Xmas on Ice (Chips)

 

It's Christmas on Trauma and what does Santy have for you? One size large 3rd degree burn from a scalding pot of grease, one malodorous nasty wound infection, one holiday stabbing at the mall, and a paaaartridge in a pear treeeee...!

It's sad when patients are NPO and can't have anything to eat or drink and they literally beg you for ice chips. "I'm sorry", "I wish I could..." (the worst is when you forget and ask them if they've ordered breakfast yet. Ouch. Sorry!)

Even sadder is being a patient hospitalized on Christmas who holds the holidays in very high regard and is alone with no family or friends in the area to visit them. But possibly saddest of all is dying on Christmas at 7:00am. Good morning and good night, and Merry Christmas.

Dear Diary

It's hard being a (new) nurse. These days I feel like I'm always asking questions or needing help with something --all the time.

The other day I was in the midst of transferring a patient and thought to bladder scan her because she'd been having low urine output, and lo and behold she had over 600 mL of urine hanging out in her bladder (that's over half a 40 oz for all you ghetto fabs out there). That meant I'd have to straight cath her which can be difficult to do on a female patient because the anatomy is not as clear cut as in the picture I just linked up there (I wish). I tried and failed and had to ask for help, and fortunately the nurse who helped me is one of my all time favorites in terms of being available and willing to help. She never seems too busy to lend a hand. An hour or more ended up passing before I was able to transfer the patient to the other floor. I was flustered, didn't take my meal break, lost my assignment sheet and my stethoscope (I thought). This was one of those days that I felt was my time to cry on the job. Luckily it didn't happen. I told myself I'd just have to stay as long as it took me to get the job done. But in the back of my mind I worried that I'd get in trouble for a) missing my break and b) leaving late.

What's a rookie to do?

Stop - Drop - Roll

Lesson #57 in fire safety: alcohol is flammable.

Tell that to the patient who catches themself on fire while engaging in a little recreational drug use and then attempts to extinguish said fire with the cocktail they also happen to be drinking. 

This is a kind of one-up to the traditional smoking-while-on-oxygen style of self immolation but doesn't quite top shooting oneself --although CAREFUL: not as a suicide attempt (per patient's report) which made this other self-inflicted injury quite unique.

The day I work with sane patients suffering from banal ailments is the day I die.

I Love Nursey

Sometimes I feel like the Lucile Ball of nurses... a well meaning, clumsy and comical nurse who accidentally trips on an IV line and rips it out, who steps on a patient's broken foot, or pats someones back which happens to be covered in 3rd degree burns (all done lovingly, of course).

I can picture myself in one of those comedy sketches from the 50's where they're tripping all over some poor injured patient and he's screaming in pain every time they accidentally let his tractioned broken arm come crashing down on his chest full of broken ribs, or let him fall to the ground as they try to help him into a wheelchair. And all the while the patient is getting madder and madder, screaming, "WHY YOU LITTLE...!!"

Hands off the catheter, my friend

I had a patient remove his own foley catheter the other day and it was not a pretty site. It's unclear whether said extraction was intentional or not but the result was a positively bloody mess. As you'll see from the diagram below, the catheter is maintained in place in the bladder via an inflated balloon, so just imagine the damage that can be done when that balloon passes through the urethra and out of the penis without FIRST being deflated.

yowee!

I hear the secrets that you keep...

...when you're delirious and hospitalized.
When asked, "Do you know where you are right now?" of some of my less oriented patients I've heard: "a barn", "a birthday party", "a bus", "a sex lab", and "Serbia" to name a few incorrect responses.

One of the unique aspects of nursing is the intimate moments you sometimes share with your patients. I've heard admissions of hatred of family members, revelations of sexual exploits, and of course there's the usual cleaning of butts, weenies, and va-jay-jays... It's kind of like being the bartender at a pub your patrons never wanted to come to (and often times don't even know they're at).

Compassion Fatigue

"Compassion fatigue (also known as a secondary traumatic stress disorder) is a condition characterised by a gradual lessening of compassion over time. It is common among trauma victims and individuals that work directly with trauma victims. It was first diagnosed in nurses in the 1950s. Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt."

You hear a lot of talk about compassion fatigue in nursing and I feel like I've seen it. We had a patient from another country who was involved in a serious car accident while on vacation in the US in which a relative of the patient died. The patient was on our unit for several weeks and I would often hear nurses complain about how needy or whiny the patient was. I know I'm new (and I hope this doesn't explain my empathy) but imagine yourself in a hospital in a foreign country where you don't speak the language, you're in a pretty good amount of pain from your injuries, and you've just lost a loved one to boot. I think I'd be pretty needy too.
I wonder why with experience and exposure to patients with acute or chronic pain it seems we become detached from the moment and start to see the patient as a just a complainer. After watching a patient sobbing in pain with tears streaming down their face this week, asking themselves and me why God would do this to a person, it never crossed my mind that this patient was a whiner and I hope it never does.

