Heartbeats of Faith

Sick or Faking?

2009-10-06T20:25:00.000-05:00

Did you ever fake being sick so you could stay home from school?

Did you pass down this wonderful trait to your own children?

When I was a kid, I would plot this out the night before. I would lay in bed and plan the whole decietful lie that would get me out of school.

First it would be a headache, however I knew that this would not be good enough, then my stomach would hurt. I would pull out my best sick, whinny voice and complain of the pounding in my head and the cramping in my belly. Mom would then put her hand on my forehead and check for a fever.

"Nope, cool as a cucumber. Now get up and get dressed you have to go to school today. ", She would say.

Ok, so this led me to more plotting. I had to figure out how to fake a fever. But until I got that figured out, I would work my magic at school. By 3rd period, I would make myself late to class, I would pinch my cheeks to make them red, splash a little water on my face and tell the teacher I was late because I was in the bathroom thowing up. She would send me to the nurse where I would get to rest for about 45 minutes. I would continue to complain of achy skin, upset stomach and such. She would take my temperature. . . NORMAL!!! Back to class it was for me.

Then one day I had it figured out. When I complained to mom before school, I would still be in bed. I had a waterbed, WITH a heater!!! I would get my hands really warm and rub my face making it a little warm too. When she came in to get me up, yep. . . no more "cool as a cucumber" for me. Off she would go to get the thermometer. She would put it in my mouth, you remember those old mercury thermometers, and then she'd go back to the bathroom to finish getting ready for work. While she was gone I would put the thermometer against the warm mattress of the water bed. Up it would go. But that didn't get it warm enough to get me out of school. So, I would rub it really fast against the blanket on my bed. Yep, 100.2! That should do it.

Next thing I know she is on the phone to the school and I am snug in my nice warm bed. After she would leave for work, I would take my blanket and pillow and find my spot on the couch. . . for the rest of the day!!!!

This rubbing the thermometer trick worked really good to get me out of class when there were missed assignments or tests I wasn't ready for. I would use the same technique as above to get me out of class and in the nurses office. She would have me lay on one of the beds in her office. Lucky for me there were curtains around each bed. After she had given me the thermometer, I would rub it against my jeans. Sure enough, my dad was there to pick me up within the half hour.

I will never forget the day it backfired. I was in my bed, trying with all my might to be sick. I had to get the themometer up there quick because mom was running late. I rubbed and rubbed really fast. Then I heard her coming. I didn't have time to check it. I quickly put it back into my mouth just before she got to my bedroom door. When she checked it it was 104!!!!

Yep, you guessed it. . . I went to school. BUSTED!!!!

What did you do to get out of school???

14 and pregant. . .

2009-10-05T18:12:00.004-05:00

When I was doing my OB clinical rotation while still in nursing school, I remember this 14 year old girl coming into the ER after giving birth to a very premature baby boy. She delivered this baby at home in the toilet.

She told the doctors she didn't know she was pregnant. She was dieting because she couldn't figure out why she was gaining weight. Then she was hurting pretty bad and went to the bathroom. Low and behold, she lost all that weight she had gained, right into the toilet!!!

She ended up being fine, the baby went to the NICU and never went home with his 14 year old mother. Instead he went home with a foster family after living in the hospital for about a month. He had no one except for the nursing staff and doctors for the first month of his life. What happened to him after that I will never know. I just have to trust that he is still alive, happy and healthy and with a forever family who loves him as their own.

What concerns me is that this 14 year old girl was pregnant and her mother didn't have a clue. What are we teaching our kids these days? Are we talking to them or are they learning by our actions? How can things like this happen?

I know it is not all that uncommon anymore for a young girl this age to be pregnant but are we doing anything to stop it from happening? These kids aren't ready to be raising kids. They can't even take care of themselves let alone be responsible for another life. Who is teaching them to respect themselves? Where was this baby's daddy?

My heart breaks each time I think of this situation. It has been 6 years since this incident happened. Where is this baby now? He would be in school already. Does he know someone loves him?

My heart breaks that we don't pay enough attention to our children to let them be children. . . to teach them what is right. . . .to give them what they need and deserve.

Are you educated?

2009-10-03T21:43:00.003-05:00

She was 25 years old came into the ER with a bad cough and trouble breathing. By the time I had seen her she had been in the hospital already for about 2 weeks.

She had a bad case of pneumonia. However it was not just pneumonia she had. While inpatient they discovered she was not just HIV+, she had AIDS. This was very difficult for her to believe, as she stated she was NOT a drug user and had not had sex in 6 years. Not since her son was born.

Nonetheless, it was in fact AIDS. She was angry, almost hateful even. She was not very nice to the staff, and would not even talk to the social services people who were trying to help her. She was convinced it was not AIDS. There must be some mistake. She was sure she didn't have what they said she had. She demanded those words not even be said in her precense.

After being in the hospital a total of about a month and a half and after many tests, many new medications, many procedures, she went home. She went home with home health to care for her. She went home to spend what time she had left with her son, who during this hospital stay also learned that he was HIV+ as well.

How can a person live that long and look so frail and sickly and never learn the fate that is set before them. Did she not go to the doctor? Did she not have the financial means to get there? Did they not test her while she was pregnant? There are so many questions here.

Where did our healthcare system fail this family? Will it ever get better?

What can we do to ensure that each person has the health care they need and the education that is so important?

I am seeing this all too often. People come into the ER for what they think is something so simple. However they don't have a family doctor because they can't afford one. They come to the ER and probably don't even have the money to pay that bill and the hospital ends up writing it off. Then while they are in our ER, they learn that because of lack of healthcare, they now have a very serious illness. One that will now take their lives because they did not have proper preventative care. Now they have to live what life they have left with AIDS, lung cancer, breast cancer, an inoperable brain tumor. . . .

Our country as a whole needs to be focusing on education. People need educated!!! It is not just the middle or lower income people who are having this issue. It is also the higher income people. Those who just think they will live forever. Don't have time, don't want to spend the money to go to the doctor. Or maybe they have the attitude that, "It won't happen to me".

Let me assure you, it can happen to any of us at any time. These terminal illnesses do not discriminate. They don't care who you are, who your parents are, how much money you have or how important you think your life is. If you don't take care of yourself and have regular check ups with your doctor you could be that person that finds yourself in the ER with what you think is an easy fix, just to learn that it's not that easy.

Ladies, go see your OB at least once a year. Teach your daughters about annual exams, and how to do a self breast exam.

Gentleman, have your yearly check ups as well. You are not exempt. Teach your sons how to do testicular exams. Did you know that men can get breast cancer too??

When you become of age for colonoscopies and mammograms, GET THEM!!! Early detection is the key!!!

If you have questions, make an appointment to see your doctor. Don't let these things go!! Love yourself and your family enough to take care of your body.

There is a young man who will now grow up without his mother. There is a mother, who will miss out on the majority of her son's life. She will probably not live to even see his 8th birthday. Could this have been changed if she had been having regular annual check ups with her doctor? Who knows. There would have at least been a better chance of them catching it earlier and prolonging her life.

Educate yourself and the ones you love!!!

Ovarian Cancer Awareness Month

2009-09-01T05:00:00.000-05:00

In honor of September being Ovarian Cancer Awareness month, I thought I would do a little education. All information below can be found here.

Ovarian cancer is the 5th leading cause of cancer-related deaths in women ages 35-74. It is estimated that 1 out of 58 women will develop ovarian cancer during her lifetime.

If diagnosed and treated early, and the cancer is confined to the ovary, the 5-year survival rate is over 90%. However, because the symptoms are not specific and because of lack of early detection only about 19% of all cases are found at that early stage. Like many other cancers, the survival rate decreases, when it is caught in later stages.

According to the National Ovarian Cancer Coalition, there are more than 30 different types of ovarian cancer. This type is determined by the type of cell they start from.

For more information on the types of ovarian cancer and the stages, click here.

Symptoms of Ovarian Cancer

Bloating
Pelvic or abdominal pain
Trouble eating or feeling full quickly
Feeling the need to urinate urgently or often
Fatigue
Upset stomach or heartburn
Back pain
Pain during sex
Constipation
Menstrual changes

These are vary vague symptoms, many of which women deal with on a regular monthly basis. However, when the symptoms persist and do not subside with normal intervention, it is IMPERATIVE to see your physician.

Screening tests are available and should be discussed with your physician, especially if you have a family history of ovarian, breast or colon cancer. You are also at risk if you are over age 35 and/or have undesired infertility. A pap test DOES not detect ovarian cancer, it detects cervical cancer.

Screening tests for ovarian cancer include:

Pelvic Exam
Transvaginal Ultrasound
CA-125 Test

If you or someone you know is at risk, please click here and learn more about detection, stages, treatment, risk factors, and prevention of Ovarian Cancer.

You can also contact the National Ovarian Cancer Coalition Helpline (1-888-682-7426) to get more information or to find support services in your area.

Don't take your health for granite, make regular visists to your GYN!!!

Acute Confusion

2009-08-25T11:25:00.003-05:00

She laid in her bed yelling out. "Daddy. . .! ", "Oh, my God, what's happening to me?" , "Brian!"

I think she was yelling out the names of her children. Daddy was refering to her husband of more than 60 years. Each time she yelled out a name, it was a long drawn out cry. It was breaking my heart. It was making the rest of the nurses and other patients crazy.
I kept hearing those famous words, "Can't you give her something?"

At 83 yrs old, Mrs. Springer was experience a nightmare within her mind. The only problem, she wasn't sleeping. I couldn't wake her up from this. I was in her room about every 5 minutes. Trying everything to distract her, reassure her, listen to her. Nothing was working. I was at my wits end. The nurses who cared for her the last two days said this was her behavior for 2 days straight. They had given her everything and nothing was working. They had tried Ativan, Haldol, Dilaudid and nothing was making a difference. They were not even helping her sleep.

She had a recent joint replacement and had returned to the hospital with a Soduim level of 119. She had pulled out a foley catheter, and 3 IV's. She was refusing food, and at times combative. I believe all of these behaviors were due to the fear she was feeling, which was in turn caused by the confusion, caused by the low sodium. A domino kind of effect.

Finally I got her to be quiet enough to hear me ask if she was in pain. She just let the tears flow and nodded her head yes. I repositioned her in bed, gave her alot of pillows and tried to make her comfortable, put her TV on the music channel and let her listen to very soft, quiet music. Then I gave her 1mg of Dilaudid through her IV. It took about 30 minutes and she was fast asleep. This was about 9pm. At 5:30am I hesitated to wake her because she had slept all night without waking up. But I had to draw her labs. I had waited as long as I could.

She was very cooperative during the lab draw, however it didn't take but 20 minutes for her to start yelling again. I thought about giving her more Dilaudid, but the last dose had her alseep for so long. It was almost morning and I didn't want her to sleep the whole day. She didn't really have anything else I could give. I offered her a drink, fed her some pudding, and went to my next blood draw of the morning.

Ringing down the hallway was the sounds of a crying, weak voice. . .
"What's wrong with me?"
"Where am I?"
"I've lost it. . . . I've lost it!"

Over and over she yelled "I've lost it, Oh my God, I've lost it!"

I went back to Mrs. Springer's bedside to try to talk to her again.

Me: "Mrs. Springer, what is wrong? Are you hurting?"

Her: "NO! I've lost it!!"

Me: "Lost what?"

Her: "My mind, it's gone, what's wrong with me?"

Me: "Mrs. Springer, you are not well right now. Your sodium level is low, that is why you are
feeling this way. We are working to make it better. You will be your old self before you
know it."

Her: "Oh my God! I've lost it! Just call the patty wagon! I'm done for!"

Me: (doing all I can to not laugh!) Now Mrs. Springer, I promise you we are working on it. The doctor will be here to see you soon. Your levels are improving it is just taking some time.

This was obviously doing no good. She continued to yell, and cry. There was no consoling her. I called the doctor and got an order for Ativan. She only gave me an order for 0.5mg IV ONCE.

Yep, it worked until shift change. Imagine day shift coming in to this poor lady yelling. That was all they needed to hear to go ahead and come to the conclusion it was going to be a terrible day. I assured them the doc had told me he would be making rounds early. They could expect him within the next hour. The look of horror on their faces didn't change.

I worried about her all the way home. Praying that she was able to find some peace within her mind. That they could find a medication that would calm her at least long enough to stop the torment she must have been experiencing.

Lessons to be learned here:

Low sodium causes major acute confusion
Confusion causes torment
Tormented patients who are confused need a patient nurse
Nurse has to be someone who knows how to pray for peace
Peace may not come for days for the patient or the nurse

Back from a blogging sabbatical

2009-08-25T10:43:00.004-05:00

I have to say, I have missed blogging! I have been one busy nurse, but after a short sabbatical from the blog world I am back. I probably won't be posting daily, maybe not even every other day, but I will try to keep up.

I have stories to that need to be told. I have stories that I need to document, because I don't ever want to forget them. I have stories, I tell you!

I have to commend all you bloggers who can post religously every day, follow hundreds of blogs and make comments and be a great blogger. I tell you, I will try. That is the best I can do right now!!

Let the stories. . . . .resume!!!

Did Somebody Say Chocolate?

2009-07-02T04:00:00.000-05:00

Everyone loves chocolate!! I am not sure I have ever met a woman who does not at least like chocolate. Many of us love chocolate to the point of not being able to go a day without at least a little taste. Some of us only really crave it once a month.

Ever wonder why women have an intense craving for chocolate around the time of their menstural cycle? There has not been alot of research on this but what I did learn was:

Chocolate is very high in magnesium. A Magnesium deficiency can exacerbate PMS. PMS for most women start 7-14 days prior to their period. It is not really known what exactly causes PMS but there is much known about helping to control the symptoms of PMS. Some of those include staying away from caffeine, taking B6, calcium and magnesium supplements, among other things.

Here is how it relates to chocolate. Before menstruation the levels of the hormone progesterone are high. This promotes fat storage preventing its use as fuel. This in turn may cause a craving for fatty foods. One study stated that 91% of chocolate cravings that were associated with the menstrual cycle occured between the time of ovulation and the actual start of menstruation. These cravings were most intense in the late afternoon and early evening.

This timing made sense to me because if it is a craving for those fatty foods, those are the times when your body would be needing more energy to get through the rest of the day.

Chocolate also generally makes us feel good. Especially if you are a "chocolate person" to begin with. You crave chocolate when you are depressed, lonely, feeling blue, etc. The sugar in chocolate causes a release of serotonin. The brain uses serotonin to reduce depressive or anxious feelings. Chocolate also causes a release of several other chemicals (tryptophan, anandamide, phenylethylamine) in the brain that can give a person a mental boost, increase the heart rate, stimulate the nervous system and produce feelings of euphoria. These chemicals effect serotonin as well as dopamine in the brain. Both serotonin and dopamine are used in antidepressants and antianxiety medications that help make us feel "happy" and/or "relaxed".

So, now you know! When you are feeling blue. . . take the plunge. Eat a piece of chocolate maybe eat two. But remember, all things are good in moderation!! Don't overindulge, you will be more blue later if you do. Especially after you step on the scale and see that extra pound or two because you ate a whole box of chocolates!

Payback's a . . . what?

2009-07-01T04:00:00.000-05:00

I bet you are still wondering about the payback from yesterday aren't you???

Well here it is. I was really smart on this and waited and plotted with some other day shift girls for a couple of weeks. I wanted to make sure that the thoughts of payback were gone from my friends mind. There were two girls under the bed that grabbed my ankles, and I only went after the one that came up with the idea.

I had worked day shift this particular day. I went home took a quick nap, met my friend for a late dinner and then we were going back to work for the night shift. I had already had it worked out with the girls that were going to coming off shift when we got there. They were almost more excited about this than I was.

While we were at dinner, I told this friend of a new resident who was admitted that afternoon. He was very angry. His family pretty much brought him in and left him. He didn't want to be there and was yelling alot. He pretty much wanted to be left alone. I warned her that if she went into his room to approach him carefully as he had been combative earlier when the other girls had tried to bathe him and such. I also told how he liked to lay in bed with his head covered up, like Mr. Lambert does down the hall. She knew exactly who I was talking about, another gentleman that slept that way. I told her, don't pull back the covers without talking to him, it made him real mad and he took a swing at Jackie today.

She fell for the story hook, line and sinker. I was so suprised. I didn't think she would really believe all that mess. However, we had several combative residents, so this was not all that uncommon.

We came on for our shift at 10pm, got our assignments, listened to report and I told her I would catch up with her to start passing our ice water in minute. I was going to the bathroom before we got started. She thought all the evening shift people had left. I went around the corner "toward" the bathroom but never went there.

A call light went off and she went to see who it was. It was "him", the new gentleman. She went into the room, and sure enough his head was all covered up. She gently touched his arm, which was also under the covers, and asked him if he needed something. She was so sweet when she talked to him. He didn't respond. He didn't move, didn't say anything. So she shook his arm a little and spoke to him again. Again. . . nothing. She then gently started to pull back the covers. Just as she did that. . . .

the "new resident" stood straight up in the bed and made a funny/scary noise at her. She yelled and ran out of the room.

It was the funniest thing I had seen in a long long time. I was watching from the bathroom in the residents room. I knew that I would never be able to pull this off by myself. Had I been the person in the bed, I would have laughed and ruined the whole thing. Jackie was great. She was my "new resident".

Payback was complete. We were even! And we laughed about it all night!

Post of the Day Award!!

2009-06-30T10:52:00.004-05:00

Thank you very much AuthorBlog!! I am very honored that you choose my blog for your Post of The Day (POTD) today!!

If you have not been to see AuthorBlog, please click on the link and go for a visit. His blog is very intersting, funny, and overall a great read! Also go visit the other blogs he chose for POTD.

What Lies Beneath

2009-06-30T04:00:00.000-05:00

Keeping to the nursing home theme from yesterdays post, I would like to share yet another tale of nursing home days long ago.

I had just started picking up some night shifts for overtime. I loved working with the night shift girls. It is no secret in nursing that night shift is a breed all its own. The girls began to tell me of the "ghost stories" of this facility. How they would see things, hear things, call light going off in rooms that had no one living in them, etc. This in turned totally freaked me out. Everyone knew if there was a call light going off, we were going to work in tandum. I hated going into rooms alone, just because I never knew what I was going to find. I sure didn't want to come face to face with that black figure they had all seen lurking around.

On one particular night, I was working with some of my best friends. We were all pretty tired because we were all on overtime. It was the middle of a bed check and we were at the far end of a long long hall. All of the sudden we hear a call light going off. I told the girl I was with that I would go and get it. I didn't really want to but I was trying really hard to overcome the fear, and be a big girl. In essence it was high time I "put my big girl panties" on. I needed to prove to them that I wasn't the "scaredy cat" they all thought I was.

I went down the long hallway that was poorly lit (we turned the hall lights down at night), and turned the corner to the short hallway that finished off this unit. There it was, the call light that needed answered. I found it a little odd that the call light was on in this particular room. The lady living in that room was very old, bed ridden, deaf, and demented. She had no idea what the call light was let alone how to use it. I kept trying to tell myself that maybe she accidently hit the call button or something. I was determined not to be afraid. There was no one really close so no one would know that I turned on the room light just to walk in and turn the call light off. The reset button was right next to this lady's bed. I turned off the call light then I reached over and pulled this sweet lady's cover back over her, she had kicked most of them off. Just as I was reaching into her bed to grab the covers. . . . .

something grabbed my ankles!!!!! There was a tight grip on BOTH of my ankles. I couldn't move. All I could do was scream at the top of my lungs and before I knew it I was standing in a nice warm puddle.

Thank goodness this lady was deaf. She had no idea what was going on around her! The hands that gripped my ankles let loose, I am sure because they were now quiet wet. And all I could hear was giggling coming from below the bed.

Two of my "dear friends" who knew my fears, had planned this all night. They had been the ones to push that call button. What was so funny is that one of them was sure I wouldn't be able to scream. We had talked about fearful times before and every time I had been in a situation where I should have been scared enough to scream, my mouth would come open but nothing would come out. So they felt it pretty safe that no noise would come from me.

It was terrible!! However now it makes for a great story when we are reminiscing of days gone by. Everyone remembers the day I had to borrow a pair of sweat pants from the unclaimed clothes in the laundry department.

Let me assure you that pay back for those people was OH SO SWEET!!!

(that is a tale for another time . . . .)

She called on, Jesus, Mary AND Joseph. . .

2009-06-29T02:09:00.007-05:00

Catherine was quiet a feisty lady. She was at least 80 yrs old and I was somewhere in my 20's when I was her Aide at the nursing home she lived in. She had raised many children, lived on and worked a farm with her husband, until they were no longer physically able. She knew the meaning of tired to the bone.

She had dementia. Her husband had already passed on several years before this, and her children had important lives to lead. They would come visit at Christmas and Thanksgiving and sometimes even on Mother's Day. But I am not sure at this point Catherine really even noticed. We had become her family, and she had become "Grandma". That is what she answered to, so that is what we all called her.

She was no longer able to walk, however she couldn't seem to remember that. She was in a wheelchair with a "lap buddy" or a tray. It really depended on the day and how feisty she was at that moment. She was able to stand but only long enough to move her from the bed to wheelchair or from the wheelchair to the toilet. Her bed was 6" from the floor with a soft mat laying on the floor beside it. She was forever trying to get out of bed, forgetting she wasn't able to walk, and then would fall. So to help prevent her from breaking anything (like a hip), her bed was lowered as low as it would go.

