Alright! I've had enough. I love my patients, I really do, I don't even mind the med students, they're fun, you get to mess with their head. But really people, do you think you can get all of your medical information from the internet???
Every day it seems we have pts convinced that they have some disease or another (mind you there in the ICU because of a stroke) and yet they don't listen to you when you tell them that they have diabetes. "Oh, I don't believe in that stuff." or the best "WebMD never said anything about that." It's great, you have to bat your college degree and the docs skill against the internet. It's a game of "How fast can you google??"
Part II, last week I caught a med student looking up a procedure on Wikipedia before he preformed it. Yep that's right folks, he was using Wikipedia as his source of medical knowledge. To say the least I pulled the equipment out of his hand. Not on my pt thank you!
Anyone scared yet??
Saturday, November 10, 2007
Sunday, November 4, 2007
Nicknames
So a pt recently gave me the nickname The Elf (I swear I'm not THAT short) and it got me thinking about the different nicknames that we earn and the people that give them to us. A lot of times it says something about their personality and your relationship. My sister calls me by a rather endearing nickname, but I would never let anyone else call me by it. Just doesn't fit into any other relationship.
Anybody else have insight on nicknames?? Or is this another dose of 2am madness?
Anybody else have insight on nicknames?? Or is this another dose of 2am madness?
The Night Beat
Wow, long time no posts. Well, I'm officially on the night shift, nothing screws up your mind more then seeing the sun just before you go to bed....it's quirky, I feel like I'm living in Alaska. Plus things get pretty quirky at night. Crazy stuff happens at 3am when no one is around ;-)
One of the most challenging things about nights (you'll probably laugh at me) is that at 6am the residents do their rounds. Now normally I really like rounds, I like giving my input and filling in the gaps. But at 6am when you've been up since 4 the day before you barely know what day/month it is, let alone what's been going on with your pt. The docs will ask "What feeding are they on? Rate? any respiratory problems last night?" Well, I can answer the respiratory with a big fat YES! Other then that, I have no idea, you can feel free to look at the pt/the feeding pump yourself. I'm always really proud of myself when I have answers at 6am, probably shouldn't be, but alas.
Anyway, over the past two weeks I feel like I've been getting the hang of things, I actually know where an a-line setup is in the Omnicell (a major accomplishment when the a-line dart is filed under internal catheter dart...and that is the one that makes the most sense..The Swan Gaunze is filed under Swandome...hmmm) and I can set up an EVD in less then 20 min (always good).
3 More days of orientation, then I'm all on my own, Hopefully I'll hold my own, I'm thinking I will
One of the most challenging things about nights (you'll probably laugh at me) is that at 6am the residents do their rounds. Now normally I really like rounds, I like giving my input and filling in the gaps. But at 6am when you've been up since 4 the day before you barely know what day/month it is, let alone what's been going on with your pt. The docs will ask "What feeding are they on? Rate? any respiratory problems last night?" Well, I can answer the respiratory with a big fat YES! Other then that, I have no idea, you can feel free to look at the pt/the feeding pump yourself. I'm always really proud of myself when I have answers at 6am, probably shouldn't be, but alas.
Anyway, over the past two weeks I feel like I've been getting the hang of things, I actually know where an a-line setup is in the Omnicell (a major accomplishment when the a-line dart is filed under internal catheter dart...and that is the one that makes the most sense..The Swan Gaunze is filed under Swandome...hmmm) and I can set up an EVD in less then 20 min (always good).
3 More days of orientation, then I'm all on my own, Hopefully I'll hold my own, I'm thinking I will
Monday, October 22, 2007
Realization
I am a new nurse. Just a small fact that you may or may not have figured out about me. So new in fact that I have more "Am I really a nurse?" moments then "I'm a nurse." I usually find myself walking into my patient's room and saying "Hi, I'm E." the whole "and I'm going to be your nurse today" I end up saying in my head. This is all very important to understand to understand what I'm about to say.
I live in Big City. So I go to Big Church. Where I hoped to meet non medical folk. I ended up meeting 2 medical students who are probably 3-4 years older then me. (I'm a young'n what can I say) Said medical students go to Big Medical Center where I work....odd. Anyway, during the day and conversations that I had with them, I realized. I've only worked at Big Medical Center for 3 months (they've been there for 3 years) and yet their treating me as their superior. Asking me my opinion on things, how we do things on our unit.