Flying Solo

This was my first week at work without my mentor/preceptor. I've finally finished orientation and I'm on my own...!

There are so many steps and phases in this profession. First there were the prerequisites, then actual nursing school and clinicals, next graduation, and after that passing the NCLEX and actually becoming an Registered Nurse. I thought it would sort of end there but then there was the months-long orientation with a preceptor, learning the ropes, and finally independence!

I was/am nervous about being on my own but luckily I've had a good first week so far. It can get REALLY busy and I haven't quite mastered the art of being in four places at the same time...

Ever felt like...

... you might accidentally pull someones toes clean off their foot? Huh, no? Oh, must be this weird profession I've gotten myself into.

The other day I was cleaning this patient's foot which looked something like this picture but a lot blacker (accurate odor description though) and I really really thought that as I was removing the bandage I was going to pull the toes right off. It was like something from a horror movie. In my mind I think when I see weird/gross stuff like this I just figure that it can't be real (must be some special effects or something!). Funnier or weirder may be how we (nurses) will talk about disgusting wounds like the one I saw while we're eating lunch. HA! It's crazy what a human being can get used to.

Where'd you get those...?

There are some nurses on my floor that wear some seriously booty marking tight scrub pants.

Call me old fashioned but it seems a little weird and inappropriate. Not to mention that there is the potential you'll be kneeling into some shit, piss, vomit, blood, or worse in those sexy numbers... Patients probably like 'em though.

Love hurts ...but not THAT much

I'm not sure that getting sliced by a lady friend qualifies as an act of love but your mind starts to invent elaborate stories when your patient's been attacked with a butterfly knife by a member of the opposite sex. 

I don't know about you, but back in my day, if a love interest double crossed me or a friend, our first instinct was not to go on a stabbing rampage. Kids these days...

Spleen in the Spotlight

So I've only been on the floor now for a month or so and there's a huge learning curve, people! ...But sometimes I forget or just don't know things that I might be expected to. I am supposedly a NURSE after all which I guess means I should come complete with encyclopedic knowledge of the human body upon graduation (not really). Anyway, over maybe the past week and a half we've had not one but two patients involved in similar freak tripping accidents in which they have fallen onto a chair, stool, box or some other object landing directly onto their spleens and causing a splenic laceration (or splenic "lac" if you're cool). This got me thinking... where the hell is the spleen again and, uh, what does it do exactly?

The spleen is part of your immune system and is located on your left side. Old red blood cells are filtered out in the spleen, and platelet and white blood cell storage also occurs there. Extra blood is stored in the spleen and its removal can make a person more susceptible to infection.
I read in wikipedia that "spleen" is a Greek word and that the Greeks considered kind and considerate people "good spleened."

Save the Drama fo yo Trauma (Nurse)

Injuries sustained in exploding meth labs... discharging patients directly to the police... patients leaving the floor to shoot speed balls and/or have sex... it's all in a weeks work!
One of the more entertaining interactions I had recently was with a patient who came in testing positive for a controlled substance following an accident. The patient asked me for pain meds to which I replied that I could bring in some Tylenol (the narcotic pain med that was ordered wasn't due yet). The patient responded in the affirmative adding that they didn't want any of "that hard stuff".

Night Shift

I took care of a patient last night who reminded me of the character "Petunia" from Futurama. I imagine her as leading a similar lifestyle out in the non-hospital world but who knows...

This morning as I was helping her get cleaned up for the day I asked if we'd gotten her...., her...
"Coochie?" She replied.
"Yeah, coochie."

Expired

I saw my first code the other day. Codes are called over the hospital intercom system so that people from different areas of the hospital can respond, and a nurse on my floor was one of the people who responded that day. As she was running out the door my preceptor yelled for her to take me with her.

When we got to the other unit the patient was on the floor. I couldn't see much because the room filled up with about 40 people in a matter of seconds. During a code there are different "jobs" that people do: there is the person who runs the code (normally a physician or NP, I believe, because they give the orders for administering drugs), a nurse who prepares/administers the drugs from the crash cart, a recorder who writes down everything that's being done and the effect (if any) the actions have on the patient, people taking turns performing chest compressions and administering breaths to the patient, and probably a bunch of other people who do other things I'm forgetting about. Oh and there are about 20 other people in the room who just want to see what's going on but who are not actually doing anything at all (and they eventually get yelled at to leave the room).
The code went on for 15 minutes -which seemed like an eternity to me- and I mostly hid outside the room trying to stay out of the way. The patient was in PEA and nothing they did was having any effect. Towards the end, the nurse who brought me with her motioned for me to come into the room. She had been working as the "recorder". Shortly after I went in, the attending physician entered the room and gave a signal for everyone to stop. The time of death was announced and the nurse from my floor put a check in the box next to the word "expired" in the "outcome of code" section on the sheet used for recording.