"Grandma" taught me how to think fast, and move fast. She hated to get out of bed. She hated to get a bath, she hated to get dressed, and she never wanted to give up her teeth for the night so they could get cleaned and soak. I learned real fast, that if I was going to make it out of her room without bleeding I had to hurry and get her dressed and bathed just as fast as I could. See, Grandma I am sure was a street fighter in her younger days. She had a great right hook!! She would hit, yell, curse, bite, pull hair. Whatever it took to get you to leave her alone. But once you were done that was the end of the battle. It was like she totally forgot you just lost 5 pounds of sweat just trying to dress her for breakfast. Once in her chair she was happy as a lark.

I learned one night while putting her to bed that if you talked real sweet to her, she would be nice just long enough to get her teeth before she bit you. See, no one was able to get those teeth out of her mouth without getting bit. She just wasn't giving them up. I would get her laughing and before she even knew what happened I could do a one finger sweep and get the bottom plate right out of there. As soon as she realized it though, she would be mad as a hornet!! But once the bottoms were out I was less afraid of being bit. See, if you can hold the bottom jaw down long enough to get the top plate out, you are home free. Just watch out for her hands because she would be swinging by this point. I could have this whole tooth thing done in a matter of less than 2 minutes.

"Grandma" was my favorite nursing home resident. I think it didn't bother me that she beat me up everyday when getting dressed and undressed because I knew she didn't know what she was doing. After her teeth were out it wasn't as hard to deal with. I would be changing her clothes while she was knawing on my arm. Her teeth were already out so she was just "gumming" me to death. That didn't bother me in the least and it kept her busy and satisfied until I got her clothes changed.

However, keeping her nails trimmed was quiet a chore. You let those babies grow too long and you were in trouble. I have scars on my arms to this day from sweet little "Grandma". I think of them as my way to never forget her!

I remember one morning I went to get her up. It was early probably 5am, but I had alot of people to get up and dressed before breakfast and I knew she was going to put up a fight no matter what time I did it, so I just as soon get her done. I went in and knelt down by her bed, rubbed her forehead and talked real sweet to her, trying to wake her up in a good mood. She looked at me with utter disgust and said, "Well, Jesus, Mary and Joseph, but especially Joseph!" I think this was her way of saying. . . 'I have been up with the chickens my whole life, can you not just let me be for one cotton-pickin' day?'

Grandma wasn't always combative, sometimes she could be so sweet. She would tell us she loved us and give us a sweet little kiss on our cheeks. And if you weren't careful when you walked by her wheelchair, she might just give you a little swat on your behind, and chuckle like a mischevious child.

The nursing home was awfully quiet after "Grandma" passed on. Of course her family showed up just in time for that, even though they had not been there much of the other time. "Grandma" had us with her too. She left this world only after making an impact on many lives of those who cared for her. Most of us in our 20's to early 30's thought we had it all figured out. "Grandma" helped us remember what is important about life. Loving someone even though, even if and even when.

She loved her family even though they didn't visit, even if she was mean to them too, and even when she couldn't remember who they were.

And we (her caregivers) love "Grandma", even though she yelled and hit, even if she pulled our hair and bit us, and even when she would slap our behinds and give us those sweet kisses.

One can not have too many Grandmas!!!

Inflammation. . . . damaging the sheath

2009-06-29T00:30:00.009-05:00

She was 37 years old, with complaints of progressive weaking in her lower extremeties over a couple of weeks. It really started with slight neck pain, then to the lower back. Then all of the sudden her left leg was really weak, then the right. By the end of the two weeks, her husband was calling 911 because she could not move any part of her body from her belly button down. She was unable to urinate, unable to have a bowel movement, unable to wiggle her toes, unable to lift her feet or legs off the bed. She could feel them if you touched them but she could not move anything! She kept complaining that her legs were tingling like they were asleep, and that they were so heavy she couldn't lift them. She really wasn't having alot of pain other than a headache and some "muscle pain" in her shoulders.

After several tests including x-rays, MRI's, a lumbar puncture, and blood work up they diagnosed her with Transverse Myelitis. What is Transverse Myelitis you ask? I am going to give you the short version since I have also left you with a very informative website. The website is where I am getting all my information for this post as well.

This is an MRI of the thoracic spine (the part between your neck and your lower back). The grey solid area in the middle is your spinal cord. The white area where there is an arrow (very difficult to see) in the spinal cord is the area of inflammation. The really white areas that kinda outline the solid grey spinal cord is CSF (cereberal spinal fluid).

Transverse Myelitis is not limited to age, sex or race. There does not have to be any family history of this for you to have it. Most cases occur however, at the ages of 10-19 and 30-39.

It is a neurological disorder that is caused by inflammation across the spinal cord. Inflammation can actually damage or destroy myelin, which is the fatty substance that insulates and covers nerve cell fibers. This ends up causing scaring on the nervous system that interrupt communication betweent he nerves it the spinal cord and other parts of the body.

There are many things that can cause Transverse Myelitis, such as viral infections, insufficient blood flow in the spinal cord, complications from syphilis, measles, lyme disease, certain vaccinations (ex: chickenpox and rabies). It often developes following viral infections such as varicella zoster, herpes simples, cytomegalovirs, Epstein-Barr, influenza, echovirus, HIV, Hep A, and rubella.

Because some affected individuals also have autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, and sarcoidosis, some scientists suggest that transverse myelitis may also be an autoimmune disorder. In addition, some cancers may trigger an abnormal immune response that may lead to transverse myelitis.

An acute, rapidly progressing form of transverse myelitis sometimes signals the first attack of multiple sclerosis (MS), however, studies indicate that most people who develop transverse myelitis do not go on to develop MS. Patients with transverse myelitis should nonetheless be screened for MS because patients with this diagnosis will require different treatments.

Symptoms may develope over several hours to several days/weeks. Usually starting with lower back pain and/or sudden burning, tickling, prickling or tingling in the legs, as well as partial paralysis of the legs. This paralysis usually progressed from the legs to the lower part of the trunk. Bladder and bowel dysfunction is very common. The patient will likely feel general discomfort, headache, maybe a fever, loss of appetite and muscle spasms. Depending on the area of the inflammation on the spinal cord, some may even experience respiratory problems.

There is currently no effective cure for Transverse Myelitis. Treatment is meant for managing the symptoms and really depends on the severity. Steroids to degrease the inflammation, they also reduce the immune system activity since there is also suspected autoimmune involvement. Then there is pain control. The goal is early treatment and keeping the boy functioning, while waiting and hoping for some kind of spontaneous recovery of the nervous system. Physical therapy place a huge role in this, with range of motion and keeping those muscles moving.

Recovery typically begins within 2 to 12 weeks of the onset of symptoms and may continue for up to 2 years. However, if there is no improvement within the first 3 to 6 months, significant recovery is unlikely. About one-third of people affected with transverse myelitis experience good or full recovery from their symptoms; they regain the ability to walk normally and experience minimal urinary or bowel effects and paresthesias. Research shows that a rapid onset of symptoms generally results in poorer recovery outcomes.

Many people with Transverse Myelitis only have one episode, however there is always a chance it can rare it's ugly head again. When/if it does return there will likely be more workups for underlying causes such as MS or systemic lupus erythematosus. Most people who have more than one episode have some kind of underlying disorder.

Now that you have had some education, let me tell you that I have seen this many times in my years of nursing. It is very scary for the patient and family. One day you have control over your own body and the next day, you can't move! People think they are just tired, been doing too much, and pretty much let it go. Thinking they just need some much needed rest.

This particular patient I cared for after she had already spent over a week inpatient. She was scheduled to go to an inpatient rehab hospital for intensive Physical and Occupational Therapies. She was diabetic, had been on 1000mg of Solumedrol for 5 days. That is ALOT!!! Her blood sugars had been hard to control because of all the steroids, so she was having to deal with that aspect as well. They also had her on Baclofen to help with the muscle spasms, as well as low doses of Vicodin for pain. While in the hospital she was also receiving therapies. She had a foley catheter, because she was unable to urinate, and she was having trouble with her bowels. They just didn't want to work.

Her husband was amazing! He never left her side. He was right there caring for her and doing whatever it was she needed at that moment. Her spirits were good. When she was admitted to the hospital, as I stated before, she could not move ANYTHING from her belly button down. The day I had her, the day prior to her discharge, she was able to lift her left leg (the first leg to be affected) off the bed. Now, she was not able to lift it far, but she did get it off the bed. She also couldn't hold it for long and was unable to hold it against pressure. But she was making progress.

Her attitude was amazing. He kept me in stitches all night. She and her husband both should have been stand up comedians. Most patients of this age would have found themselves in a heap of tears and doom. Looking only at the possibility of never being able to move again. Not this young lady. She knew she was going to recover fully and have a full normal life.

I have not heard of her or seen her back at my hospital since that night. My prayer is that she did recover. That she is home with her husband, living life to the fullest!

To ICU or Not?

2009-06-26T04:30:00.000-05:00

I had a 47 year old patient several months ago that was admitted from an outside hospital because he had a ruptured appendix that ended up causing a MAJOR infection. He had been in our hospital for about 4 weeks and had just been transferred from ICU that morning.

He was extubated the day before, had been in a vest restraint as well as soft wrist restraints in ICU because he has pulled out a total of:

* 3 IVs

* 1 PICC Line
* 2 Small bowel feeding tubes

* 1 Foley catheter

* 1 Rectal tube

* 2 Chest tube

*Rectal Tube - the large blue end in the bottom left
of the picture is what is inserted into the rectum.
It is then inflated like the picture above to secure placement.
The other end of the long tubing is connected to a collection bag.

*Small Bowel Feeding Tube - Inserted into the nose down the back of the throat through the esophagus and stomach to the small bowel. Can be used to give liquid feedings and medications for patients that can't swallow well and are at risk for choking.

This was all included in my shift report at the beginning of my shift. The day shift nurse also told me he had been "pretty good" that day. He was no longer in restraints. He did however have a sitter, and his mother stayed in the room with him. But he wasn't pulling at anything. Well, HELLO??? Was there anything left to pull out??? He did have PICC Line but that was all that was left. He was only really oriented to his name. He had no idea where he was or why he was there. He could not tell me the year or who the president was. He was very confused and most of what he said didn't make sense. His mother was off the chain!!! You could tell she was so worried about him and she just wanted to do whatever she could to make him better, but really she couldn't do anything but sit there and listen to him talk crazy and drop the "F" bomb about every 45 seconds.

On first assessment he complained he couldn't breath. He thought his lung was collapsing again. His assessment was negative, however I did call the doctor just to inform her of how he was feeling, even though his lungs sounded great. He was pretty anxious so I ended up giving him oxygen just to make him feel better. I actually worked. It gave him something to play with. He didn't keep it on however. But since his O2 sats were 98% on room air, I wasn't really concerned too much.

As the night progressed, he became more and more confused. He was increasingly agitated and began hallucinating. He was seeing birds in the room, he thought there was a fire in the room. He also told the doctor how beautiful her ears were, they looked just like those of a baby deer. He was so sweet when he said it, he was sure he was giving her the grandest compliment.

I had been giving him, per her orders, Fentanyl 50-100 Mcg IV for pain. He could have it every 3 hours. Normally it would have made other patients sleep for a while. He was not sleeping. He was crawling out of bed, yelling, and requiring me to be in his room ALOT. I had 3 other patients so this was not that easy. She had me begin using Ativan to see if that would calm him. Two mg would calm him, but only for a short time. She decided to put a request in for a med psych bed and we were going to transfer him once there was a bed available. Well in the middle of the night this is not a quick task.

He kept complaining about his breathing and I kept talking to the doctor about it. Finally we got a chest x-ray, ABG's and some other labs. His x-ray didn't come back too bad but his ABG's were all jacked up. The doctor stated to me that if he was in ICU she would be intubating him right now. Then she said she was calling the ICU resident and they would probably intubate him and take him to ICU. She wanted to intubate him on the floor, without having the rapid response team or code team there.

While she was on her way to the room I called my house supervisor who also came because she was not going to allow anyone to be intubated on the floor without the team there. Well, short version, the ICU doctor wouldn't take him in ICU. They had 9 admits already that night and he and the other doctor that I was dealing with collaborated back and forth on what to do.

Ultimately he ended up with a 50% venti mask and alot more drugs. She said pretty much he was hyperventilating. He wouldn't slow down to breath well enough to get good air exchange. So she wanted him as sedated as I could get him without sending him to the ICU so he would breath slower and more calmly.

He ended up with the Fentanyl every 3 hours; 2 mg of Ativan every hour, and 5 mg of Haldol every 3 hours. I calling her before I gave any of it because he really wasn't going to sleep. He was calming down some but it was really hard to keept he mask on him. He kept taking it off. I was so afraid all the meds were going to catch up with him and eventually knock him on his butt! The doctor was calling me about every hour (when I wasn't calling her) checking on him. There was so much charting to do just to keep up with what we were doing with him. And then there were my three other patients.

He ended up sleeping about 45 minutes out of my 12 hours shift. Med Psych never had a bed, the meds never caught up with him.

I reported off to the day shift and apologized because he was going to be so much to handle. I recommended her getting him off the floor as soon as she could because he was really a 1 on 1 patient and this floor doesn't staff that way.

I went back to that floor 3 days later. . . . .

He was being discharged to home as I was coming on to my shift. He was a new man!!! Evidentally that day shift after I left him last, he was quiet. He didn't cause them any trouble at all. And by that next evening shift he was off all oxygen and totally alert and oriented and no longer hallucinating.

Now you tell me what causes someone to change mental status so quickly!!! I worried about him and the day shift nurse the whole time I was off that day. And within less than 24 hours he is totally a different man!!!

AMAZING, what a body goes through!! How much it can handle and how quickly it will recover sometimes. I was glad to see him going home. Not because I didn't want to take care of him again (although, it did make for a really rough night!!!), but because he was becoming more himself. He had a young daughter to go home to. He had a life. He was not an ill person before all of this. He was hallucinating and acting crazy before the doctor had me giving him all the meds, so it wasn't the meds causing him to be acting crazy. But whatever it was, it was better. He was going to be ok. He would be back to work in a few weeks after his surgical incision healed and hopefully he would have little memory of his bizzare behavior in the hospital.

Thank God for selective memory!!

Today, I wish him well as he should be fully recovered and living a full and happy life with his family, what mattered most to him!!!

Is it wrong to need people to be sick. . . .?

2009-06-25T15:56:00.002-05:00

"When you're a nurse you know that

every day you will touch a life

or a life will touch yours.

-- Anonymous

Ok, so this is going to be quickie! It was jut running through my mind how a census can change so quickly at a hospital. I heard this past week that a major hospital in our city was on diversion. We received alot of admits because of this. Our census went way way up. Which for me is a great thing because I get to work. Then this week, census is way, way, way low. I have been scheduled for three shifts so far and only worked one of them. I was cancelled the other two! This is not good when you are nonbenefited!

So is it bad to want people to be sick? Because my job and lively hood depends on it?

Or maybe I should just pray that the people who are already sick and at home and refusing to get medical attention for whatever reason, FINALLY decide to show up so we can make them well!!!

THERE! That is better. I don't want people to be sick so I can do my job!!! Just want the sick people to use their heads and get help.

Good grief, I hope I don't get cancelled tonight. This is certainly messing up my sleep pattern!!! I sleep all day then try to go to work then get cancelled then up all night!

Gotta run!!! Got to get ready for work!!!

MRSA & C-Diff

2009-06-25T04:58:00.009-05:00

Have you ever smelled MRSA. . . . .what about C-Diff. If you haven't you probably have no idea what I am talking about. If you have, it is a smell you remember for life. One that goes with you in your nostils after you leave your place of employment. And the only way to rid that smell is to immediately take a shower and try to drown yourself with the water spraying from the hot-as-you-can-stand-it shower.

I walked into a patient room, knowing the patient was there because of cellulitis of her foot and diabetic foot ulcers. Also by this time it was known that she had osteomylitis. What she didn't know at this point was that she would most definatley be losing part of her foot before this hospital stay was over.

Anyway, as I was saying. . . I walked into her room and immediately smelled it. MRSA!! She wasn't in isolation yet, I guess they were waiting to get the wound cultures back to confirm what we already knew. It was MRSA in that foot! I backed out of the room and went ahead and called for an isolation cart for the room. Once it arrived I gowned, and gloved and went in to see what the smell was all about. The closer I got to her bed the stronger the odor was. I thought I was going to lose my lunch! I could see blood stains on her sheets around her feet. I uncovered them and the odor just about knocked me on the floor. There were two large wounds on her right foot. Her big toe was about twice the size it should be, and very red and the reddness was halfway down her foot. On the back side of the toe it was all black and oozing clear/pink drainage (serosangous). There was no dressing on this wound just left open.

There was another wound just below the toe on the bottom of the foot. This was about the size of a dime and I could see bone inside it. If you picture it like a bullseye, it would look like this: immediately around the opening is a thin, hard black ring, then a hard white ring, then the rest of the foot is red and hot. This wound had thick, yellowish, puss draining from it (purulent). It did however have a dressing over it. It had a dry 4x4 gauze that was STUCK to it. I took that off and cleaned it all.

I asked her what she used at home as a dressing and she said usually she got out of the shower and would dry it off and put toilet paper on the bottom one. She didn't know about the one on her toe. She didn't know it was there and had not seen it. She just knew her toe was red and hurting. So, I guess that explained why I was digging toilet paper out of that wound huh? GROSS!!!!

I put a wet to dry dressing on it because there weren't really dressing orders and I knew the podiatrist was doing to be seeing her in the morning and hopefully telling her what the plan was. She was really wanting to get home. She had no clue how serious this was. The xray showed definate osteomylitis. She was on 2 different antiboitics and she was going to leave the hospital, minus one toe.

I felt bad for her because she was in such deniel. She was non compliant with her diabetes. She didn't take her medicines at home, she didn't eat right, she had poor hygeine. All of this leading to the condition her foot was in now. AND. . . she was in her mid 50's!!!

About two hours after I did all the work on her foot, I went to help her to the bathroom and low and behold. . . . C-DIFF!!!! She had been on antibiotics evidentally just long enough to cause her to have C-Diff. Now not only did I have to smell the wound infection in the room. . . . I could smell the C-diff all the way to the hallway.

At the end of this shift. I was wishing we had a staff shower that we could use. I so didn't even want to get into my car or come into my house I was feeling so grimey! Poor lady, had to live in that room with that smell! And she was still going to lose her toe! AND. . .ALL cultures came back positive. She did in fact have C-Diff and MRSA!

Moral of this story~~~~

If you are diabetic, take care of yourself. Keep your sugars in control, take your medicine and pay attention to your skin. And for goodness sakes DON'T DRESS A WOUND USING TOILET PAPER!!!

**If you dont' know what C-Diff and MRSA are let me know. I will do a little more education in another post!

Defying Gravity!!!

2009-06-22T23:04:00.004-05:00

I recently went to see the musical Wicked.

I have to say I absolutely loved, loved, LOVED it!!! There are a couple of songs in it that have brought me to tears at times and also made me think back in my life of different times.

This particular song, "Defying Gravity" makes me think about my time in nursing school. See, many of you who read this really don't know me. Not the real me! So let me tell you a little.

I was an "OK" student in high school. Really? I did just enough to graduate, nothing more! I had a high school counselor who actually told me after I took the SAT's that I wouldn't even be able to get into a community college because my scores were so low and my grades were not good enough in school. So I might as well decide now to try something else. That was a real downer!! Actually, I don't ever remember in all my high school years ANY school counselor, acedemic advisor, teacher, or any other adult leader, telling me what classes to take or advising me on things to do to actually make it to college. No one telling me that I should take the harder courses not just the easy ones.

I decided to try college anyway. My grandmother was an elemetary school teacher and the job I had as a high school student was working in a day care. So, how hard could it be to become a teacher. I liked kids. So I thought I would try that. Maybe kindergarten, since the older kids really just mostly made me angry with their attitudes. Well, short version, I did get into the local college. I again didn't have much help putting my class schedule together and ended up with a crazy schedule of pretty in depth classes the first semester. Needless to say, I didn't do so good. I hated it actually. So I guess I proved that high school counselor right when I decided to quit school after a semester and a half!!!

Back to working at day cares and minimum wage jobs for me!! That was not going to land me anywhere fast. I then ended up in a nursing home working as a CNA for a long long long time. I watched as the nurses would get burned out. I watched as I would get angry at lazy nurses. I watched as the older CNA's would struggle with their job because of their age, yet this is what they had done all their lives and couldn't/wouldn't do anything else. I knew that I didn't want to be a CNA forever! I couldn't live on that kind of money. This is where I also decided that maybe being a nurse was for me. I wanted to be better than those nurses who were just there for the paycheck. I wanted to be a nurse who really cared.

I fianlly decided to go to nursing school. (that decision in itself is a whole other post!) I was 29 years old when I walked into class for the first time. There were many people who thought I was crazy. Many people who thought I didn't have what it took. And some who thought I wouldn't make it at all. There were also moments when I myself thought I was drowning and wouldn't make it through. Being in classes with those young, right out of high school kids who had planned for years to be a nurse and took all the biology and anatomy they could in high school was pretty intimidating! I had alot going against me at different times during my college years. I cared for a grandmother who had Alzheimer's. I also helped care for a mother-in-law, who had Alzheimer's, and I had a family! It was by far the hardest thing I have ever done. AND looking back, I truly feel that I did EXACTLY what I was supposed to do. I am EXACTLY where I am supposed to be in my life. I have no doubt about that at all!!!

I really did DEFY GRAVITY!!!

Below are the lyrics to that song from the musical Wicked. Every time I hear it, I think of how I overcame the odds and made something of myself!

(I did leave off some of the lyrics at the end, but this is the jist of it)

DEFYING GRAVITY

Something has changed within me

Something is not the same

I'm through with playing by the rules

Of someone else's game

Too late for second-guessing

Too late to go back to sleep

It's time to trust my instincts

Close my eyes: and leap!

