might happen in here in a pandemic or other mass casualty situation.

For silly stuff:
In the e-mailed joke category, DisappearingJohn has a good one this week. Let's just call it...
Going to third grade.

Monday, May 5, 2008

Nuggets for May 5

Yes, it's Cinco de Mayo, folks. Sorry, no tacos, but I did find a few things of interest in the realm of the dismal science, economics, recently in my adventures in the blogosphere.

BTW I'm still waiting for my economic stimulus check. Hope you've got yours. Enjoy it, spend it, or save it, because it's yours!

Enjoy!

M.D.O.D. had this post about universal healthcare called Bar Stool Economics.

FatDoctor talks about how much fun it is to be on call in this post called Highly Paid Intern.

Yes, folks, there is even a publication called Nursing Economic$ (Yes, the dollar sign is supposed to be there).

This link to their Continuing Nursing Education articles gives you a look at some of the issues discussed in this magazine.

If this list of goodies has whetted your appetite for more economic-related material, check out this site for more links to all sorts of economic topics: http://economics.about.com/