All Thumbs

 

Some days I feel like a complete dunce. I sure can't wait to feel like I've got everything under control (that WILL happen, right?). I guess this is why orientation lasts three months.

First (almost) Successful IV Insertion

I attempted my first IV insertion yesterday and actually got it in on the first try but then the vein blew out! We tried twice on the same patient and both times the same thing happened, we got flashback, but after advancing the catheter and checking placement it wasn't in the right spot.

IV insertion is really tricky --I feel like I need about four hands to do it! Not only do you have to find a good vein and get the needle into it correctly, but then you have to slide the plastic catheter off the needle once it's in the vein, retract the needle, and connect the hub to a saline flush -all while trying not to make a bloody mess.

phlebotomy! phlebotomy!!

I've had this song stuck in my head all day -except I sing "phlebotomy" where they sing "lobotomy" in the opening lines :)

I spent the whole today at a lab drawing blood. No more Shakey Hand McGee over here! Next hurdle: IV insertion!!

Head Bobble

I recently encountered the "Indian head wobble" or "bobble" for the second time in my life a few days ago at the hospital. For those who have never interacted with someone who uses this gesture it can be very confusing and even unnerving. Does it mean yes? No? Maybe? It's especially hard when you're working with a patient and there's a language barrier. Are they happy? In pain? Do they agree? According to this article, the wobble can mean anything from yes to thank you to hello depending on the speed and intensity.

I'm Still Here!

I've been in orientation now for three weeks now, with a couple more days to go until I actually hit the floor. I want to keep writing about my experiences at the hospital in my new role but so far... uh... I haven't had any! Orientation has been long and we are all dying to get with some patients, but it's good that the hospital is so thorough. It's been a lot of review, a lot on policies, etc. They want you to go into the job knowing how to do things the right way, which makes me very happy.

There's been a lot of scaring the crap out of us too... a lot of stories about medication administration errors, code blues, mean doctors, mean nurses... When I started on this journey I thought that when I finally came out of nursing school I'd know how to handle ANY situation. I soon began to realize that that just isn't so. It takes a lot of time and a lot of experience that school just can't begin to prepare you for.

Transitioning

After a LOOOOOOOONG and relaxing vacation, I have finally started my very first job as a nurse! The first day was BORING though... it will be several weeks before I even get to the floor I'll be working on. Today I sat through hours of being talked at about health insurance, life insurance, disability, retirement saving plans... I wonder if I'll have a paycheck left at the end of the month after all the "benefits" are subtracted. hmmmm.... I am lucky to have a job though.

The transition from student back to worker bee is strange. It's weird to come home and not have a text book or test looming over me. It's time to try to remember what that concept of "free time" is all about and what one does with such a luxury!

I CHANGED MY NAME!

WAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

Prepare to DIE

WHY NCLEX, why?

You think Gingko Biloba can hewp me with my cerebral insufficiency?

studystudystudystudystudystudystudystudystudystudystudystudystudystudystudystudystudystudystu

AAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHH

All I do these days is study for for NCLEX, study for NCLEX, sleep, wake up, study for NCLEX, coffee, study for NCLEX, have a drink, watch Jersey Shore (don't judge me, I'm unstable!), study for NCLEX...

 

It would be more fun if I had this cute little group of nursey's to study with but I feel like I'm in siberia!!! No contact with humans, just snooki y mi cervecita.

Dear Patron Saint of Nurses...

Please help me pass the NCLEX!!!! I'm straight up loozin my shizz over here...

NCLEX is coming....!!!

I signed up for the NCLEX a few days ago. I'm so scared!!!!

Please, oh spirit of my deceased kitty, let me pass on the first try!!!

Sometimes Life is Happy...and Sad

Spring finally arrived...

 And graduation from nursing school was overshadowed...

...by the loss of a dear friend.

Miss you, little kitty.

oh no you didn't

IT'S FUNNY CUZ IT'S TRUE!