It's time to try

Defying gravity

I think I'll try

Defying gravity

And you can't pull me down!

I'm through accepting limits

'Cuz someone says they're so

Some things I cannot change

But till I try, I'll never know!

Too long I've been afraid of

Losing love I guess I've lost

Well, if that's love

It comes at much too high a cost!

I'd sooner buy

Defying gravity

Kiss me goodbye

I'm defying gravity

And you can't pull me down

It's got to be hard being the "on-call" doc

2009-06-22T13:25:00.000-05:00

James was admitted one day before I was blessed with him on my assignment. He was a 70'ish year old man with a very distended and firm abdomen. He was scheduled for a colonoscopy the next morning so I had the previledge of administering the bowel prep. He was sitting up in a chair with his wife, son, dauhter-in-law, granddaughter and grandson visiting him , when I started my shift. I quickly went in did my assessment and got out, giving them time to visit and giving me time to see my other patients before I would be busy with this bowel prep.

He had been having a little trouble breathing when he was in bed because of the pressure from his belly. So sitting up made him feel better. I explained what the evening was going to consist of and told him I would be back in about an hour to get everything started. He had already been drinking miralax so we were well on our way with the easy part of the prep.

About an hour later I came back and was going to talk to him about the timing of the enemas and how much miralax he still had to drink, but I was incredibly distracted by the wheezing and coughing I heard from him. He had not been doing this when I was in the room an hour earlier. His face was flushed and he was freezing. His wife had 4 blankets on him.

I helped him back to bed, raised the head of the bed up so he could breath better and took his temp. . . 101.9! Great! I asked him about the wheezing and couphing and he said he just started that. I listened to his lungs and they did sound a little wheezy too. He was NPO (nothing by mouth) so all I had for the temp was a tylenol suppository. So we postpone the enema (x2) that was supposed to be the next part of the prep, and go straight for the suppository. I called the doc about the wheezing, as he also had a heart history, and I was a little concerned about fluid overload with the fluids they were giving him. We ended up with a chest xray that came back clear, and respiratory treatments.

I no more got that order written and sent to the pharmacy, that I hear his pulse oximenter beeping. His oxygen had dropped to 82%. . . and he was already on 3L of oxygen. I called the RT (respiratory therapist) to get the neb treatments now, and put him on a 50% venti mask.

Poor guy, stayed on a venti all night long. I can't even begin to tell you how many times I called that doctor. I felt so bad for her, calling in the middle of the night but I really didn't have alot of choice. She was the one on call. However she was not the doc that had been seeing this patient, so we did alot of conversing and putting our heads together to keep this guy comfy through the night.

One of the times I called her was for a critical lab. His INR was way high. So high that I knew they would surely cancel the colonoscopy scheduled for the morning. Then by 6:00am (my shift ends at 7:30) his blood pressure was dropping. I had to call her yet again, because it was below the call orders. I also inform her that this patient has been getting fluids all night and has not urinated. We did the enemas, but had no results, and his belly is bigger than it was when I started my shift, AND his face is a little puffy, and his arms are a little puffy (they weren't this way to begin with). By this time the wife is getting a little freaked out. The on call doc simply said, Dr. Surgeon (who was his admitting doc) will be in in a couple of hours. See what he wants to do.

I go to inform the wife that I am sorry, we will have to wait for Dr. Surgeon to get here. I let her know that the on call doc said Dr. Surgeon should be here early. She thanked me and seemed ok with this information. I however felt terrible, my gut knew something was not right!

What I wanted to do was stop the fluids, sink and NG and get it hooked up to suction, anchor a foley and give the man some lasix. But of course I am just the nurse. . . . I had to trust Dr. OnCall and wait for Dr. Surgeon to get there.

I reported off to the day shift nurse and told her all my concerns. She then informed me that Dr. Surgeon is NEVER there before 10AM and since this is a weekend, it would probably be later. I then asked if there was someone else I could call before I left to try to get something done before I clocked out. She just looked at me with this really dumb look and said, "No, but thanks." She really didn't appear that concerned about anything I had told her.

I worried about this man all the way home. I went to sleep and woke up to get ready for my next shift still with him on my mind. Wondering what was done and was the nurse attentive enough, proactive enough, to take care of him.

I didn't work that same floor that next night. However what I learned was that the colonoscopy was in fact cancelled and Dr. Surgeon didn't come in until around 11 and took him straight to the OR. I am assuming they did a bowel ressection, but I have not heard that. Last I had heard, he was still vented in ICU. As soon as I heard the news, I went to the ICU waiting room to see if his wife was there. She never left his side since the day he admitted so I thought maybe she would be sleeping in the ICU waiting area. She was no where to be found. When my shift was over, I stopped by the ICU waiting area again, and still was unable to find her.

All the way home that morning I prayed for him to recover and for his wife to have her husband back at home with her. I have thought of them several times since then. They were a very sweet couple and I felt so bad for them and what they were enduring that particular night.

I never did fine out what the outcome was with James. This is the part of the job that is hard. I have to care for them and let them go. However there are so many that I can't let go of. They remain with me as a gentle reminder of why I love my job. This is the part of my job where I learn to have faith in God, knowing that He will take care of these people. Either way. . .

Forever Changed . .

2009-06-22T04:00:00.000-05:00

Not long ago I was blessed to care for an incredibly brave woman. Not that most of the patients I care for aren't brave but this one was different.

She came to the ER because she was "turning yellow". She was in her 80's had already suffered and mostly recovered from a stroke a few years earlier. She had just a few minor residual effects from that stroke. In the ER they did a scan, admitted her to the general med floor where she stayed for 3-4 days. She learned during this stay that there was a mass on her pancreas. Not only was there a mass, but she had cancer, it had already metastasized to her liver and basically she was told there was nothing they could do for her. She was not a surgical candidate and really it was too far already to start treatment.

The family all gathered around and took shifts staying 24/7 with their mother as the doctors worked to find ways to improved her quality of life. To see if there was anything that could be done. They changed her to a DNR, and were making plans to take her home to die at home.

Issues. . . her INR was off the charts!! I am not sure I have ever seen one this high. We were giving her Vitamin K to help reverse it and decrease the chance of spontaneous bleeding, but it was not working. After several doses of Vit K the INR results were left unchanged. Her liver was not functioning enough to make the clotting factors needed to bring the INR back down. The original plan was to get the INR down and send her home.

The night I cared for her, was crazy. I had the Resident on speed dial and he spent many hours talking to the family, and on the phone with me. The patients IV went bad. We were giving her fluids to help with her blood pressure because it had been so low, she was also receiving antibiotics through the IV. I pulled the bad IV with the intentions of starting a new one, however that didn't work out. When the bad IV was pulled, the bleeding started. I held pressure on that spot for literally one hour! That is not a good thing when you have 3 other patients on your assignment. I called for help from another nurse who tried to start another IV while I held pressure on the bleeder. He tried twice to get the IV and both times the vein would blow then more bleeding. The doctor was called about the IV site problems then came questions from the family. I spent many hours at the bedside of this sweet lady. Comforting her, answering questions and trying to help them make sense of this sudden diagnosis and what to expect. They were a very attentive family. They loved her very much and that was evident. They wanted to make sure we were doing everything possible. They were fine letting go if that was the only option, they just wanted to be sure. They were scared, and I could certainly understand that.

She didn't get much sleep that night. It seemed there was a reason for me to be in that room at least every hour. Then when morning came and it was time to check vitals again, her blood pressure was 70/40. At this point I again called the in house Resident. We both thought there was probably internal bleeding going on. It only made sense. When the patient saw this blood pressure on the Dinamap, she looked at me as serious as could be and said, "I'm dying aren't I?"
HOLY COW!!! What am I supposed to say to that? I sat on the corner of her bed, held her hand and as gently as I could I told her the truth. That is what she wanted. I told her that the blood work was not good. I explained about the INR being high, I explained that the blood pressure wasn't good but that we were going to see if we could get it up. I also told her that as she knew the prognosis wasn't good. This was not new news to her. However I didn't think she was going to die today. Her daughter looked at me with tears and asked if they needed to get her other children in town. Some of them lived out of town and even out of the country. I told her daughter that it would probably be a good idea, however I nor the doctors would be able to tell them when she would die or how long she really had. That was up to someone much bigger than us. The patient squeezed my hand and thanked me for being honest with her. She said she already knew all of this but still felt she needed to ask.

My heart was breaking. She was so sweet and was so brave. She laughed and joked and told stories and treasured the time she had with her children. If she herself was fearful at all she certainly didn't show it. At one point all the family had stepped out of the room for one reason or another and the two of us sat on in the room, just us, and I prayed with her. I prayed that God would give her strength, that He would ease the pain she felt and keep her at peace with what was before her. I prayed for her many children and grandchildren that they would be able to handle this journey as well. That they would hold on to all that was good about their mother. We together prayed for safety for the children that were traveling. I could tell this was difficult for her, however she faced it with such courage. Not letting on that if there was one ounce of fear.

She went to the inpatient hospice unit the very next day. She knew she would never again see the inside of her home. She knew that this was where she would spend her final days with her children and grandchildren by her side. She was resolved that this was what was left of her life here on earth.

She lived about a week longer. Honestly, it was a week longer than I expected. She passed peacefully with her family at her side. She savored all the moments she could with each of them until God decided it was time.

I will never forget her smile. . . her courage.

I go to work thinking that I am there to help my patients, to care for them and hopefully bring some form of healing to their lives, their bodies. What I learn is, that most days, the patients that I care for are really bringing some form of healing to me. I take a piece of them with me at the end of my shift. Whether it be the patient who is dying, the one who has tried my very last ounce of patience, or the one that is a simple post op that will stay 24 hours and go home. I learn something from each of them. And, my heart is forever changed. . . . on a daily basis!

Uninterested. . . .

2009-06-22T00:27:00.002-05:00

I have been tagged by Deanna over at Mops and Pops Place.
I am to identify 6 uninteresting things that I love and then pass this task on to 6 others. This is not as easy at it sounds. I think my life overall is pretty uninteresting and how fun is it to share uninteresting things with people who don't know you well, ya know like all 12 of you who actually take time out of your busy day to read this blog.

So I guess here goes. . .

1. I love to people watch - I could go to the mall and sit there for hours on end just watching people. I don't really like to shop so sitting on a bench would suite me just fine! You can learn alot about a person just watching.

2. I do love spreadsheets (not that I like to admit it - so let's just keep this between us ok???) - keeping a list and putting things into a spreadsheet keeps me organized. Sometimes it is the only way to take what is twirling around in my head and make it make sense. I have done a spreadsheet for house cleaning, for how to care for our dogs, for our finances, for vacation planning, for items needed to be purchased (when we were building our house), for my work schedule. . . you name it and I can make a spreadsheet for it. Most people I know think this is pretty "geeky" (is that a real word??), but it works for me!

3. I love to read other blogs - my family thinks it is crazy, and mostly a waste of time, but I love to have that little window into the lives of other people. Maybe because it takes my mind off of mine for a while, maybe because their life is a little more exciting than mine, or maybe because it makes mine look less crazy. Who knows, but I do love it.

4. Crossword Puzzles - this is a new thing for me. But I am starting to like it. . . does that mean I am getting old. I always thought it was older people who did crosswords, but I caught myself searching the hospital giftshop the other day for a crossword puzzle book that I could actually do. You know the easy ones. That is where it all started. They banned facebook from the hospital computers so on my downtime at night when all patients are sleeping and things are quiet (however we never ever ever EVER say that "Q" word outloud!!!!!). I have been working crossword puzzles. Unfortunately for me, my nights have not been "Q" enough lately to even have a chance to pee, so that book is not good and broke in yet.

5. I absolutely love love love musicals!!!!! - We own a ton of DVD's and given the choice I would rather watch a musical than any other kind of movie. And better yet. . . see it in real life! I don't think I have many friends or even family that share this same love for music and theater and I don't get to do it near as often as I would like. I could probably name every song from every Rogers and Hammerstein musical. If there was a trivial pursuit category on musicals, you would definately want me on your team! I love them! My dream (in regards to musicals) is to see a real live Broadway show actually on Broadway!

6. I check the obituaries daily - does that totally make me strange? Many of my friends would say so. However, I have cared for many many people in my career. And sometimes that is the only way to find out what ever happened to them. You can learn alot about a person from their obit. Ok, so don't think I am totally nuts or obsessed with death. I just like to be in the know. . . ya know?

This did take some thinkin' power. But now I am supposed to pass this along to 6 other people, to do the same. Please check out their blogs as I have listen them because I feel they are worth reading. I am choosing blogs I read often but don't comment on alot. I have to admit I am a terrible commenter, even though I love love love it when people comment on my blog. Guess I will have to work on that huh?

Raising My Malia

Malia,
the cutest little girl I have seen in a

really really long time.
She also gives her mama

lots and lots to blog about!!

Michelle's Path

An adoptive mom, Air Force wife, and crockpot cook.

Great recipes, stories about a sweet

brown eyed baby girl, and a woman of great

strength raising a baby while

her husband is deployed.

Our heros are our soliders AND their families!!!

Dr. Grumpy in the house

A neurologist who totally cracks me up!
Maybe because I love neurology who knows.
I can totally relate to many of his stories though.

A Five Course Meal or a PB&J Sandwich

A new blogger who inspires me every day!

She has a great positve outlook on life and can

always find the sun shining even

when there are clouds.

Go check her out and welcome her to blogland!

Call Bells Make Me Nervous

A fairly new RN working in the Emergecy Department.

She has some great stories to tell and it is so

nice to see and hear from a yet

unjaded, compassionate nurse.

Future RN

A nursing student and single mom of three children.

This alone makes her my new hero!!

A blog I have been reading but for some reason am

not able to comment on. I click on the comment link

and nothing happens. So I hope she reads this and

knows that I am tagging her and reading her

blog and cheering her on in the wonderful adventrue she is on!

OH. . and don't worry 1/5 IV starts isn't terrible!

You will get the hang of it. It is totally a practice makes perfect thing!

Ok, so go check out those blogs, show them some love and get tagging!! This is a great way to learn more about the people reading your blog and those you read. It is also kinda fun!

My Ministry

2009-06-19T15:48:00.000-05:00

No one ever said this job was going to be easy! Some days I wonder why I ever chose a profession that will allow me to be beat up mentally and sometimes physically (by those demented, detoxing, and thoroughly confused patients). That will put me in a workplace where people don't really care about the people they are caring for, they just want the paycheck at the end of the week. That will place me in a world of strange work politics. That will have me working with people who find the petty things to complain and whine about that can't see past the "small stuff" to see what is real.

Then there are those days that I remember that God truly placed me in this profession. That if it weren't for Him holding my hand and clearing my mind, I would have never made it through nursing school. That if it weren't for the life experiences I have had, that God allowed me to go through, I would not have the compassion that I have to take care of those difficult patients. If it wasn't for his constant reminder that we are ALL His precious children that keeps me from becoming totally irate with those our of control patients who abuse their nurses verbally and hit and bite and kick and yell, and, and , and. . .

I have been exhausted by work this week. Haven't been able to get enough sleep. Been surrounded by death for the past two weeks and that in itself is exhausting. I have been presented with:

1. A patient who was dying of pancreatic cancer. Who didn't even know it was there until they were admitted to the hospital. Who at one point looked at me with fear in their eyes with one question. . ."I'm dying aren't I?". Who had a 4 day hospital stay then transfered to inpatient hospice. Whose family was amazing and realistic and stayed at their loved ones bedside holding on to every minute they could get.

2. A patient who was admitted with meningitis who has had head trauma in the past and because of that was "just not right". Who insisted on taking pictures of me with her cell phone. Who was laughing hysterically one minute and screaming from a headache the next. Who was impulsive and unsafe. Who refused to bathe and was so incredibly dirty my stomach turned from the smell of the room. Who I am not sure even realized they were dirty or that there was anything wrong with that. Who put their call light on literally every 10 minutes just to make sure somene would come when they called. Who really wanted to get home to their 2 year old daughter. Who I couldn't believe actually had a 2 year old daughter. . . . . who had to have social services intervene due to mental status.

3. A patient who had ischemic bowel who was 95 years old who was dying because surgery was too risky with the other health issues. Who's family along with the patient decided to make themselves a DNR. Who's family decided that along with no CPR they still want every blood draw, every test, every intervention possible done to safe this poor person. Who is having to be stuck with a needle multiple times a day for blood work and IV starts because an IV won't stay good. Who's family doesn't want to put them through getting a central line. Who has a very large family with no less than 5-8 people in the room at one time 24 hours a day. And this nurse doesn't have the heart to tell them to leave. And this nurse sees and sense the fear in the family that this is really the end, as they hold on to everything they can to stay in control. Whose family asks the same questions multiple times during a 12 hour shift, seeking a different answer than they got the first time.

4. A patient who was admitted with venous status ulcers all over their calves. Who lives at home with home health changing the dressings daily, however the dressing were no longer white gauze and kerlex, they were brown from filth. Who, when in the ER had cockroaches crawling out of their clothes, and dead ones their body. Who refuses to go to a nursing home where they can have real help. Who has no family to advocate for them. Who had nurses practically refusing to have them on their assignment because of the cockroach issue. Who was totally alert and oriented just unable to care for themselves physically.

5. A patient who was virtually blind from diabetes, obese, and on dialysis. Who was left in a car while a spouse was shopping in a store. The heat was too much and they were brought by ambulance to the ER because they were unresponsive. Who's blood sugar was 50 in the ER. Who was mentally, not intact. Who was impulsive, out of control, and very difficult to care for. Who had diabetic ulcers on their feet that were dressed in week old dressings. Who didn't notice the stench when the dressings were removed and who couldn't feel their feet when the wounds were being cleaned and redressed. Who has already had most of their toes removed and will probably end up with complete foot amputations before it is over. Who needs to be in a nursing home instead of living at home with a spouse who can't care for even themselves. Who social services is now involved with.

6. A patient who was the sweetest thing I have ever seen. Who thanked me each time I walked into their room. Who is slowly recovering and getting better after several days inpatient. Who will most likely go home with oxygen because they can't seem to keep their O2 levels high enough on their own. Who has an incredibly outlook on life. Who is 88 years old. Who didn't mind that there were labs to be drawn at 4am. Who smiled even when I said, "Your IV just went bad and I need to start a new one." Who made my day by telling me I was a great nurse and they hoped I was back for another shift. Who made my night totally worth it!!!

Nursing is my ministry and I am OK with that. However, what I have learned over the years is sometimes it is the patients who minister to me. Even when it is a bad day, even when the circumstances of my shift may bring tears to my eyes, whether tears of sadness or frustration. Even when I don't agree with the politics. Even when I am among the cliquishness and cattiness of some of the other staff. Even when . . . . .

I know I am in the place God wants me to be. I know this my ministry. I pray that God will use me in whatever way, to bring comfort to the people I care for each night. I pray that God will use me to be an example to those few co-workers who just can't see past themselves.

This is my ministry!

Dealings with the mentally ill. . . .

2009-06-12T02:51:00.003-05:00

A patient gets transfered from an outlying hosptial at her request. In report I learn that she is refusing to eat, take medication, answer any questions or even be touched. She will not allow that hospital to treat her at all. She has been inpaitent there for at least a week.

She arrives to her assigned room, I go to greet her with a smiling face hoping she is more happy now that she is in our hospital. After all this is what she wanted. She has a very badly infected surgical wound that I was sure was going to require and I&D. I go through the whole admission process and as I am walking out of the room to go check orders and call our docs to let them know she is here, she informs me that someone has stollen her wallet. She was sure she had it with her when she got here. It only contained her insurance card, pacemaker card and driver's license. So I search her belongings looking for it. It is not there. I called the other hospital, they don't have it, I call the ambulance company and of course since it is after midnight I have to leave a message.

Later, she calls me into her room to let me know that there are two men in a black car that keep circling the parking lot looking into room. I assured her there was no one outside her window. She didn't believe me, she becomes hysterical. I continued to tell her this was not possible as we are on the 6th floor and there is no way possible a car could be driving by her window. I close the curtains and this satisfies her for the time being. The docs have not seen her yet, so I have no orders and no meds to give her to help calm her down.

Later, I am trying to start an IV and her arms are all bruised up. She has terrible veins and after 2 attempts I am unable to get the IV. I apologized and told her that with all the bruising it looked as if they had already used up all the good IV places. She looked at me with angry eyes and said, "If you had been held down by 5 people why they were trying to kill you, you would look like this too. I just knew if I didn't get out of there tonight I would have been dead by morning." I told her I was sorry, she had had such a rough time and we would see what we could do to get her IV started and get her medications going. Another nurse tried and again, no success.

Later, another nurse comes into her room to answer her call light. She proceeds to tell that nurse that her wallet was laying on the table. She said, "that nurse (referring to me) took it and put it there trying to hide it from her." What she was actually seeing was an eraser for the dry erase boards in the rooms. The nurse tried to tell her that wasn't her wallet but she didn't believe her. She actually showed her the eraser and she still didn't believe her. So at this point in the night I became a theif and took her wallet.

I was so upset that my co-workers found out about my secret wish. I had always wanted someone elses pacemaker card. I didn't want anyone to know that I was collecting them and wallpapering my guest room with them. (Please read the sarcasm in this) Really? Why would I want her wallet???

As I was leaving my shift, she was standing in the hallway with her walker. I asked her if she needed something, since she really shouldn't be up walking in her condition. She looked at me and said, "I want to go home!" I told her that she was going to be seeing the doctor today and they were going to take care of her infection. She then looked at me with very angry eyes and said, "How could you treat your mother this way? I have always been good to you and you have no respect for me!" Another nurse was approaching slowly to help me when I told this lady, "I am not your daughter, I am (my name) and I have been your nurse all night. You are at (hospital name) with an infection and are scheduled for surgery today to fix it. Let's go back into your room and we can talk about this." She then said to me, "You and your mother are trying to kill me and are going to put me in the furnace. I heard you talking about it and I am not going to let that happen!" I then looked at the nurse that came to help and told her I thought it would be easier without me. The other nurse was able to get her into her room. I just thought since she was thinking I was someone who was going to hurt her it was probably making her worse for me to even be there.

