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
Monday, October 22, 2007
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!
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