After this I realized that the residents and attendings at Big Medical Center have started treating me as their equal too.
It's a bit odd....It's great, don't get me wrong, but when you haven't come to terms with your new status as a nurse and everyone else seems to have come to terms with it, it throws you for a loop.
Anyway, things generally are going great. I have bad days, really bad days. But even after the bad days I realize that I still love this unit, I still love neuro and I wouldn't trade it for the world. The best thing is that I have really good days too. And I'm starting to feel like I fit in on the unit. Who knew that that would ever happen? That my quirky personality would fit in somewhere???? Alas
I live in Big City. So I go to Big Church. Where I hoped to meet non medical folk. I ended up meeting 2 medical students who are probably 3-4 years older then me. (I'm a young'n what can I say) Said medical students go to Big Medical Center where I work....odd. Anyway, during the day and conversations that I had with them, I realized. I've only worked at Big Medical Center for 3 months (they've been there for 3 years) and yet their treating me as their superior. Asking me my opinion on things, how we do things on our unit.
After this I realized that the residents and attendings at Big Medical Center have started treating me as their equal too.
It's a bit odd....It's great, don't get me wrong, but when you haven't come to terms with your new status as a nurse and everyone else seems to have come to terms with it, it throws you for a loop.
Anyway, things generally are going great. I have bad days, really bad days. But even after the bad days I realize that I still love this unit, I still love neuro and I wouldn't trade it for the world. The best thing is that I have really good days too. And I'm starting to feel like I fit in on the unit. Who knew that that would ever happen? That my quirky personality would fit in somewhere???? Alas
Saturday, October 13, 2007
Best Moment
Everyone always talks about the best moment that they have had in medicine. This week I've been thinking. I've had a rough couple of weeks. Each week I've had at least one brain dead or almost brain dead pt. D/cing care is hard, family is tricky, I never know what to say to them and the docs never seem to say enough, or they don't speak clearly about the situation. So we're left with the questions.
Anyway, the point is that I needed a good moment. What I didn't know is that I would get one of the best moments one of the best thank yous I've ever gotten.
I'd had this pt who was paralyzed and we had to put a trach in, so she couldn't speak, but she was totally aware. It was really hard on her. She would try to mouth words to us to tell us what she needed. I worked so hard to figure it out, sometimes I got it and sometimes I didn't. The days I had her were rough, I could see the frustration in her eyes, but we never gave up. Well, last week they capped her trach. I didn't have her that day, but I went in to say hello. Little did I know that she would say hello back. We both started tearing up and she just started saying "thank you, thank you"
It was a thank you that I never needed, but hearing her voice was the best moment that I've ever had. It was wonderful and something I never want to loose.
Anyway, the point is that I needed a good moment. What I didn't know is that I would get one of the best moments one of the best thank yous I've ever gotten.
I'd had this pt who was paralyzed and we had to put a trach in, so she couldn't speak, but she was totally aware. It was really hard on her. She would try to mouth words to us to tell us what she needed. I worked so hard to figure it out, sometimes I got it and sometimes I didn't. The days I had her were rough, I could see the frustration in her eyes, but we never gave up. Well, last week they capped her trach. I didn't have her that day, but I went in to say hello. Little did I know that she would say hello back. We both started tearing up and she just started saying "thank you, thank you"
It was a thank you that I never needed, but hearing her voice was the best moment that I've ever had. It was wonderful and something I never want to loose.
Tuesday, October 2, 2007
Tip of the Day
Today's tip: When transferring a patient from another unit (whether it's an outside hospital or inside hospital transfer) to a neuro unit...GET A NEURO EXAM! It's easy, promise a good neuro exam can take you less then 5 min let's go through it step by step...
1) walk into the patient's room, see if they open their eyes when you walk in (tip: give neuro pts, at least 30 secs to respond to anything you do, and 30 sec is longer then you think!)
2)if the pt doesn't open their eyes, say hello, introduce yourself and explain why your there, see if they open their eyes.
3) if they still haven't opened their eyes you have to move onto painful stimulus, this is what scares new nurses the most. Just remember if they need this, they need it, you're not hurting them to hurt them.
Tips to giving go stimulus: avoid the sternal rub if you can, to do a good rub you should leave your nail marks on your hand and a bruise on their sternum (get the picture) There are better places to produce stimulus. My favorites: Take a 1 1/2 inch pinch of the trapezius muscle (grabbing muscle, not just skin) and twist (try this on yourself it hurts.