I went to tell the nurse I had reported off to about this incident, and immediately she said, "I don't have time for this today! If she wants to leave then fine! She can go AMA!" She then called the charge nurse and told her she had a patient that wanted to go AMA and wanted us to call a taxi for her.

I was so not believing my ears!!! That patient NEVER said all of that. And besides she was OBVIOUSLY mentally ill. She had a horrible infection, had not had any medications because she was NPO for surgery and had been having hallucinations through the night. Was she seriously telling the charge nurse to just let this person go???

What are our responsibilities as nurses for taking care of people? She was not really ok at that moment. She needed medication! She needed that infection taken care of before it went systemic! And this nurse was just going to blow her off because she didn't want to deal with her?

Sounds like someone needs a vacation! So I come home and worry about this patient all day. Did she end up leaving or did she go to surgery. Did someone get a psych eval? Did she finally get some medication that would bring her back to reality?
Will I ever know if she was ok or not?

This is the part of nursing I hate. I take care of you one night and then I may never know what happens to you after that.

God, please bring peace to this ladies mind. Please help the staff be patient and tolerant. Please give the doctors the compassion to treat her as a whole person and pull in the extra disciplines needed to treat ALL of her! And. . . . keep her save as she recovers.

Optical Rectitis

2009-06-10T15:15:00.002-05:00

I was getting report from the day shift nurse on a gentleman who was in his mid 50's. He had colon cancer a few years back went through chemo and all the cancer treatment. He had a bowel resection with a colostomy. . had the colostomy reversed about a year ago and now had been suffering from fistulas with infections. NOT GOOD! He also had a pretty extensive heart history and had dealt with MI's, stents, multiple cardiac caths, etc. He pretty much was a hot mess!! He was scheduled for surgery AGAIN, the next morning. So he was NPO and really because of all the other tests they had done he hadn't eaten in about 48 hours.

When we are reporting off to the next shift, we give report to the oncoming shift in the patients room. That way the patient hears what we are saying, meets the oncoming staff, and can give their input, incase there is something the nurse forgets. This makes the patient feel more like they still have some control over what is going on. It also is a great time to check for incontinence, almost emply IV bags, or other things that seem to ALWAYS get left for the next shift. Those little things that slow you down at the busiest part of your shift.

During this report when the nurse was done telling me everything, she asked if there was anything he wanted to add.

Patient: "She forgot to tell you I also have Optical Rectitis, they found it on the CT scan they did last week."

Me: "Really? (trying hard to go through my memory rolodex searching for that diagnosis)"

Patient: "Have you heard of it?"

Me: (Again, starting to feel a little dumb and not wanting to admit it) "I don't think so, at least that is not one I remember hearing about. They found it on a CT scan?"

Patient: "Well, alot of people have it, but it doesn't get an official diagnosis very often. This is because it is so hard to treat and insurance doesn't like to pay for the treatment."

Me: (still thumbing through that rolodex. . . not finding anything)

Patient: "Basically, what it means is that I have a shity outlook on life."

All of the sudden he and the day shift nurse bust out laughing! I had never heard this before and was so thankful that I couldn't find this diagnosis in my memory bank. I was so starting to feel really stupid!

Truth, he did have a pretty bad outlook on life. However, he was working on it. He had been dealt a pretty bad hand and had kept going through it all. He was really just hoping this last surgery would take care of everything, but because of past experience it was hard to believe that would happen.

By the end of my shift we were both telling jokes to each other and laughing pretty hard. I think his "Optical Rectitis" was starting to go into remission.

Were You Suprised?

2009-06-08T01:05:00.001-05:00

A very good friend of mine was working as a CNA about 15 or more years ago. It was one of her first days on orientation and the girl that was working with her sent her into a room of a gentleman that had parkinsons to give him a bed bath.

She went in and did everything by the book. This man was very alert and oriented, and she was very careful to keep his dignaty and keep all parts covered that weren't being washed at that moment. When she pulled the covers back to wash his "parts" she was suprised at what she saw. Her face turned all shades of red as she gently covered him back up and said she would be back to finish in a few minutes.

She left his room and went to find the girl who was training her. When she found her in the hallway she was standing around with a few other CNA's laughing hysterically. My friend simply looked at her preceptor and asked, "Is he always that way or was he just happy to see me?" What the preceptor neglected to tell my friend was that this particular 70'something year old man had a penile implant.

My friend had never seen one before so she had no idea what was going on. After she regained her composure she went back into this mans room and finished the bath with all appropriateness. This story became one frequently told as one of the best moments at this particular nursing home. I think she became a legend that day.

Strong Committment

2009-06-05T15:49:00.005-05:00

I love working on the surgery obs unit. Those are the patients who come in to have surgery and then go home within 24-48 hours.

I had a patient who came in for a lap chole (laproscopic gallbladder removal) and ended up in an 8 hour surgery having an open chole. It didn't work laproscopic. He had just came returned from PACU about 10 minutes after my shift started. I had just enough time to get him tucked in and do an assessment before his family started showing up.

He was a Hispanic older gentleman who spoke NO English! I speak no Spanish. So the assessment was somewhat difficult, however we made it though and were able to understand each other JUST ENOUGH. He was scheduled for vitals every 2 hours, and labs every 6 hours, so the tech and myself were in his room alot.

At one point I counted 25 people in his room. Thank God for private rooms. He was so tired from the surgery that I am sure he was not aware there were so many people there. They were all very quiet, children included, and were just standing around staring at him. I kept thinking to myself, I was glad I was not the one in the bed being stared at by my family. They were very attentive and were good to move out of the way whenever we needed to do anything. There were very few of them that spoke English so the conversations between them an myself took a while so someone could translate and keep the whole family informed of what was going on.

It was 10pm and time for vitals and labs to be done. The tech asked me if I would ask some of the family to leave because she was uncomfortable going in a drawing his labs with so many people in the room. I explained to her that I was sure they would be leaving soon as it was getting late they had children. She didn't like this response too well but I just didn't have the heart to tell them to leave.

They were not doing anything wrong, they stayed out of our way and didn't interfere with taking care of him and they were very quiet. I was torn because I know I wouldn't like that many people around right after I had surgery and because I knew he needed his rest. However, he was resting and they were allowing that to happen. I decided that I would not enforce the visiting hours that technically ended at 8pm and I would allow them to stay for a while longer.

I realized that this was their father, grandfather, uncle, brother, . . .relative. . . loved one. This was their culture. I admired their dedication to this gentleman, their concern and love for him. I was saddened by the memories I have of all the patients I have cared for who had no one come see them, no one call, no one to send flowers or a card and no one to go home to when they discharged. I was touched by the committment of this loving family. What if we all this same committment. Would there still be discord among families? Would peopel realize how precious life is and decide to simply love each other instead of holding on to all the past hurts and disappointments that are shared in so many families. Would they hold on to the disfunctions or would they let them go to care for someone who is their blood, who is their family?

This family had it figured out! It wasn't about anything other than being there and showing their care for this gentleman. This is a time when families feel helpless and this family chose to not feel that way, instead they chose to be there, just in case. So he would see them when he woke, so they could offer him a moist cold sponge to wet his mouth when woke and complained of being so dry. So they could offer a hand during his times of pain. This was their way of coping with an ill family member.

How do you cope? Do you stay away because you can't deal with it? Are you able to let go of past hurts and disappointments to be there for your family? Don't wait until there is a reason to "rally". Don't wait until someone is sick to show them how much you care. I could tell from all the love shown in that room that this was a tight nit group and that love ran deep. Show the people you care about that you care. . everyday. Don't let anything get in the way and seperate you from the love of your family. Forgive. . . .move on. . . and let it go. You never know when they won't be there anymore. You never know when you won't have a chance to change your mind and decide that family really IS important.

I thought I was going to work that night to help someone else. I thought my job was to show compassion and care for the patients I had been assigned to. What I learned that night, is that I was there to learn from my patients. I was there to be taught about the compassion of a family, about the comittment of a family and the love of a family.

Don't let another minute go by before you decide how you will treat your family and loved ones. Will you be the committed family or will you let discord stay?

Drunken fight and snow, not a good mix!

2009-06-04T15:05:00.005-05:00

AND THE NUMBER ONE REASON NOT TO GET DRUNK, GET MAD AND WALK OUT ON YOUR GIRLFRIEND, WHEN THERE IS 2 FEET OF SNOW ON THE GROUND!!!

I got report and was told about this guy that had frostbite on his hands and feet. The nurse giving me report explained what had happened then told me to have a good night. . "Oh and by the way, he is on his call light about every 5 minutes. . . see ya tomorrow!", she said giggling as she walked away.

Well that is never a good sign. I started doing my rounds seeing all my other patients thinking I should get as much done as I could before he starting calling. When I made it to his room NOTHING could have prepared me for what I was about to see. The nurse did not give me a good report, obviously! In my mind I thought this man had SOME frost bite, we were treating and would be back to normal before ya know it.

What I saw when I walked in was an 50'something year old man that looked about 70'ish. The tip of his nose was completely black, the rest of his skin was dark (kinda like age vs diabetes vs bad circulation) and wrinkly, he had not a tooth in his head, he looked to weigh around 100 pounds on a good day after a huge meal, and his hands and feet were thickly wrapped in kerlex. He was laying in bed mostly uncovered with a T-shirt on and an adult diaper that was totally open. Both of his hands, well his dressings on his hands were covered in BM. When I asked him what had happened he looked at me like I was from another planet. He saw nothing wrong with the way his dressings looked or smelled.

I got him cleaned up from the mess, changed his whole bed, and started to undress his hands. What I found under his dressing made me want to throw up. His hands, BOTH OF THEM, were as black as cole. They were hard as a rock and he obviously had no feeling in them. They looked like if he hit them to hard on something the fingers would simply just break off and crumble. His hands were frozen in such a way that it looked like they had frozed while holding a glass. He was totally unable to move them at all.

I put the new dressings on and asked him what had happened. How did they get this way. He said he was drinking on night with his girlfriend and they started arguing. He went outside to "cool off" and smoke and the next thing he knew he was waking up in the hospital. He had fallen while outside in the snow, with no coat, gloves, OR shoes! His girlfriend was so mad and drunk herself that she left him there and went back to her house. A neighbor had found him and called 911.

He told me they were wanting to amputate his hands and his feet but he didn't want them to. He was going to go home and with all his limbs and live life as normal. I tried to explain to him that his hands and feet were too bad and wouldn't come back, they were not going to heal. He seriously looked at me and asked, "would you let them cut off your hands and feet, or would you just rather die?"

I told him that he cold still have a productive life without his hands and feet and they could get special devices to help him. He still was not interested. So I thought I would go the route of reason. He told me he lived alone. So I went that route. I asked him who was going to fix his meals, feed him, help him bathe, wipe his butt, and clean up after him. He told me he had a friend that he had been friends with for about 20 years that needed a place to live. He had been homeless for some time. "If I let him live with me I am sure he will do all those things", he said. All I can say is that is ONE GOOD FRIEND!!! I am not sure I have a friend that would put up with my attitude (if it was like his), let alone wipe my butt and feed me and be at my beckon call.

I then proceeded to tell him that the hands and feet would not get any better, they would eventually become infected and probably start falling off at home. He was still very determined to go home that way. Not to a rehab or nursing home but to HIS home. Then he said, "all I have to do is find out where this friend is and tell him he can live with me, but I'm not sure where he is."

He did end up going home after about 4 more days in the hospital. I don't know how much help he had at home since I only took care of him that one night. What I do know is that he was back within a week getting both hands and feet amputated. Then he did in fact go to a rehab center of some sort. I have no idea where he is now. Hopefully he is living life, no drinking, and has someone to teach him about assistive devices to help him go about everyday living as best he can. He was so young to be so old. He had made a rough life for himself and I am not sure he knew he could be any better. I am not sure anyone ever told him he could be any better or that he was worth more than that. That his life did matter.

He was a demanding patient, he did make my life crazy that night. AND, I am glad I was able to care for him compassionately and be real with him about his health. I really felt like I had been a nurse that night. Not just someone who comes and checks on you, gives you pills, and does a mound of paperwork. We got to know each other, and spent alot of time talking. I think he was kinda lonely. So it was ok with me that he wanted some kind of snack about every hour and I had to feed it to him. That meant that he got to see a real person, and have a conversation and someone to sit with him for at least 10-15 minutes out of every hour.

I hope my little frostbite man is doing well today!

Lesson in this. . . . don't get drunk, walk out on your girlfriend while there is snow on the ground! Your life may never be the same after that one bad decision. . . .

Harold ALWAYS Had the Last Word

2009-06-02T19:50:00.004-05:00

Harold was in his 80's had CHF (Congestive Heart Failure), Diabetes, and many other health issues. He was a somewhat grumpy old guy. He liked who he liked and if he didn't like you, you were sure to know it.

He was very bloated, full of fluid to the point of weeping. His legs were huge and fluid would seep from his skin. He didn't want them wrapped because he was always hot. His hands and arms were the same way. He would always sit on his bed and face the window (with his back to the door) watching to see who was coming and going from the nursing home he lived in. He always had magazines and such on his bedside table and a radio in his window sill that would play country music. He usually played it pretty loud, upsetting the other residents who lived in the rooms close to him. However, he was so grumpy that he really didn't care that anyone was upset.

One night I was working night shift. This was many many years before becoming and RN. It was myself and one other CNA (Certified Nurse Aide), as well as an LPN taking care of about 56 people. The other CNA (we will call her Shelly) and I worked together alot. Harold was not doing well. He was in bed but very close to death. His wife had been in and said her goodbyes, but just couldn't stand to stay. So Shelly and I decided we better make a good plan for the evening. We started our first bedcheck on his end of the hall since his room was the last one at the end of the hall. We decided when we got to the middle one of us would go back and check on him then continue down the rest of the hall and then check on him again.

Well, he was hangin' in there so we hurried through our bedcheck, went and checked and then when we knew he was ok (or at least still with us), we finished the bedcheck. As we got to the very last room at the complete other end of the hall, we heard Mr. Johnson yelling out. This was not too unusual. Mr. Johnson lived in the room next to Harold and had an ajoining bathroom. Mr. Johnson had dementia in a bad way, was on a low bed (about 6 inches from the ground) and would usually start yelling out when he had fallen out of bed onto the soft mat that lay beside his bed. So, Shelly and I went to put Mr. Johnson back to bed, except when we got to his room, he wasn't on the floor. He was in the bed. And he didn't quit yelling when we got there. I looked at Shelly and said, "We better go check on Harold."

Sure enough as soon as we got to Harolds room, Mr. Johnson stopped yelling. And Harold had passed. It was as if Mr. Johnson was trying to tell us that Harold had died and we needed to do something about it.

The LPN did her thing, called the family, the doctor, and the funeral home. Is this where I should tell you that this was the VERY FIRST person to die that I had to help take care of. See, in a nursing home (here at least), when someone dies, you clean them up and get them ready for the funeral home to come get them, or for the family to come.

Since Harolds wife wasn't coming, we had to get him ready for the funeral home. So Shelly and I gave him a bath, changed his gown, and cleaned his room, gathering all his belongings and bagging them up. We both loved Harold and he actually liked both of us. We both cried our way all the way through this process. To help make it a little easier, we turned Harolds radio on and up to help drown out some of the emotion.

When we left the room, Shelly turned off the radio and unplugged it letting it remain on the window sill where Harold always kept it. The funeral home came to pick him up and as I saw them coming out of his room I said something I will never forget. I didn't even think and had never seen this before. However, the tears started once again when I looked at the funeral director and said, "Don't cover him up that way, he won't be able to breath!" It was not until those words were out of my mouth that I realized that Harold didn't need to worry about not being able to breath anymore. However it was a good laugh for the funeral director, Shelly and the LPN that was standing right there.

After they left, Shelly and I hurried around to get caught up on the rest of our work. By this time it was time for another bedcheck. We started at the opposite end of the hall from where Harolds room was. When we got the middle we heard music and it was really really loud. We both started walking looking for where it was coming from so we could tell the resident that had it on to turn it down. It was the middle of the night and people were sleeping. When we got the the source of the music, it was Harolds room. His radio was playing! It still sat in the window, still sat unplugged but was playing. Neither one of us could believe it! Shelly checked to see if there were batteries in it, but there wasn't. She tried to turn it off but it wouldn't, it would turn down. Even when it clicked it didn't turn off. So we left it alone and it remained playing softly.

We were both quiet freaked out to say the least! Then we just decided that Harold needed to have the last say. He always needed to have the last say! So this was probably his way of telling us "Goodbye" or maybe his way of saying "F-off!" (as he would put it) to all the residents that got mad when he played his radio.

Who knows what is true. . . What I do know is that Harold will not soon be forgotten!!!

There Was An Old Lady. . .

2009-06-01T04:00:00.000-05:00

There once was an old lady who swallowed a. . .

Oh wait that's the wrong story!

What I meant to say was. . .

There once was a semi-young lady who just wouldn't wake up.

Ok, so really. . .

There once was this 70'ish year old lady who had been fine all day long. I actually don't remember what she was initially admitted for but I do remember her vitals were fine, she was up walking around in her room all day and in good spirits. I had not needed to call any docs on her that shift. Nothing abnormal.

Nothing that is until after lunch. I went into her room and and she was taking a nap. At least I thought she was taking a nap. I needed to do an assessment and check her vitals so I tried to wake her. She wouldn't open her eyes and didn't move at all. She was still breathing but that was it. . no response to verbal stimuli, no response to gently shaking her arm, no response to me lifting her very limp arm and letting it fall to the bed, no response even to very hard nailbed pressure on her fingernails and toes. I proceeded to take her vitals as I called for another nurse for back up. Vitals were all normal.

I called the doc who just happen to be a few rooms down. He came and tried all the things I had already tried and still no response. He then called her by name and told her she needed to wake up or he was going to pinch her. Still nothing. He proceeded to pinch her right in that crease between your chest and your arm, right at the armpit area. Still nothing. He did a sternal rub and again. . . nothing!

He motioned for me to leave the room with him and go to the hall, which I did. That is when he told me he thought she was faking. He then told me what he was going to do. I tried to talk him out of it but he promised it would prove she was faking. He explained he was going to raise her arm above her face and then let go and let it drop. All I could say was, "Are you sure? What if it lands on her face and it breaks her nose? I don't have time for a bloody nose! How will you explain THAT to the family?" He assured me that would not happen, but IF it did, we would deal with it.

We go back into the room, all the while I am holding my breath. He talked to her, did another sternal rub, pinched her again, then proceeded to pick up her right arm and hold it over her face.

Then. . he let go. . . .

Sure enough it dropped and landed right on her CHEST!!!! He was my hero for the day. No bloody nose. She still did not open her eyes, or respond in any way.

I guess she had acted out quiet a bit the day before, which SOMEONE, forgot to tell me in report. They had already been trying to decide if she needed to be transported to med psych for evaluation. So he is on the phone at the nurses station trying to get a psych consult. I go into another room and do a few things to catch me up since this is starting to take a while. We meet back at the desk approx 5 minutes later. He tells me to just let her be and to turn the bed alarm on. Psych consult has been called and someone will see her that day. He is still charting in her chart while I go to turn on her bed alarm.

I get to her room and the door is closed. This struck me as odd, as I didn't remember closing her door. This is not common practice, especially with patients in her state. I slowly try to open the door but cannot. I then try to push the door a little harder but still it won't move. He sees what I am doing and comes to help. The door is definatley blocked by something. We both try to push the door, it moves a little and she screams. Immediately we both stop, not knowing what is on the other side of the door. Maybe she fell or something and opening the door this way could make it worse.

We called security because she is still screaming and they are going to help us get in the room safely. Security comes pretty quickly and they try to talk to her through the door. She screams back. They tell her to move away from the door. She doesn't. They push and slowly whatever is in front of the door is allowing them to get the door partially open. . . then all of the sudden the door moves much more easily. When we get into the room she is yelling and screaming at us to get away from her. He had put a very large chair in front of the door and was evidentially sitting in it. I knew this because there was large amounts of BM in the chair, and a trail from her bed to the door. It was terrible!!

Security tried to get her to stop screaming and just sit down so we could help her and get her cleaned up. I was so afraid she was going to fall, especially since she and the rest of us, had no other choice but to walk through the mess that was ALL OVER the floor. She picked up a smaller chair and threw it at the window. Thank God for multipane glass that just won't break. Especially since we were on the 6th floor! While security was trying to talk her down, another nurse and I changed the linen on her bed and tried to get the biggest part of the floor mess cleaned up.

Security eventually got her to the bed and this poor lady was placed in 4-way leather restraints, and given a nice dose of Haldol. It was definatly time for her to take a little nap while we decided what was causing this and how to get her moved as quickly as possible to med psych where she would be safer.

This was my first experience with a patient that was this combative. My first experience with security and my first experience with 4-way leathers! I HATED IT!!!

The Haldol lasted about 20 minutes. By the time I was pushing her (in her bed, still restrained) down the hall to the elevator to go to the 8th floor, she was again screaming at the top of her lungs!!

I hated this for this lady. Put me in 4-ways and I would scream too! I don't know what caused her to act out, nor do I know what ever happened to her after she got moved.

What I do know is that I learned I loved this doc that trusted his gut enough to know he wouldn't break her nose. I also know that I have not had to use 4-way leathers since that day and I am very thankful for that! I also know that at the end of my shift I cried because my heart broke for her. What could be tormenting her so bad? What could I have done differently? What did I miss? What ever happened to her?

