Reason 83: Why should we do research?

I really enjoyed reading this article lately. I've always been fascinated about how things we'd never expect are used as treatments.

As a rehab nurse, I've certainly seen (and smelled) more than my share of 1) poop and 2) C-diff.

My favorite quote, though, sheds some light on the why/how physicians do research.


“After the first four or five patients, we started thinking, ‘We can’t go on doing this kind of obscure treatment without evidence,’ ” Dr. Keller said. “Everybody is laughing about it.” 

If you thought you left high school when you entered the international renown of medicine, you really haven't.

Who would have guessed...

Heard on the unit, volume 2

"RehabRN!" "RehabRN!" "RehabRN!" Patient #2
Remember him from our last installment? Yes, Mr. Demented proceeded to call out my name all weekend according to the night shift and he did it on day shift, too.

One of these days, we'll get those meds calibrated correctly, won't we smarty Dr. GeroPsych?

"Who is that nurse who looks like Gumby in pink?" Mr. Complains-a-lot.
All I can say is....I like Easter egg colors some times.

"If I had the middle covered up on this brace, (a TLSO) I'd paint a six pack on it." Mr. Renoir
Somebody really, really doesn't want to adhere to a diet that does not allow pie with every lunch and dinner. Said patient was outed to the dietician for eating seconds on pie this weekend, which is not part of his weight loss plan.

And if that's not entertaining enough, seen in orders....

"Record patient bowel movements to see if we need more forceful bowel preparations." noted for one of our patients being evaluated for colostomy.

We really like BM stories at the Hotel. We also get requests for frequency, color, and smell. We sent a C-diff for one patient after s/he suffered all weekend soiling the linens and the MDs wrote it off as a diet change....right!

School started recently so I'll be reading away.

Don't forget...the next Change of Shift will be right here at the Hotel Rehab on February 4th. Keep those cards and letters coming!

Up, down and all around

That's been my story lately. A lot of things almost whirling around my head and inside the building. A fly kept buzzing the table as K. and I ate our dinner. I watched it whirl around the room. No matter what I did, it wouldn't land.

Later that evening, K. caught said fly in a weak moment and slapped it dead on the table, and sent a bag of open potato chips all over the floor. Thankfully, one of the nursing assistants found the broom and dustpan (housekeeping usually locks this stuff up) and it was cleaned up quickly.

My patients were reasonably good. Both have my least favorite bug, C-diff. If I only had a dollar for every time I was in their rooms and for every, single, solitary time I had to wash my hands (since that ol' hand sanitizer won't do with C-diff), I would have a whole lot of money. I am so paranoid with C-diff. I go home and disinfect my shoes with bleach spray (since housekeeping hides ours).

School's gonna kick my butt if I'm not careful. My first paper came back yesterday. I talked to the instructor about it because of the grade and we have a resolution. Stay tuned! I have two weeks to resubmit, which I thought was a nice thing for her to do. From her discussion, I suspect she gets a lot of people who would be going to the dean or something if they don't get x grade. Not that I like a not-so-hot grade, but if the instructor's amenable and has a solution, I have no problem working with them. We'll see how it goes. I have a few more ideas and another paper to submit by Monday. This weekend will be busy in a few more ways than one.

Gotta run...an off day means errands and homework! More to come...

The merry, merry month of May

Ah, yes, it is. And it's been merry so far this week. I was temporarily inundated with multiple patients, but nothing too difficult. Some of my people are even fighting to get me back! How nice it is to feel loved!

Anyway, feeling loved is a heck of a lot better than smelly C-diff. Ugh! I had one patient with it this week and it's always fun when the docs want a room, they start saying, "Well, his WBC numbers are down, let's take him off isolation." All I have to say is, "What happened to those ID rules (infectious disease, such as this sample one)?" No one asked for any more tests, so who knows!

Today there was a party and BBQ for the patients. People everywhere. I got my patient up earlier than usual and he tried to go back to bed before I left. He's not liking that rehab status at all! There will be more excitement next week, but I'll be at home until the weekend.