4)if after giving painful stimulus (try multiple types in multiple locations) they haven't opened their eyes, you can say that they aren't responding.
5) next, look at their eyes. This may mean opening them yourself. Take a penlight and see if they react. A general rule of thumb that the neurosurgeons go by is that if they have pinpoint pupils they may be sluggish, but they cannot be fixed.
6) Check for movement in all extremities. If they're not moving one limb or one side, first ask them to look at that limb and move it, if that doesn't get a response pinch that limb and see if you get a response. Again, if they need a pinch to get moving, you need that information.
7)If they're moving everything and following commands there are a few more things that you can have them do, if not you may have to stop at this point.
8) ask them to take your hands and pull you towards them, push you away, this will give you an idea of arm strength
9) ask them to lift their foot off the bed and keep it up as you try to push it back down onto the bed, do the same on the other foot
10) have them stick their tongue out at you (some pt enjoy trying to touch their tongue to their nose as well, and it makes them smile which gives you a good idea of facial symmetry)
11) have them give you a good cough, take a sip of water (not necessary if you're short on time)
See it's easy, now let's see what info we have gathered.....You've been talking to them, so you know speech status, you know PEERLA, strength, you may know orientation, you have successfully assessed their motor function and their consciousness!
Not knowing the exact size of their pupils, or the total Glasgow Coma Scale score, EOMs, sensations aren't a huge deal, any neuro nurse will be grateful that you took the time to do a simple neuro exam and that information is going to allow us to be prepared for what is coming!
The exam may look long, but trust me, it is simple, it just takes a bit of practice and you'll have your style down, before you know it you'll be assessing neuro status on the fly in the grocery store!
1) walk into the patient's room, see if they open their eyes when you walk in (tip: give neuro pts, at least 30 secs to respond to anything you do, and 30 sec is longer then you think!)
2)if the pt doesn't open their eyes, say hello, introduce yourself and explain why your there, see if they open their eyes.
3) if they still haven't opened their eyes you have to move onto painful stimulus, this is what scares new nurses the most. Just remember if they need this, they need it, you're not hurting them to hurt them.
Tips to giving go stimulus: avoid the sternal rub if you can, to do a good rub you should leave your nail marks on your hand and a bruise on their sternum (get the picture) There are better places to produce stimulus. My favorites: Take a 1 1/2 inch pinch of the trapezius muscle (grabbing muscle, not just skin) and twist (try this on yourself it hurts.
4)if after giving painful stimulus (try multiple types in multiple locations) they haven't opened their eyes, you can say that they aren't responding.
5) next, look at their eyes. This may mean opening them yourself. Take a penlight and see if they react. A general rule of thumb that the neurosurgeons go by is that if they have pinpoint pupils they may be sluggish, but they cannot be fixed.
6) Check for movement in all extremities. If they're not moving one limb or one side, first ask them to look at that limb and move it, if that doesn't get a response pinch that limb and see if you get a response. Again, if they need a pinch to get moving, you need that information.
7)If they're moving everything and following commands there are a few more things that you can have them do, if not you may have to stop at this point.
8) ask them to take your hands and pull you towards them, push you away, this will give you an idea of arm strength
9) ask them to lift their foot off the bed and keep it up as you try to push it back down onto the bed, do the same on the other foot
10) have them stick their tongue out at you (some pt enjoy trying to touch their tongue to their nose as well, and it makes them smile which gives you a good idea of facial symmetry)
11) have them give you a good cough, take a sip of water (not necessary if you're short on time)
See it's easy, now let's see what info we have gathered.....You've been talking to them, so you know speech status, you know PEERLA, strength, you may know orientation, you have successfully assessed their motor function and their consciousness!
Not knowing the exact size of their pupils, or the total Glasgow Coma Scale score, EOMs, sensations aren't a huge deal, any neuro nurse will be grateful that you took the time to do a simple neuro exam and that information is going to allow us to be prepared for what is coming!
The exam may look long, but trust me, it is simple, it just takes a bit of practice and you'll have your style down, before you know it you'll be assessing neuro status on the fly in the grocery store!