What I also know is . . .

There once was a semi-young lady. . . .who faked being unresponsive. . .

Why did she fake being unresponsive?

I will never know!

Now we know who kept Sears & Craftsman in business

2009-05-30T23:15:00.005-05:00

I remember when I was in nursing school and it was my patient I was assigned to who was scheduled for surgery. I was LESS THAN excited about this. . . actually I tried to get out of going with her. I volunteered to take someone else's patients and let someone else go to the OR and observe. But with everything I tried, my instructor didn't buy it. I had to go. I HATED IT!!!

My patient was an 83 yr old lady who had fallen and broken her hip the day before. She was confused due to dementia and had to lay in the bed for over 8 hours before she could have surgery to fix her hip.

I had not been through the OR part of our classes yet. I knew NOTHING about what I was getting into. I was actually "scheduled" a few weeks later to do an "observation" in the OR and a day before that scheduled time I would learn all the ins and outs about the OR so I would actually know what to expect or what I should/could do and should/could not do.

So I get to the OR with this patient who had broken her hip and the OR staff ask me to help position her on the table. So I do. I noticed all the tables full of equipment and all the blue sheets. I was so "green", I had no idea there was a section of the room that was sterile and other sections of the room that was not necessarily sterile. One of the nurses asked me to help her with her sterile gown. She walked me through how to properly grab the velcro and ties without breaking the sterile field. Then . . .in walks the surgeon. He also asked me to help him with his sterile gown. I was so nervous!!! They had told him I was a student and was observing so he was well aware I was there. I did as he asked and helped him, then moved out of his way. That is when I decided I didn't like him very much. He pretty much yelled at me for walking toward the "sterile" tables. There were so many people in the room at that time, I was having a hard time finding a place. So I was just moving out of the way. I was several feet away from the table and there was NO chance of me even touching it.

The circulator was nice enough to tell me where to stand so I could see and still be out of the way. This surgery totally grossed me out!!! It looked like the surgeon had gone into his garage and brought all his "Craftsman" tools to the OR.
They sedated this lady and laid her on her side, then put her leg up on foam type positioning devises that held it in place. They draped it and cleaned it . . then the noise started. All I really remember after that is the drilling and hammering. I can't believe anyone recovers so well from a hip replacement. The pain has to be absolutely terrible, especially after seeing the drilling and hammering.

The video below is an advertisement for a live webcast of a surgery. It is the video that I found that shows the equipment the best. I wanted you to have the visual that I had during this surgery. Pay close attention to the drilling and hammering. . . . if you have a weak stomach you might want to bypass the video and just take my word for it!

Now remember the purpose of the video is to show the hammering and drilling. This is not exactly the method I observed that day. They actually had a drill with a really long drill bit on it, kinda like what you see in horror movies. They totally removed the head of the femur and drilled down into the middle of the femur. Then hammered in the joint hardware. Once completed it looks something like this picture to the left.

The picture to the right is very similar to the hardware that was placed in this ladies hip.

The entire surgery lasted maybe 2 hours. I was amazed at how the body can hold up for a surgery such as this and how well the good bones can hold up with all the trauma they go through during this surgery.

I admire anyone who goes through this and makes it out on the other side and still has the ability to go about everyday life virtually uneffected.

I also learned that I DO NOT want to be a surgical nurse!!!

To Seize or not to Seize. . .

2009-05-29T04:00:00.000-05:00

Do you ever wonder what some people are thinking when they come to the hospital? I know most people come because they are sick and need "special" attention, but there are those few who come for routine tests that require inpatient stays.

Those are the ones who have the best stories. The ones I will never forget but at times wish I could. (Some of those will have to be for another post)

One of the hospitals I have worked in had a special video EEG unit. This is where people who had seizures would come spend up to 5 days hooked up to an EEG monitor. They were allowed to move about their rooms (only in the presence of the nurse, they are considered a "fall risk" because they have seizures), but they cannot leave their rooms. They have electrodes attached to their head 24/7 for the entire hospital stay. They have to wear button up shirts because they can't have anything that goes over their head, it would mess up the electrodes. Actually because of all the wires they wouldn't be able to get the shirt off. The wires from their head attach to a portable box that has a cable that is attached to the wall. So they are literally attached to that room.

These patients actually sign a waiver stating they are aware that EVERYTHING in the room is audio and video recorded. The only time they are not on video is when they are in the bathroom and at that time there is a nurse standing right outside the bathroom door.

So you can only imagine how wonderful it is to be the nurse of these patients. Sitting in a control room watching computer screens and being able to see your patients and their visitors at all times. Now, these are normally "healthy" patients. They don't really need alot of typical "nursing" care, like other hospital patients. So the nurse is not in and out of the room as much.

The funny part comes when there are patients who for whatever reason feel they need to fake a seizure. I remember Joe, who was a post-op patient. He frequently came to this unit after any surgery. On the particular shift that I was working Joe was comfy in his bed and asleep. I was sitting watching the monitors. The next thing I saw made me and the EEG techs just simply laugh. . .

He reached for his "seizure button" (the button the patient pushes when they "feel" a seizure coming on). This button sets off alarms, marks the event on in the monitoring equipment, turns on lights in the room and turns of the TV in the room.

Joe then used one arm to cover his head and then started to shake in a seizure like fashion. We could tell by the monitoring equipment this was NOT a seizure. So no one really ran to the room. About 20 seconds later, we see Joe peaking out from under the covers to see if anyone is coming, then he covers his head back up and continues the seizure like shaking. We go into the room and Joe won't stop shaking, won't respond to us, proceeds to urinate in his bed, then slowly stops shaking, rolls his eyes around and then lays there still and virtually unresponsive. Joe has just "faked" a seizure. He didn't "wake up" for about 30 minutes afterwards and stated that he didn't remember any of the event.

He did this same seizure like activity 4 times in 2 days that he was hooked up to the equipment. None of the seizures were real. Joe eventually ended up with a psychiatric consult and was moved to a regular post-op room.

I will never found out why Joe faked the seizures. I do find it interesting that they are aware they are on video and do such a poor job of acting.

I have many stories about these patients and would love to tell you more, however it would make for a long long post. So I will save them for another time.

Moral of the story. . . if you are going to fake an illness, make sure you read up on it first and maybe even practice so it doesn't look so fake. If you are willing to pay or have insurance pay for a hospital stay for a fake illness, make it a good show!

FOR THE BIRDS!!!

2009-05-28T16:40:00.003-05:00

I know . . It has been over a week since my last post! Ha! This sounds like a confession. I am not Catholic, but I feel like I am waiting to hear how many "Hale Mary's" to do.

I don't have anything exciting to write about right now. I am kinda having a little "writer's block" or something. Maybe someone could make a suggestion. . . .?

I do have some pretty good stuff stirring in the background but I am waiting on all the information to get here. I am working with a Mother of a small child to write some of her story here. It is amazing! So you will definatley want to stay tuned for that to come around.

I am starting to feel the sting of this horrible economy! And it is not making me very happy! I work at a pretty large hospital in my town. There are actually several large hospitals to choose from and I like this one pretty well. I have worked here for a long time. I am currently in the "float pool". This means that I am not benefited, I get paid more, I pick my own schedule as long as I get at least 36 hours scheduled a week, and I have to work 2 weekend shifts a schedule. So, I usually work every other Friday night and still have my weekend to play. In the "float pool" I call in to the hospital 1 1/2 hours before my shift starts and they tell me what unit I am working that night. I can work just about any unit in the hospital with the exception of: Pediatics (YUCK!), ICU (don't want to anyway!), Maternity (NOT FOR ME!), ER (too many crazies), and OR (don't want to stand in one spot for that long!). So pretty much it is basic med/surg, neurology, cardiology, cardiovascular/pulmonary vascular, respiratory, infectious disease, oncology, hospice, womens surgery, general surgical, and med pysch. Pretty basic really.

Here is the catch. . . .

If the census in the hospital is down, the "float pool" are the first people to be cancelled. So for the past few weeks, I have been cancelled at least one shift a week and sometimes two. This is not good on the paycheck as these days are unpaid.

What I am learning is that the floors are keeping their overtime people and telling the staffing office they are on numbers and don't need us "float pool" people. So we get cancelled while someone else is getting overtime and sometimes bonus pay for those shifts!!!

I also just learned that there are some people who take a lesser pay and are benefited in the "float pool". These people get the shifts before us non-benefited people do. So tonight I got canceled because there was a benefited "float" person who took my spot.

Now, I keep hearing about this nursing shortage and I have even posted about it previously. But I have to tell you, I am not sure that the shortage is as bad as it seems. I have been looking, for at least the last month, for some supplemental income. Thought about doing "float pool" at another hospital on a part time basis or doing some PRN at another hospital. I have at least 4-5 hospitals to choose from in my area. I get online and ALL they are hiring for is FULL TIME in the ER, PEDS, NICU or ICU!! All four of which I HATE! I could easily go work at a nursing home for around $22/hr, however I would have to do med passes and medicare charting on up to 35 people. I was in administration for a nursing home for about 9 months and it was scary how the state regs were so lenient when it came to ratio. That is not even safe!!!

So, I guess I would ask all you other nurses out there, what is is like in your area? How do you earn that supplemental income? Are places hiring in your area? What about agency or travel nursing? I don't think I would want to travel for weeks on end but a day or two here and there wouldn't be bad. . . maybe?

Leave me a comment and give me your input, suggestions, or what you see happening in the nursing world.

This getting cancelled and not paid is for the birds!!!

Mr. Cunningham Goes Home

2009-05-14T13:39:00.006-05:00

I had just taken Mr. Cunningham his evening medication. His brother had been in from out of town visiting, he came several hundred miles just to visit his brother who had been in the hospital for about a week now. Mr. Cunningham came in with dehydration and a UTI. He was on the mend however during the stay they found prostate cancer. It was not advanced and at this point treatable. The prognosis was pretty good. This man was 70 years old they were giving him several more years if he did the treatments.

When I gave him his medication, we had a conversation about how nice it was for him to see his brother. He hadn't seen him in several years and he was touched by his brothers devotion. Mr. Cunningham was in great spirits and was looking forward to his discharge tomorrow. His brother would stay another week and they would spend time together while Mr. Cunningham was home and they could enjoy each other more.

I left Mr. Cunninghams room, went back to the nurses station and began "speed charting". It was the close to the end of my shift and there were several things left to chart and orders to check before the next shift arrived. I had not been out of Mr. Cunninghams room 10 minutes when I saw his dinner arrive. Mr. Cunningham was pretty self sufficient. He was stong enough to and able to walk the hallways alone, as he did earlier in that day. He didn't require help with his meal and knew to use the call light if he needed anything.

Another 5 minutes pass, and I receive a call from telemetry.

"The patient in room 3215 just haed 15 beats of VT", the person on the phone informed me.

"Ok, I was just in there and I will go check on him right now"

His room was not even 40 feet from where I was standing. I hung up the phone and started walking, pretty quickly that way. My phone rang again, this time I heard. .
"Now it is sustained VT". Ok, now I am running. I was in the room before I even hung up the phone.

"CALL A CODE!" that is all I could get out of my mouth. There were several nurses at the nurses station and they saw me begin to run. Now, when you see a nurse running there is usually another one not far behind. Even if they don't know why they are running, a running nurse means trouble somewhere, so it is kind of an unwritten standard that someone follow just in case.

Mr. Cunningham was laying sideways across the bed. All 100 pounds of him totally sideways. I tried to get him to respond but he didn't. He did have a pulse, a very very fast one, but I could feel something. He was breathing really really shallow but at this point still breathing. We got him in the bed right, put oxygen on him and I hear what I believe must be a heard of elephants coming down the hallway.

Yep, you guessed it. . . I worked in a teaching hospital. Residents come out of the woodwork for a code. They immediately go him hooked up to the cardiac monitor and began compressions. Respiratory therapy attempted to intubate. This was my second code as a nurse and I was totally not into this at all!!! I had more nurses helping me than I knew what to do with. Administration came to help, someone recorded, someone else pushed meds, RT finally got him intubated and the residents took turns with compression. More residents worked together to get a femoral line. I stayed at the end of the bed, answering questions and telling the other nurses what we needed, so we had a runner for more equipment if necessary. I couldn't believe my eyes. He was just fine 20 minutes ago!!! He was chatting with his brother and ready to go home tomorrow. Now. . . it doesn't look like he will make it. I began to silently pray. I prayed that God would give him more time. More time to spend with his brother. That was all the family he had. Then it dawned on me, we didn't have a phone number for his brother. He was planning on being back tomorrow, but the only number we had was a neighbor. That was his emergency contact. I wispered this to the nursing administrator who then worked with social services to find a way to contact the brother. He had not even been gone 45 minutes probably.

They worked on Mr. Cunningham for over an hour. Shift change took place. The other nurses went back to their patients, nursing administration stayed to help me and everyone went about their scheduled tasks. I stayed. I stayed because he was my responsibility. I stayed because, I was afraid to leave. I stayed even after all the residents and ICU docs left and went back to their living and breathing patients. I stayed to get Mr. Cunningham ready for his next journey. The nursing supervisor helped me clean the room and get the paperwork done. She helped me get him cleaned up and we called security to take him to the morge to await his brother.

My heart broke that day. He was so sweet and so full of life that day. He knew he was going home. He looked forward to the time he was going to spend with his brother. He was on the mend and there was no warning. None at all!! I am very confident we did all we could for him and at the same time, no one wants to lose a patient. Tears fell to the floor as I picked up syringe wrappers, central line kits, empty medicine viles and threw them away. This was all the evidence left in this room that proved there was once a valuable life eating dinner here.

I cried all the way home. I prayed that Mr. Cunninghams brother would be found BEFORE he came for his visit in the morning. I prayed that he had someone besides Mr. Cunningham in his life to give him support.

Mr. Cunningham was so excited to get to go home, and I am not sure he realized at that moment exactly what that meant.

Mr. Cunningham went HOME.

Will You Be My Grandpa?

2009-05-12T04:00:00.000-05:00

I spent several years working in a nursing home as a certified nurse aid. This was a great time in my life. It is an extremely hard job physically and can at times be hard on the heart. I loved each resident I cared for, even the most difficult ones who didn't want to be there or want us taking care of them. This is where I learned about adopted family.

I had several adopted grandparents during this time in my life. I remember one gentleman in paticular, Mr. Smith. He had a very poor memory, he had sons and grandsons and a wife. His wife was very diligent in coming to see him as often as she was able. He was a farmer, he was sure his farm was across the street and he would sit at the window "supervising" the men who worked the field. His son and grandsons came occassionally but it appeared they spent time working the farm and visiting with their mother and grandmother. Mr. Smith had suffered a stroke. He was unable to feed himself and unable to walk. He was reliant on staff to meet his daily needs.

I took care of Mr. Smith every day. I would bathe him, dress him, shave him, feed him, lay him down for naps, talk to him, listen to him, and at times cry with him as he would talk about his wife whom he missed and his farm and life before the stroke. He had what we called "emotional incontinence". One minute he would be laughing the next minute he would be crying and many times the emotion was not appropriate for what was really going on. For example he might cry when it would be more appropriate to laugh.

I remember when Mr. Smith stopped eating. He would not eat for anyone else but me. He kept saying he was tired of the nursing home food. He wanted something better. Because he was on a ground diet there wasn't much we could do to help him. Then one day I got an idea. I went to lunch before the residents would eat and on this particular day I went to taco bell. I got him a burrito with refried beans, cheese, onions and the "fixin's". When it was time for his lunch. I opened up that burrito and fed him only the insides of it. He wasn't able to eat the tortilla. He immediately thought he was in heaven. For the next several weeks, he would eat either a fish sandwich from McDonald's or a burrito from Taco Bell every day that I worked. And on some days when I didn't work I would still bring it to him. He was loving to eat again and was gaining weight.

The evening shift staff began to get angry with me. They had to feed him dinner and he wouldn't eat for them. His wife decided that it was ok, if he didn't want to eat dinner. He was getting calories and still gaining some weight just be eating what I was bringing him during the day. His health was deterioating so it really didn't matter what he was eating as long as he was eating. He was enjoying it and that is what mattered, at least to his wife.

The day that Mr. Smith passed, was a sad day for me. I felt I had lost a grandfather. I had cared for him and loved him like family. He was so sure I was going to marry his grandson. The funny thing is that his grandson was about 10 years or more younger than me. But Mr. Smith didn't care. He just wanted to bring me into his family.

Mr. Smith was a special man. Someone who touched my heart and blessed my life. I only hope that I gave to him as much as he gave to me.

In my mind that is what nursing is all about. Caring and compassion!

HAPPY MOTHER'S DAY!!

2009-05-10T04:00:00.000-05:00

Happy Mother's Day!!!
The celebration of Mother's Day goes all the way back to the ancient Egyptians. They held an annual festival in honor of the goddess Isis. Isis was regarded as the Mother of the pharaohs.
So, as you see, Mother's Day has been around for centuries. I find it sad that once upon a time people and society would celebrate goddesses and symbols rather than actual Mothers.
What I have learned is, the personal touch of celebrating Mother's Day is a somewhat new thing. It has only been in the last few centuries that celebration on Mother's Day actually turned into celebrating the woman who gave you life. The one who cared for you as a child through your adulthood.

Being a mother doesn't necessarily mean you have to have birthed a child. There are many ways to become a mother. One could become a mother through adoption, surragacy, fostering, loving someone as a "mother" would, or any number of ways. Being a mother means you care with your whole heart. You love unconditionally, forgive always, nurture, teach, guide, nurse, your child (as well as many other things). You do this from birth (or the time they become your child), until death. There is something in your heart, your soul even that won't allow you to not love this child, this person who calls you "Mom". You would give your own life for them. You would sacrifice your own happiness at times for their happiness. It is part of the nurturing part of being a mother.
You are happy when they are happy, you are sad when they are sad. When their heart breaks into a million pieces so does yours. Only your heart is breaking as you help pick up the pieces of their heart and gently hold it in your hands, and love it back together again. You give your child wings to grow and learn. You watch them make mistakes, sometimes really big ones. Then you are there to help them out of their mess. How ever many times it takes. You stand your ground, and have standards, and at the same time balance the love and affection you feel for them. You hold your breath with each step they make, praying they won't trip and fall. And when they do. . .and yes. . they do. . .you are there to hold their hand until they get their footing again.
Being a mother means holding them when they are crying, little and big. Wiping their brow when they are sick, no matter the age. And knowing that one day, they will move on. They will start their own lives with their own families and you will no longer be their everything. You will be the one sitting in the background silently cheering them on to the victory in life.
And in your mind you quietly pray that you instilled in them all that is important about life. All that will keep them safe and honest and good. You pray that you have been a good teacher about what it means to love unconditionally. What it means to care for someone as well as taking care of someone. You pray that one day, when you are really old and febble, they will remember all the times you held them close and wiped their brow. You silently pray that they will in your old age, come back from their busy lifes and care for you with the same love and compassion you have given to them since their first breath.

See, being a mother is not one thing or another. It is alot of things. There are many ways to become a mother. There are many ways to have children. You cannot have too many mothers, too many people loving you as a mother does.

On this day, I salute all the mother's. I want my mother's to know how much I appreciate them. How much I love them and how grateful I am that they are a part of my life. I am who I am today because of the Mother's in my life. What I have recently learned is that life is a precious gift. You never know when it will be snatched away from you. You may have one day or you may have 50 years left with your mother. Never take the time for granted. Love your mother with all your heart and tell celebrate her life today; the life she has and the life she has given to you.

Happy Mother's Day!!

Always Time. . .

2009-05-08T04:00:00.000-05:00

Sitting out side her room she suddenly bagan to cry. Not just any cry, it was a whole body shaking cry. I jumped up to see what was causing her such anguish.

Me: "Are you ok, Mrs. Kimble?"

Her: "No!"

Me: "Are you hurting?"

Her: "No!"

Me: "Why are you crying?"

Her: "Why do I have to live like this?"

Me: quickly trying to think of something appropriate to say to a dieing 90 year old woman. . .

Me: I gently put her hand in mine. . "I am so sorry, I wish I could make it better. Is there
something I can do for you?"

Her: beginning to go from hysterical cry to hysterical laugh

Her: "Yes there is"

Me: "What is it you would like?"

Her: "A new body!" as she is giggling

Me: "Ok then, I will call Sears and put one on special order, how old would you like it to be?"

Her: "Ummm, how about 50, that was my best years."

Me: "Consider it done. I will call right away and ask for expedited shipping"

Her: "You might want to order three."

Me: "Why is that? One for you one for me and a spare to put in the closet?"

Her: laughing again. . ."You are really funny! I think I want to go to sleep now."

She was 90 years old, actively dying, she was scared and woke up from a deep sleep. She then couldn't go back to sleep, instead she lay in bed thinking back over her life at all the had accomplished and all she had yet to accomplish. All she had loved and those she wished she had loved better. She was in her final chapters. This was it, had she lived it best? Had she fullfilled her "bucket list"? Did she have regrets? Was there that "just one more thing" that she wished she had done?

It is interesting to me who people see their lives when they are at this moment. Waiting on death. Waiting to leave this world, leave their bodies and go to someplace better. Someplace we have heard about but have never seen. It is at this moment when people start realizing how messed up their priorities were.

What was important?

Was it the job that took them to the top? Is that how people knew them? Was it because you were president of the PTO and attended ALL the funtions at the school and hid behind your child's identity? Was it your financial status? Were you the one with your name posted all over every charity in town? Is that was defined your life?

Or. . .