Ah...more to come. Stay tuned!

Nuggets for May 12

Here are the latest and greatest goodies I've run into in my various voyages on the internet. Enjoy!

Blind, miscellany

Being blind, 'you have to be adventurous' (from www.cnn.com)

BTW did you know that the VA is one of the leaders in blind rehabilitation? If not, check out the information here at the Blind Rehabilitation Service.

C. diff infection rate rising among US hospital inpatients (from www.nursezone.com)

And from our friends in ED land...

ImpactEDNurse has a great post on mouth-to-mouth resucitation on his blog. I'm so glad our policy forbids mouth to mouth in certain instances, such as this. I'm with you on the compressions, Ian...at least you can dodge the flying bits!

DisappearingJohn is on the way up. Good for you!

Finally, Happy International Nurses' Day May 12

On the birthday of Florence Nightingale, don't miss this op-ed piece by Sandy Summers today on solving the nursing shortage.

Hurry up and wait

Yes, it's my day off again, so now I'm engaged in the latest version of Hurry Up and Wait, the car maintenance edition.

Since the mechanic's got wifi at the shop, I thought I'd keep busy, even if I'd really like to find a quiet corner with a big couch and go to sleep. Thankfully, I'm well-caffeinated with my Starbucks and working away.

Work was finally placid...at least for most of the night. We had bed bingo again because C-diff is loose on the unit again, much to everyone's surprise. It was bound to happen since our docs throw Vancomycin at everything all the time. One of our guys was even on prophylatic PO Flagyl and lactobacillus and still came up positive. So much for that idea...

I tagged teamed with another nurse to get one of my patients cared for, since he's a two person turner. It was nice. We got her guy situated, since he works better when he stays up longer than he wants. He's a rehab patient who would like to stay in bed all the time, but he is just starting to get his conditioning back again. Since the docs want him up, we have a good excuse to keep him there until he's ready for his nightly rituals.

Otherwise, I'm glad I'm off today. I need the break! More later...

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...

No truer words

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

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

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

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

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

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

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.

Heard on our unit...

"Remember that DNR. I've changed my mind. I want to be resuscitated."

This is what one of my patients on Saturday told the MD yesterday when he actually came in to talk to him about the DNR he wanted me to take as a verbal order. G. told me about this today. I just about fell over on that one....what?

"He's C-diff positive."

Not Mr. Z., since his results are still out, but Mr. K. my recent amputee patient won the prize (not our fault) and got his very own room. We now get to gown and glove to see him, and wash our hands each and every time we go in the room. Silence may be golden, but then again, so is C-diff.

"48 (blood sugar) is in the ballpark."

Famous words of a non-Saintarama diabetologist who only had the nurses calling him q2-4 hours re: his 19 year old IDDM patient's blood sugars. This kid came to us straight from the land of tubes and wires (ICU) with his own PRN vent.

I'd don't know about you, but I don't want to play in that ballpark, thank you very much!

"I don't like that antibiotic."

My patient, Mr. T. (yes, I took him back this week after a week of vacation from him on my team) after I gave him his Cipro two hours post corn flakes and milk. At 1020 he has emesis of about 200cc. At least, I didn't see the pill in there. The best news is that his Cipro will be over after his 2100 dose tomorrow. Note to self: give him his Cipro as soon as I can get it.

"Can I have lots of ice? I like ice."

We must have the best tasting ice on the planet, or we have some people who really love it. I heard this over and over today.

I had a pretty good day today. I had a brand new patient (another BKA) come in early enough that I was able to stay over a bit to help the evening shift. I got her assessed (found 2-4 small PUs) and set up in the room and helped J. get the care plans in the computer, since she took my team. The secretary was still around, so she helped with the rest. I still managed to get out just before 1700. Hooray.

More fun and excitement (and surely, ice) tomorrow. Stay tuned!