My Chicken Hez TB

Measles
Chicken pox
Herpes Zoster (shingles)
Tuberculosis



AIRBORNE PRECAUTIONS!
- Negative pressure room preferred
- Staff wear mask/respirator
- Patient wears mask when leaving room

So many urias... so little time

Oliguria -- low urine output
Anuria -- no urine output (less than 50 mL/day)! (eeek!)
Polyuria -- too MUCH urine output
Dysuria -- PAINful urination
Enuresis -- inability to control urination!! (subclasses include: nocturnal, diurnal)
Hematuria -- blizzud in yr pizzee

8 Days

Just eight more days until I graduate from nursing school. I'm really not one to toot my own horn, but I can't believe that all the YEARS of hard work, studying, blood, sweat, and tears that went into reaching this goal (that started with one Chemistry class in 2007!!!) is finally coming to an end. I'll still have to study for that pesky licensing exam and then actually BE A NURSE after next Friday, but I really can't believe that something that started as just an idea a few years ago will soon be reality! To some of my classmates our graduation next Friday isn't such a big deal, some aren't even attending the ceremony. Many of them came straight into this program after finishing their first bachelors degree already having taken the prerequisites as part of their first degree. For me it is another story and it IS A BIG DEAL! I spent three long years working and going to school at night just to get to nursing school, and now I'm finally finished.

toot toot

When I should be studying for NCLEX...

Watch live streaming video from nytnestcam at livestream.com

I'm watching the Hawk Cam...

Friday Night

After 24 hours of NCLEX review spread over three days, I think I deserve a little break :)

i wan go home now!!

Last Day of Clinical

Yesterday was my last day of clinical. I only have to wear my nursing school uniform one last time for about 2 hours and then I can BURN IT!

On my last day I took care of a patient who'd been set on fire by her boyfriend several years back. She was on our floor for another reason though and was hell bent on getting outside to smoke a cigarette. She wouldn't do anything (or in her words, she "wasn't doin shit!!") until someone took her outside to smoke. She was pretty feisty and she could be kind of mean but I really liked her.

Baby's First Rectal Medication

I gave my first suppository the other day. The nurse I was working with said, "...patients ALWAYS refuse suppositories." But wouldn't you know it... when we asked the patient if they wanted it, the answer was a resounding "Yes!"

Burn Trauma

Last night we got a patient who'd lit up with his oxygen nasal cannula in causing an explosion that caught his face on fire. When he got to the floor his face was covered in dripping blood and the nurse had to carefully wash his face and shave him. She explained to me that patients with facial burns or burns on the head have to be shaved everyday -a rather painful process as you can imagine! I felt so bad for this guy. He was probably the most gruesomely injured patient I've seen so far.

This is the End

I'm in the final stretch of nursing school. Just a month and a half to go before my classmates and I emerge from under the protective wings of our instructors to hopefully not fall out of the nest onto our faces as new fledgling nurses!

Yesterday I started my preceptorship on the surgical trauma unit where I'll be working for the next 80 hours. I was expecting to see mostly traumatic injuries (as the name would suggest) but the patients I worked with last night had a whole range of histories from cancer to car crashes.

I'm happy to report that my preceptor is VERY nice and in fact all the nurses I met on the floor were friendly (no meanies)!!

Med/Surg is Over

A friend mentioned to me the other day that Chariots of Fire plays in her mind lately when she thinks of me. I'm hearing that song today, and I'm laughing and crying at the same time. I'm the guy with mud all over the front of his shirt and a dorky smile.



The Med/Surg rotation is OVER! On to studying for the NCLEX and completing my 88 hour capstone on a Surgical Trauma unit.

Queen Bee Syndrome

 Note to self (taken from a recent lecture):

• The person who is unwilling to teach others and does not want others to succeed is termed a “queen bee,” and the activities and behaviors used to keep others from power are called the “queen bee syndrome.” 
• Unfortunately, this syndrome is more prominent in women and thus is evident in nursing, with many experts commenting that “nurses eat their young.”

Can't wait to graduate and start chewin' on some babies... oh wait, I'm gonna be the baby getting chewed on!

Lifer

I realized the other day that over the past 15 years, there have been just 3 years that I have NOT been in school (and those 15 years don't include any high school or anything like that, this is has been my own doing).

Ready to not be in school.

Priorities

Here is an amazing video I had to share.

Sex Ed, B.O. and Nutrition

Today I got to teach three different groups of 12-year-old girls about germs and hygiene after my classmates filled them in a little bit about the birds and bees and how to eat right. It was pretty fun until we got to the third group which was slightly on the loud and rowdy side.