Was it that you were kind, gentle, loving. That you gave to others wholeheartedly without expectation. Was it that you chose to spend special days with your children even if they are grown showing them you love them by giving of your time instead of with gifts and money? Are you the person who will go out of their way to help a friend, to listen to a stranger who is standing in the grocery store and just needed someone to talk to for 5 minutes? Was it important that that you were a relection of the love of God? How important was it that people in your life new how important YOU were?

This time will come for all of us. Who will you be? Is there still time to make each moment count? Is there still time to show the people who are most special to you, how much you love them. Is there still time, for you, to change your priorities and put what really counts first?

Only you know those answers. . . . this is your time to reflect. Make each moment count, make each day count. Because when it is your turn to be 90 years old, who will be holding your hand ordering you a new body? Hopefully, you have people in your life that love you enough to hold your hand through the end, no matter how long from now that is.

There is ALWAYS time!

Nurse or Family. . . .Which Role is First?

2009-05-07T05:00:00.005-05:00

Today I am not a nurse, today I am a family member. Today I am on the otherside of my job. Someone I love very much had a major surgery. She is in the ICU currently and I am learning how it feels to be a "family member" instead of a "nurse".
Today I am not sure how pleased I am with my place of employment. There are things that have occurred that to some could be considered trivial, however to me they are important. It is my loved one this time that is laying in a bed, intubated and unable to communicate. It is my loved one who is in so much pain that she can't catch her breath and suddenly feels she might hyperventiliate and yet there is nothing she can do to stop this process. It is my loved one who is waking up from anesthesia and feeling sufficated by the tube that is in her throat and looking scared and feeling like no one is listening to the body language of fear, and yet because of this tube unable to make words. Unable to communicate verbally that she feels like she is smothering.

I watched an experienced nurse train a "baby" nurse today. It was refreshing in the beginning to see the experienced nurse being ever so patient and playing everything by the book. Then as my loved one began to wake up and start to feel the pain from surgery and begin to feel the need for the tube to be removed from her throat. I became a little concerned about the "baby" nurse. Baby nurse was doing a great job, however the tube was causing a feeling of panic and it was MY loved one who didn't feel like she could breathe. They FINALLY decided to extubate her. "Baby" nurse began first with the OG (orogastric tube) that was hooked up to suction. She ever so slowly began to pull this tube out. I understood being cautious, however what I didn't get was that when she got to the "gag" reflex she moved even slower. From the outside looking in, it appeared she was wanting to suction as she went, removing all unwanted saliva while removing the tube. She took a while to get this tube out. Once at the gag reflex she lingered, just suctioning. My loved one came up off the bed, gagging, feeling like she might vomit. My heart ached for her. She had just been cut open, I am sure this is causing unnecessary pain. I felt as if my hands were tied. I just wanted to scream at them. I am not by any means an ICU nurse. I have never seen someone extubated before, however they were nice enough to let me stay, to help keep her calm. She really wanted those tubes out!!!
At another point as she was waking up and coming out of the anesthesia, my loved one began to feel the REAL pain of surgery. She would moan with each breath. The older more experienced nurse proceeded to tell my loved on that she should "stop moaning, she was going to scare all of her family." I am so thankful at this point there was another family member in the room that was a nurse. I was not the only one TOTALLY offended by this comment. The other family member spoke up and told my loved one she could moan as much as she wanted, we understood she was in pain. I can't believe this older experienced nurse even said that.

Where is the compassion? Is it just me or does this senerio not seem right. If you are in pain, who has the right to judge that and tell you to lay there and not make noise? She was in obvious pain!

Today, I am not happy with my place of employment. Today, I question the integrity of some of those I work with. Today, I am not liking being a family member. Today I am learning to be a better nurse. Today, I am embarassed to say these are my co-workers. Today, I am family first, nurse second. Today, I have been fearful of the outcome of my loved ones illness. Today, no one has seemed to check in with us as a family to see how we were coping with this sudden illness. Today, I am sad I work with nurses who have seemed to have lost their compassion.

Today, my loved one had surgery. . .

Wordle Wednesday

2009-05-06T05:00:00.000-05:00

Not A Hunka Burning Love!

2009-05-05T05:00:00.001-05:00

Decadron, is a drug that can be used for many things. It is a steriod and is often times used as an anti-inflammatory, however it can be used during chemotherapy as well as to help control post-operative nausea.

There are several things I have found in common with people who are on decadron. We monitor their blood sugar, even if they are not diabetic. It can increase their blood sugar during their hospital stay and require small doses of insulin to correct this. It is important to keep the blood sugars down to promote healing. Also, these patients seem to be very hungry most of the time.

Something else I have found in several patients is that when it is given IVP (intraveneous push) it causes perineal burning. For those of you who are not familiar with the term perineal, according to websters it is: the area in front of the anus extending to the fourchette of the vulva in the female and to the scrotum in the male.

After doing some investigating, it appears this is happening when this medication is pushed into the IV too quickly. It should be pushed 1ml over 2-3 minutes. That is a long time if you are the one pushing the medication, especially if you have other patients to give meds to. However, let me tell you, it is a good thing to do, take your time and use all 3 minutes. I have seen women cry over this burning sensation it causes. I have yet to see or hear of a man complain about this. I have had women state it felt like they were on fire, felt like they were going to be incontinent (even if they had a foley), and that the burning just plain hurt. It has NEVER been described to me as a "good" burning sensation. I have watched this medication be pushed and as it is going into the IV, I have seen the patients facial expression change immediately. Suddenly they have this very confused look on their face. They want to ask what is wrong, what is happening, however they are a little embarassed to say it. Who wants to reveal to their nurse that their vagina is burning!! Especially if the reason they are in the hospital has absolutely nothing to do with their vagina!! However, they become forced to say something when they feel like they want to run and jump on a block of ice just to stop the sensation.

So I guess this is more of an educational post. Look it up, google it, remember what you read and next time you have to push Decadron, be mindful. . . .take the full time and then some. This is NOT a normal 1ml/min drug!

Do You Hear What I Hear?

2009-05-04T00:22:00.003-05:00

Did you know nurses talk alot? Well, just in case you have never been a patient in a hospital or a family member of a patient in the hospital, let me enlighten you.

During the day it is feels normal to hear papers shuffling, doctors and nurses talking in the hallway or nurses station, visitors in the hallways, carts, that despirately need their wheels lubed, moving up and down the hall, TV's from the patient room next door, who obviously has someone in there who is next to deaf, the beeping of pump alarms, bed alarms, and any other alarm that may or may not be necessary and then there is the ever so loud announcements over the intercom.

All of those sounds (noises) seem very appropriate or "normal" during the day. However night time is OH SO different. Sitting in an ICU room with a sick patient, I have heard, very loud nurses at the nurses station. I could tell you what they are doing for vacation, whose child is acting up, who is dating whom, and which doctor and patient they like the best. I actually think they have forgotten they have patients trying desperately to get some rest before the respiratory therapist, physical therapist, speech therapist, occupational therapist, doctor, or nurse actually come in and wake them up for another treatment, exercise, meal, or medication. Patients no longer come to the hospital for exhaustion. They actually leave the hospital after an acute illness and go with a diagnosis of exhaustion.

Patients are often times woke in the middle of the night to check their vitals every 4 hours and sometimes depending on why they are there, more often than that. They are woke to check their pain level and give medications, they are woke BY THE NOISE!!!

I am so suprised at what I have heard. I promise I will be ever aware of my own personal noise level from here on out! Not that I think I am a loud person, but it is something I will certainly pay attention to.

Patients need rest!! I understand they need assessed, they need meds they need therapy and all those things, but the body needs rest too. We need to be more aware of caring for the WHOLE patient and not just the illness. Florence Nightengale was really on to something with the whole patient care role she introduced. We should follow her example and see if our patients happier and recover a little faster.

I will be a better nurse because of this.

LEMONADE STAND AWARD

2009-04-30T05:00:00.000-05:00

I have been nominated for my first EVER blog award!!! WHOO HOOO!!! Thank you so so much Mops and Pops Place!! She nominated me for the Lemonade Stand Award. This award is given to "people who have a good attitude or a sense of gratitude".

The goal is to pass this award along to others. So if you are nominated you can then nominate up to 10 others. Post a link to their blog and then send them a message that you nominated them.

Here is who I nominate. . .

My Charming Kids

Bring the Rain

Michelles Path

Go visit these three blogs and congratulate them! These are three that I truly love reading! It is hard to pick people for an award. So I just narrowed it down to my favorite three.

Thanks Mops and Pops!!!

Wrestlemania

2009-04-29T18:35:00.006-05:00

I have a good friend who has been bugging me to write this post. It is a funny story, however I think it was much funnier when it happened.

On the day in question, there were about five nursing students doing clinicals on our floor. They were in their last semester and one of the students was assigned to one of my confused patients. I have to say that at the beginning of my shift I was already thankful for this. I got report from the previous shift that this sweet 75+ year old lady, was not so sweet. She lived in nursing home and had become increasing confused. They wanted her admitted for "med adjustments". In the hospital world that means that she was "out of hand" and causing trouble and they needed a break for a few days.

The reporting nurse told me how this lady had not slept all night. She was climbing out of bed, yelling, hitting the staff and pulled out her IV. The night shift was unable to get another IV in her and she had medications that she HAD to have. The doctor didn't want to do a central line because she wasn't going to be there long enough and why risk infection, right?

So when I got to her room to do my first assessment, she was in a vest restraint in bed with a bed alarm on her bed. They had already told me that had used wrist restraints to keep her IV in, but she somehow got out of those. They had also already tried mittens and again, she got out of those.

So, I talked to the Student nurse and explained the situation. She was going to have to stay VERY close to this room all day. We needed her out of restraints for 24 hours so she could be discharged and we had to get an IV in her. . .somehow. The student jumped at this. She needed to do an IV and was so excited.

Later that morning, she and another student came in. That is when the student and I went over the "starting and IV" process. She said she had done one before with her instructor, so she and I were going to do this one. Even after this lady had her medications to help calm her down, she was still pretty alert and just not very nice. So I had one of the students hold her hand and just talk to her. Trying to keep her calm. The other student was going to start the IV while I held that hand in hopes of keeping her from moving it. The lady ALL OF THE SUDDEN turned really sweet. I think she liked having her hand held. The Student who was starting the IV was very confident and ready to go. As soon as that needle hit the arm, the patient turned. She started yelling and trying to move her arm away. She had already been told what we were about to do, but like I said earlier, she was confused and demented. I am sure she didn't remember. As the student kept working, I tried talking to the lady, trying to keep her calm.

The student wasn't able to get the IV, however she was OH SO CLOSE! I grabbed a hold of the butterfly she was using and told her to trade me places. As I was leaning over her to get this IV in, this little 90 pound lady pulled her leg up and put it her foot on my shoulder. At this point I am thinking, "Ok, at least she is not kicking me, I can still do this." I told the students to just leave her legs alone. She was not hurting me and holding her legs would just make her more angry.

Now this is all happening very very fast. I am in the vein, I have a good blood return. All I have to do is flush it and dress it. As I reach for the flush, the patients leg is no longer on my shoulder. Nope, it is now wrapped around my neck!!! I was in a headlock!! All I could do was laugh, but I could still reach her IV and it was still compromised as long as I didn't have the dressing. So, the students continued to hold her hands to keep her from hitting me, and I got that silly IV flushed and dressed with a leg wrapped around my neck.

I know it is hard to believe and you have had to be there probably to see how incredibly funny it was. By the time we left that room, we were all sweating and laughing so hard!!!

The IV stayed good at least through my shift, she got her IV meds and because there were students who could sit with her, she didn't have to have the restraints. I am not one that is big on restraints. I truly believe if there is any other way, then that should be tried first! Restraints most often times, just aggrivate the patient more.

That day, I was pretty impressed with my IV skills. It is not every day you have that big of a challenge. But I was up for it that day.

I was thankful the lady was much more sweet in the afternoon than in the morning! The rest of the day went like clockwork!

Thank God for the nursing students, who learned that day how to become a WWF Nurse!!!

A Mother's Love Never Dies

2009-04-26T20:12:00.005-05:00

I have always had a love for seniors. I especially enjoy caring for the ederly who have some form of dementia. Alzheimer's is a terrible diagnosis and so sad to witness. However, I love caring for those patients. I spent many years working in long term care and several of those years were spent on a dementia unit. Since my time working in the hospital, I have become known as the nurse who would trade patients with other nurses. I would gladly take the 80 year old lady who has no clue where they are, and is climbing out of bed, all while she is forgetting that she is no longer able to walk, rather than take the 25 year old male who has just had an appendectomy. Most nurses don't understand why I would do this because the dementia patients are much harder to care for.

There was one day I was working on the dementia unit and we were going through our nightly rounding and one of the every two hour bedchecks. There was a lady who was yelling out most of the night. There was nothing that could be done to help her sleep. We went into her room and all she kept saying was "It's coming, it's coming!" She kept telling us to get the doctor. She thought she was having a baby. When we went into the room she was laying uncovered with both of her knees up, "in position". The other nurse that was working with me had already done all she could do to help her. We couldn't figure out how to get her to settle down and go to sleep. She was starting to wake up the other residents. And if you have ever worked in long term care, several people awake at one time in the night, makes for a very long night.

This lady had a baby doll that she carried around all day. This doll was laying in a chair by her bed, so the nurse told this lady to "PUSH!" She instructed her just like she was in the maternity ward. Within minutes, this sweet 80+ year old lady was handed a sweet baby (doll). She immediately stopped yelling and smiled from ear to ear. She named the baby (doll) John, held him in her arms and went fast to sleep. We didn't hear another peep out of her all night.

Now, I don't know what it was that made her yell like that, or made her think she was having a baby. What I do know is that sometimes, with dementia you just have to go to whatever space they are in and be there with them. Even though there was nothing physically, that we could see, that was even close to that of giving birth, this sweet lady believed it was time. In her mind, she was pregnant and ready to deliver and there was no one there to help her.

After she woke the next morning, I am sure she had no memory of the previous night. It was back to business as usual. The nurse aids helped her get up, get bathed and dress and fed her breakfast. She carried around "baby John" all day, just as she did every day. I don't think it ever occured to her that "John" was only a day old.

The beautiful part of dementia is that most times these patients go back in their mind to happier days. At least at some point of the disease process they do this. This lady raised many children, that is what she was really good at. She was a great mother to her children. She was content and happy knowing that she was still raising "children".

My prayer is that as those precious people in my life grow old, they will remember all that is good about their lives. When their minds play tricks on them and they have trouble remembering, I pray those memories of what was most important to them and those "happier days", will come front and center. I pray that they will live out their lives remembering all the love they shared and those who loved them as well. I pray that whomever will be there to care for them at that stage in life, will not try to make them wrong. That they will not try to bring them back to the reality that haunts them. I pray that those caregivers will have mercy, and compassion, and go to the place where THEY are, and just "be" with them. Wherever that may be.

This reminds me of Jesus. Not all people were allowed to come or well enough to come to the synagogue. That did not hinder Jesus, he went to them. He calmed their fears, healed their bodies and simply showed them love.

For more information about Alzheimer's or to find support in your area click here.

Don't "stroke" out!

2009-04-24T01:03:00.008-05:00

Have you ever known anyone to have a stroke? Have you ever been the caregiver of someone who has experienced a stroke? Many times it is not an easy task for the patient or the nurse. Once stroke symptoms start you are suddenly on a time schedule. You have so much time to get to a certified stroke center and get the appropriate medical treatment for the type of stroke you are having, to be able to minimize the mass long term effects of a stroke.

If you are having an ischemic stroke and are treated within 3 hours of FIRST symptoms you have a much higher percentage of recovering with little residual effects than someone who is not treated within this time frame. Therefore it is important to know the signs and symptoms of a stroke as well as the risk factors of having a stroke.

Some of the warning signs of a stroke include:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden, severe headache with no known cause

If you or someone you know experience the above symptoms call 9-1-1 immediately. Do not drive them yourself to a hospital or clinic.

There are two types of risk factors for stoke; controllable and uncontrollable

The uncontrollable risk factors include:

* Age
* Gender
* Race
* Family History
* Previous Stroke or TIA

The controllable risk factors include:

High Blood Pressure (Hypertension) - A blood pressure below 120/80 is considered "normal". If you have high blood pressure your heart is working harder to pump blood through your body, which can weaken the blood vessels and damage your brain as well as other major organs. Medication can be used to control high blood pressure.

Atrial Fibrillation (AF) - This is where the atria of the heart beats unpredictably and rapidly, which produces an irregular heartbeat. This causes blood to pool in the the heart and form clots. When the clots are released from the heart and carried to the brain, this causes a stroke.

Atrial Fibrillation increases the risk for stroke up to 6 times. Medication can be used to help control atrial fibrillation.

High Cholesterol - A fatty substance in the blood that our bodies make on their own. However we also get it from fat in the foods we eat.

Arteries can become clogged by too much cholesterol in the bloodstream, and lead to a stroke or heart attack. This also puts you at greater risk for heart disease which in turn puts you at greater risk for a stroke. Your combined HDL and LDL cholesterol should fall below 200mg/dL

Diabetes - In diabetes, the body doesn't produce enough insulin or the cells ignore the insulin.
Most diabetics have other health problems such as high blood pressure, high cholesterol and obesity/excess weight. These problems increase their risk of stroke even more. People who are Diabetic are at a 2-4 times greater risk for stroke.

Tobacco Use/Smoking - Smoking damages blood vessel walls, speeds up the clogging of arteries, raises blood pressure and makes the heart work harder. Smoking doubles the risk of stroke.

Alcohol Use -Drinking more than 2 drinks per day may increase stroke risk by 50%.

Obesity/Excessive Weight - Excess weight makes people more likely to have high cholesterol, high blood pressure and diabetes. It also puts a greater strain on the body in general.

Suprisingly up to 80% of all strokes are preventable! Know the risk factors and if you fall into any of these catagories pay attention to your body.

Below is a list of things you can do to help prevent a stroke:

* Monitor your blood pressure and if it is above normal range speak to your physician about

ways to help keep manage it and keep it at a safe level for you.

* If you have atrial fibrillation, take your medication and follow up with your physician.
* If you smoke, stop.
* If you drink alcohol, keep it in moderation.

* If you are diabetic, work with your physician and a dietician to help keep it closely monitored

and controlled.

* Exercise! Even a 30 minute brisk walk can help reduce your risk and improve your overall

health.

* Lower your sodium and fat intake in your diet.

* Know the symptoms listed above and don't wait to act on them.

If you have ever seen anyone have a stroke or seen someone with mass effects from a stroke you will understand why this is so important. I have personally cared for many stroke patients. Some who made it to the hospital in time and were treated and had little residual effects. Others who were not so lucky and had mass effects.

It is saddening to see a patient young or old who is unable to communicate, unable to swallow, unable to eat, unable to move one side of their body and now has to rely on caregivers to do normal tasks that they once were able to do for themselves. It is saddening to speak to a patient who is unable to speak back to you, but you look at them and can see in their eyes that they have something they so desperately want to say but can't. They can't tell you what hurts, they can't tell you they are afraid, they can't tell their family how much they love them. They can't tell you how humiliated they are feeling because they have urinated on themselves because they couldn't communicate to you, their caregiver, that they even had to urinate.

It breaks my heart to see these patients. I have seen many recover, with the help of good physical therapy, occupational therapy, and speech therapy. However, I have seen all too many who leave the hospital not walking, not able to live at home any more and now will live their days in a facility, where they will have 24 hour care by professionals, not their family.

Please, if you or someone you love is at risk for a stroke, share this information. Educate yourself and your loved ones. Seek medical attention and advice from your physician.

I am a medical professional, however I am not a doctor. All I can do here is increase awareness and pray that each of you understand the importance of knowing the risk factors and symptoms to watch for. All the information on this particular post was found at the above red links.
For more information on strokes please go to the National Stroke Association website at www.stroke.org or the Amerian Stroke Association at www.strokeassociation.org

Keep yourself educated!!

Better Today Because of You

2009-04-21T05:08:00.005-05:00

There is one day in particular that I will never forget during my med/surg clinical rotation in nursing school. I had an instructor that I did not like at all. Actually, come to think of it, not many of the students liked her. She was arogant, and pretty much talked down to all of us. We all decided that since we had her first year they must be trying to break us down in the beginning so they could build us up in the end. Kinda like the military, I would think.

On this particular day, she had handed out our assignments. There were 8 of us and she was going to watch all 8 of us administer medications that day, like she did every clinical day. She told me I could go last because I had the most medications to give. The patient I was assigned to had over 16 medications to give that morning.

I promptly went to get his med book and started writing down all the medications I was to give. I looked them all up and wrote as much as I could on my little paper. I knew that she was going to ask me questions about ALL of them, and I tried to anticipate what the questions would be. She was one that would pick the most unusual things to ask. It was like she was trying to pick something to ask that she would know you would not have written on your paper.

All the other students were running behind and she came to me 2 or 3 times asking if I was ready. I just told her no and reminded her she told me I could go last. Then on the 4th try, she finally said, "Let's just do it, no one else seems to have their act together today!" I again reminded her that I was not finished writing everything. She then replied with, "well, I guess we will see how ready you are." So instead of arguing with her, I just gave in. I knew it wouldn't make a difference and she was already mad because of the other students.

We went into the patients room, and she had me set the med book on the window sill. I laid each med out beside it's name in the book, that is like she liked us to do it. Then one by one I did the checks, reading the name and doage of the med from the book then again from the med packaging. She would proceed with questions like:
1. What is this used for? 2. What are the side effects? 3. Will it interact with anything else they are taking? 4. What labs need to be followed while on this medication? There were other quesitons but this was the basics she asked on almost all the meds.