Saturday, September 29, 2007
OSH
So here is that story....this may or may not be true, all names have been changes ect. in accordance with HIPAA.... yadda yadda yadda
So I took my very first outside hit (OSH) on Friday. A hit is any patient that is sent to us from an outlying hospital when they decide they can't deal.
I'm talking to the nurse over the phone and the conversation when a bit like this::
Me: "Hi."
OSH: "Hi."---pause for 2 min to cough--"sorry, I should be home now."
Me: thinking...yeah, you should, stop coughing on my patient! "what do you have for us?"
OSH: gives various details..."Patient became combative, brought into the ER, we intubated."
me: thinking...you intubated an alert patient...hmmm.."What are her vent settings?"
OSH: "O2 100%" gives various other settings
me: "100%!, is a PEEP set?"
OSH "no PEEP"
::time out:: realize that at this point my head is screaming, you did what!!!!!!! my preceptor is frantically looking between me at the attending who is standing over my shoulder (nerve wracking..a bit) trying to figure out what is going on and what we should do
Back to conversation
Me: "Access?"
OSH: "Two PIV, one with 0.9NS, one with D5W and propofol"
Me: "Turn off the D5w" (don't worry, I had an order)
OSH: "our pharmacy says you have to run D5w with prop"
Me: "if you have to turn off the prop to turn off the D5W that's fine, but turn off the D5W"
::time out:: at this point you have to realize something about neuro, something I didn't know until recently and then maybe you'll realize my frustration. The brain likes glucose and water, so giving it D5W is giving your brain directly the fuel it needs which in theory is good. In practice it means that the cells in your brain swell up. So any edema that the patient is already experiencing can be doubled by giving them D5w.
Me: "Any neuro exam"
OSH: "PEERLA"
Me: "anything else?"
OSH: "she's medically paralyzed."
Me: "no exam prior to that?"
OSH: "Don't know, she wasn't my patient."
WHAT????!?!?!?!?!?!?!
Are you kidding me?? I'm getting report from somebody that didn't even have this patient? Wow, that is something..To say the least we got the patient to our unit ASAP and got the story straightened out.....It was an interesting experience.
Most the unit was laughing from the time I hung up the phone until the patient rolled up, it wasn't particularly funny, just trying to deal with another bad situation.
Gotta love it!
So I took my very first outside hit (OSH) on Friday. A hit is any patient that is sent to us from an outlying hospital when they decide they can't deal.
I'm talking to the nurse over the phone and the conversation when a bit like this::
Me: "Hi."
OSH: "Hi."---pause for 2 min to cough--"sorry, I should be home now."
Me: thinking...yeah, you should, stop coughing on my patient! "what do you have for us?"
OSH: gives various details..."Patient became combative, brought into the ER, we intubated."
me: thinking...you intubated an alert patient...hmmm.."What are her vent settings?"
OSH: "O2 100%" gives various other settings
me: "100%!, is a PEEP set?"
OSH "no PEEP"
::time out:: realize that at this point my head is screaming, you did what!!!!!!! my preceptor is frantically looking between me at the attending who is standing over my shoulder (nerve wracking..a bit) trying to figure out what is going on and what we should do
Back to conversation
Me: "Access?"
OSH: "Two PIV, one with 0.9NS, one with D5W and propofol"
Me: "Turn off the D5w" (don't worry, I had an order)
OSH: "our pharmacy says you have to run D5w with prop"
Me: "if you have to turn off the prop to turn off the D5W that's fine, but turn off the D5W"
::time out:: at this point you have to realize something about neuro, something I didn't know until recently and then maybe you'll realize my frustration. The brain likes glucose and water, so giving it D5W is giving your brain directly the fuel it needs which in theory is good. In practice it means that the cells in your brain swell up. So any edema that the patient is already experiencing can be doubled by giving them D5w.
Me: "Any neuro exam"
OSH: "PEERLA"
Me: "anything else?"
OSH: "she's medically paralyzed."
Me: "no exam prior to that?"
OSH: "Don't know, she wasn't my patient."
WHAT????!?!?!?!?!?!?!
Are you kidding me?? I'm getting report from somebody that didn't even have this patient? Wow, that is something..To say the least we got the patient to our unit ASAP and got the story straightened out.....It was an interesting experience.
Most the unit was laughing from the time I hung up the phone until the patient rolled up, it wasn't particularly funny, just trying to deal with another bad situation.
Gotta love it!
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