These kids would NOT be quiet during our presentation and I pretty much had to yell. I don't know why but the teacher did not do anything to quiet them down. During my classmate's Sex Ed talk with that group we heard all kinds of interesting unsolicited comments... "My friend popped her cherry because she ran into a pole with her legs spread apart!" That's a hard one to come up with a response to. And there were some other, scarier comments that came out of no where like, "This girl I know told me her uncle raped her." Equally difficult to respond to when one is not prepared (their teacher had nothing to say either). Meanwhile, our male classmates were off in another classroom teaching Sex Ed to the 12-year-old boys and got the question, "Does it feel good to get raped?" from a member of their audience.
The school nurse told us there were 40 mental health arrests at that school last year (that's when an ambulance pulls up and takes you to the psych ward of a hospital against your will). One kid broke a paramedic's nose after punching him in the face.
At lunch time I sat down with some second graders to get a break from the older kids and a little girl immediately asked me what my favorite color was and informed me that her favorite animal was a white unicorn. I wanted to tell her, "PLEASE, don't every grow up!" (or if you do, please grow up to be the next Supreme Court Justice and not someone who has been so screwed over by adults that you want to kill yourself and/or other people).

On that happy note: 58 days till graduation!

Spring Break...

...is almost over.

Three more weeks of STRESS until our Med/Surg rotation ends. I'm hoping April will bring sings of SPRING and less anxiety!

Tomorrow marks two months till graduation!!!

Healthcare and the LGBT Community

 

We had a great talk today about the need for healthcare providers to address the sexual orientation and gender identities of their patients. Many healthcare professionals do not consider how knowing their patients' gender and sexuality background can affect the services they provide, and how many LGBT people are afraid to come out to their providers let alone seek healthcare at all. 

I found out today that lesbians have a higher rate of breast cancer than their straight counterparts. Why is this, you ask? Well, it's not because being gay makes you more prone to cancer, it's because lesbian women have higher rates of smoking, obesity and other factors that put them at greater risk for cancer than straight women. Likewise, transgender folks have higher incidence of nicotine and drug use, relationship violence and "anatomical" cancers. Consider the transgender man at risk for breast or ovarian cancer -how likely will he be to seek a breast exam or pelvic exam? How prepared are healthcare workers to provide these services in a respectful manner? I think a lack of knowledge around these issues is a major part of the problem when you put aside the whole homophobia thing (a 2004 survey found that given the option, 36% of nurses would decline to treat LGBT patients. Hey nurses! That's not very compassionate of you!!).

Ostomy Pride

Well, I've never written two posts in one day but as I was sitting here studying for a test I have on Monday, I came across this picture of a sexy lady with an ostomy.

This sort of reminds me of something you'd see in San Francisco where diversity of EVERY kind is celebrated. It's got to be mighty difficult living with one of these.

Nurses are Bitches

I don't think many people know how mean nurses can be to each other and to students. It's been a few weeks since I've come across one, but there are some really angry nurses out there. If you don't believe me, look around for yourself, there are entire books dedicated to the topic. As students, we see a lot of this (I'm hoping more of it than we will as RN's).

I had a classmate get a pen thrown at her by an angry nurse on our OB rotation and I've spent the day with plenty who would not even introduce themselves to me. It's been FUN! Whenever I come across these people, I can't help but think, "You weren't BORN a nurse! What is your problem?" We've talked about it in class and our instructors know the story. "Don't they remember being students??" we cry, and their reply is always, "No, they don't."

End of Life

My patient this week was in his 9th decade -a WW II veteran from the Marine Corps who'd been all over the world. I got my first shot at shaving a patient with him, which was scary and also kind of funny. I didn't cut him, thank god, but he looked kind of like a mangy puppy after I finished. He was so happy though, he just kept telling me what a great job I'd done even though he had no idea what he looked like. 

I was so surprised at how lucid he was when I met him. I like how he called his hearing aids his "ears", his glasses his "eyes", and his oxygen cannula his "breathers."

Thinking about how he was reaching the end of his life made me a little sad. I don't think he's going to make it too much longer. Even though he's had a long life and a pretty good one judging by his spirit, it's still an end none-the-less. He'll have some time now to look over his life and think about everything he's done and seen, and when he's gone someone will have lost their dad, their husband, their buddy... It's like the end of an era. Makes ya feel a little melancholy...

Neurosurgical Floor

This week my clinical group moves from a general Medical/Surgical floor to a Neurosurgical floor. I've heard really great things about this unit from classmates who spent their first 5 weeks of the Med/Surg rotation there. This means I'm half way through the Med/Surg rotation!! I'll be singing and dancing when April comes (not only will I be done with Med/Surg but I hear Winter will be over by then...).

I skipped my 8am class today to study for a damn Med/Surg test I'm taking this afternoon. This is the first class I have missed during this entire program (yes, I'm a nerd)!!!