Now, remember that she didn't give me the time she had promised and I had already told her I wasn't done looking everything up. So, for the first few meds I was doing great. I answered 100%. Then all of the sudden she asked me about the med Cozaar. I told her that was one that I didn't get looked up. She then again asked me what was it for. I had not given this med before, and remember we were first year students, so they were not ALL etched in my brain just yet. I proceeded to tell her, "I think it is for high blood pressure." Her reply, "You THINK? You mean you don't know?" Again I reminded her that I didn't have time to get them all looked up and that was one that was not looked up. She then looked at me with horrible anger and said, "I guess you are right, your not any more ready than the rest of them. I will be back to finish with you and you better be ready."

All of the above interaction happened IN the patient's room. I was so embarassed. She walked out and I told the patient I was sorry and I would be back in a few minutes with the instructor. I gathered my things and rushed out of the room and looked up the rest of the meds as quickly as I could. I still had 4 left to look up and I hadn't been able to look up the lab results from that morning yet because all of the staff nurses were on the computers.

It wasn't 5 minutes before she was back. I had the med written down but not the labs. I wasn't about to tell her, I just prayed she wouldn't ask. We went through the same steps as before. When we got to Cozaar, I knew for SURE it was for high blood pressure. I was angry because I was right before, and she wouldn't take the answer. She was angry because none of the other students had been ready and when she got to me I wasn't ready either. Then the dreaded question came. I had to give the patient potassium. She wanted to know what his potassium level was that morning. I know I must have had a defeated look on my face because that is certainly how I was feeling. All I could do was look at her and say, "I don't know." I tried to explain that I was not able to get on the computers to check lab results because the staff nurses were on all of them. At that moment she picked up the med cup that had all the unopened meds in it and threw them up in the air. She then proceeded to walk out of the room. When she got to the door she turned around long enough to tell me "Let me know when think you are ready!", and then she was gone.

There I was, standing in a patients room, again, after being yelled at. Except now his medications were all over the floor. I apologized again to that patient, quickly picked up the meds and left the room. I went to the bathroom and cried. I was so angry and my feelings were hurt and I was humiliated!! I wanted to run!!

My instructor did come back, I did give my meds and care for my patient that day and I survived! At the end of that particular day, my patient actually apologized to ME. I told him it was ok, it was not his fault, and I apologized to him for having to be witness to my learning experience. He was very sweet and understanding. I think he realized how terrible my instructor had acted and I think he kind of felt sorry for me. That was the longest semester ever!! And I know that I am a better nurse today because of it.

At then end of my last semester, while we were planning for the pinning ceremony, I had the opportunity to talk to that instructor again. Until that moment I had done everything in my power to stay as far away from her as possible. And when the moment came, and I had all the courage I could muster up, I said these words to her,
"I didn't really like you during our first semester. I thought you were too hard on people. There were moments of humilation during that clinical rotation with you. And what I learned is that I will be a better nurse because of the instructors who treated their students like we didn't know anything. I will be a better nurse in spite of those moments of humilation. I will also have mercy on the students who come after me, that I will someday be a mentor to. So, thank you, for teaching me mercy, and making me stronger in myself." I didn't really give her a chance to say anything in response. I walked away, with my head high and shoulders back, ready to graduate and take on that nursing world that came many times be cruel and nonmerciful.

I hold on to this experience so I will not forget what kind of nurse I strive to be. How I treat my paitents, how I treat the new students who come to do clinicals where I work, and the new grads that we train.

I have compassion, and mercy and tolerance. Nursing school was a hard time, a time that could have easily broken my spirit. I conquered it!!! My spirit soars today, knowing that I am a great nurse and I truly care. This is not my job, this is my ministry!

When the patients are sleeping. . . .

2009-04-21T04:58:00.002-05:00

So what is it that nurses do when the patients are sleeping?
Well tonight is the first night in a really long time that I have had a TOTALLY uneventful night. Three patients, all ready to be discharged to home in the morning and all sleeping very soundly ALL night long. No one used their call buttons once. No one had medications between the hours of 9pm and 5am. No one required their vitals taken between the hours of 9pm and 5am. What's a nurse to do. . . ?

Well, in between checking to make sure everyone was breathing. . and they were. . they were ALL SNORING! Very loudly might I add. I would look in on each of them about every hour. Then I watched the clock move slowly, and the more the night went on the slower the clock seemed to tick. It was almost painful!

Then it was internet time. . . I googled strange medical terms, diagnosis that I didn't know, I read through patient charts, I read blogs, I tried to plan a vacation, I helped other nurses (who were just as NOT busy as I was). Then I read more blogs.

I also took some time to pray for a sweet 5 month old baby boy named Stellan who will be having a Heart Ablation this morning. Please take a minute to check out his moms blog. You won't be able to read one post without falling in love with this child. The whole world seems to be following her blog and praying for this child. There is a button to the right on my blog that will get you there. It is amazing how God is working in his little life.

So, I am bored silly and really can't think of any great funny stories to tell. So, leave me a comment telling me what you do at work, when the work seems to be all done and there is nothing to do. I would love some new ideas, because reading the newspaper online is getting a little old.

Are These Your Teeth?

2009-04-15T04:40:00.011-05:00

I was in my early twenties working in a nursing home. I enjoyed my time in long term care, I worked as a CNA (Certified Nurse Assistant). That was some of the hardest work I have ever done, and I loved it. I loved learning from the residents, they were so wise and just loved to share their knowledge. What I loved even more were the residents who had Alzheimers. I enjoyed going to "their world" with them. Many times the world they would revert back to was much more pleasant than the current place they were in, in their lives. And joining them there, made it all the better for them.

At this time in my life, I was working night shift. This shift in a nursing home is a very regimented shift. First, make sure everyone that didn't get put to bed on evening shift, is now safely tucked in for the night. Second, start bedcheck; turn, change, potty, offer drink, and anything else they wanted. Third, dump linen, and restock the linen cart. Forth, wash wheel chairs, change out supplies, etc. until the next bedcheck. Bedcheck was every 2 hours. If you were lucky enough your assignment didn't take a whole 2 hours to complete a bedcheck.

During a particular night shift, I was working with a LPN (Licensed Practical Nurse) and a new QMA (Qualified Medical Assistant). The QMA was helping me with bedcheck and the CNA duties. She was still on orientation, as I remember it. We were so lucky this night because we had some down time in between bed checks. She was so excited to be able to sit back put her feet up and read a magazine. Just as I was realizing what she was about to do, I informed her, during the down times we were to clean. Clean wheelchairs, resident rooms, bedside tables, resident closets, dresser drawers, or anything that looked like it needed to be cleaned.

I told the new QMA to head down the hall and brush all the dentures that were sitting on each person's bedside table. I knew that many times the evening shift would take a "short cut" and just put each person's dentures in a cup of cold water, without brushing them. They would just soaked all night. So, the QMA headed down the hall to begin brushing teeth. I started on antoher cleaning project. It wasn't 10 minutes before I saw the QMA coming down the hall with a wash basin. "What'cha doin'?", I asked her. She replied with a simple, "Washing dentures". I quickly learned that she had filled a wash basin with water, placed several tablets of efferdent in the water and then proceeded down the hall to gather the dentures. There were probably 15 sets of dentures sitting in that water soaking up the goodness. She sat down at the table where I was, pulled out ONE toothbrush and some toothpaste. She was so proud she was going to get these dentures so clean and save some time by doing them all at the same time.

I was having trouble trying to process this. I couldn't believe what she had just done!! "You can't do that!", I said, "How would you like to brush your teeth with someone elses tooth brush? Besides that, do you know who all those teeth belong to?" She replied that she did not, while her head just hung. She was realizing what she had just done.

At the time this happened, dentists were not putting a name inside dentures. So, without knowing how to fix this any other way, we went and got more tooth brushes, cleaned each set of dentures individually. Afterwards we spent the rest of the night, fitting dentures, cleaning them, and refitting them.

It was no suprise to me when I learned that this particular QMA only worked in this facility for another few days, then she was gone. I have no idea where she is now, and honestly don't even remember her name. What I hope is this: where ever she works at, I hope she doesn't use the same toothbrush on every resident. I hope she brushes her teeth. And I hope all dentures have names in them, just in case.

Mistakes are made to be learned from. We all certainly learned that night. She learned about sanitation. We all learned that in healthcare, there are no real or safe shortcuts. We also learned one of the arts of denistry. . . denture fitting!

Suggestion. . . .keep up with your dental visits, keep your teeth healthy, brush three times a day, floss at least twice a day and if you do have to have dentures someday. . . make sure your name gets put in them.

Take This Quiz. . . Read Following Post. . .

2009-04-15T04:17:00.002-05:00

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Ignorance Is Not Bliss

2009-04-15T03:51:00.009-05:00

When I saw this little quiz it reminded me of a patient I cared for probably 20 years ago, back when I was Certified Nurse Aid (CNA).

I worked in a long term care facility and there was a patient admitted who was in his late 30's. He was no longer able to care for himself at home because he had AIDS. It had advanced to the point that he required 24 hour nursing care.

The day he was admitted the whole facility was in an uproar. People were scared to death, to say the least. Little did he know, he was the talk of the facility. The nurses didn't feel comfortable caring for him and many of the CNA simply refused. I was just as uneducated as the rest of them. I will not lie, there was an element of fear. However, I knew that no matter what his diagnosis, he was here for us to take care of. He needed us.

I remember sitting in the breakroom before the start of my shift listening to all the "buzz" that was going on. I was hearing all kinds of stories about how he contracted AIDS. I heard he was gay and very permiscuous. He was an IV drug user and just plain white trash. He has had it for a very long time and was knowingly passing it on to other people he slept with and the stories just went on and on.

I was so angry that people would actually refuse to care for him. I was NOT going to be one of those people. However, I was just as ignorant as the rest of them. I did have him on my assignment. I did double glove when I cared for him. I did listen to all the stories, and wasn't sure which ones to believe. It was something for our small town nursing home to have a patient with this diagnosis, let alone one this young.

He was a smoker, and at that time there was a room designed just for the residents of this nursing home to sit in and smoke. Every day he would wheel himself to the "smoke room" and sit there for as long as he could stand it. There was a TV in that room, to keep him company, as well as other residents who also enjoyed smoking. He was young, he didn't want to play Bingo or do crafts. He just wanted to live out the rest of his days in peace and quiet. He wasn't always nice, as a matter of fact he was rarely nice. He didn't talk to much of anyone. He was angry about his diagnosis. He was angry about where he was in life. Basically he was just angry. He didn't like it when the nurses or CNA's would double glove. He was totally offended by this and had no trouble letting us know it. He would yell, cuss, and kick people out of his room.

It wasn't long before word got around to the other residents that he had AIDS. Then the trouble started. He would go to the smoke room and the other residents would leave. He would be alone. They would complain that they couldn't sit in there with HIM. They were afraid, afraid of what they didn't know. They were ignorant too.

As the rumors continued to spread about this young man, people began to learn the truth. Administration had done their best to keep details of his diagnosis away from us. I think part of this was because they thought it would help him in the long run. All we needed to know was that he had AIDS. They thought we needed to know this so there would be no "short cuts" made in the area of universal precautions. However, the rumors were getting out of hand. We needed to know the truth. The truth was, he got a raw deal. His wife had an affair, he had contracted AIDS from her. He had done nothing wrong, he didn't deserve this (no one does), it just happened. He divorced his wife, however she visited him every day. I think there was some guilt she had to deal with. I am not sure, but she was faithful in her visits.

Once everyone knew the "truth", they seemed to lighten up a bit. People were nicer to him, kind of like they now felt sorry for him. In return, he started being nicer too. However the stress of going to the "smoke room" was becoming too much for his body. It was becoming too cold for him to go outside, where he could isolate himself and he still wanted to smoke. I remember working night shift and caring for him. He always had his bed close to the window, and he always kept his door closed. One night as I was doing my bedchecks, I smelled smoke. I followed the smell into his room. He was laying in bed with a plasic cup of water in the window sill and was smoking. He had the biggest grin on his face. I told him he was only allowed to smoke in the smoking room. He reminded me that was impossible at this point. He couldn't make it down there anymore, he was too weak. I couldn't argue that. So I went and spoke with the nurse. Between the two of us, we decided to let it go. I had a talk with him and we decided he could smoke in his room during our shifts. But he had to promise not to tell anyone, because we could get in so much trouble. He had to promise to be careful and could not fall asleep while smoking. He agreed.

Looking back now, I can't believe we allowed this. It is so dangerous, anything could have happened. Even though it was SO against the rules, it helped create a bond, a trust so to speak, between him and me. He would allow me to care for him, and he was happier when I was on shift.

We spent many nights talking in between bed checks. He shared his fears and his anger with me. I began to learn true compassion from him. I began to understand why he was so mean to us in the beginning. I began to truly care for him.

It wasn't long after the night I caught him smoking that he passed. He couldn't fight anymore. He was too tired and frail to continue on in this life. And I will never forget how I learned to have compassion for those with AIDS. I learned to not have prejudgements about people with a certain diagnosis. I learned to overcome my own fear of caring for someone with AIDS.

Fear in this case and in most cases come from ingorance. If we all educate ourselves on the things we are afraid of, some of those fears will no longer exist. Some of those fears are able to change from fear to caution. Now when I care for someone on my current job that has AIDS, I no longer fear their diagnosis. I still remain cautious, and use the skills I have learned to protect myself and them. But I do not have fear.

Education is the key here. Education and compassion.

Some facts about AIDS you might not know. . .
Information found here

According to the CDC, in 2000, an estimated 850,000-950,000 people in the United States were living with HIV and approximately one fourth of these people did not know they were infected.

HIV can be transmitted through the blood, sexual fluids (semen, preseminal fluid, or vaginal fluid) or breast milk of an HIV-infected person. People can get HIV one of these fluids enters the body by way of the mucous membranes (the soft, moist skin found in any opening of the body) or the blood stream. The disease can be passed during unprotected vaginal, anal or oral sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment (or works) including cookers and cottons with someone who is infected.

The following information found here. . .

HIV is NOT transmitted through casual contact including: hugging, kissing, using public toilets, sharing eating utensils, pools or coughing.

There is NO cure for AIDS. Scientists have discovered strong medications to slow down the disease so people will live longer, but there is NO cure.

There are other ways to prevent the spread of HIV and AIDS by blood or body fluids:
Never touch another person's sores, cuts, or blood. If someone at school or at sports gets hurt and starts bleeding, ask an adult for help right away.
Never pick up or handle needles that you might find outside.
Health care workers such as doctors, nurses, and dentists should always wear plastic gloves when working on a patient. Hospitals have strict procedures for handling samples of blood and other body fluids to prevent others from coming in contact with HIV.

What I learned in nursing school . . .

This suprised me probably more than anything in nursing school. It is easier to get Hepatitis C from a patient that I am caring for than it is for me to get AIDS from a patient I am caring for. Rule of thumb. . . treat everyone the same, protect yourself and them, and use universal precautions on every patient.

There is a greater risk of you passing germs to the AIDS patient that will make them very ill, than there is of you catching AIDS from them. Their immune system is so compromised, that is you could easily pass your cold, or respiratory infection to them (if you are at work with a respiratory infection), causing them to become very ill.

So again. . . rule of thumb. . .
Treat each patient as you would like to be treated. Do not judge them by their diagnosis. AND. . show compassion. You don't know what their day/ night was like (in their mind) before your shift started. It could be any one of us in their shoes one day, wishing someone would treat us like a person and not a diagnosis.

Where Are The Nurses?

2009-04-14T05:00:00.001-05:00

It is no secret there has been and continues to be a nursing shortage in the US. This is ever so evident if you are in fact a nurse. We work many hours, and I would guess that most of those hours are spent with an increase in patient/nurse ratio. This causes the quality of care to decrease. I would say that many people in our country may not realize how important this is. As a nurse, and speaking generally, we try to not let it show that we are many times overworked. We do what has to be done to care for our patients, while not letting the stress show. Not letting the patient know how many other patients you are responsible for, while you are caring for them.
We work extra shifts out of guilt. Guilt of leaving our fellow nurses short staffed, as well as guilt for leaving the patients with an inadequate number of nurses. We leave our shifts feeling as though there was something missed, too many corners cut, and not really feeling like a nurse at all. We drive home in our cars thinking about how we didn't have time to listen, really listen to our patients as they try to tell their stories. We think about how we may have been a little short or standoff'ish with that one patient who pushed their call button one too many times for things that really could have waited. We think about who that particular patient may have just wanted the reassurance that someone would come if they called. We think about that person who was disoriented and climbing out of bed every 5 minutes, and how we didn't do the trial restraint release on our shift, because we didn't have the time to sit with them until they fell asleep and forgot that they were trying to get up and were unable to walk. (Don't even go there, if you are a nurse, you know - you know what I am talking about. And if you are not a nurse, don't judge this until you have walked in the shoes of a nurse.) You think about your charting, did you forget something, what about that shift note that you probably should have written but didn't because really, nothing significant happened, but the notes are important and you let that one go.

Studies are showing that the nursing shortage is predicted to just get worse. The Council on Physician and Nurse Supply released a statement in March 2008 that stated, based on a study done by the University of Pennsylvania, 30,000 additional nurses should graduate annually to meet the US healthcare needs. This was 30% more than the current number of graduates at the time of that study.

The problem with this number is that I found this study by AACN that showed 49,948 qualified applicants were turned away from baccalaureate and graduate nursing programs in 2008. Why were they turned away, if they were qualified, you ask? Because there was not enough faculty, clinical sites, classroom space, or clinical preceptors. This report also listed budget constraints. The report listed that almost 2/3 of the schools surveyed listed faculty shortages.

Another point of focus could also be the average age of the current RN. This study released in July 2006, by the Nursing Management Aging Workforce, showed 55% of the nurses reported intended to retire between 2011 and 2020.

Forty-four years old. That is the projected average age of RN's by 2012. Nurses in their 50's are expected to become almost 1/4 of the RN population. These nurses will be, by this time, seriously looking toward retirement. They will be burned out and/or looking toward management positions, because the patient care load is too much, the pace is too fast, the physical labor may be taking a toll on them.

In essence what I see happening? Put simply. . .

No faculty = less graduates = higher patient/nurse ratio = decrease in quality care

=increase in burnout = increase in nurse turnover rate
= decrease in continuity of care
= decrease in quality of care

Do you see a cycle here? It all goes back to quality care.

From what I saw as a nursing student 4 years ago, facaulty was not paid well. They were expected work an ungodly amount of hours. Not necessarily hours with students but hours in preparation, clinicals, classroom time, grading papers, tutoring, mentoring, encouraging students, meetings, etc. They do this for little pay. In the state that I live in, I just learned the average salary for an Assistant Professor was $51,000. I know RN's who are associate nurse RN's who are working in hospitals making more than that. Those assistant professors are still working full time hours and then taking work home to prepare for classes and clinicals. No wonder we don't have enough faculty!

A report initiated in March 2007 by the Agency for Healcare Research and Quality on Nursing Staffing and Quality of Patient Care found that the RN shortage along with increased workload, did in fact pose a potential threat to the quality of care. Increasing the RN staffing showed reductions in hospital related mortality and failure to rescure and also decreased the average length of stay. Patient care and safety showed compromise in hospitals with less than adequate staffing.

This Chart Found Here

What can we do about this? Well, I found alot of information about how bad it is, but I didn't find alot of information about how we are going to make it better. What I found was information on the Nurse Education, Expansion, and Development Act (NEED Act). This Act if passed would amend Title VIII of the Public Health Service Act, authorizing caitation grants for nursing schools. This will result in the increase of faculty which results in the increase of students. This is called a capitation grant. This is not a new idea. Capitation grants have been helping to stabilize the nursing shortage for years. The Nurse Training Act of 1971, as well as the Nurse Traning Act of 1975 were brought about to increase enrollment thus help the shortages. From 1971 to 1978 the government provided capitation grants to nursing schools in support of education.

There are also many initiatives at a local level to help stabilize the nursing shortage. There are monies available in some states that will give extra financial assistance to nurses who are continuing their education in a master's program. There is also some states that have a loan forgiveness program for nurses who become faculty.

For me, it is nice to see there are initiatives being put into place. It was also disturbing that I found more research and studies done on the problem than I found on the solution.

What I know is that most of the nurses I know and work with are not doing this job because of the money. The money is good, I will not lie about that, and it does help. But most nurses just love the job. They love that they have the chance to make a difference in someone's life, that their life is changed on a daily basis by the patients they encounter. Many of the nurses I know, if given the opportunity and finances to quit their job, would not do it. I myself would not do it. Someone could give me $1million today. I would be estatic. I promise you that, but I would not quit my job. Nursing is a part of me. It makes up who I am. I would feel there was a piece of me missing if I did not have patients to care for. I would feel I have lost my purpose.

So, even though there is a shortage and many of us feel overworked. I keep my chin up, I show up for work when I am scheduled, I do my very best to have a good attitude and never let my patients know or feel that I might not have time to listen to their story. I have learned over the past several years, that some of those stories they feel they need to tell. The stories of their illness, misfortune, fears, and recovery have been meant just for me to hear. Some of those stories are imbedded in my mind and heart and help me daily be the compassionate nurse that my patients deserve.

Shortage or no shortage, I will always be a nurse and will always love what I do.

If you have considered being a nurse, take a minute to do some research. Ask a nurse you know if you can shadow them one day on their job. See what it is all about. Learn how rewarding this job can be and what a difference your patients can make in your life.

Help us end this shortage, and be able to provide the care each person deserves. You may be a patient some day and wish that your nurse had more time to spend with you. That is when you will get to see the other side of this story. That is when you will remember what you have read here. When you do, please remember to thank your nurse. They work hard to care for you. And even when the day is bad, and your nurse is running like a mad person, they really do care. That is just the nature of being a nurse.

Milk and Molasses

2009-04-13T05:00:00.000-05:00

I was a "baby nurse", not even out of school 8 months when I was assigned to a VERY difficult patient. Now if you are a nurse or in the medical field, you know where I am about to go with this. It is not that she was medically difficult, it was that behaviorally she was difficult. She was your basic med/surg patient. I can't exactly remember what her diagnosis was. What I do remember is that she was on her call light every 30 minutes for trivial things. She would want more water, then in 30 minutes she would want to go to the bathroom, then in 30 minutes she would want a snack. I would come back with a snack and she would say, "Oh, I'm sorry, could I get something more to drink too?". I had no problem giving her what she asked for but if I was already going to the kitchen to get a snack and had asked her if she needed something to drink, and she said no, then changed her mind when I got back to the room, I felt like I was just running the halls. Not to mention I had other patients that were much worse off and needed more attention.

Besides running me crazy, I also remember this particular patient was scheduled to be moved from my floor to a regular med/surg floor. She was placed with us as an overflow patient. However, they didn't want her to go until she had a BM and she hadn't had one in about 4 days. The doctor told me to give her an enema and once it worked we could move her. When I looked at the order, after the doctor left, he had written for a "milk and molasses enema". WHAT??? Was he serious? I had never heard of such a thing. I asked the more seasoned nurses working with me if this was a joke. They assured me it was for real and explained to me how it works and to get in touch with dietary to bring me the molasses.

I had all my supplies ready in the kitchen. Evidentally, I was supposed to mix this myself. I was instructed to mix half milk and half molasses, warm it in the microwave, then put it in the bucket and wahla! Ready to go.

I did exactly as I was told as far as mixing. I had given enemas before but they had always been in a bag, not a bucket. I was so afraid I was going to make a mess, so I opened the plastic around the bucket and just pulled it down, but didn't take the bucket out of the plastic. I kept ALL the supplies in the plastic to save on room when I had to carry it back to the patients room. I have the milk/molasses mixture all ready and warm and start pooring it into the bucket. They told me to make 800mls of it. All of the sudden the bag is filling up. There is a HOLE in my bucket!!! I immediately stop pouring and put my finger over the hole while I try to figure out what went wrong. I took the bucket out of the bag, only to find the tubing is NOT already attached to the bucket. They didn't tell me that! By now there is milk/molasses mixture running out of the bag onto the counter. I still have a finger over the hole, but I had to figure out how to get the tubing attached. With my free hand I grab the tubing and quickly attach it to the bucket. Now there was milk/molasses running down the front of the cabinet onto the floor. HURRY. . . clamp the tubing! Just when I think all is well, there is yet another fountain of milk/molasses coming from the tubing. WHAT? I looked at it, just to find, I put it on backwards. There is an extra hole in the tubing so all the liquid is coming out that hole. That is the part of the tubing that is supposed to be inserted for the enema. This is where it gets really bad. I put my finger over the hole, and try to figure out how I am going to get the tubing turned around without losing all my mixture to the floor. I don't know how I did it, but I did. And I did it without adding too much to my already large mess.

Now for the clean up. I set the bucket aside, grab all the wet papertowels I can and start cleaning up the countertop and cabinets. Did you know that molasses is REALLY sticky? Then I wiped up what I could off the floor. I peeked out the kitchen door looking for a housekeeping so I could get a mop, just as my boss was walking by. "Do you need something?", she asked. "Oh no, just looking for a housekeeper. I will find her." was my reply. "Here, let me help you", she said as she walked in to see what needed cleaning. She asked me what happened and I reluctanly told her. Then she left. Next thing I know, I have a mop and help from ALL my co-workers, as they are laughing to see what in the world I had done.

Let me tell you, while all of this was going on I felt like I was in the middle of an I Love Lucy show and I was Lucy Ricardo. All anyone could do was laugh. It was embarassing, but even more than that it was so funny.

I bet you think that is it right? Well. . . hang on cause it does get worse.

I was instructed on how to give this enema, and it was very detailed instructions. The patient was to lay on her left side, I was to let a little of the mixture go in, then she was to hold it in, turn on her right, let a little more go in, then she was to get on all fours and let the rest go in. Yep you hear right, all 200 pounds of her on all fours in her bed, while I am letting this mixture go in. As much as she could hold. That was terrible. I had this horrible feeling the mixture was going to go straight across the room to the wall. Fortunately it didn't.

She held it for as long as she could then needed help getting to the bedside commode. Once there, she let go! And I do mean, LET GO!!! The pan on the bedside commode ended up on the floor, and yet again, milk and molasses was all over the floor! I called for the mop again, hung my head as I headed to the nurses station and asked someone to please hurry and get the bed assignment for her room move.

Poor lady, never had good results, but she did have some great entertainment from this nurse. AND she got to move within the hour.

I have never given another milk and molasses enema, however people I don't even know that work in the hospital where I work have heard the story. Some of them don't know it was me, but I have heard them telling other "baby nurses" the story of the milk and molasses enema. I guess I have created quiet a reputation.

Murphy's Law Morning

2009-04-12T05:00:00.003-05:00

The night started out as any other normal nightshift. My night was very uneventful! I had time to do the little extras, to "fluff and puff" as I call it. So when 3:00am came around, I thought I would put off some of my normal duties to allow my patients a little time to sleep in.

At 4am one of the patients put on his call light. I went into his room only to find out his speech was a little slurred and the right side of his mouth was slightly doopy. After completing a full assessment I called the on call number for his doctor and got a returned call from the nurse. We sent him for a STAT CT Scan. Within 15 minutes he was whisked off the floor to the CT. "Whew. . .", I thought, "Now I guess I should quit waisting time and get busy!"

Another patient, was going into what is called Diabetes Insipidus (DI). He was putting out way too much urine. So again, I had to call the same nurse to report this output and see if we were going to start giving him DDAVP. We decided to just keep measuring and monitoring. He needed to be watched closely.

I quickly began to go room to room doing assessments, taking vitals, drawing blood, and meeting the needs of my other patients. I had made it through most of my rooms and sent all the blood drawn down to the lab, when another call light went off. Upon entering this particular room, I found the patient in the bathroom with BM all the way from the bed to the bathroom. I felt so bad for him. He just kept saying he was sorry. I told him to stay in the bathroom and I would go get clean linen for his bed, a clean gown, wash clothes and towels as well as something to clean up the floor. While I was in the linen room gathering my supplies, my phone rang. Another one of my patients had a critically low potassium. I had arms full of linen and the phone between my ear and shoulder. I quickly went to the desk, set down the linen, wrote the information down and repeated it back to the lab tech. I paged the doctor, grabbed the linen and was finally on my way to help this poor man get cleaned up.

With a fresh clean bed and clean gown, and freshly mopped floor, the nice older man was ready to get back to bed. My phone rang, I told the doctor about the critical potassium and got new orders to give that patient a potassium replacement via IV. I took a deep breath and reminded this doctor that the patient that needed the potassium had 4 different IV antibiotics going, and only one line. The potassium would take four hours and we didn't have that kind of time due to the timing of the antibiotics. So, I asked if there was a reason she couldn't take it PO (by mouth). He ok'd the order for the PO potassium, so I wrote that order and sent it to pharmacy.

As I was heading back to her room with the potassium effervescent tablets, my patient that had the CT Scan is coming down the hall. The transporter needed help getting him back to his bed. So I have to stop to get him situated and comfy again. He is doing good, no change from before, thank God. So off I went with the potassium. The patient took it and I was on my way to my next patient. Just in time for another phone call from lab.

My gentleman who had the BM mishap, had a critically low Magnesium. So I called the doctor. As I was on the phone with the doctor another call light was going off. It was the patient with the low potassium. I was on the phone with the doctor as I walk into her room. She had vomitted! "Ok", I am thinking to myself, "deep breath". Anyone that knows me, knows I don't do vomit well. I handed her a washcloth, while I was listening to the verbal orders coming from the doctor talking to me on the phone. Then I noticed that the patient only vomitted the liquid potassium I had just given her. So, I needed to find another route to give this. I decided I would just use her tube, since she has one. She asked that I wait about 30 minutes to give her stomach a break. Now I was feeling time is getting away from.

I took the order for the magnesium replacement and send it to pharmacy. I had to wait for them to get it to me so I took a minute to try to chart. HOLY COW! Is that dayshift people I see? It was now 6:30am, day shift is coming in!!! I had not charted anything since 4:00am, I still had magnesium to give, potassium to give, and try to watch for the results of the CT Scan so I could call that nurse back. WAIT! What about the guy who was urinating every hour. . . .?

Yep sure enough there goes his call light, another 400mls of urine that require urine being sent to lab, as well as another call to the nurse. Now I was feeling a little overwhelmed.

I got the urine taken care of, and checked for the CT results. Oh great. . . the CT showed nothing new, but it did show an old stroke. Nowhere did his chart say ANYTHING about an old stroke!!! Later the patient told me he had a stroke about four years ago. Boy, I wish I had known that earlier!

Now day shift to be ready for report. Still the potassium had not been given, the magnesium was not up from pharmacy yet, and I had still not charted. I went ahead and gave them report, and the potassium and magnesium had to be done by day shift. I sat down to chart my morning, trying to concentrate on deep breaths, so I could stop feeling overwhelmed.

I left that morning feeling like a horrible nurse. I put things off for an hour thinking I was doing a good thing by letting my patients have one extra hour of sleep, and it threw my whole morning off. I hate leaving things for the next shift and now they had to give meds that I should have given. Was there something I missed, the morning went so quickly it all seemed like a blur.

That is when I remembered that nursing is a 24 hour operation. We all do our best to not leave things for the next shift. Sometimes that is out of our control. We just work for it to not be a habit. I did what was needed to be done. I made the calls. I tended to the needs, and prioritized as best I could. I was so thankful it was my last day of the week because at that point I was exhausted!

I prayed on the way home that all my patients for that night would ok during day shift and that they knew I did my best. Then I resolved that this particular morning was nothing more than a "Murphy's Law Morning".

Moral of the story? Don't put off for an hour, what can be done now, to save your behind later! And, if you decide to put it off anyway, make sure you have a pair of rollerskate to get keep up the pace.

Dinner and A Movie

2009-04-11T10:30:00.006-05:00

How far you go in life depends on you being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and the strong. Because someday in life you will have been all of these. - George Washington Carver

I was working on a neurological floor and had only been an RN for about a year and a half when I had a patient, I won't soon forget. He had come to the ER 2 days earlier, with a severe headache that would just not go away. The pain was so bad it was causing him to vomit and pain medication was doing little more than taking the edge off. His wife had come to the ER with him, leaving his 3 small children at home with a babysitter.

He was sure they would give him some medication, the headache would go away and he would be home in time to wake his babies up the next morning. Instead he found himself lying in a hospital bed facing his life in a totally new aspect.

When I was assigned as his nurse, he had already had two surgeries. The first to remove a large brain tumor that was found during a scan while in the ER. The second surgery was to place a feeding tube directly in his stomach, now that he had lost his ability to swallow safely.

See, after the scan, this 30 'something year old man and his wife were informed he had what was called a Glioblastoma. Now, I remember alot of things about this man, but I do not remember what grade this tumor was. I do remember how devistated, scared and hopeless he and his wife felt. He had already faced a long major brain surgery to remove this tumor. The surgery had affected his emotions. He was what I call emotionally incontinent. He was unable to control them. He would laugh when it really wasn't appropriate to be laughing, and cry when just at anything, right in the middle of saying a word he would begin crying. He was confused by these runs of emotions. He was afraid. . . . He was frustrated. . . . He was hungry! He was having difficulty swallowing after the surgery and they had placed a feeding tube. So his belly was getting full, but he was not able to eat or drink anything, no tasting of his food, no food for pleasure.

The doctors told him his swallow would probably return but it would take speech therapy and several months. He had also been told, he would be expected to live 6 months to a year. This tumor had been removed, well most of it anyway. They were unable to get everything. He would undergo radiation therapy and if he wanted possibly another surgery, but that would not change the outcome. For him, it would only prolong the inevidible.

His wife had gone home to be with their 3 small children for the morning. She was due back later that afternoon. He spent his morning contemplating life. What was he going to do? The realization that he would never see his children grow up was beginning to hit him hard. His mind was racing of the things he had done or not done, to plan for his families future. Would his wife be ok? Would she be able to make it financially with 3 small children? Would she find someone else to fall in love with and be a father to his children, and if she did, was he ok with that?

I had spent some time in his room that morning, refilling his feeding bag, taking his vitals, assessing his incision, listening to his lungs, walking with him to the bathroom, and just talking. He was disappointed this particular day, because he had planned a nice date for him and his wife for the following evening. They had a babysitter arranged, he had reservations at a nice resturant and she was going to take her to a movie. The first date they had been able to have since the youngest child was born just less than a year a ago. Now. . . he was here, not able to eat, they were both faced with an uncertain future, and the babysitter was no longer available tomorrow night. His wife, instead had told him she would spend the night at home that night and be with the children, who were beginning to feel the effects of daddy being in the hospital. In his heart he knew it was the right thing for her to do.

I asked him quetions about their date, where he planned to take her, what movie they were going to see. Making small talk and giving him the chance to talk it out. I told him that I was scheduled to work the next day and since he would not be having company, I would share a "dinner date" with him. We talked about what movies he liked and I promised to bring him one.

The next day when I came to work, he was bluer than blue! His wife had not been there most of the day, as she was trying to keep things as normal as possible for their children and she felt she needed to be home with them. No one else had come to visit him that previous evening or morning and he was feeling quiet alone. It was giving him way too much quiet time to sit and think about what was to come. So, during my lunch break, I went into his room with the VCR and TV cart we had on this particular floor. I gave him 3-4 movies and told him to pick one. I asked what his favorite meal was. He told he was really craving a T-bone steak with a baked potato and a nice green salad. That is what he had planned on having on his date with his wife that evening, that was now not going to happen. So, I reached into my pocket, pulled out several Sharpie markers and on his feeding bag, drew a picture of a T-bone steak and baked potato. I put the movie in that he chose and we watched a movie for my entire lunch break.

That day, is one I will never forget. That day my heart was full. That particular day, I learned that as a nurse, giving and receiving are in fact the same. As I was able to give this young man a moment of my time to show that I did care about what he was going through, he was able to give me something as well. He showed me courage through a storm. He made me feel happy that I had become a nurse. He gave me confimation that I was doing exactly what I was called to do. This is what nursing is all about. Not just caring for the body, but also caring for the spirit. His spirt had been broken. That day, both of us were able to end our days with a lifted spirit. No matter what was to come next. . . . it had been a good day.

It was about 8 months later that I saw his obituary in the paper. He didn't make it to the one year mark, he did though make it past 6 months. He lived each of those days loving his wife and children the best he knew how.

What's My Name. . .?

2009-04-10T02:21:00.004-05:00

There were no balloons, no cameras, no proud papa's standing on the other side of a double pane window pointing at the "one". No one making goofy faces as they ooohed and ahhed at all the tine wrinkled faces with tightly bundled up bodies in white hospital blankets. No, this little boy had no one. . . .

I was in my 3rd semester of clinicals and was so excited about it being my OB rotation. I just knew I was going to do so good this semester. Really, how hard can it be to just love up on all those sweet little babies? Boy was I ever wrong about that!!!! I had clinicals twice a week at a local hospital. One day I would be assigned to a "mother" and the next day I would be assigned to a "baby". I didn't really care for being assigned to the mother's. They all just wanted to be left alone. Understandably, they wanted to spend the next 24-48 hours (all the time they had in the hospital), with their husbands, boyfriends, baby and other family. They did not want some nursing student coming in asking them about pain, pushing on their belly's and looking for more drainage. They did not want a nursing student reminding them to wash and stay clean. And they certainly didn't want a nursing student trying to help them learn how to breastfeed their child.
I just knew after that first day with a mother, that I would love being in the newborn nursery even more. I would bathe, and hold and just love on all those babies. That is exactly what I did.

Day #1 - He's a boy!!! A sweet little bald headed boy. That is who I was assigned to. I went in the nursery, found my babies chart, wrote all the information I would need to write my paper. He was healthy, nothing unusual, normal weight, not eating really well, but that was to be expected. He was less than 24 hours old. While I am writing, I realize the nursery is much noiser than I expected. There is this one baby crying non stop. All the nurses were busy with other babies. In my mind, I kept thinking, "Why won't someone make that baby stop, why won't someone just pick him up, take him to his mother. . . something!". I put down my paper and pen and go to the crib of the now SCREAMING baby. I learned this was MY baby for the day. I also had heard from the other students that Nursery Nurses are VERY possesive. . . ask BEFORE you pick up ANY baby. So I asked the nurses if it was ok for me to hold him. They just looked at me with this weird face and said, "Sure, if you want. . ". I picked him up and he immediately stopped crying. I was hooked right there! I looked at the little blue "tag" in his crib but there was no name. It just said "Baby Boy". I took him to a rocking chair and rocked him with is pacifier in his mouth. Once he was quiet I asked another nurse about the name on the crib card. Maybe the mom hadn't decided yet . . .?

This is where it all went south!! I learned that his mother in fact had not named him. This little one didn't know his mother, his father, his grandparents, aunts, or uncles. Did he have siblings? See, his mom had given birth to him late the night before. When the nurses went to check on her that morning, shortly before I got there, she was nowhere to be found. She was all of 19 years old. She had come into the hospital alone and now alone is exactly how she left this sweet little baby boy she brought into this world. She had abandoned her baby!!!

Before I could stop myself, I had tears streaming down my face. How could someone do such a thing?? I just didn't understand, couldn't understand, and really didn't want to understand. It was totally unacceptable!!! Social services had been contacted. They had tried to contact the mom of this baby, without success. She was gone. . . long gone! This "Baby Boy" would now become a ward of the state, he would be in foster care until a judge decided he could be adopted. He was now crying again. . . I was crying. I couldn't contain myself. I just held him and prayed. There was nothing else to do. I wanted to take him and run as far away as I could. I could give him a good home, I would love him, I would take care of him. But I knew that I couldn't do that. I knew that would just be worse. It was my moment of irrational thinking. You know the one. . . when someone is in crisis and you will do just about anything to make it all better, even if it means breaking the law. Then all of the sudden reality hits you so hard in the back of the head you feel like you have whiplash. . . that is what happened. So, instead of running, I prayed. I prayed that a good family would be found, QUICKLY! I prayed for his mom, that she would be ok, that she was healthy and would somehow, someday find resolution in what she had done. I prayed that he would grow up knowing he was loved and have a big full life of all that is wonderful! Together we cried and rocked for what seemed like my entire day.

It was that day in paticular that I remember most about my OB rotation. The day I decided I wanted NOTHING to do with being an OB nurse. The day I realized my heart would break every day if I had to deal with new life being taken for granite like this. The day I realized I really didn't like this part of nursing school. The first day of a semester full of tears.

That was in 2004. "Baby Boy" would be 5 years old now. I still think of him often and it still brings a tear to my eyes. Did he find a good home? Is someone loving him enough? Is he healthy and happy? Maybe I have seen him somewhere and didn't even know it. But there is a connection. That day we were both grieving his lose. Today, I pray that he is living an abundant life, full of hopes and dreams. Running through the grass barefoot, playing in the dirt and learning to ride a bike. He would be a "Big Boy" now!

The Nightengale Pledge

2009-04-09T03:30:00.004-05:00

When a person graduates from Nursing School, he/she not only has a graduation, but they have a pinning ceremony as well. For me the graduation was a big deal, but the pinning ceremony is what really counted. That is what really made me feel like I had accomplished being a nurse.

We listened to our Professors give us words of wisdom, encouragement for the jobs we were about to do, the world we were about to face. And we heard numerous funny stories of happenings during out time in school.

Then the serious part came. . .
We walked across the stage one at a time when our names were called. Each of us wore white robes, under which we were dressed in our Sunday best. We were given a pin. This pin stated we had made it, we had graduated from this school. We were ready to take our state boards, go out into the "real" world and be RN's!!
THEN . . . It happened. . . .

We all stood together and said the following words in unison. . .

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

Those words are "The Nightengale Pledge". This pledge was composed by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.

It has become tradition for Nursing Schools across the country, maybe even the world (I am not sure). I believe I read somewhere that there are variations to this pledge. That some words are been replaced (such as using "God"), however that is totally another post!!!

I remember crying as I said those words. I remember praying as I read those words. Praying that God would give me the wisdom to do this job; that I would not forget all that I had learned in those 4 years. I prayed I would have all the compassion needed, the stomach it took, and the patience to care for all who crossed my path. I remember walking out of that auditorium that day with my head in the clouds, my heart full, and . . . scared to death. I had just become a nurse. I had just fulfilled a dream. I had just become someone who would at some point in my career be in a position where I had to advocate for a patient or family, someone who might have to challenge a doctor, someone who had potential to make a fatal mistake. I would be given the opportunity to hold the hand of a dying person, young and old. I might have the opportunity to be witness to a first breath of new life. OH MY. . . I was an RN!!

Today, I still remember that pledge. It has been 4 years since I first spoke those words. I still pray everyday on my way to work.

Lord, please give me the wisdom to care for the patients whom I will be assigned to today. Give me patience for those who are difficult. Give me patience for the doctors who are difficult. Lord, allow my compassion to show, even during times of frustration. Remind me to look at the whole picture, and that the person I am caring for is so much more than a diagnosis. Lord, let my arms be your arms, and my hands be your hands. Let he words of my mouth speak nothing but kindess. Let my co-workers see You through me today.

I still LOVE being a nurse. I love that I work a different unit every day. I love that I am continuing to learn new things with each shift. I love and crave the times that my team is small enough that I have time to give to each individual patient. Listening to their fears, their joys, or anything else they want to share.

I LOVE THAT I AM A NURSE!!!